Download NHS Grampian

NHS GRAMPIAN
JOB DESCRIPTION
POST REF NO: LF9960
CLOSING DATE: 11 FEBRUARY 2015
JOB IDENTIFICATION
Job Title:
Optometrist Principal
Department(s):
Optometry
Location:
Aberdeen Royal Infirmary
Hours:
8 sessions per week (32 hours)
Band/Salary:
Band 8A - £39,632 - £47,559 per annum pro rata
Job Purpose To provide an advanced level of optometric service and to support the well established
services within Ophthalmology including Age Related Macular Degeneration, Cataract,
Retinal Vein Occlusion, Cornea, Glaucoma and Primary Care clinics throughout NHSG
and Shetland.
To include a new service to optometrists by way of Intra vitreal injections.
To deputise in the absence of 8b
The eye out patient department provides a comprehensive ophthalmic service to over
32,000 patients per annum. This includes patients attending as new referrals, returns,
casualties and patients attending as tertiary referrals from out with Grampian and
Scotland.
The department of Ophthalmology in NHS Grampian provides a wide range of basic and
specialist ophthalmic services. It is a tertiary referral centre for macular, retinal, corneal
and inflammatory diseases and the optometrist plays a key role in provision of specialist
services
A number of examinations and procedures previously carried out by middle grade and
upwards medical staffs are now undertaken by hospital optometrists so expanding the
role of the optometry department.
Organisational Chart
Unit Operational Manager
Clinical Lead
Optometrist Principal/Head Optometrist (8b)
Optometrist Principal x2 (this post)
Specialist Optometrist x2 (Band 7)
1
Communication and relationship skills 5a
Provide and receive highly complex, highly sensitive information; barriers to
understanding; present complex, sensitive or contentious information to
large groups
The post holder will routinely provide and receive sensitive and contentious information
which requires persuasive, motivational and negotiating skills.
e.g. Explaining complex medical procedures and their results, to patients and relatives,
along with benefits and contraindications –as in the case of Fluorescein Angiography;
Intra Vitreal injections; various surgical options including suitability of anaesthetics
The post holder will be frequently exposed to distressing or emotional circumstances. E.g.
imparting news of irreversible sight loss which may revoke driving abilities or threaten
livelihood wrt occupational visual standards.
The post holder will advice on visual standards required for DVLA and numerous
professions.
Recording in patient notes must be accurate to allow clinicians to follow through
procedures (including dictation).
The post holder will issue prescriptions for spectacles and low visual aids where
necessary, giving appropriate detailed instructions and making complex judgements
regarding patients’ visual needs.
Where appropriate, liaise there after with outside agencies such as NESS to provide
counselling support to relevant patient groups.
Participate in teaching and training of registered optometrists, pre registration
Optometrists, orthoptic and medical students, and of postgraduate medical staff in
preparation for the Royal College of Ophthalmology examinations.
To contribute to peer review case discussions.
To contribute to maintaining a high profile for the department at a local level and at times
at a national level within groups such as Area Optometric Committee, Community Health
Partnership, Hospital Eye Service (HES) Scotland, Eye Health Network. This may be by
means of poster presentations or talks to groups of 10 to 50 people.
2
Knowledge, training and experience 8a
Advanced theoretical and practical knowledge
Optometry degree
Diploma in Optometry
General Optical Council (GOC) Registration
Evidence of CPD/CET in accordance with GOC regulations
Highly developed specialist knowledge and relevant practical experience gained over a
significant period of time to include exposure to HES/shared care schemes
Post holder will be expected to have a depth of knowledge across a range of fields such
as AMD, Cataract, and Cornea.
The post holder will undertake patient examinations at a level equivalent to middle grade
and upward ophthalmologists.
(At present there is no Masters in Optometry available.)
Independent prescribing – preferable or working towards qualification.
3
Analytical and judgemental skills 4
Range of complex/ highly complex facts, requiring analysis, interpretation,
comparison of range of option
To undertake extended specialist clinical activities in the management of eye diseases
alongside consultant ophthalmologists and other medical staff. Clinical assessment
includes anterior and posterior segment examination using slit lamp bio microscopy and
thereafter selecting and arranging further appropriate investigations. Accurate
interpretation of the results of numerous further investigations to formulate treatment
plans.
To select and administer appropriate ophthalmic drugs available to optometrists (as
specified in current regulations). Post holder will decide on the clinical appropriateness of
the drugs used.
Manage personal caseload within specialist services and assist in the management of the
complex cases referred internally and externally.
Provide and receive sensitive and contentious information.
Ensure professional standards are achieved and maintain at all times for the provision of
highest quality specialist optometry services
Cataract
To examine patients, on a one to one basis, and share findings including clear
explanations and advise whether surgery is required. Patients are counselled and
consent discussed for surgery by the post holder. First diagnoses of sight devastating
conditions are daily practice (e.g. Age Related Macular Degeneration - ARMD).
Macular Disease
To examine patients with macular disease including wet AMD, DMO, BRVO and
CRVO.
To request appropriate further investigations including OCT and Fluorescein
angiography whilst advising of risks involved.
To counsel patients with regard to indications and contra indications for relevant
treatments including intra vitreal injections.
To monitor patients visual status throughout treatment courses.
To have direct involvement in macular clinics with expert tuition and training from
macular specialists.
To undertake virtual reviews of patients with established macular disease, at times
working autonomously.
To counsel patients on visual loss.
To advise on partial sight and blind registration.
To advise on all aspects of AMD including diet, smoking, low vision aids, social
aspects and rehabilitation.
Intra Vitreal Injections
To undertake intra vitreal injections, following training and accreditation by the lead
macular clinicians. Working to agreed protocols thereafter.
Primary Care/Cornea
To examine patients presenting with a range of eye complaints encompassing all
areas of general ophthalmology and advise on treatment options.
To prescribe relevant treatments if IP qualified.
Glaucoma (to be introduced at a later date)
To examine patients using a variety of instrumentation, including
gonioscopy, tonometry and pachimetry and use the results to formulate treatment
plans in conjunction with the Glaucoma Consultant.
To autonomously monitor established Glaucoma cases and identify cases where
treatment courses need alteration.
To counsel on visual loss with special attention to driving standard and need
for DVLA notification.
Paediatric Contact Lenses
To examine and fit neonate and paediatric patients for contact lenses most
commonly following surgery for congenital cataract. At times investigations will take
place in theatre alongside a paediatric ophthalmologist.
To liaise closely with parents and counsel in all aspects of visual development of
such individual cases..
To teach parents, and young children, insertion and removal of contact lenses.
Core Optometry Skills
To undertake refraction on adults with a range of challenging ocular conditions and
advise on choice of optical solutions. E.g. corneal grafts, keratoconus, scarring of
cornea, high myopia and aniesometropia, specific learning difficulties
To undertake refractions and fundoscopy on children of all ages including neonates,
using an appropriate selection of eye drops, and to advise on treatment plans
thereafter.
To undertake Low Vision Assessments on those with significant visual impairment.
To select and advice on use of specialist optical equipment such as magnifiers,
telescopes, filters and lighting To counsel on visual loss and advise on Partial sight
and Blind registration.
4
Planning and organisational skills 3
5
Planning complex activities requiring adjustment
To work with high volume caseloads and prioritise patient treatments and reviews as urgent,
routine etc.
In conjunction with outpatient department, to routinely review clinic templates to reflect the
demands of the various specialist services, to maximise efficient running of clinics and
throughput of patients to meeting the changing needs of the department and accommodating
short term absences.
To plan training of pre registration optometrists ensuring that they gain maximum exposure
to all complex cases within each speciality. To train orthoptic, medical students and
postgraduate medical staff in preparation for the Royal College of Ophthalmology
examinations or equivalent.
Physical Skills 3b
Highly developed skills, accuracy important, manipulation of fine tools, materials
Majority of tests/examinations in clinic require a high degree of speed and manual dexterity
or uncomfortable working positions to ensure accurate measurements throughout the patient
examination. E.g. use of diagnostic lenses 78D, 90D, gonio lenses etc
Majority of roles require highly developed skills involving both precision and speed where
significant levels of hand eye coordination are essential. Often involves working in restricted
positions/posture that cannot easily be changed such as when working with a slit lamp.
Frequent repositioning during examination of challenging patients to obtain clear retinal
views is required
Intra vitreal injections are a surgical intervention. Inappropriate execution could result in sight
loss.
6
Responsibilities for patient/client care 6a-c
Develop specialised programmes of care/ care programmes;
Within each speciality, of which there are approximately 7, individual care plans for each
patient need to be formulated in consideration of multiple factors such as clinical findings,
patient health, drug interactions, social factors etc. Thereafter the post holder will advice on
the treatment plan and provide patient education.
Technical specialist services provided will include corneal topography, Low Vision
Assessment, Specialist refractions (High myopes, aniesometropia, scarred corneas,
paediatric aphakics)
7
Responsibilities for policy and service development implementation 3
Implements Policies and Proposes policy changes, impact outside own area
Post holder must work within numerous professional policies such as SIGN guidelines.
The post holder will contribute to the devising of optometry service policies in conjunction
with clinicians of multiple disciplines, to take account of new developments and Health
Information Systems circulars. Such policies impact on out patient services, nursing support
and imaging services within ophthalmology.
8
Responsibilities for financial and physical resources 2
Authorised Signatory
The post holder can authorise invoice expenditure less than £5000, travel expenses, basic
equipment and will make use of PECOS and STSS.
9
Responsibilities for human resources 3a/b
Day to Day Management
To participate in initial stages of recruitment, conduct, grievance and disciplinary procedures.
To undertake eKSF of junior staff.
To provide appropriate training to new recruits.
To act as a mentor for pre registration optometrists
To provide appropriate training to supporting staff on an ad hoc basis.
10
Responsibilities for information resources 1
Records personally generated information
Use of computer packages such as Microsoft word, Xcel, PowerPoint. The post holder will
have access to the intranet and internet as well as an email account. The post holder will
use Medisoft programmes to update patient records within the AMD clinics. KSF. May be
required to produce statistical reports from IT systems.
11
Responsibilities for research and development 2b
Regularly undertakes R & D, clinical trials, R&D activities as a major job requirement
Participate in clinical audit and trials and to contribute to collaborative undertakings with
other departments providing ophthalmology services
Participate in original research programmes and clinical trials in collaboration with medical
and research staff. To adhere tightly to set protocols. To maintain certification with research
bodies. To complete appropriate documentation.
12
Freedom to act 4
Guided by principles and broad occupational policies
Specialised nature of post means working autonomously as an independent specialist
practitioner. Clinics involve decision making and highly specialist advice contributing to
diagnosis, care and education of patients.
To work within parameters of guidelines, to use good professional judgement and only in
highly complex cases will seek/share information with lead clinician of service.
When working in Shetland or peripheral clinics where multidisciplinary teams is unavailable,
will work independently.
13
Physical effort 2a
Frequent sitting in restricted position
Manual handling skills are required to assist patients of all ages and abilities to obtain good
patient positioning for optimal examination. Pushing and pulling of equipment is a continual
requirement.
Stooped and awkward working positions, in a confined space, in a darkened room, using slit
lamp bio microscopy and machinery for periods of 20 minutes per patient can equate to 80%
of day.
Restricted working positions, high degree of speed and dexterity are required on a daily
basis.
14
Mental effort 3
Frequent concentration, work pattern unpredictable
High levels of continuous concentration requiring working under significant pressure, with
frequent interruptions from other clinical staff requiring advice.
Specialised services require frequent prolonged periods of intense concentration and
frequent exposure to distressing or emotional circumstances.
Intra vitreal injections require in depth mental attention and concentration. Each procedure
requires 20 minutes and multiple procedures are undertaken in each session (approx 10
procedures)
15
Emotional effort 3a
Occasional/frequent distressing or emotional circumstances
To counsel patients on indications and contraindications of various treatment options
including surgery and intra vitreal injections.
To counsel patients on visual loss, loss of driving licence, inability to meet occupational
requirements. To advise on partial sight and blind registration.
To impart unwelcome news that will impact on livelihood and independence.
16
Working conditions 2a
Occasional unpleasant working conditions
The post holder will at times be exposed to unpleasant conditions/situations e.g. unpleasant
odours, infections and disease such as MRSA, hepatitis, head lice, aggressive patients, poor
hygiene, eye discharges, infectious conjunctivitis etc.
AM
Monday
AMD One Stop
Tuesday
Optometry
PM
AMD Injections
RVO
Wednesday
Cataract One
Stop
AMD One Stop
Thursday
AMD
RVO
Initial
Proposed
Timetable
NHS GRAMPIAN
PERSON SPECIFICATION
The Person Specification should meet the demands of the job and comply with current
legislation. Setting unnecessary standards may, for example, unfairly discriminate against one
sex, the disabled or minority racial groups. Applicants should be assessed in relation to their
ability to meet the real requirements of the job as laid down in the job description. Shortlisted
candidates MUST possess all the essential components as detailed below.
POST / GRADE: Optometrist Principal / Band 8A
LOCATION/HOSPITALS: NHSG ARI
WARD/DEPARTMENT: Eye Out Patient Department
ATTRIBUTES
Qualifications
Experience
Special Aptitude and
Abilities
Disposition
Physical Requirements
Particular
Requirements
of the Post
ESSENTIAL
DESIRABLE
General Optical Council
Independent Prescribing
Registered
Qualification
BSc Optometry
A depth of knowledge across a
Diploma in Optometry
range of fields such as AMD,
CPD/CET in accordance with GOC Cataract, and Cornea.
regulation
Relevant practical experience gained Experience of working
over a significant period of time.
closely in multi-disciplinary
Experience in HES or shared care settings
schemes
Excellent communication skills
Audit and research skills
Prioritisation and good time
management skills
Independent worker accountable for
own professional actions
Excellent interpretive, judgement
and analytical skills
Team Player
Sense of humour
Positive attitude
Flexible and adaptable
Enthusiastic, highly motivated
Patience and empathy
Organised
Good general health
Ability to work within very busy
clinics, to liaise comfortably with
other professionals and adapt to
changing needs of the department
MAJOR RISKS IN DOING THIS JOB
Please indicate the major risks the job holder could face in doing this job e.g. lifting
patients/objects, working with hazardous substances, dealing with violence and aggression.
If there are no major risks for the job holder please tick this box 