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AGENDA FOR CHANGE NHS JOB EVALUATION SCHEME JOB DESCRIPTION 1. JOB IDENTIFICATION Job Title: BANK SPECIALIST ORTHOPTIST Reports to: HEAD ORTHOPTIST Department, Ward or Section: ORTHOPTIC DEPARTMENT, OPHTHALMOLOGY CHP, Directorate or Corporate Department: SURGICAL & ANAESTHETIC DIRECTORATE Job Reference: SSSARAIGOPTC02 No of Job Holders: 1 Last Update: 06.04.16 2. JOB PURPOSE To provide Orthoptic and allied services for the medical profession (notably ophthalmology) and the general public, in NHS Highland, NHS Western Isles and NHS Orkney. This involves assessing, diagnosing, treating and monitoring defective visual development, ocular motility problems and defective binocular vision. The post holder must deliver a complete and specialist Orthoptic Service, to an unpredictable and diverse patient caseload, which is equitable throughout the above geographical area. (See additional notes) The post holder requires to be lead clinician, administratively, for a designated peripheral clinic area. 3. DIMENSIONS Orthoptic Department Staffing: Head Orthoptist Specialist Orthoptist x 6 (4.4 wte) Orthoptic and Child Hea;th Screening Assistant x 3 (2.2wte) Staffing Budget: £280,000 Supplies & Services: £31,000 Patient Group: See section 11 Departmental Caseload: 7000 (approx) patient contacts per year Post holders Workload: 8.5 clinical sessions (3.5hours per session) per week – pro rata Locations and Frequency of Orthoptic Clinics; Raigmore Hospital, Inverness, 9 sessions per week Caithness General Hospital, Wick, 5.5 sessions per month Thurso Community Health Centre, 5 sessions per month Lawson Memorial Hospital, Golspie, 1 session per month Belford Hospital, Fort William, 4 sessions per month Portree Hospital, Portree, 1 session per month Mackinnon Memorial Hospital, Broadford, 1 session per month Western Isles Hospital, Stornoway, 4 sessions per month Ospadal Uibhist agus Bharraidh, Benbecula, 3 sessions every 3 months Balfour Hospital, Kirkwall, 3 sessions per month Preschool Visual Screening in all preschool centres in NHS Highland and NHS Western Isles These are clinical sessions and do not take into account travelling time or overnight stays. Clinics may change in frequency in order to meet service needs. 4. ORGANISATIONAL POSITION General Manager of Surgical And Anaesthetic Directorate Head of Service for Ophthalmology Consultant Ophthalmologist x6 Head of Orthoptic Services Specialist Orthoptist x6 Bank Orthoptist x2 X6 x6 Orthoptic Assistants x3 5. ROLE OF DEPARTMENT To provide Orthoptic and allied services, for NHS Highland, NHS Western Isles and NHS Orkney for patients of all age groups and specialities, in order to attain and maintain the best possible ocular status. 6. MAIN TASKS, DUTIES AND RESPONSIBILITIES Clinical To be professionally and legally responsible and accountable for all aspects of a specialist clinical workload To take sole responsibility for visual and ocular motility assessment on patients referred to the clinic, which includes diagnosing new patients, review of follow-up patients, emergencies and inter-unit referrals. To be able to work effectively with a continuously unpredictable workload which includes patients from paediatrics, neurology, A & E, facial-maxillary, endocrinology, medical, special needs and specific learning difficulties. Some patients will be blind or partially sighted. To formulate and amend individual specialist management and treatment plans using clinical reasoning and a wide range of treatment skills. These include Orthoptic exercises, occlusion therapy, manipulation of refractive error, prismatic correction, coloured overlays and pharmaceutical therapy. To effectively communicate with patients and carers the diagnosis, prognosis and home treatment plans, using motivational skills where necessary to ensure understanding and compliance. To take the lead in the decision of type and timing of squint surgery. To identify surgical risks (pre, peri and post surgery) and to discuss these with the patients, carers and surgeon. To undertake pre and postoperative assessment of strabismus and motility patients requiring surgery. Surgery is based on Orthoptic measurements. Therefore significant manual dexterity and speed are required to provide a high degree of accuracy. To assist the ophthalmic surgeon in postoperative adjustable suture procedures. This involves being available to provide accurate measurements and advise the surgeon immediately post-op, to allow adjustment of sutures for optimum surgical outcome. To assess patients’ post-operative outcome and modify treatment accordingly e.g. altering optical prescription. To consider the use of Botulinum Toxin as either a diagnostic or therapeutic procedure in ocular motility problems, and discuss the pros and cons with the patient and Ophthalmologist. To regularly travel to peripheral clinics and to provide an equitable Orthoptic service to patients in these areas. This will require the ability to modify standard Orthoptic treatment due to geographical barriers and maintain telephone contact with these patients when appropriate. To screen for visual defects in pre-school children, autonomously diagnosing previously undetected anomalies of vision and initiating appropriate referral to hospital ophthalmic services. To assess reading difficulties in patients referred by partner organisations e.g. Education To undertake focimetry for the measurement of spectacle strength. To be responsible for the decision to instil eye drops for diagnostic, anaesthetic and refractive purposes, determine the appropriate strength required and advise patients of purpose, action and side effects. To develop and maintain skills required to work at an advanced level and to use an extended scope of practice in the highly specialised area of Glaucoma (Shared Care Glaucoma Clinics) To monitor intraocular pressures, using Tonometry, which involves precise contact with the surface of the eyeball. To determine the clinically appropriate visual field assessment programme, depending on the presenting information. To assess visual fields using the Humphrey visual field analyser and interpret the highly complex results for disease progression, which determines future clinical management. To be responsible for assessing visual fields and vision at the request of the DVLA and report the findings. To provide clinical teaching for Ophthalmologists, GPs, GP trainees, Community Paediatricians, Optometrists, Health Visitors, Visual Impairment teachers, Occupational Therapists, School nurses, Nurses, and Medical Students. This may be in the form of lectures, tutorials or one to one teaching. To liase with Highland Education Vision Support Services, Visual Impairment Services Highland Family Support Officer, health visitors and school nurses regarding the educational, social and visual needs of patients Managerial and Administrational To be aware of and comply with Organisational and Departmental policies and procedures To be aware of and utilise National and Professional guidelines to ensure clinical effectiveness and improve local working practise To take lead responsibility for the organisation of at least one peripheral clinic, as designated by the Head Orthoptist. This involves monitoring workload, prioritising and appointing new referrals, monitoring patient numbers, co-ordinating travel and overnight stays where appropriate, ensuring clinical effectiveness/audit and service development equitable to other areas, monitoring and ordering stock and equipment. To deal with enquiries which arise during the working day and take appropriate action To be responsible for organising appropriate review appointments. To contribute to the planning and development of the Orthoptic Service Professional To maintain professional state registration with Health Professions Council (HPC) To have documentary evidence of Continuing Professional Development (CPD) To participate in annual Personal Development Planning and Review (PDP&R) To participate in monthly Orthoptic departmental meetings including journal club presentations, case presentations and reporting from meetings attended elsewhere to constantly improve personal clinical knowledge and practice, and that of Orthoptic colleagues To attend, and contribute to on a rotational basis, monthly Ophthalmology audit meetings, and weekly Ophthalmology clinical meetings, in order to increase own understanding of ophthalmology related conditions and to inform multi-disciplinary ophthalmology professionals regarding Orthoptic related conditions. To comply with departmental, local and national policies and quality procedures as required, To represent the department externally at local, regional and national meetings regarding Orthoptic services and clinical expertise To attend appropriate training events, courses and lectures thereby maintaining up-todate knowledge and skills To observe and maintain professional standards at all times To observe safe working practices and equipment procedures, complying with legislative requirements under H&S regulations To respect patient and staff confidentiality at all times 7a. EQUIPMENT AND MACHINERY Equipment Use Car – own or hired To regularly drive long distances to peripheral clinics Visual Field Perimeters – manual and automated To assess peripheral vision and fields of binocular single vision To measure intraocular pressure Tonometer To measure spectacle lens prescriptions Focimeter To provide pictorial record of ocular motility Lees Screen/ Hess Charts Synoptophore/Prism Bars/Prisms/Various Stereo acuity Tests To measure squints, ocular motility and binocular function To assess uniocular fixation Visuscope To examine back of eye Ophthalmoscope To assess the refractive state of the eye Retinoscope To measure near and distance visual acuity Visual Acuity Testing Equipment-various for literate, illiterate and non communicative patients Various other miscellaneous Orthoptic Equipment and toys To complete Orthoptic examination To video Orthoptic conditions for teaching purposes Video Camera Computer/Printer Phone/Answer machine Fax/copier 7b. SYSTEMS Maintains patient records in accordance with British and Irish Orthoptic Society guidelines and NHS Highland standards Completion of PDP&R Responsible for the manual recording of Orthoptic Patient activity on a daily basis Ensures correct use of IT Systems e.g. Patient Administration Systems, Intranet, Internet, Microsoft Outlook, PowerPoint and Word, eLibrary 8. ASSIGNMENT AND REVIEW OF WORK The post holder is responsible for prioritising referrals at their designated peripheral clinic. The post is unsupervised and consists of daily planned routine i.e. appointed patients, but also involves unplanned additional patient workload i.e. emergencies, and requests for Orthoptic Assessment, advice and management from medical staff The post holder has contact with the Head Orthoptist and Orthoptic Colleagues but this may be by telephone only at times i.e. peripheral/ single handed clinics Patient care is peer reviewed throughout the patient journey by colleagues in Orthoptics and Ophthalmology who are involved in the patient’s ophthalmology pathway. The frequency of review is dependant upon patient condition and treatment plan. Patient care is also regularly reviewed by reflective practise and peer group discussion. Job performance is monitored by the Head Orthoptist within the clinical setting and during the PDP&R system The post holder is expected to anticipate and deal with problems/challenges, in the absence of, or in conjunction with the Head Orthoptist 9. DECISIONS AND JUDGEMENTS The post holder will be required to autonomously Determine diagnosis based on a range of Orthoptic clinical findings Formulate specialist individual management plans using broad professional standards and clinical reasoning. Consideration must be given to a wide range of aetiologies and factors (e.g. age of onset, presentation, refractive error, cerebral and visual development, cosmetic appearance, domestic/social circumstances, geographical barriers, patients perceptions/attitudes, previous experiences and consultations). This may include second opinions where differing advice has been given. Make decisions and judgements on patient management based on the clinical signs and symptoms they have identified which may be conflicting or require a differential diagnosis. Take a lead in the decision and timing of surgery for strabismus and ocular motility problems and discuss surgical options with the Ophthalmologist based solely on Orthoptic findings and measurements. Decide on the need for in patient hospital admissions for patients requiring Orthoptic treatment. Decide to instil eye drops for refractive, anaesthetic or diagnostic purposes Decide and organise appropriate onward referral to Ophthalmology or other partner agencies e.g. Education Vision Support Services, Optometrists in the private sector. Decide on the clinically appropriate visual field assessment required using knowledge of presenting medical or ocular condition Determine whether a visual field assessment performed on behalf of the DVLA fulfils their requirements Analyse and interpret highly complex visual field results for disease progression in Shared Care Glaucoma Clinic 10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB Unpredictable and diverse patient caseload, in all clinic sessions, involving the post holder in adapting from one specialist area to another e.g. 1. Baby with visual impairment with emotional and distressed parents 2. Elderly stroke patient with visual field deficit 3. Adult presenting with sudden onset double vision with potential neurological aetiology 4. 5 year old requiring glasses and patch treatment (Average 12 patients per half day session) Sessions therefore require continual concentration and significant mental effort to ensure appropriate investigation, diagnosis and management. Advising and counselling patients with degenerative conditions whose diagnosis and prognosis is worsening, e.g. Multiple sclerosis, Dysthyroid Eye Disease, Myasthenia Gravis. Regularly the first point of contact for patients with recently acquired signs and symptoms of ophthalmic, neurological and systemic disease. Delivering unwelcome news to patients and carers with regard to prognosis. Frequently managing patients with complex health and social needs Discussing diagnosis and management with patients/parents/carers whose condition may have life changing implications Communicating difficult concepts effectively to all age groups and abilities Motivating patients/ parents to comply with course of home treatment Travelling long distances by road or air prior to clinics often involving an extended working day and anti social hours/overnight stays Adapting to changes in working conditions, administration systems and personnel at peripheral clinics Adapting standard Orthoptic management to account for remote and rural location 11. COMMUNICATIONS AND RELATIONSHIPS The post holder has a working relationships with Internally: Patients, Parents, Carers, Head and other Orthoptists, Ophthalmologists, other Medical, Nursing, Clerical and Secretarial staff, etc, Externally: GPs, GP trainees, Community Paediatricians, Health visitors, School nurses, Optometrists, Education Vision Support services, Social work, Educational Psychologists and other Allied Health Professionals, etc, The patient group will consist of all age groups and abilities, with the majority being young children, but also a significant caseload of adults and elderly patients. ASSESSMENT Highly developed communication, persuasion and motivational skills are required to initiate cooperation during assessment. This includes children and patients with difficulties in communication and comprehension, e.g. stroke, learning disabled, complex sensory loss, i.e. speech, visual, and/or hearing, other communication disorders and non English-speaking patients. This involves the use of non-verbal tools such as Makaton. DIAGNOSIS Explaining the diagnosis to patient/carer is highly complex and can be conflicting due to the diverse range of aetiologies affecting vision, strabismus and ocular motility disorders. This can also involve discussing unwelcome outcomes of a highly sensitive and distressing nature, which requires empathy, reassurance and support e.g. visual impaired baby. The diagnosis and recommended management options require to be effectively communicated to the Ophthalmologists and other relevant Health care professionals. MANAGEMENT Standard treatments regularly require to be adapted due to the post holder’s geographical clinical commitment. (e.g. due to rural constraints for patient review) This involves developed communication skills to ensure compliance with home treatments to overcome geographical barriers. The post holder must guide and influence and motivate patients/carers as to the importance of compliance with treatment e.g. spectacles and patching, the pros and cons of surgery, and the timing of surgery. The post holder must have the ability to counsel patients prior to adjustable suture surgery and botulinum toxin procedures. OTHER The post holder will have the skills To deal with complaints from patients and carers, and to handle confrontational situations with sensitivity To provide adequate support and facilitate learning in those requiring Orthoptic Teaching To liase with other healthcare professionals and partner organisations. This is an ongoing commitment from initial examination to discharge in order to maximise the holistic aspects of patient care. To represent the department and promote the Orthoptists role to relevant professional groups. 12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB PHYSICAL A high degree of manual dexterity skills are required to ensure accurate assessment results e.g. in children and infants requiring surgery where the type and amount of surgery is based on Orthoptic measurements. Fine motor skills and good hand eye co-ordination are required for instilling eye drops especially in children Patient examination regularly requires uncomfortable working positions including leaning forwards, kneeling, bending and twisting to assess children at eye level or below. Manual handling skills are required to assist patients of all ages and abilities, e.g. movement of patients from wheelchairs to examination chairs, lifting children etc The post holder is required, at times, to extend their working day, when going to peripheral clinics. The post holder will be required to catch early morning planes (Stornoway, Benbecula and Orkney) and drive long distances (Fort William, Skye, Golspie, Wick and Thurso) prior to commencing clinics. MENTAL All clinic sessions (3.5hours) require continual intense concentration and significant mental effort to ensure appropriate assessment, diagnosis and management of a diverse and unpredictable workload (E.g. maintaining a young child’s visual attention on one object whilst considering a diagnosis dependant on visual responses observed throughout a variety of tests.) Concentration must be maintained despite regular interruptions during clinical assessment e.g. 1. Clinical enquiries from patients/colleagues 2. From patients/relatives 3. Telephone enquiries EMOTIONAL Empathy, reassurance and tact are required when discussing diagnosis, prognosis and management with patients, parents and carers who may be confused, distressed, anxious or scared. This is also necessary when dealing with children with specific learning difficulties and their parents who have experienced years of frustration and challenges associated with education and learning. Advising patients on ability or lack of ability to drive based on DVLA standards requires tact, empathy and counselling skills as this has a significant impact on independent living Vision is a significant factor in functional abilities regarding education, employment, independent living and quality of life therefore advanced clinical reasoning skills are required in order to integrate Orthoptic management into a holistic health and social care package ENVIRONMENTAL Working conditions may be unpleasant with exposure to fleas, lice, childhood illnesses, MRSA, odours, body fluids, etc. The post-holder will be in contact with soiled equipment including filthy glasses used eye occlusers, blenderm and prisms. May occasionally be kicked, hit or spat on by children when instilling eye drops 13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB Essential: To possess a BSc in Orthoptics, B MedSci (Orthoptics) or a Diploma for the British Orthoptic Council (DBO) To be state registered with the Health Professions Council (HPC) To possess at least 5 years post-graduate clinical Orthoptic experience in order to cope with high level of professional autonomy required due to working in remote and rural locations. To possess highly developed specialist knowledge gained through in-depth experience and significant Post-graduate training in all areas of Orthoptics to allow post holder to efficiently adapt to seeing any type of patient during busy single-handed clinics. (See additional notes) To have good interpersonal and communication skills with patients. To demonstrate efficient decision making ability e.g. to prioritise urgent onward referral. To demonstrate good leadership and organisational skills required to lead the Orthoptic service for one or more geographical locations and deputise for the Head Orthoptist in her absence To demonstrate a sound general knowledge base of Ophthalmology and related conditions To demonstrate the ability to deal efficiently and tactfully with stressful/difficult situations To have evidence of up to date CPD activity To hold a current UK driving license Desirable: To possess post-graduate experience at a senior level To have training and experience in visual field assessment. To have training and experience in assessing with coloured overlays To have experience in glaucoma clinics To have post-graduate experience of working with children with special needs To have evidence of active participation in departmental teaching programmes, clinical supervision, etc. To have research/audit experience To demonstrate a knowledge and understanding of professional issues locally and nationally To have competent IT skills 14. JOB DESCRIPTION AGREEMENT I agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of signing. Job Holder’s Signature: Date: Manager’s Signature: Date: ADDITIONAL INFORMATION The Orthoptic Service in Highland, Western Isles and Orkney is unique in the UK due to the large geographical area with remote and rural communities. It is essential that all Orthoptists in Highland are experienced and competent to an advanced level in all areas of Orthoptics, some of which, in other areas may be defined as specialist or designated to dedicated clinics. In larger departments the Orthoptic role is more easily divided and the opportunity exists for lead/specialist clinicians in several fields (e.g. Stroke, Glaucoma, Neurology, Reading difficulties etc) Due to the large peripheral clinic commitment, in this area, being shared amongst the relatively small staff establishment, such division of speciality is not possible. Therefore Orthoptists require to be “Specialist Generalists” to cope with the diverse, unpredictable workload, often in remote single-handed clinics. Post holders must have evidence of ongoing CPD in all areas deemed specialist in other areas of U.K. The responsibility for clinical effectiveness must also be equally shared. This is essential to provide an equitable and efficient, patient- centred Orthoptic service to the whole area