Orthoptist

Job overview

We are looking for an enthusiastic and motivated Orthoptist to join our friendly multi-disciplinary team. The post will be based at the Royal Eye Infirmary (University Hospitals Plymouth NHS Trust). The post would suit a newly qualified Orthoptist, who will be fully supported through the BIOS (British and Irish Orthoptic Society) preceptorship scheme. Newly qualified orthoptists will be appointed at band 5 initially, with progression to band 6 being expected after 18 months (subject to the applicant's development).

The post covers a varied Orthoptic caseload comprising of paediatric and adult patients. The department receives referrals from a number of departments within the Trust including Accident and Emergency, the Maxillo-Facial Unit, Neurology, Rheumatology, Paediatrics and the Stroke Rehabilitation Service.

The Orthoptic department is a centre of excellence for delivering dedicated nystagmus/ complex ocular motility clinics in conjunction with Professor Chris Harris.

The department is an accredited training centre for undergraduate orthoptists and orthoptic apprentices.

The applicant will be supported in professional development, such as participating in the departments regular Journal Club and CME sessions, as well as opportunity to attend national conferences and courses.

The applicant will hold a degree or diploma in Orthoptics and be registered with the HCPC.

Main duties of the job

***Preference will be given to internal Trust staff, as well as ‘Priority’ and 'At Risk' status including NHS At Risk staff throughout Devon who are able to display recent relevant experience as dictated by the Person Specification.***

• To provide clinical Orthoptic services to adult and paediatric patients.
• To use and develop effective communication and motivational skills with patients and carers to gain their cooperation for treatment and to ensure understanding of more complex conditions
• Provide orthoptic assessment, diagnosis, treatment and advice to adult and paediatric patients and their carers. The caseload will include a wide range of acute and chronic care cases, many having complex disabilities and needs.
• Work as an autonomous practitioner working in accordance with British and Irish Orthoptic Society and Health Professions Council guidelines and codes of practice and statutory Trust requirements. These services require state registered Orthoptist knowledge
• Provide supervision, training and support to junior staff and students.

To comply with organisational and departmental policies and procedures.

• Participate in clinical governance activities e.g. audit, research and service reviews.
• Maintain an up to date knowledge of all areas of clinical practice using a variety of CPD methods and to maintain a CPD portfolio.

Detailed job description and main responsibilities

• Orthoptic Clinical Duties:

To take sole responsibility for the Orthoptic assessment, diagnosis and treatment of patients referred from outside agencies and to manage, using individual treatment plans, the associated amblyopia (non pathological vision loss) and other visual symptoms. This group of patients includes children with significant sight defects and requires a considerable degree of empathy and family support. In adults the diagnosis of acute onset ocular motility defects require a significantly high level of anatomical and neurological knowledge when there may be the need to make a differential diagnosis between clinical conditions.

To formulate, implement and monitor individualised management and treatment programmes using clinical reasoning and a wide range of treatment skills, for patients of all ages using advanced clinical reasoning and evidence based practise. Communicating effectively with patients, & / parents, & / carers those plans and to assess capacity and gain informed consent to those treatment plans.

To take sole responsibility to formulate relevant discharge plans and onward referral. This patient group comprises all cases of ocular motility defects and amblyopia (reduced vision with no pathological cause, which can only be treated before the age of 7-8 years), complex congenital and acquired cases, including neurological abnormalities, genetic disorders and associated ocular abnormalities.

To be responsible as an autonomous practitioner for the evaluation of visual acuity and visual behaviour in referrals from the specialist services.  This includes infants with strabismus (squint) and amblyopia, congenital or developmental abnormalities, genetic referral, adult illiterates, children and adults with significant learning difficulties as well as acute ocular motility defects in both children and adults.

To assess patient results and act when they show new or change in existing clinical signs.

To work with and support the Consultant Ophthalmologist.

To perform appropriate Lees charts (documenting ocular motility disorders) and Fields of Binocular Single Vision (illustrating areas of single and double vision) of all patients, this requires highly specialist skills.

To perform auto-refraction and to be responsible for the maintenance and safe use of the Auto-refractor

To accurately assess spectacle prescriptions using automated and manual focimetry.

To be responsible as an autonomous practitioner, for the decision to instil drops for refraction tests, diagnostic and treatment purposes. To gain consent and instil drops when required and to advise patients/ carers of the side effects.

To liaise with the clerks assisting with the Orthoptic clinics.

To assess, diagnose and treat patients with special needs. This group of patients can often include assessment of non-seeing babies and specialist communication skills are needed in conveying this information to the parents / guardians.

To assess mentally and physically disabled patients, some of whom will present with very challenging behaviour e.g. physically / verbally abusive.

To assess eye movement disorders in patients from specialist clinics including Neurology, Maxillo-Facial, Endocrine and Casualty etc.

Where clinical signs and symptoms do not always fall into particular categories, and or where information is limited or unavailable the Orthoptist will be expected to determine the diagnosis, prognosis and management.

To liaise with the Head Orthoptist regarding problems arising from any Orthoptic treatment.

To undertake single-handed clinics at peripheral hospitals or clinics and to manage own workload.

To undertake pre and post-operative measurements of motility defects. Significant manual dexterity and speed will be required to ensure accurate results especially in infants and patient with special needs having eye surgery. Surgery will be based on the Orthoptic measurements.

To discuss surgical options with the surgeon.

To assist the surgeon in post-operative adjustable suture techniques. This requires accurate measurement to assist the surgeon with ocular alignment whilst the patient is under local anaesthesia.

To identify risks (pre, peri and post surgery) and to discuss these with the patient (parents/ carers) and surgeon.

To take the lead in the decision and timing of surgery. This requires an up to date knowledge of evidence based practise.

To assess patient’s post-operative outcome and modify treatment accordingly.

To liaise with the visual impairment service team and health professionals regarding the educational and social needs of patients and to impart specialist knowledge to these professionals.

To assess patient referral letters and triage appropriately for clinical urgency.

To work as part of a multi-disciplinary team consisting of Ophthalmologists, Optometrists, Orthoptists, Nurses, Paediatricians, and Advisors for the Visually Impaired and Clerks etc.

To liaise with social services in cases of suspected child abuse.

To assist and provide internal cover for colleagues during periods of annual leave, sickness and vacancies.

For further details please see the attached JD & PS