Specialist Orthoptist

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Main Duties and Responsibilities

1. To be professionally responsible and accountable for the management of Orthoptic patients in Bedfordshire as an autonomous practitioner.
2. To assess, diagnose, treat and manage (including discharge when clinically appropriate) the patients referred to the Community Eye Service.  These include Paediatric visual disorders (squint, amblyopia, and reduced visual responses), ocular motility disorders, other ophthalmic conditions and congenital developmental abnormalities.
3. To formulate specialist individualised management and treatment plans using advanced clinical reasoning and a wide range of treatment skills.  
4. To assess patients pre- and post-operatively and discuss surgery options with the Consultant Ophthalmologist.  To identify the opportune timing of surgery and discuss post-operative risks with the patients, carers, and surgeon. The degree of surgery will be based on the Orthoptic measurements. To assist the surgeon in postoperative adjustable suture techniques. This requires accurate measurement to assist the surgeon with ocular alignment while the patient is under local anesthetic.
5. To diagnose and treat children with special needs in community and multidisciplinary clinics and special schools. The caseload will include children with complex neurological disorders, high level medical needs, autistic spectrum disorders and sensory impairment.  Close liaison with other members of multidisciplinary team/early years contributes to the management of the ‘whole’ child. When patients are wheelchair-bound and with young children it is necessary to adapt tests, be mobile and work at awkward angles at times.
6. To take responsibility for advising patients, relatives, and carers of the prognosis regarding their eye condition, including visual outcomes, squint surgery and any possible complications.  Informing relevant clinicians and members of the multidisciplinary team where needed. Patients may have very complex medical problems requiring a high level of neurological and medical understanding to manage the case effectively prioritising ophthalmic care as required.
7. To support/advise the Orthoptic Support Workers (OSW) providing the 4-5 year school vision screening service.  
8. To promote the need for early intervention and treatment of childhood eye problems.
9.  To offer advice and support in the clinic and over the telephone, and deal with queries from patients, carers and other health professionals.
10. Assess, diagnose and manage children presenting with visually related reading difficulties seeking advice from the Orthoptic Team Leader where necessary.
11. Undertake specialised assessment of patients admitted to the Stroke ward. Determine the presence of any ophthalmological conditions and manage as required, liaising with ward staff and Ophthalmologists as appropriate. Organise patient referral and follow up as needed. Provide the patient and other health professionals with information to maximise rehabilitation potential and adapt to visual symptoms.
12. To contribute to Education Health and Care Plan (EHCP) for patients with Special Educational needs when required.
13. To triage new referrals prioritising their urgency.
14. To direct referrals appropriately to the Consultant Ophthalmologist, Specialist Optometrist or the Orthoptist Team Leader.
15. To analyse, diagnose, and formulate treatment plans for patients with complex ocular movement disorders referred by Consultant Ophthalmologists and Acute referrals at Moorfields at Bedford and Luton and Dunstable Hospital trusts.  
16. To analyse patients referred from other medical specialists, to make an Orthoptic diagnosis and contribute to the multidisciplinary care plan.
17. To assess and interpret visual fields using Goldmann Field Perimeter using knowledge of the visual pathway and to forward the results to the appropriate medical and surgical teams e.g., Neurology teams at local acute trusts, tertiary centres and DVLA.
18. To maintain and check current and discharged clinical records on SystmOne.
19. To work independently in busy community children's clinics within professional guidelines and Orthoptic competencies, referring selected patients for ophthalmic/optometric care.
20. To provide support for the Orthoptist Team Leaders and:
    a.    Act as a deputy in her absence
    b.    Assist in the monitoring and maintenance, development and implementation of professional and organisational quality standards

Planning

1. To prioritise and organise own clinical caseload.
2. To be responsible for booking patient appointments and related administration at single-handed peripheral community paediatric Orthoptic clinics on SystmOne, (S1) and ensuring compliance with 18 week criteria for initial appointments.
3. To organise additional sessions as required and take responsibility for the quality of the service in peripheral clinics in Bedfordshire.
4.  To plan and organise joint Ophthalmic and Orthoptic community clinics across Bedfordshire.
5. To formulate joint ophthalmic/orthoptic treatment plans for complex cases with the Specialist Optometrist /Consultant Ophthalmic Surgeon giving an informed professional opinion.

Policy development:

To contribute to the improvement of the service and development of agreed policies and guidelines.

Information Resources:

1. To collate statistics and submit in a timely manner.
2. To have a good standard of computer skills and adhere to the Trust IT policy.
3. To maintain accurate contemporaneous patient records in line with the Records Keeping Policy
4. To respond to requests for data and information following Trust procedures.

Communication

1. To communicate condition-related information, including the diagnosis and its implications to patients, relatives and carers, especially where this may have a major impact e.g. a child is partially sighted or blind. This may require explanation of clinical information to those who have difficulty understanding i.e. learning difficulties, hearing problems, stroke, emotional problems, people with a high level of anxiety i.e. with sudden onset double vision and those who use English as a second language.
2. To liaise with and provide detailed medical information to all members of the Community Eye Service and other professions as necessary in order to establish a high quality co-ordinated Service, e.g. Education, other health care professionals, GP’s and Eye Clinic Liaison Officer (ECLO).
3. To gain informed consent and compliance for assessment and treatment by negotiation and encouragement for children and adults of all ages and abilities.
4. To communicate effectively by transferring patient information and records (in accordance with local Information Governance processes) in a timely and organised manner when patients transfer between North, South and Mid Bedfordshire clinics, into acute ophthalmic services at Moorfields at Bedford Hospital or Luton and Dunstable Hospital or child development multidisciplinary centres.
5. To communicate with parents/carers to give an understanding of the clinical processes, the diagnosis and aims of treatment signposting to other sources of information as required.
6. To deal with tasks on SystmOne liaising with admin and clinical colleagues as required
7. The assessment of patients involves a high level of concentration for the duration of the assessment.  During that time, the Orthoptist may be disturbed, often by telephone calls, a member of the ophthalmology team, receptionists or another Orthoptist regarding a variety of matters.
8. There is often a requirement to impart upsetting news to parents/carers regarding the discovery of very poor sight in one or both of their child’s eyes, along with the appropriate course of treatment which can be distressing to parents. There is also the requirement to inform patients and parents/carers of the need for a surgical procedure and complications.  Patients with incurable double vision need to be advised of the fact that their condition cannot be cured and is unlikely to change. They may no longer be eligible to drive
9. There is occasional exposure to safeguarding children issues and to terminally ill patients whose eye condition may be one of the first signs of deterioration e.g. brain tumour - the Orthoptist is often asked by the patient if it is connected to their illness.  Also occasional exposure to otherwise healthy patients whose eye condition is the presenting symptom e.g. multiple sclerosis.

Key Relationships:

1. Orthoptists and Ophthalmologists across Bedfordshire in all clinical settings
2. Patients, relatives and carers
3. Administration staff at all bases
4. Local Optometrists
5. 0-19 years teams (School nurses, Health Visitors)
6. GPs
7. Multi-disciplinary teams
8. The team in the Health Hub

Budgetary Responsibilities

1. To be responsible for the care of clinical equipment, to report any faults and ensure adequate stock levels are maintained.
2. To identify and order clinical supplies as agreed with the Orthoptist Team Leader, liaising with the buying department & submit invoices for payment.

People Management

1. Maintaining own professional development and requirement to take part in appraisal and KSF process.
2. To demonstrate and teach Orthoptics to Undergraduate Orthoptic students and visiting health professionals.
3. To promote Orthoptics as a profession
4. To be a mentor for newly qualified Orthoptists or those who are returning to work.  To do this the post holder must have good communication skills to provide professional, clinical, personal support and assisting the mentee in identifying training needs and support requirements.