Prosthetist/orthotist

Prosthetists or orthotists improve people's mobility and help them be as pain-free as possible by using aids and creating and fitting limb replacements

The roles of a prosthetist and orthotist are similar, however the way that they help patients differs.

Prosthetists - create and fit prostheses or aids for people of all ages requiring artificial limb replacements. This includes those who have been born with a limb defect or missing limb (congenital absence), those who have lost a limb through trauma, or those who have had limb amputation due to infection or long-term health conditions.

Orthotists - work with people whose limbs are not functioning well due to a clinical condition, such as spinal injury or deformity, neuro-muscular disorders, musculoskeletal concerns, traumatic injuries and congenital anomalies. Using a range of aids, they work to relieve pain and correct and/or compensate for impairments in nerves, bones and muscles while improving mobility and function.

Although training covers both orthotics and prosthetics, it's typical to specialise in either one or the other area of work. However, a few centres in the UK have opportunities to work in both as a dual practitioner.

You'll see people of all ages and can work with them during their lifetime forming long-term professional relationships.

Responsibilities

As a prosthetist/orthotist, you'll need to:

• assess people to understand their problems and determine how a medical device can help improve their movement and quality of life
• assess movement and identify any biomechanical abnormalities (this is commonly called gait analysis)
• evaluate joint range of movements and muscle strengths
• create a treatment plan and agree goals going forward which may include a prosthesis (artificial limbs) or orthosis (brace)
• prescribe, measure, engineer and design a prosthesis, orthosis and footwear to meet the needs identified
• shape capture using plaster or digital imaging and 3D scanning, CAD (computer-aided design) and CAM (computer-aided modelling) to make a model
• liaise with technicians who will manufacture the prosthesis/orthosis
• fit people with their prosthesis/orthosis
• modify prostheses/orthoses to perfect alignment and walking/function as required and monitor the impact of any changes
• review the impact of wearing a new prostheses/orthoses and help patients to adjust to using their new devices
• work as part of a multidisciplinary team with other healthcare professionals, including medics, nurses, physiotherapists, podiatrists, occupational therapists and technicians, to help manage patients' rehabilitation.

Salary

• Jobs in the NHS are usually covered by the NHS Agenda for Change (AfC) pay rates. Starting salaries for qualified prosthetists/orthotists range from £28,407 for those with less than two years' experience, rising to £34,581 for those with over four years' experience (Band 5).
• Senior and specialist prosthetists/orthotists can earn between £35,392 and £42,618 (Band 6), rising to £50,056 at the top of (Band 7).
• Salaries for consultant prosthetists and orthotists with management responsibilities can reach up to £57,349 (Band 8a).

Salaries for prosthetists and orthotists working for companies contracted by the NHS vary but are often similar to NHS pay. Practitioners working for these companies may receive additional benefits including a company car.

Income figures are intended as a guide only.

Working hours

Most prosthetists and orthotists in the NHS work a standard 37.5 hours a week, Monday to Friday. Working hours are usually between 8am and 6pm, although there may be some shift work involved, including nights and weekends. Part-time or flexible hours may also be available.

If you work in a private prosthetics/orthotics clinic or company, you may work evenings or weekends to suit your private clients.

What to expect

• Prosthetists are usually based within rehabilitation centres in NHS or private hospitals. Orthotists are often based in hospital outpatient clinics. As an orthotist, you may see people in ward settings or in their own homes, move around several hospitals and visit special needs centres.
• You could work independently or as part of a multidisciplinary team that includes clinicians and technicians to aid patients' rehabilitation.
• The work is both rewarding and challenging as you combine theoretical engineering solutions and practical and manual skills with a significant level of people contact to improve lives.
• Jobs are available throughout the UK, but you may need to relocate to find work or to further your career. There are also opportunities to work abroad.
• You may need to travel during the day between different client sites or patient homes.

Qualifications

To work as a prosthetist/orthotist, you must be registered with the Health and Care Professions Council (HCPC). To register, you'll need to complete an HCPC-approved degree programme or degree apprenticeship in prosthetics and orthotics.

Currently, degree courses in the UK are only offered by the University of Salford and the University of Strathclyde. Courses are full time and take three or four years to complete.

Courses combine theoretical learning with clinical work placements, which can take place in prosthetic or orthotic centres anywhere in the UK. This means you'll need to be flexible around geographic location as you may have to relocate temporarily during placements.

Funding of at least £5,000 a year is available to all pre-registration prosthetics and orthotics students through the NHS Learning Support Fund. As this is a shortage subject, you'll also get an additional £1,000 a year. You don't have to pay it back and are still able to access funding for tuition and maintenance loans from the Student Loans Company. For more information, see Health Careers.

It's also possible to enter the profession through a degree apprenticeship (Level 6) in prosthetics and orthotics. You'll need to apply for an apprentice position with a healthcare provider and will typically need a Level 3 qualification or above, as well as a genuine interest in the profession. Search for apprenticeship vacancies at NHS Jobs and Find an apprenticeship.

An HCPC-approved Masters programme in prosthetics and orthotics is available at Keele University, suitable for anyone with an appropriate science or exercise-based degree. If you have a 2.1 or above you can apply straight after your degree, however if you have a 2.2, you’ll need a minimum of two year’s relevant experience and evidence of continuing professional development activities. The course lasts two years and allows you to put your theory into practice within clinical environments.

You'll have to pass an enhanced criminal record check to get a place on a degree or Masters course. Before taking any placements, you may also have to pass a health assessment.

Once you've attained the qualification, you're eligible to apply for registration with the HCPC and can then choose to specialise in either prosthetics or orthotics. You can also become a member of the British Association of Prosthetists and Orthotists (BAPO), the UK professional body for prosthetists and orthotists.

Skills

You'll need to have:

• good listening skills, for learning about and understanding patients' needs
• excellent verbal communication skills to explain treatment solutions to technicians and patients
• patience and the ability to stay calm in challenging situations
• sensitivity and understanding towards patients and their families
• good manual skills including coordination and dexterity
• knowledge of manufacturing production and processes
• confidence in using software packages
• scientific understanding, particularly human biology and physics
• creativity and problem-solving skills
• strong IT skills and a willingness to embrace new and emerging technologies
• good attention to detail
• the ability to work as part of a larger team alongside other medical practitioners
• determination and an ability to motivate people
• a driving licence - is useful for many positions as you'll be travelling during the day to visit patients at home and in hospitals.

Work experience

Getting work experience in prosthetics and orthotics can be difficult. Try contacting your local NHS centre to see if you can arrange a visit, some work shadowing or work experience. Focus on Disability provides a list of disablement service centres in the UK. You could contact local ones to see if they can offer any opportunities. It's also worth contacting BAPO or the universities of Salford and Strathclyde for details of your local centre.

Joining BAPO as a student member is also helpful as it will help you to keep up to date with developments in the sector, allow you to network and also show your commitment to the area.

Paid or voluntary work experience in other health and care disciplines is also useful, especially in areas that bring you into contact with patients.

Find out more about the different kinds of work experience and internships that are available.

Employers

Prosthetists and orthotists are usually employed by hospitals, clinics and health centres within the NHS, as well as by commercial and private prosthetics and orthotics companies contracted by the NHS.

Opportunities to work in the field can also sometimes be found in:

• manufacturing and servicing companies
• overseas healthcare providers
• voluntary organisations such as the British Red Cross who work in regions affected by war.

Look for job vacancies at:

• Health Jobs UK
• NHS Jobs
• NHS Scotland Recruitment
• websites of individual NHS trusts and organisations.

If you're a member of BAPO you will also be able to access vacancies through the member login part of its website.

There are also opportunities to set up in private practice and run your own clinics.

There is currently a national shortage of prosthetists and orthotists, so career prospects are good in this challenging but rewarding role.

Professional development

Training in your first year after registration with the HCPC usually involves being mentored by an experienced prosthetist or orthotist to help consolidate your skills and knowledge. You may choose to specialise in either prosthetics or orthotics, or practise in both (although roles in both disciplines are rarer).

You'll need to undertake continuing professional development (CPD) throughout your career to retain your registration with the HCPC and to keep your skills and knowledge up to date. CPD activities include attending conferences, workshops and seminars, some of which are organised by BAPO. Membership of BAPO also provides the opportunity to network with other prosthetists and orthotists.

The universities of Salford and Strathclyde both offer opportunities to undertake research degrees (MPhil, PhD) in prosthetics and orthotics. These qualifications are particularly useful if you want to move into research and teaching.

Career prospects

As there is currently a shortage of prosthetists and orthotists, both in the UK and internationally, career prospects are generally good. The profession is relatively small, however, so you may need to relocate to progress your career.

You'll begin in a junior position and can progress into a more senior clinician role with experience. There are opportunities to specialise in a specific clinical area such as sports injuries, neurology or diabetes, or with a particular client group, such as children.

With further experience, there are some opportunities to move into supervisory and management posts, with responsibility for managing staff and budgets within an orthotics or prosthetics service.

You could also progress into a teaching or research and development role, but additional qualifications may be required.

Some practitioners also go on to set up their own clinics, either independently or with other prosthetists and orthotists.