Prosthetist/orthotist

The roles are different, but both help people to move more freely and keep their independence.

Prosthetists create and fit prostheses (artificial limb replacements) for people who have:

• been born with a limb difference or a missing limb (congenital absence)
• lost a limb or part of a limb through trauma
• had an amputation due to infection or long-term health conditions.

Orthotists assess people whose limb function is affected by a condition, such as:

• spinal injury or conditions affecting spinal alignment
• neuromuscular disorders
• musculoskeletal concerns
• traumatic injuries
• congenital anomalies.

Using a range of aids, such as braces and splints, they work to relieve pain and support, correct and/or compensate for impairments in nerves, bones and muscles, improving mobility and function.

Although training covers both orthotics and prosthetics, it's typical to specialise in one area. However, some centres offer opportunities to work across both as a dual practitioner.

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

Responsibilities

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

• assess people to understand their needs and determine how a prosthesis, orthosis or specialist footwear can improve movement, comfort and quality of life
• assess movement and identify any biomechanical issues (commonly called gait analysis)
• evaluate joint range of motion and muscle strength
• agree a treatment plan and goals, which may include an artificial limb (prosthesis) or support (orthosis)
• take measurements and capture body shape using plaster casting and/or digital methods such as 3D scanning
• specify, design and prescribe prostheses, orthoses or footwear to meet the needs identified (including materials and components where appropriate)
• use CAD/CAM to create or refine device designs and models
• liaise with technicians and manufacturers during production and quality checks
• fit and adjust prostheses or orthoses, modifying alignment and function as required, and monitor the impact of any changes
• review progress and provide follow-up support to help people adapt to new or updated devices
• work in close collaboration with other healthcare professionals, such as surgeons, physiotherapists, occupational therapists and podiatrists.

Salary

• Jobs in the NHS in England are usually covered by the NHS Agenda for Change (AfC) pay rates. Starting salaries for qualified prosthetists and orthotists range from £31,049 for those with less than two years' experience, to £37,796, for those with over four years' experience (Band 5).
• Senior and specialist prosthetists/orthotists can earn between £38,682 and £46,580 (Band 6), rising to £54,710 (top of Band 7) for roles such as clinical lead.
• Salaries for consultant prosthetists and orthotists with management responsibilities can reach up to £62,682 (top of 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, and are usually based in daytime clinics. Working hours are commonly between 8am and 6pm, though patterns vary and can include early starts, late finishes and occasional weekend or on-call work. Part-time or flexible working may also be available.

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

What to expect

• Prosthetists are usually based within rehabilitation or disability centres in NHS or private hospitals. Orthotists are often based in hospital outpatient clinics. As an orthotist, you may see people on wards, in their own homes, across several hospital sites and in specialist education or community settings.
• You could work independently or as part of a multidisciplinary team that includes clinicians and technicians to support people's rehabilitation.
• The work can be both rewarding and challenging, combining technical problem solving with practical skills and a lot of contact with people.
• Jobs are available throughout the UK, but you may need to relocate to find work or to further your career. There may also be opportunities to work abroad.
• As an orthotist, you may need to travel during the day between different clinics or people's homes.

Qualifications

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

Undergraduate degree courses are offered by the University of Salford (three years full time) and the University of Strathclyde (four years full time).

There is also a two-year HCPC-approved Masters programme available at Keele University for those who already have a 2:2 degree or above in a relevant subject such as anatomy, biology, biomechanics, health science, exercise, engineering, nursing, psychology or physics.

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 location and may have to relocate temporarily during placements.

Funding of at least £5,000 a year is available to eligible pre-registration prosthetics and orthotics undergraduate and postgraduate students in England 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 can still access tuition and maintenance loans from the Student Loans Company. For more information, see NHS Health Careers.

For funding arrangements in Scotland, see the Student Awards Agency Scotland (SAAS).

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

The University of Derby offers a degree apprenticeship (Level 6) in prosthetics and orthotics. Apprenticeships combine paid work with part-time study, so you can train on the job. 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.

Once you've attained an approved qualification and have met HCPC health and character requirements, you're eligible to apply for registration and can then choose to specialise in either prosthetics or orthotics. You can also become a member of the British Association of Prosthetics and Orthotics (BAPO), the UK professional body for prosthetists and orthotists.

Skills

You'll need to have:

• excellent listening and questioning skills to understand people's needs and goals
• strong communication skills to explain assessment findings, options and device use clearly to patients, families/carers and colleagues
• empathy, sensitivity and professionalism when working with people who may be coping with pain, loss or long-term conditions
• critical thinking and problem-solving skills to make safe, effective decisions and adapt solutions when needs change
• a solid scientific and technical understanding, especially anatomy, biomechanics and materials
• good coordination and manual dexterity for measuring, casting/shape capture, fitting and adjustments
• attention to detail to ensure comfort, alignment, safety and quality control
• confidence using digital tools and technology and a willingness to learn new methods
• the ability to work well in a multidisciplinary team
• organisation and time management skills to manage caseloads, documentation and follow-up appointments efficiently.

A driving licence is useful for travel between hospitals and to visit people at home.

Work experience

Getting work experience in prosthetics and orthotics can be difficult. Try contacting your local NHS limb centre/Disablement Service Centre (DSC) or orthotics service to see if you can arrange a visit, work shadowing or work experience. Focus on Disability provides a directory of disablement service centres in the UK, which you can use to find local services to contact.

Joining BAPO as a learner member is also helpful for keeping up to date with developments, networking and showing your commitment to the profession.

Paid or voluntary experience in related health and care disciplines is also useful, especially roles that involve working directly with people, supporting rehabilitation or using communication and teamwork skills.

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 private prosthetics and orthotics providers contracted to deliver NHS services.

There are also opportunities to work in private practice.

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

• prosthetic and orthotic manufacturing, servicing and supply companies
• universities and research teams (for example, in teaching, clinical education or rehabilitation engineering)
• overseas healthcare providers
• humanitarian and rehabilitation organisations working in regions affected by war, disaster or poverty.

Look for job vacancies at:

• BAPO Jobs
• Health Jobs UK
• NHS Jobs
• NHSScotland Jobs
• websites of individual NHS trusts and organisations.

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

Professional development

In your first role after registering with the HCPC, you'll often have a period of structured support (sometimes called preceptorship), which may include supervision or mentoring from an experienced prosthetist or orthotist as you consolidate your skills. You may choose to specialise in either prosthetics or orthotics, or practise in both (although dual roles are less common).

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

If you're interested in research or teaching, you can study for a post-registration postgraduate research qualification (such as an MPhil or PhD) offered by universities such as Salford and Strathclyde.

Career prospects

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

You will usually work in either prosthetics or orthotics and can specialise further within these areas, for example in complex upper or lower limb prosthetics or in orthotic footwear, neurology or diabetes. You can also work with a particular client group, such as children, athletes or older adults.

You'll typically begin in a junior position (often Band 5 in the NHS) and can move into more senior roles as you gain experience. As your technical expertise grows, there are opportunities to progress into enhanced and advanced level practice roles, before eventually becoming a consultant.

There may also be opportunities to move into supervisory and management posts, with responsibility for managing staff and budgets within an orthotics or prosthetics service.

There are some opportunities to progress into teaching and research, although additional qualifications may be required. You could also move into product design and development.

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