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Warning Over Looming Exodus of Orthotists

The dissatisfactions of junior doctors, nurses and other 'core' NHS staff are well-publicised. Now a new study has shown that the disgruntlement extends to orthotists – the mobility specialists who design and fit external devices including insoles, braces, and splints, designed to support and improve posture, function, and mobility, and to manage pain and deformity.

Orthotists are autonomous registered practitioners who provide gait analysis and engineering solutions for patients with problems of the neuro, muscular and skeletal systems. Orthotics services provide treatment options for people with a wide range of conditions, the study authors said, and orthotists work closely with a number of clinical specialties within the NHS, including diabetes care, elderly medicine, neurology, orthopaedics, paediatrics, stroke and trauma teams.

However, the orthotist profession is facing "a national staff shortage", which has been compounded by high attrition rates. This has led to around 70% of orthotist services in the UK being subcontracted to private companies, with the company providing the orthotist often having "little or no involvement with how the service is structured or delivered". There has been little investigation of how this has affected job satisfaction or intention to remain in the profession.

More than 1 in 3 Would Leave the Profession if They Could

For their survey, a cross-sectional comparative study carried out from May–July 2019 at Anglia Ruskin University (ARU) in Cambridge, 123 orthotists completed an online questionnaire comprising 32 questions regarding their working conditions and job satisfaction, with a combination of free-text and 5-point Likert scale formats. Results, published in the British Journal of Healthcare Management, showed that 46 of the respondents - more than a third (37.4%) - would leave the profession if they could. This suggests a potential retention crisis may lie ahead.

Of the total sample in the survey, 36 orthotists (29.3%) were employed by the NHS and 82 (66.7%) were employed by private companies. Overall, 30 respondents (24%) said they would leave their current job if they could, as against 61 (49%) who wouldn’t, and 32 (26%) who were unsure. Additionally, 46 orthotists (37%) stated that they would leave the orthotic profession entirely if they could, versus 48 (39%) who indicated they would not want to do this.

The authors reported that the strongest predictive variable for intent to leave was how orthotists felt they were treated by their employer, which was found to have a greater influence than working environment, pay, team working or autonomy.

Job Satisfaction Consistently Poor

Overall job satisfaction was low in both groups and "respondents consistently reported that their working environments were poor", but this was worse for those who were privately employed than for those employed by the NHS. However, the proportion who would leave the profession if they could was roughly the same among the two groups.

In open-ended questions about their working conditions, many respondents also reported they did not have enough time with patients during appointments, with inadequate time for assessments, fitting, and reviews, and that facilities were inadequate. Sample responses included needing more space and lacking essential equipment, including access to the moving and handling equipment that they required, as well as employers to hire more staff to ease their workload.

The authors said that "better management practices" were needed to improve satisfaction and retention among orthotists, but noted that managers were likely to be unaware of orthotists' perceptions of being poorly treated, "as orthotists are often missed in NHS staff surveys". Employers must act to improve staff satisfaction to prevent orthotists leaving their roles or the profession, they said.

'Considerable Implications' for Future Workforce

Lead author Katie Prosser, who carried out the research while studying for a masters degree in healthcare management at ARU, said: "These are concerning results with clear and considerable implications for the future of the orthotic workforce, as well as patients requiring their services. Usually if people are dissatisfied with an NHS post they can look to move into private roles. However, in this profession it appears there is little to be gained in terms of job satisfaction or conditions by doing this, which may lead orthotists to want to do something else entirely."

The authors said that orthotic services can substantially improve patients' quality of life, helping them to live with chronic disabilities, improve or manage pain, reduce their risk of falls and ulcerations, and regain their independence. The services "provide financial value to the NHS". A previous report by the NHS Purchasing and Supply Agency found that the health service could save £4 for every £1 spent on improving orthotics services, because patients who access these services suffer fewer falls and require less pain relief and fewer surgical interventions.

NHS England has estimated that around 2 million patients in the UK receive treatment from orthotic services, and demand is expected to rise. However, there is a national shortage of orthotists, with only around 500 working across the whole UK, and more retiring than entering the profession each year.

Challenges of Staff Retention

Dr Nebil Achour, co-author of the paper and associate professor in disaster mitigation at ARU said: "This study highlights the substantial challenges facing the orthotic profession in terms of staff satisfaction and retention. The perception among orthotists that they were treated poorly by their employer appears to be the catalyst for a significant number wishing to leave not just their job but the profession overall.

"This is a vulnerability in our healthcare sector and needs to be addressed urgently. A resilient healthcare sector requires all professions and capabilities to be ready to respond effectively during times of adversities."

The authors concluded: "The orthotic profession may be facing a staff retention crisis. Employers should focus on improving working environments and ensuring that staff feel appreciated. Further research is required to investigate the impact of these issues on patient care."

This research was part of an MSc qualification undertaken by author KP, which was part-funded by the Orthotic Education and Training Trust. However, no specific funding was granted for this study. The authors declare that there are no conflicts of interest.