Prosthetists and Orthotists Role in HSC

1. Prosthetists and Orthotists Role in HSC Jonathan Bull BAPO chair www.bapo.com

2. Prosthetists • Autonomousregistered HCPC practitioners • Gait analysis and Engineering solutions to patients with limb loss • Mechanics, Bio-mechanics, and material science • Anatomy, Physiology and Pathophysiology. 

3. Prosthetists • Competent to design and provide prostheses that replicate the structural or functional characteristics of the patients absent limb. • Qualified to modify CE marked prostheses or componentry taking responsibility for the impact of any changes.

4. Prosthetist caseload • Includes – • congenital loss • loss due to diabetes • reduced vascularity • infection • trauma • Military personnel • Whilst they are autonomous practitioners they usually work closely with physiotherapists and occupational therapists as part of multidisciplinary amputee rehabilitation teams.

5. Orthotists • Autonomous registered HCPC practitioners • Gait analysis and Engineering solutions to patients with problems of the neuro, muscular and skeletal systems • Mechanics, Bio-mechanics, and material science • Anatomy, Physiology and Pathophysiology.

6. Orthotists • Competent to design and provide orthoses that modify the structural or functional characteristics of the patients' neuro-muscular and skeletal systems enabling patients to mobilise, eliminate gait deviations, reduce falls, reduce pain, prevent and facilitate healing of ulcers. • Qualified to modify CE marked orthosesor componentry taking responsibility for the impact of any changes.

7. Orthotist Caseload • Include - • diabetes • arthritis • cerebral palsy • stroke • spinabifida • scoliosis • MSK • sports injuries • Trauma

8. Orthotists • Often work as autonomous practitioners • Form part of multidisciplinary teams such as within the diabetic foot team or neuro-rehabilitation team.

9. Current Service Provision in HSC • Predominantly Contracted Model • 6 Prosthetists • 8 Skilled and Experienced Prosthetic Technicians • 9 Orthotists (equates to 6-7 WTE) • 12 Skilled and Experienced Orthotic Technicians • 3MTO – 1 in Muckamore, 2 in Royal

10. Orthotics in Diabetes • Reduce ulceration risk • Increased mobility • Better quality of life • Reduced NHS costs • Able to maintain employment

11. Orthotics in Stroke • Quicker rehabilitation – less need for multiple therapists if correct orthosis is used • Early mobilisation • More independence • Earlier discharge

12. Orthotics Reduces Falls • Reduction of Hospitalisation • Better independent mobility • Improved balance

13. Service Supporting Evidence • Fully Equipped 2000 • Fully Equipped 2002 • Orthotic Pathfinder Report 2004 • APLLG Orthotics Charter 2008 • Hutton York Economics Report 2009 – Cost saving case studies • AFO Best Practice Statement following Stroke 2009 • CEBR Report 2011 • BAPO Standards for best practice • Prosthetics and Orthotics Career Framework, Education and Preceptorship Guides

14. Recognised service problems and solutions • 'The current fragmentation of the Orthotics Service.allwith their own standards and policies, is a recipe for inequity and inefficiency' (Audit Commission, 2000) • 'Orthotic Services should be managed within one Clinical Directorate, with a dedicated budget' ( British Society of Rehabilitation Medicine , 1999) • 'Develop protocols and guidelines for direct referrals by health professionals to Orthotic Services' ( South Thames Health Authority, 2002) • 'Implement condition-based direct GP Access' ( Orthotic Pathfinder PASA , 2004)

15. The financial cost of not implementing findings from the Orthotic Pathfinder report • The cost to the NHS of delaying implementing of these changes is £390m per annum.(£1.1million per day)