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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;
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Raigmore Hospital, Inverness, 9 sessions per week
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Caithness General Hospital, Wick, 5.5 sessions per month
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Thurso Community Health Centre, 5 sessions per month
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Lawson Memorial Hospital, Golspie, 1 session per month
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Belford Hospital, Fort William, 4 sessions per month
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Portree Hospital, Portree, 1 session per month
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Mackinnon Memorial Hospital, Broadford, 1 session per month
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Western Isles Hospital, Stornoway, 4 sessions per month
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Ospadal Uibhist agus Bharraidh, Benbecula, 3 sessions every 3 months
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Balfour Hospital, Kirkwall, 3 sessions per month
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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
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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
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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
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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
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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
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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
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Maintains patient records in accordance with British and Irish Orthoptic Society
guidelines and NHS Highland standards
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Completion of PDP&R
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Responsible for the manual recording of Orthoptic Patient activity on a daily basis
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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
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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
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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
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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