My name is Tracy Crooks and I am an Orthotic assistant practitioner, I am currently employed by North Lincolnshire and Goole NHS Trust. I have been in this role for just over 3 years and prior to this I spent 6 years as a physiotherapy technical instructor.  I work very closely with our Orthotic provider which is TayCare.

As an assistant practitioner my role varies slightly from that of an orthotic assistant in that I can run my own clinics and I am  responsible for my own case load, but I also work with my line manager to keep track of budgets, Investigate, and manage complaints which are very few luckily, I chair team meetings regularly  and monitor waiting lists for our services across all three sites which are Grimsby, Goole and Scunthorpe.

It’s a role which I truly enjoy and a typical day for me looks like this:
I arrive at work at 07:45 and log on the system, look at emails and look at my day ahead. Today I am running my own clinic in Grimsby.

08:00-12:00 As it’s the school holiday I have children booked in all morning and it seems to fly by because it is so busy. This morning I’ve seen, five children for review of their footwear and all five need new boots, so I measure each one up and they choose their new boots for order with a little help from Mum or dad. Four reviews for insoles, three need new insoles so I take two FIB box impressions for some new custom-made insoles in EVA and I draw one draft for a set of thin board insoles. Four review helmets, three are fine but the last one needs a new custom-made helmet, so I need to take all the measurements which proves a little challenging because he thinks it’s a great game to keep moving about and starts to laugh each time he does it, so it takes a bit of time to get it done but we get there in the end and he decides he wants it to be made in red and yellow to match  his football team . When I finish the clinic, I catch up on notes from the morning.

13:00 -16:00 Afternoon clinic starts. Today I have two leg length discrepancy assessments which were straight forward with no complications. One was issued with an internal heel raise from stock but the other requires an adaptation of a through raise to the sole of the shoe as the difference is 28mm.

Three fit footwear appointments, two of which  went well with the footwear fitting nicely and no issues however the third I am unable to fit as the patient since being measured for the footwear is diabetic and while everything at the last appointment was fine, he has now developed an ulcer under the foot which at present has a dressing on and was bandaged by his nurse quite thickly this morning. I discuss this with the patient and advise them that it will be better to book them in again with the orthotist once the dressing has been removed.

I have a review with a patient for night splints that were issued 3 months ago. Patient is now able to reach Planter grade independently though there is still a bit of tightness there so we agree that he will continue with the calf stretch exercises and the splints for a while longer yet.

I have worked in health care in one form or another for over 35years but this is the role that I have been the happiest in. While a role of an assistant practitioner may not be the most glamorous and can sometimes be very difficult, it is a very rewarding job.

Many people think assistant practitioners because of the word assistant, are just there to fetch and carry or make up the numbers but we’re not!  Assistant practitioners have a bigger scope of practice and more autonomy than that. You can have an enormous impact on someone and their view of the NHS and this is especially true in Orthotics. The difference you can make to someone’s ability to function daily by reducing pain and discomfort not only influences how a person lives from day to day, but how they socialise and interact with others This in turn can also, and quite often, have an enormous effect on a person’s mental health.

For example, one of our orthotists recently saw a lady who had a very large abdominal hernia. The lady was very self-conscious and did not like going out in public because she was embarrassed. She stated that her relationship with her husband was strained because of it and that every time she had tried to tell people how she felt they seemed to brush it off and she cried in the appointment. This was obviously affecting her mental health and her relationships with others, and when she first came to us, she had resigned herself to the thought that this was her life from now on. She was unsure why she had been referred to orthotics. She did not know what we did or what we could provide, and her consultant had not explained either. Then the orthotist explained that we could look at a support, but she wasn’t convinced. He took the measurements and had it made. When she came back for fit and supply, she was still unconvinced. However, as soon as she put it on the difference was very significant to how she looked. The joy and amazement she had was contagious. She was so overwhelmed that she started to cry but this time from happiness. I have since seen her for a follow up review, and she has said that the difference this has made to her mental health has been huge. She now goes out again and she is happy to let people take her photo again.

This is just one example of why Orthotics is so important and so worthwhile as a whole service.

When we have busy clinics, and we are rushing because the next patient is waiting, it’s all too easy to forget what some of our patients are feeling or experiencing in their private lives. Or that for some of these patients, especially the elderly ones who live alone, that we may be the only person they have seen all week. We need to be more aware of our own clinical practice, which is one of the main pillars of care that we all strive to work to. Its vitally important we think about the person that is behind the patient in front of us. We need to see them as a whole and not just the condition to which they have been referred to us. We need to let them have a voice and make them feel that they have been listened to. By letting them have their own voice they then become more empowered which leads to better outcomes like the lady above. Once she had been listened to and had things explained her rather than been spoken at or to, the outcome was dramatically different.
One of my favourite quotes is by Dr Jane Goodall “What you do makes a difference, and you have to decide what kind of difference you want to make.”

For care to improve it takes someone to take the first step. That first step could be by anyone, and it could lead anywhere.
By Tracy Crooks