Jonathan Bull BAPO 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.

 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.

 ◦ ◦ ◦ ◦ ◦ ◦ ◦ 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.

    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.

  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.

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

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

 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

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

    Quicker rehabilitation – less need for multiple therapists if correct orthosis is used Early mobilisation More independence Earlier discharge

   Reduction of Hospitalisation Better independent mobility Improved balance

         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

    '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)

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