Service Provision Guidance forProsthetic Orthotic Services - PDF document

1 Service Provision Guidance forProsthetic
Service Provision Guidance forProsthetic & Orthotic Services GlossarWho has Produced this GuidanceWho is This Guidance ForExecu�ve SummarA call to Ac�o1 Introduc�on to Prosthe�c and Ortho�c Service1.1 What is Prosthe�cs and Ortho�csDefined Specialist Professionalis1.2 Who uses Prosthe�c and Ortho�c ServiceProsthe�c Service UserOrtho�c Service User1.3 Service User Goal1.4 The Prosthe�c and Ortho�c Treatment Cycl2 The Need for Prosthe�c and Ortho�c Service2.1 Clinical Benefits of Treatmen2.2 Financial Benefit2.3 Social Benefit2.4 Benefits for Children and Young Peopl3 Current Arrangement3.1 Current Commissioning Arrangement3.2 ‘In House’ and ‘Contracted’ Service 3.3 Op�ons for Service Delivery……………â€

2 ¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦
¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦..……………………………………244 Key Aspects of Service Deliver4.1 Environment, Facili�es & Loca�o4.2 Access to Informa�o4.3 Referral, Triage & Service Acces4.4 Appointment Logis�cs & Episodes of Car4.5 Procurement, Provision & Timely Deliver4.6 Communica�on with Medics & AHP Colleague4.7 Inclusion of Technical Colleague Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.8 Con�nued Professional Development & Workforce Plannin4.9 Administra�ve Suppor4.10 Systems & Record Keepin4.11 Protec�ng Service Users & Sta4.12 Clinical Governanc4.13 Stakeholder4.14 Evidence Based Prac�c5 Implemen�ng this Guidanc5.1 Key Point5.2 Steps to Effec݀

3 069;ve Planning and Service Revie6 Princ
069;ve Planning and Service Revie6 Principles and Expecta�onAppendix 1 – ReferenceAppendix 2 – Contact Detail Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 AHPs - Allied Health Professionals BAPO - Bri�sh Associa�on of Prosthe�sts and Ortho�stsCAD/CAM - Computer Aided Design/Computer Aided Manufacture CCG – Clinical Commissioning Group CPD – Con�nuing Professional DevelopmentCTEV - Congenital Talipes Equino VarusDNA – Did Not A�end HCPC – Health and Care Professions Council ICT – Informa�on Communica�on Technology KPI – Key Performance Indicators MDT – Mul�-Disciplinary TeMHRA - Medicines and Healthcare Products Regulatory Agency NHS – Na�onal Health Service NICE - Na&#

4 x00740069;onal Ins�tute for H
x00740069;onal Ins�tute for Health and Care Excellence QOL – Quality of Life RTT – Referral to Treatment WHO – World Health Organisa�on Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 serviceprovisionguidancehereinbeenpublishedAssocia�onof Prosthe�sts and Ortho�sts (BAPO).These guidelines are produced with the BAPO mission statement in mind: BAPOrepresentsinterestsortho�cprofessionals.BAPO members,membersBAPOrecognisedprofessionalbody 1,200Prosthe�sts/Ortho�stsregisteredProfessions(HCPC) in the UK.guidancepreparedProfessionalCommi�eeBAPOcollabora�ve consulta�onworkingconsis�ngregisteredProsthe�sts/Ortho�sts.BAPO iden�fiedinterestproduc

5 40069;onresource.externalbeen developres
40069;onresource.externalbeen developresource.workingrepresentsProsthe�sts/Ortho�stsna�ons sectorsworkforcerepresenta�onemployedclinicians,contracted service providers, academic professionals and private providers. Sco� McNab – Ortho�st Lynne Rowley – Ortho�st (Scotland Repesenta�ve) Johnathan Bull – Ortho�st (N. Ireland Representa�ve) Paul Charlton – Ortho�st (England Representa�ve) Nicola Eddison - Ortho�st (England & Academic Researcher Representa�ve) Alasdair Gilbertson - Prosthe�st (England Representa�ve) Miriam Golding-Day – Ortho�st (Academic Researcher Repesenta�ve) Lauren Jennings - Ortho�st (England Repesenta�ve) Duncan Marchbanks – Ortho�st (Paedia

6 tric Repesenta�ve) Jana Middl
tric Repesenta�ve) Jana Middlebrook – Ortho�st (England Repesenta�ve) Chri�an Pankhurst – Ortho�st (England Repesenta�ve) Douglas Young – Ortho�st (Wales Repesenta�ve) Joshua Young - Ortho�st (England Repesenta�ve) Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 BAPOguidelinesconsideringdeveloping or reviewing a prosthe�c and/or ortho�c service. A recent survey indicated that only 40% thoseortho�cservicesclinicalbackgroundortho�csneedguidanceresourcesthose new to prosthe�cs and ortho�cs. beenthoselookingestablishservicesthoseestablishedservices,readerresourcesbenchmark their service to allow a baseline and drive service improvement.

7 guidanceexplainsortho�cservi
guidanceexplainsortho�cservicesreferenceservicesofferservicehealthcareHerein,BAPOdiscussrecommenda�onsimplemen�ngguidance presentedopera�onallevel.principlesexpecta�onsqualityortho�c services are also defined. clinicallevel,Prosthe�sts/Ortho�stsfamiliarthese guidelinesdelivertreatmentserviceframework presented.servicesstandardscliniciansguidelinessupport a case for undertaking a service review process and to help drive posi�ve change. Prosthe�c Service Users Assessing service needs services services services services Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 pagesBAPOpresentserviceprovisionguidancerequirementskeys aspects of service delivery:Throughout all aspects of this document, the key me

8 ssages are: Environment, Facili琀
ssages are: Environment, Facili�es & Loca�on Access to Informa�on Referral, Triage & Service Access Appoin�ng Logis�cs & Episodes of Care Procurement, Provision & Timely Delivery Communica�on with Medical & AHP Colleagues Inclusion of Technical Colleagues Con�nued Professional Development & Workforce Planning Administra�ve Support Systems & Record Keeping Protec�ng Service Users & Staff Clinical Governance Evidence Based Prac�ce Stakeholders Prosthe�c and ortho�c services are commissioned for the service user, on behalf of the service user The best interests of the service user must be considered at all stages in development of services Prosthe�c and ortho�c services provide unique care and treatments of great clinical and wider benefit Prosthe

9 �sts/Ortho�sts req
�sts/Ortho�sts require to be enabled to deliver quality treatment through careful commissioning Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 BAPOWorkforceindicatedissa�sfac�onProsthe�sts/Ortho�stssuitabilityclinicalenvironments,volume of caseloads and protec�on of service users. alsoservicereviewortho�cdeliver the 2015 service specifica�on.threeservicedelivery.this impactsserviceexperiencequalityreceived.Furthermore,these are mirrored‘ImprovingOrtho�cServicesEngland’ NHS England report narra�ve (2).A recent survey showed reali�es of this in prac�ce (1), repor�ng:Increasing volume of complaintsVariances in appointment dura�onsInsufficient app

10 ointment dura�ons to complete
ointment dura�ons to complete assessments and design treatment plansVariances in wai�ng �mes for 1 appointmentsVariance in lead �me for supply of devices following assessmentPoor access to technologiesexamplesna�onallyefficientortho�cservicesdeliveringexcellent enableserviceobjec�veguidelinesequipthoseinvolved servicemanagementencourageexcellencealsofounda�onensureunderstandingminimalrequirements Prosthe�st/Ortho�stenableddeliverstandardsthose who rely upon their treatment. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 1.1 What is prosthe�cs and ortho�cs?healthcareillnesspopula�on. needsenableci�zenslivelives,poten�alop�miseability life

11 acknowledgedeffec�ve rehabil
acknowledgedeffec�ve rehabilita�ondeliversimprovedqualitylifepoten�alreduceinequali�esmakesignificantortho�c services have a major role to play in this.Whilst‘prosthe�csortho�cs’o�enconsideredprofession,industry,and aspect of healthcare, there are dis�nct differences between the two component disciplines. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Prosthe�cspoten�alindependentliving.replacement,ar�ficialknown. The clinical skillsettreatments is the role registeredknown Prosthe�stscliniciansassessmovementengineering solu�ons to pa�entsupper and loss. They are trained at undergraduatelevel mechanics,bio-mechanics,materialpathophysiology

12 . Their qualifica�onsmake to
. Their qualifica�onsmake to and that replicate the structural or func�onalcharacteris�cs the pa�ent’s absent They treat pa�ents congenitallosswelllossdue to diabetes,reducedvascularity,infec�ontrauma.Militarypersonnel,injuriesmul�pleloss,notable part of their caseload.Whilstthey arecloselyrehabilita�on consultants,physiotherapists, nurse specialists and occupa�onaltherapists as mul�disciplinary amputee rehabilita�on teams (4).Ortho�csextemodifyforceshuman body in mobility,func�on,facilitate pain/discomfort.upperfunc�onalinsoles,specialistspinalbraces,collars,abdominal supports,conven�onalcallipers,trusses, The clinicaskillsetortho�ctreatment is the role registeredknown clinicians assess and movement in order to enginee

13 ringsolu�ons to pa�
ringsolu�ons to pa�entsmuscularskeletalextensivelyundergraduatelevelmechanics,bio-mechanics,materialanatomy, and pathophysiology. Their qualifica�onsmake to and orthoses that modify the structural or func�onalcharacteris�cs the pa�ents'neuro-muscular and skeletalenablingpa�entsmobilisesafely,eliminatedevia�ons,reducefalls,reduce prevent and enable ulcers. They are also qualified to modifymarked orthoses or componentry,responsibility the impact any Ortho�sts treat pa�ents a condi�onsdiabetes,cerebralpalsy,stroke,bifida,scoliosis, musculoskeletal concerns, sports injuries and trauma. Whilst Ortho�sts as they o�enmul�disciplinarysuch as the diabe�c care or neuro-rehabilita�on In scenarios,ortho�cwill be d

14 elivered as a component of these special
elivered as a component of these specialist services. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Prosthe�sts/Ortho�stsfounda�onprofessionalresponsibili�esrequiredAllied Professionsclinicians.Prosthe�st/Ortho�stcombina�onof specialistclinicaltechnicalskillsknowledgehealthcareenvironments.equipsProsthe�st/Ortho�stserviceadvisecomplimentmedicaltreatments.Ortho�stssupportedskilledtechniciansmanufacturing,Prosthe�st/Ortho�stfreeclinicalskills,communicatecloselyensure the best result for the pa�ent. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 1.2 Who uses Prosthe�c

15 and Ortho�c ServicesOrganisa&
and Ortho�c ServicesOrganisa�onstatesrehabilita�oninterven�onsachieving the following broad objec�ves (5): preven�ng the loss of func�on slowing the rate of loss of func�on improving or restoring func�on compensa�ng for lost func�on maintaining current func�on ortho�ccliniciansdelivertreatmentobjec�ves. objec�vesconsideredalongsideservice(sec�onformulate individual treatment plans.ortho�cservicesreliedtreatmentmodali�es currenthealthcareortho�cservicelong as such a treatment objec�ve correlates with those presented above. es�materequirespecialistortho�ctreatmentlife�mepopula�onaccessingservicesthis would extrapolate to over 327,000 poten�

16 0740069;al persons currently accessing s
0740069;al persons currently accessing services.Those with congenital limb absence will be lifelong candidates for prosthe�c care from infancy. causeamputa�onlinkeddiabetesPeripheralVascularDiseaselaterlife.Youngerpa�entsundergoamputa�onbecausecondi�onsmeningi�stumours).es�matedyear-oldwhoseamputatedrequireprostheseslife�me ortho�cserviceiden�fiedinfancy.Treatmentchildrencondi�onscongenitaldysplasia,congenitaltalipesequino cerebralpalsy,bifida and global development delay are common. neurologicalimpairment,stroke,musculoskeletalcondi�ons,diabetes treatedlifediagnosis.requireepisoderesolveproblemlife-longpackagepersistsconserva�vetreatmentis es�mated�mesrequireortho�ctreatmentcomparedtreatmentThoselosspresentiden�ï

17 ¬ableneedaccessservices,whereaskeyskill
¬ableneedaccessservices,whereaskeyskillsOrtho�stassessiden�fyif ortho�c interven�on is appropriate. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 1.3 Service User GoalsService usersorthosisor more treatment goals. These include those defined by rehabilita�on and re-enablement pathways (7): Developingskillsthechildrenrequiredevelopskillsovercome barrierspresenteddevelopmentaldifficul�escondi�onshealth and independence as they grow. unexpectedillnessadmissionhospitalstroke, surgical complica�on, infec�on, etc.Managementcondi�onslong-termmedicalcondi�onfrom rehabilita�on interven�ons to help them regain and maximise their independence.condi�onslong-termcondi

18 �onenabledreducedevelopingsec
�onenabledreducedevelopingsecondaryproblemsaffec�ngeithermentallossstrengthcardiovascularcontractures,depression. traumarehabilita�onre-enablementregainmaximise their skills and independence, including returning to work.maximiseindependenceprogressivecondi�ons:earlydiagnosis, assessmentinterven�onop�miseskillsindependencepossible. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 servicesupervisionThe key, unique skillset of both Prosthe�sts and Ortho�ststechnicianspathways Assess Treat Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 biomechanical Service Provision Guidance for Prosthe�c & Ortho�c Services •

19 1st Edi�on • BAPO â€
1st Edi�on • BAPO • 2021 and 4 the5indicator assetout in the discussed the and in both health and This includes such asthe accidentand and injury Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 benefi�ngprosthe�c Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 6classes and orthosesare noted on the WHOGlobal of 50list These Diabetes Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Theneeds an and the burden diseaseand and that and be There is that can cost and add and acrossthehealth and care illness and the costly

20 is toany this is outlined in Heal
is toany this is outlined in Healthand Excellence a analysis the and insoles to users . these canalso tothehealthcare in concurrentreducedneed acute and both on costly care and scarce beds a in the such as and orthoses reduce the a user’s needtoaccess other such as or asthe canbe to the reason the user other For a to and recurrent access to Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 treatmentpoten�alspecific solelyservice Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 and clear to health and social care and in the For by the in older and and itis toreduce theneed social care contribute tohealth itis that ca

21 n toreduce theneed acute to and also a
n toreduce theneed acute to and also and those been As and are a in Foradults a ororthosis be that to todo soand contribute tosocietyin the Prostheses and orthosesenable to tocontribute the healthyand Itis clear that and canactasatool to the thatsits Reduced Reliance Inclusion Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 consider thatchildren and tobe enabled by their and orthosessoastoensure in their their their be in orderto social thecrucial any and they toobtain thecorrect or itcould be theyare and this resultsin endurance unnecessary and Italso the the and resultsin theneed and on a This not only their health but also their and social health. and needsas they and and they At only standalone clinics users.This that

22 children barriers to care and not b
children barriers to care and not beassessedbyclinicians are to costis considered asa can Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 House’ are the theclinical trustsand boards the toruntheclinics and the clinical assistants and technical directly. onsite These are theclinical are bythe eitheron oratthecontractor’sexternal A ‘contracted also thecontractor and and the clinical Inthis clinic and also and are contractedin arecent study are ahybrid these An bea ‘contracted’ theclinical and are bythe but the retaincontrol and a be house’ are directly bythe trust Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2

23 021 Health and are on but a in
021 Health and are on but a in contractstobeestablished the a canbe in the2015 theQuality in This includes discussion Itis notethatthe are by contracts. based Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 approach, the centre close are both Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Thenature an is to This is becausethere is the in both and secondarycare thecaseload usersis also than in standalone based clinics cater all or orthosis on General AHPs and based clinics bedesirable a cohort usersare but needs. clinics neuro and Inthese itis the to as a the and their into the centres to in close Paediatrics Service Pr

24 ovision Guidance for Prosthe�
ovision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 ortho�cservicesclinicalservicesrequireclinicalserviceguidelines Serviceseekensureservicesenable clinicians to work within the standards set by (HCPC) (23, 24) and professional bodies (BAPO) (25).ma�ersconsidera�onplanning Environment, Facili�es & Loca�on Access to Informa�on Referral, Triage & Service Access Appoin�ng Logis�cs & Episodes of Care Procurement, Provision & Timely Delivery Communica�on with Medical & AHP Colleagues Inclusion of Technical Colleagues Con�nued Professional Development & Workforce Planning Administra�ve Support Systems & Record Keeping Protec�ng Service Users & Staff Clinical Governance Evidence Based Prac琀

25 69;ce Stakeholders Service Provision Gui
69;ce Stakeholders Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.1 Environment, Facili�es & Loca�oninforma�onrecommenda�onsspecialistprosthe�c/ortho�c func�onprosthe�c/ortho�cse�ngenvironment for the service user and clinician to provide specialist consulta�on, examina�on and treatment. Belowlistedfeaturesexpectedclinicalcentre.and ortho�c outreach services are conducted, efforts should be made to provide all these features:servicewheelchairaccessibleappropriatewai�ngarearecep�on facility. Servicemember,carersufficient space to accommodate all comfortably. Environments must offer service user privacy and protec�on of dignity.The

26 service must have access to a couch or
service must have access to a couch or plinth.ComputerDesign/ComputerManufacture(CAD/CAM), and/or alterna�ve shape, capture and measurement facili�es must be available. suitablyequipped,posi�veplasterrec�fica�onareaavailableservices.suitableserviceavailable.assessment,observa�onalinstrumental,prosthe�c/ortho�cassessmentfinal10-meterconsideredclinicianundertakevalidated�medapprovedmeasurement in prosthe�c and ortho�c prac�ce (26).There must be ready access to wheelchairs and walking aids, and to a parallel bar set up.Accessworkshopsmanufacture,repairadjustmentorthosis should be available onsite.Adequatestorage,infec�ondecontamina�onfacili�espar�cularlyimportant prac�ce.facili�essuitabledisposal methods f

27 or general, clinical, infec�o
or general, clinical, infec�ous and sharp waste. appropriateligh�ng,ven�la�on, la�ermandatorymanufacturingareasmachineryand/or(i.e.adhesivessolvents).�mesprofessionalserviceenvironment.alsoapplicableprofessionalshould work within a uniform policy and maintain high personal hygiene standards. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Givenpropor�onprosthe�c/ortho�cservicepresentmobility impairment,servicesaccessiblewheelchairdistancestransportoffsminimised.Accessibletoiletsfacili�esalsorequired. serviceloca�onaccessiblepa�entcaseload.servicetransportlinksand/orparkingencouragepa�entsmakearrangementspossible.servicesuitabletransportservicespa�ents who are

28 unable to make their own way for medica
unable to make their own way for medical reasons.Serviceslocatedcloseadjunc�veservicesminimiseservicea�endingmul�pleappointmentsProsthe�sts/Ortho�stseasilycolleague AHPs such as physiotherapy, occupa�onal therapy, podiatry, orthopaedics and musculoskeletal.4.2 Access to Informa�oncontactservice,serviceaccessinforma�onempowermakeinformedserviceable to demonstrate that pa�ents have access to the following: Keyopera�onalcentre�mes,contactemergency access pathwaysDetails of a named clinician allocated to each pa�entwri�eninforma�onprosthesis/orthosispoten�al problems to be aware of and what to do about themCondi�ons of provision and/or loan of the prosthesis/orthosisUser groups and/or pa�ent support systems in the local

29 i�es served (if applicable)Ch
i�es served (if applicable)Chari�es and organisa�ons providing relevant support to the service userinforma�onwebaddresseslocalna�onal organisa�onsCarer support networks and organisa�ons4.3 Referral, Triage & Service AccessOn receipt of a referral, the clinical team should triage the referral and ensure:Appropriateness of referralPriority and urgencyAppointment dura�on requiredAny special facili�es or equipment an�cipated to be sourcedSkill level needed to assess the pa�ent (Junior, Senior, Clinical lead).clinician accessreferralmedicalhistory,medica�ons, comorbidi�es,influencetreatment.clinician alsoaccessmedicalrecordsmakerequestsinves�ga�ons where appropriate. Service Provision Guidance for Prosthe�c & Ortho�c Se

30 rvices • 1st Edi�on â
rvices • 1st Edi�on • BAPO • 2021 ortho�cservicesmeetna�onal‘referraltreatment’targetsensurepa�ent’sappointment�mely�medcomplementtreatments receiving.certainpa�entsreferrals,appropriatepriori�seassessmentinterven�on.servicedemonstratemechanismsare placereferralsensurepa�entsseenop�mumassessment and that the service meets any na�onal, regional or local standards that are in place.serviceadherencestatedmandatethis should occur.Serviceaccessnecessaryhealthcaredisciplinesmeetneedsthe service and/or by referral to a suitable local provider.serviceendeavorminimisemul�plehospitalvisitsprosthe�c/ortho�c appointments and other therapy appointments where viable.services‘appliancerequests’referrersortho�crest

31 rictserviceclinicianservicereferralShare
rictserviceclinicianservicereferralSharedrehabgoals,Ortho�c/prosthe�cobjec�ves, Biomechanicalobjec�ves,Ortho�c/prosthe�creferralspromote ‘SOBO Steps to Success’: S Role of the MDT including Prosthe�st/Ortho�st Role of the Prosthe�st/ Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Clinicalurgencynecessitateimmediateaccessserviceappoin�ngdiariestreatmentunexpectedemergencycasesSimilarly, emergencyrequestsrepairbrokenorthosisservice user is reliant) should be appointed to clinic within one working day. pa�entsreferredeitherelec�vesurgerypost-opera�vely. Childrencongenitalanomaliesreferredcondi�oniden�fiedi.e.parents may be referred to the servic

32 e before the child is born.Established s
e before the child is born.Established service users should be able to self-refer at any �me for review/repair/re-assessment. currentlyregisteredcentresreferredhealthcare professional or previous prosthe�c centre.serviceseenanotherservice,currentservice informed,receivingserviceagreeserviceand the host clinical commissioning body must agree to fund the transfer of care.Servicepensionersaccessservicesbecausewhilstarmedforces are en�tled to priority treatment for that condi�on (27). Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.4 Appointment Logis�cs & Episodes of CareEpisodesplannedassessmentcarefulof appointments.appointmentsrequiredepisodethese scheduledoutsetminimise�mescalesbetweenappointments.guidanceepisodesortho�coutlinedBAP

33 OStandardsBest Prac�ce (25).s
OStandardsBest Prac�ce (25).serviceofferappointment�mesmeetneedsindividualsoffer pa�entmakingappointments.availabilityappointmentsoutside workinghours,consideredbasedserviceavailablefinancial resources. serviceservicereviewbe established for:Paediatric and adult user groupsService users undertaking their first episode of care (known as primary service users)Usersorthosesrequireregularmechanicalinspec�onserviceoutlined by the manufacturerDomiciliary visits should be an op�on where the need of the service user warrants this.servicerecordmeasureseverypa�entreviewedcurrentservice usersup-to-dateplan.servicepropor�onrecordsthese aspects detailed.servicedischarge,onwardreferralrepor�ngNot A�end (DNA) protocols. Prosthe�c and ortho�c services should meet na�onal ‘referral

34 to treatment’ (RTT) targets (1). Ser
to treatment’ (RTT) targets (1). Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.5 Procurement, Provision & Timely DeliverySystemsrequiredorthosisassessment.availabledeliveryservice.Bespokeavailable workingproducts,workingof 30 working days for complex bespoke products.serviceorthosis,issued.Provision allowances should be in line with na�onal policy where applicable (28). efficientrepairserviceavailablecomplimentprocesses4.5. Quality repair services will ensure extended lifespan of each prosthesis/orthosis (6). Serviceselectronicallyprosthesesorthosescomponentryreferenceeachindividual components should be �ed to the service user to allow manufacturer recalls to be processed.servicecomponentsagreed commissioners of the service and includes a process for scoping funding of except

35 0069;onal cases. servicescoveredarrange
0069;onal cases. servicescoveredarrangements.Servicessignpos�ngpa�entspresentThere are special arrangement for military personnel via the Ministry of Defence. assessment,serviceenable�melydeliveryprosthesis/orthosis.considered ‘�mely’greatly dependingthe presenta�on of theservice user,of condi�on,orthosessuppliedreadinessaccessresources. The service should be guided by recommenda�ons made by the clinical team. serviceregularlyreviewdelivery�mesiden�fyremovebarrier�mely delivery.Servicesestablishtarget�mescalesdelivery鄀standa牤鈀‘typical’serviceusers, par�cularlyareascons�tutecaseloadservice. Regular audit should be undertaken to report performance in mee�ng targets. Service Provision Guidance for Prosthe�c & Ortho�

36 c Services • 1st Edi�on
c Services • 1st Edi�on • BAPO • 2021 4.6 Communica�on with Medical & AHP colleaguesCliniciansenabledmakeonwardreferralsserviceimprovedmetaccessdifferentclinicalservice.requireddiscusspa�entneedsexploreadjunc�vetreatmentop�onsmedicalAHP colleagues.rela�onshipsreferrersimprovescommunica�onop�misesserviceefficiency. Servicesdeliveringreferrerstreatmentop�onsensure receiptappropriatereferralsalsoensurehealthcareworkforceare skilled to iden�fy poten�al prosthesis or orthoses users. Outcome repor�ng should be undertaken to ensureendepisodecare,referrerassessment, prescrip�on ra�onale, treatment success and future plan.resourcesenableclinicianundertakesupervision ortho�cgraduatesworkingservice. Cliniciansreferservicecounsell

37 ingservicesengageservice user in social
ingservicesengageservice user in social prescribing. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.7 Inclusion of Technical Colleaguescliniciancommunicateortho�c technicians.Servicesencouragecommunica�onmul�-direc�onalbetweenclinicaltechnical teams.Developmentworkingrela�onshipsmanufacturersencouragedimprove and/or maintain ‘right first �me, on �me’ rates (29).Developmentworkingrela�onshipsmanufacturersencouragedlocal awarenessinnova�veproducts,feedbackdiscussionssupplierprocurement nego�a�ons. Processesplacetechnicianspar�cipateclinicalundersupervisionof the clinicians. Normallythis would be duringevents such as device fi�ngs,par�cularly caseswo

38 uldn’ttechniciansseepa�ents
uldn’ttechniciansseepa�ents on their own for limited repairs etc.Non-conformance processes will be established with regular review of performance. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.8 Con�nued Professional Development & Workforce PlanningClinicianskeeptreatmentop�onscon�nuallyexpandingevidencebase to support and guide treatment ra�onale.Clinicianskeepmaterials,techniques,componentryassociated products.Con�nuedProfessionalDevelopmentmandatoryregistra�on,serviceensuresetclinicianpar�cipatethis task (23, 24).Mee�ngneedsageingpopula�onna�onalortho�c workforceincreasedclinicalexper�selinkedobesity, diabetes,cardiovascularvasculardiseasesserviceworkforce planb

39 lueprintdevelopclinicalbasediden݀
lueprintdevelopclinicalbasediden�fiedlocalindicateclinicalskillsetrequiredBAPOcommissionersna�onallyapprovedcareerframework,educa�onframeworkpreceptorship guide (31-33). servicestructuredarrangementsmanagementdevelopimprove.recordsIndividualneedsiden�fiedregularlyreviewedalongsidePreceptorshipgraduatesclinical supervision programme should be implemented.The service will have a clear mangement structure and leadership development programme. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.9 Administra�ve Supportclinicianaccessmeetadministra�vetasksrequiredlocal level. Service users must be given contact details for administra�ve and appointment booking purposes. Administra�vegivenservicestrong link between the service use

40 r and clinician. 4.10 Systems & Record K
r and clinician. 4.10 Systems & Record KeepingServicesenableclinicianmeetclinicalrecordkeepingset professionalstandardsDigitalmeetstandardsexpectedprocessing physical hardcopies. Organisa�onsemployprofessionalmakepa�entrecordsthose records.Clinicians,however,confiden�alitythoserecords.professionalcontractedclinicalserviceanotherorganisa�on,condi�ons will normally specify the legal owner of any records.‘Shared’‘integrated’recordkeepingmembershealthcarecontribute) may be used in some situa�ons in accordance with an agreed local protocol.centreintegratedInforma�onCommunica�onenables serviceinforma�onopera�onalservice user demographic informa�onclinical note keepingreferral and transfers between centresfinancial informa�onappointment u�lisa�on

41 equipment/components currently and previ
equipment/components currently and previously issuedmanagementcentresDepartmentPolicies for Informa�on Governance (34). A recent study reported that: Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 4.11 Protec�ng Service Users & StaffServicesafeguardingnamedsafeguardingwith links to local community and emergency safeguarding services established. servicerespondrequestspa�ent’schosenpartner,carer, rela�on, guardian or advocate, to accompany them during their treatment.servicemakerequesttreatmentclinicianpossible.servicesaccesssuitableif requested or required during service user treatments. clinicianserviceaccessinterpre�ngservicesreliantlicensed interpreta�on provided by a rela�on or friend. guidanceavailableservicecarer applicable,s

42 afelyunderstandu�liseprosthes
afelyunderstandu�liseprosthesis/orthosisSimilar availableinstructareasself-managementcare. resourcesuniversallyaccessiblepa�entsthereforeservicedemonstrateequalityconsidera�onsguidancearrangementsbasedthe foremost needs and capabili�es of the service user. Incidentrepor�ngplacemonitoredsafetymedical device concerns.serviceplannedensureare serviced within manufacturers stated �mescales.serviceguidanceImprovement (NHSI) (35).The service should have a policy detailing zero tolerance to bullying, discrimina�on and harassment. ‘Off-label medicalalteredmanufacturer.Servicesassessmentplace‘off-meetMedicinesHealthcareRegulatoryAgency MHRA s�pula�ons (36). Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Clinicalpa&#x

43 00740069;entsubjectneedcriminaldisclosur
00740069;entsubjectneedcriminaldisclosurechecksappropriate depending upon the region of the UK.4.12 Clinical GovernanceClinicalgovernance鄀aframeworkorganisa�onsaccountablecon�nually qualityservicessafeguardingstandardscrea�ngenvironment in which excellence in clinical care will flourish’ (37, 38).Servicesengageregularservicedeliveryclinical,technicaladministra�veareas.servicereviewservice againstagreedkeyindicators(KPIs).standard; presently the na�onal mean sits at 8% (1). Servicesevidence-basedestablishrecommendedtreatmentservice users which are underpinned by this. Services must contribute to na�onal outcome measures to support na�onal guidance. The service provider will be able to demonstrate the following:pa�entsassessmentneedsmul�disciplinaryreferralthe service and at appropriate intervals a&

44 #x00660074;er this where necessaryPa�
#x00660074;er this where necessaryPa�ents receive the most appropriate treatment to meet their needsThe role of each member of the team in the care pathwaycriteriaplaceiden�fyop�onsavailableservice users based upon presenta�on of the individualA record is kept of audit ac�vity in rela�on to clinical effec�veness of treatmentpoliciesplacecoverpar�cipa�onpa�entsresearchdevelopment Processesimplementedoverseeintroduc�ontreatmentmodali�esthese arise or when novel components are introduced to the marketplaceServicesacceptancerespondingcomplimentscomplaintsserviceSimilarly,servicesac�velyseekconsultlocalservicegroups regularly. quality place(e.g.standardsservice.This includesqualitycarriedqualityqualityserviceservicepoliciescoversafetydemonstrateplansresolveproblem

45 s.includesindustryequipmentissuesrepor&#
s.includesindustryequipmentissuesrepor�ng,componentreusecomponentetc.)generalworkplaceissuesas incident repor�ng, moving and handling, first aid, fire safety, infec�on control, etc.) Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 The a and local as enablesashared are Forthese should establish The these The ensurethatit and its toall the The a and in clinical to the Administra�on Senior Junior Prosthe�c and Assistant Carers Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 treatment framework Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO

46 • 2021 5.1 Key points.The2015 t
• 2021 5.1 Key points.The2015 theQuality in ’10 Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 1.Does the clinical commissioning group (CCG) have a lis�ng of all providers and their services? 1.Recognise the prosthe�c & ortho�c services2.Consider encouraging services to start small and then support them to grow. 2.Have ambi�on for the services & the people3.Consider joining up with other CCGs? Share risk for less common clinical presenta�ons by crea�ng regional specialist clinics? 3.Make services “join up” & have common key4.Does walking the pathway of care with a user iden�fy any gaps or areas for improvement? Have you considered prosthe�cs and 4.Prosthe�c & ortho�c services s

47 hould not be5.The key principle behind c
hould not be5.The key principle behind commissioning for outcomes is a clear focus on the actual results being achieved and pu�ng in place the most 5.Consider outcomes to be achieved.6.Establish what outcome measures are already being collected. Are they robust and can they be used for benchmarking? What 6.Iden�fy some common measures & ask7.Have services been commissioned that focus on care closer to home? This is par�cularly important for preven�on of admissions and 7.Consider the range of se�ngs where8.Considered how prosthe�c and ortho�c services can help deliver primary, secondary and early interven�on for a local diverse 8.Take a strategic view to invest to save.9.Are tradi�onal aspects of prosthe�c and ortho�c care being undertaken by other AHP groups at present? Cou

48 ld these be done be�er or 9.C
ld these be done be�er or 9.Cross-check services against the local10.What forums do you use to share good prac�ce locally, regionally and n 10.Ask for advice and support if necessary.11.Commissioners require to find the best approach for any given situa�on with the confidence to create innova�ve and transforma�onal 11.Note that there is no single evidence-based Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 the indicators setout the asan tool use TheWorldHealth a could be asa cycle Itis tobe about the toberealised Establish a baseline . Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 A and should bebasedon the a a Service Provision Gui

49 dance for Prosthe�c & Ortho&#
dance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 maintaining employment, independence and reducing shouldmore favourable to both the pa�ent and the Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 Inthe those into and a and a the and then to the are outdated access the user and the is in and theThe the of with thathealthcare ensurethat are to With a to and ensure theability access to and and orthoses. The and and cannot Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 7 Appendices Appendix 1 – References1 Eddison HealyA. in 2 theQuality in 2015. ] 3WorldHealth in Healt

50 h 2017. ] 4The and Whoare and 20
h 2017. ] 4The and Whoare and 2020. ] 5WorldHealth Guidelines in Health-Related 2014. ] 6WorldHealth and 2017. ] 7 Guidance 2016. ] 8 Directory 2020. ] 9 and and Guidelines 3rd 2018. ] 10 ] 11AssociateParli 2011. ] 12Flynn PJ. 2004. ] 13 Round 2014.] 14The and the Quality in 2015. ] 15 D. The on the thePerson J. ] 16 Health. 2016. 2016 ] 17WorldHealth Priority access to 2016. ] 18 2014. ] Excellence. Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 20Audit and the Health in and Wales. Fully Audit 2002. ] improved 22 2016. ] 23Health 2013. ] 24Health and ethics. 2016. ] 25The and 2013. ] 26 WoolleyH. An to in and The and 2015. ] 27 Healthcare Pr

51 iority 2015 ] 28 Guidelines to
iority 2015 ] 28 Guidelines to and 2019. ] [Available ] 30Health TheFuture the and in tothe theQuality in 2017. ] 31Nichol A. Health NorthWest 2014. ] 32Nichol A. NorthWest 2014. ] 33Nichol A. in Health NorthWest 2014. ] 34 Alliance the Health. Records and 2016. 2016. health-and-social-care-2016] Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 35 2020. ] 36 and Healthcare 2014. ] 37 Health. AFirst Quality in the ] 38 Donaldson and the in the Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on • BAPO • 2021 • 0141 561 7217 Service Provision Guidance for Prosthe�c & Ortho�c Services • 1st Edi�on •