1. Jonathan Bull BAPO chair www.bapo.com

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

3.  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.  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.  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.  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.

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

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

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

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

12.  Reduction of Hospitalisation  Better independent mobility  Improved balance

13.  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.  '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)

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