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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