Jonathan Bull BAPO chair . Autonomous registered HCPC practitioners Gait analysis and Engineering solutions to patients with limb loss.

Prosthetists and Orthotists Role in

HSC

Jonathan BullBAPO chair

www.bapo.com

Autonomous registered HCPC practitioners

Gait analysis and Engineering solutions to patients with limb loss

Mechanics, Bio-mechanics, and material science

Anatomy, Physiology and Pathophysiology. 

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.

Prosthetists

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.

Prosthetist caseload

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.

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 orthoses or componentry taking responsibility for the impact of any changes.

Orthotists

Include - ◦ diabetes◦ arthritis ◦ cerebral palsy◦ stroke◦ spina bifida◦ scoliosis◦ MSK◦ sports injuries ◦ Trauma

Orthotist Caseload

Often work as autonomous practitioners

Form part of multidisciplinary teams such as within the diabetic foot team or neuro-rehabilitation team.

Orthotists

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

Current Service Provision in HSC

Reduce ulceration risk Increased mobility Better quality of life Reduced NHS costs Able to maintain employment

Orthotics in Diabetes

Quicker rehabilitation – less need for multiple therapists if correct orthosis is used

Early mobilisation More independence Earlier discharge

Orthotics in Stroke

Reduction of Hospitalisation Better independent mobility Improved balance

Orthotics Reduces Falls

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

Service Supporting Evidence

'The current fragmentation of the Orthotics Service.all with 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)

Recognised service problems and solutions

The cost to the NHS of delaying implementing of these changes is £390m per annum.(£1.1million per day)

The financial cost of not implementing findings from the Orthotic Pathfinder report