Download lothian university nhs trust

LOTHIAN UNIVERSITY NHS TRUST
JOB DESCRIPTION
1. JOB IDENTIFICATION
Job Title:
Orthotist
Responsible to (insert job title):
Principal Orthotist
Department(s):
Orthotic
Clinical Group:
Musculoskeletal Directorate
Operating Division:
Musculoskeletal Services
Job Holder:
Job Reference:
No of Job Holders:
Last Update (insert date):
3
31/7/12
2. JOB PURPOSE
Under the supervision of a Band 6 Advanced Orthotist, to provide a patient-centred, clinical orthotic
service to referred patients by:

assessing referred patients’ orthotic needs and, either alone or in collaboration with other members of
the multi-disciplinary clinic team, prescribing and providing orthotic devices required to meet these
needs

supervising the manufacture and procurement of orthotic devices prescribed for referred patients

reviewing patients’ orthotic requirements to ensure the effectiveness and safety of devices provided
3. DIMENSIONS
The Orthotic Department provides a clinical orthotic service to the people of Lothian’s and referred
patients from the rest of Scotland to the in-house service. The department is the only centre to provide the
Orthotic care to the Scottish National Spine Deformity Service
Each year, around 6,240 new patients are referred to the Service and in the region of 20,000 orthotic
devices are delivered to patients. The Service provides continuing specialised clinical care to about 35,000
patients held on Orthotic file.
Clinical work is carried out at a number of locations including RIE, SMART Centre Astley Ainslie
Hospital, RHSC, Liberton and on an add hoc basis at all sites within the Trust. The manufacturing and
procurement of devices take place in the SMART Centre, Astley Ainslie Hospital.
The annual budget for the service is £1.2 million.
When fully staffed, the current Service employs 6.1 wte Orthotists (including the senior grades), 1.2 wte
Senior orthotic technician, 4.92 wte Orthotic technicians and 2.6 wte clerical officers. [Under
restructure/review at present]
4. ORGANISATIONAL POSITION
Present structure but under review
Head of SMART
Head of Orthotics
Band 8A
Senior Orthotic
Technician Band 5 x 1.2
Advanced Orthotists
Band 6 x 4.7
Appliance Officers /
Administration Officer
Band 3 x 2.6
Orthotist Band 5 x 2.4
Orthotic Technicians
Band 4 x 4.92
5. ROLE OF THE SERVICE
The Orthotic service forms part Rehabilitation Medicine of Edinburgh CHP
The Orthotic Service works closely with other clinical specialities throughout NHS Lothian - including
orthopaedics, trauma, rheumatology, diabetic services, medicine for the elderly and paediatric services to provide a comprehensive clinical service which includes the provision of all types of Orthotic devices
of contemporary designs using modern materials.
6. MAIN DUTIES/KEY RESULT AREAS
1
Attending clinics for the purposes of assessing patients’ Orthotic needs, advising on the
prescription of orthoses and reviewing patients currently using Orthoses. Clinics are held in a
number of locations throughout Trust;
2
Recording and taking into account, as necessary, any information regarding patients and their
backgrounds relevant to the proposed orthotic treatment;
3
The taking of casts (or the use of other shape-capture techniques) and anthropometric
measurements, and the modification of positive models to be used in the production of orthoses;
4
Formulating and recording the Orthotic design, including the selection of materials and
components, and supervising the fabrication of Orthoses for patients under his/her care, by
technicians;
5
Fitting and adjusting Orthotic devices, evaluating the function of devices on patients and taking
any further action necessary to ensure the best fit, function, cosmesis and workmanship;
6
Ensuring that accurate clinical records of patients' treatment are maintained and updated and
specifying appropriate future actions relating to patients' Orthotic management;
7
Performing specified delegated operational duties, e.g. inventory and stock control, health and
safety measures and quality assurance procedures;
8
Dependent on experience, the supervision of student Orthotists undertaking clinical placements;
9
Participation in clinical governance and clinical effectiveness activities to ensure continued
improvement in service quality;
11
Engaging in continued professional development (CPD), research, audit, development and
evaluation activities as circumstances allow, either in collaboration with other research workers or
independently;
12
.Other duties of a similar nature as may be required by the Principal Orthotist or his/her deputy.
7a. EQUIPMENT AND MACHINERY
Insert as appropriate to area]
Equipment
Frequency (contact will
vary dependent on speciality
Instruments
Anthropometric
Through out day
Hand Tools
Including cutting instruments and electrically
and pneumatically powered tools.
Through out day
Hammers, screw drivers vices, cast clamps,
full range of spanners wrenches etc, knives
and leather
Electrical Equipment
High speed grinding, routing, buffing and
polishing machines
Through out day
Drilling and cutting machines
Ovens,
vacuum
forming
equipment
compressor sandblasting band saw etc
Manual handing equipment
Hoist and mobile hyhraulic trolley lift
As required
Componentry
Rivets screws ,nuts, bolts etc the full range of
orthotic joints
Through out day
Full Range Of Appliances And Orthoses
Other equipment
Gas welder, arc welder Lathe, milling
machine
As required
Casting materials
Plaster of paris bandages and slabs
Through out day
Through out day
Thermal Equipment
Hot Packs, Ice
As required
IT Equipment
Personal Computer,
Through out day
Understands, appropriately selects, applies safe use and monitors Orthotic equipment
Equipment used will vary dependent on the clinical area within the specialty
7b. SYSTEMS

These include functions which handle patient information, TRAK ,RETIS for clinical records,,
PECOS, job processing, patient appointments, stock control, stock ordering and management
reporting. The post-holder will require to use the orthotics systems on a routine basis for
recording of information, job progressing, analysis and communication with other members of
the service team.
Edinburgh CHPoperates
a quality system which assures the quality of the service provided to
patients, carers and other healthcare professionals. The post-holder will be required to follow
all quality procedures.

Familiarity with Windows-based applications for word processing (Microsoft Word),
spreadsheets (MS Excel), email, internet browsing and presentations (MS PowerPoint) is a
requirement of the post.

8. ASSIGNMENT AND REVIEW OF WORK
The Orthotics Service operates on the basis that each Orthotist will maintain his/her own caseload under
the direct supervision of an Advanced Orthotist and overall supervision of the Head of Orthotics(Under
Review). This allows for continuity of contact with individual patients and presents an opportunity for
the Orthotist to build up a professional relationship with the patient based on respect and trust. This is an
essential requirement of the service as many patients remain users of the service for life.
Initial allocation of cases, resulting from new referrals to the service, will be controlled by the Advanced
Orthotists. The Orthotist will then be responsible for the appropriate treatment and review of cases and
his/her work will be monitored by an Advanced Orthotist in terms of clinical outcome and against agreed
service delivery times.
NHS Lothian operates a system of performance and development review which seeks to provide each
member of staff with:

a clear expectation of how he/she can contribute to NHS Lothian’s goals

an opportunity to identify his/her own development and training needs

a chance to discuss work issues - in detail - with his/her immediate manager

a chance to receive constructive feedback on his/her individual performance
9. DECISIONS AND JUDGEMENTS
The post holder is an autonomous practitioner who is governed by the legal requirements of stateregistration and clinical governance frameworks, and is guided by the advice of the professional body (the
British Association of Prosthetists and Orthotists - BAPO) and HPC Council. The post holder is expected
to use his/her own training and education, work experience, peer support, the clinical supervision
framework and to research the evidence base before deciding how to proceed with a particular clinical
case.
The post-holder is required to assess, evaluate the effects of, and treat, a wide range of complex
conditions. This often involves difficult clinical judgements which arise from the analysis of the
biomechanical and neurological effects of multiple pathologies. This means that some treatment options
may improve the patient’s condition in one area and potentially make them worse in another, therefore the
course of action is not always clear. These clinical decisions, therefore, require interpretation, comparison
of a range of options and communication to patients, carers and other healthcare professionals. The result
is usually a negotiated and agreed specialised / personalised treatment regime or care package.
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

Working with severely disabled individuals, many of whom have incurable, degenerative conditions.

Due to the nature of managing a complex caseload, the post holder will frequently be required to deal
with individuals experiencing distressing or emotional circumstances. This may include working with
clients and carers through degenerative illnesses (from diagnosis to death), parents with children
recently diagnosed with disabilities, patients with severe disfiguring disabilities, etc.

Occasional exposure to body fluids and infection risks.
11. COMMUNICATIONS AND RELATIONSHIPS
WHO
Patients
FREQUENCY
Daily
METHOD
Face to face
Relatives
Medical staff,
GP’S
Head of Orthotics
Advanced
Orthotists
Orthotists
Senior Orthotic
Technician and
Orthotic
Technicians
Departmental
A&C Staff
Orthotic Students
from national
Universities
AHP’S from all
disciplines
Multidisciplinary
Team
External Agencies
As required
Daily
Face to Face, Telephone
Face to Face, Telephone
Daily
Face to face
Operational management, work allocation,
feedback. Problem solving and clinical
reasoning. Appraisal/Review/Supervision
Daily
Face to face
Orthosis design specicfication
Information, In-service Training,
Development
As required
Administrative requirements
Daily
Face to face
Written
Face to face
As required
Face to face
Mentoring, education
Daily
Meeting/face to face
Telephone/written
Telephone/written/face
to face
Patient referral, clinical communication
information exchange, discharge planning
Patient specific legal reports and
testimonies.
As required
PURPOSE
Advice, treatment, treatment plans,
information
Advice, giving/receiving information
Advice, giving/receiving information
Mentoring, education
The post-holder is required to communicate complex information to patients, carers and others. Orthotic
management of the patient is often the last resort or all that is available, in terms of treatment. It is usually
not a cure but can prolong function for very significant periods. On being told that there is no cure for a
particular condition, patients can easily reject treatment. They often need to be convinced of the value of
continued treatment. This is because the impact of the treatment is not always immediately obvious. This
requires the post-holder to have highly developed communication skills (verbal, non-verbal and written) to
enable them to educate, motivate and persuade the patient and his/her carers.
There is also a need to communicate with other professionals, agencies and organisations as orthotic
treatments often impact on other professional areas and negotiation is often required to agree joint goals
and objectives. Good presentation skills are of benefit in this regard.
Accurate and concise clinical record keeping is a pre-requisite of this post and the post holder should be
familiar with all relevant professional standards and guidelines in this regard.
The post holder must be able effectively to communicate the specification and manufacturing details of
devices to technical staff and may be required to participate in the training of technicians in novel
fabrication techniques.
Orthotics Service and other CHP meetings are held regularly during which the post holder will be expected
to participate in discussions relating to the aims and objectives of the service, clinical governance and
effectiveness, service development, case studies, quality matters, risk management issues, etc.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
The post requires highly developed levels of manual dexterity, co-ordination and sensory skills during
the assessment of pathological conditions, the moving and handling of patients, the taking of plaster
cast moulds, the modification of plaster models and the fabrication and adjustment of orthoses.
By its nature, the orthotic treatment of patients - many of whom have foot pathologies - requires
significant and frequent periods of bending, kneeling and sitting.
A high degree of concentration and hand-eye co-ordination is required during the use of precision
cutting tools and cutting and grinding machinery.
Many of the non-clinical aspects of the post (writing up/dictation of clinical records, discussions with
other healthcare personnel etc.) take place in a shared office area with the inherent distractions that
can result.
The emotional demands of the job have been detailed in Sections 10 and 11, above.
Physical Skills
Skills to perform the full range of orthotic casting including
manually positioning patients to obtain casts of any part of
the human body required. Manual skills to assess range of
movement of joints
Through out day
Physical Demands
Patient transferring/manoeuvring e.g. wheelchairs, hoists
Through out day
Operating hand tools and heavy industrial machines
Hand strength to rectify body casts and machine up
orthoses
Through out day
Through out day
Handling heavy bulky awkward shaped materials and
orthoses
Fine hand eye coordination with tools grinders/machines
and componentary
Through out day
Bending, kneeing, lifting transferring orthotic clinical notes
and patient orthotic equipment and material and stock items
between sites for clinics
Frequently
Driving between sites for clinics
Frequently
Mental Demands
Emotional Demands
Concentration required when assessing and treating patients
Through out day
through out day.
Prioritising workload to meet variable service requirements.
Clinical risk assessment sometimes within areas where
reducing risks to a desired level is difficult.
Clinically
reason
and
risk
assessing
the
treatment/management of patients with unfamiliar
conditions or new surgical procedures.
Timely decision making in acutely deteriorating patients.
Responding to bleep and telephone.
Using IT for patient notes reading, writing and recording
information
Dealing with patients who have communication difficulties.
Communicating with distressed/anxious/worried patients
As required
and their families and/or friends in a supportive manner.
Impart unwelcome news regarding patient’s rehabilitation
prospects.
Treating terminally ill patients.
Dealing with patients who have unsightly wounds and/or
disfigurement.
Undertaking distressing treatment modalities e.g. naso-pharyngeal
suction
Working conditions
Daily exposure to body fluids (sputum, sweat, faeces and
Through out day
urine), odours
Exposure to bacterial and viral infections
Some exposure to a degree of verbal abuse and physical
threat from patients and their family or friends.
Working small cramped clinic and workshop space at RIE.
Varied Temperatures. e.g. the high temperature ovens in
workshop
Dust grime from drilling grinding and buffing materials.
Handling orthoses that have been worn by patients and not
clean
Noise of machinery [several in operate at one time]
hammering
Handling chemicals, resins and adhesives.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
Honours Degree in Prosthetics and Orthotics, or an equivalent qualification approved by the Health
Professions Council to allow State Registration.
Registration with the Health Professions Council.
Awareness and understanding of all relevant NHS Scotland and NHS e policies and procedures.
Awareness and understanding of own professional standards and guidelines (in this regard, membership
of the British Association of Prosthetists and Orthotists is highly desirable).
14. JOB DESCRIPTION AGREEMENT
A separate job description will need to be signed off by each jobholder to whom
the job description applies.
Job Holder’s Signature:
Date:
Head of Department Signature:
Date: