The standards of proficiency for orthoptists
You must meet all the standards of proficiency to register with us and meet the standards relevant to your scope of practice to stay registered with us. It is important that you read and understand this document.
If your practice is called into question we will consider these standards (and our standards of conduct, performance and ethics) in deciding what action, if any, we need to take.
The standards set out in this document complement information and guidance issued by other organisations, such as your professional body or your employer.
We recognise the valuable role played by professional bodies in providing guidance and advice about good practice which can help you to meet the standards in this document
Your scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets our standards and does not pose any danger to the public or to yourself.
We recognise that a registrant’s scope of practice will change over time and that the practice of experienced registrants often becomes more focused and specialised than that of newly registered colleagues. This might be because of specialisation in a certain area or with a particular client group, or a movement into roles in management, education or research.
Every time you renew your registration, you will be asked to sign a declaration that you continue to meet the standards of proficiency that apply to your scope of practice.
Your particular scope of practice may mean that you are unable to continue to demonstrate that you meet all of the standards that apply for the whole of your profession.
As long as you make sure that you are practising safely and effectively within your given scope of practice and do not practise in the areas where you are not proficient to do so, this will not be a problem. If you want to move outside of your scope of practice, you should be certain that you are capable of working lawfully, safely and effectively. This means that you need to exercise personal judgement by undertaking any necessary training or gaining experience, before moving into a new area of practice.
It is important that you meet our standards and are able to practise lawfully, safely and effectively. However, we do not dictate how you should meet our standards. There is normally more than one way in which each standard can be met and the way in which you meet our standards might change over time because of improvements in technology or changes in your practice.
We often receive questions from registrants who are concerned that something they have been asked to do, a policy, or the way in which they work might mean they cannot meet our standards. They are often worried that this might have an effect on their registration.
As an autonomous professional, you need to make informed, reasoned decisions about your practice to ensure that you meet the standards that apply to you. This includes seeking advice and support from education providers, employers, colleagues, professional bodies, unions and others to ensure that the wellbeing of service users is safeguarded at all times. So long as you do this and can justify your decisions if asked to, it is very unlikely that you will not meet our standards.
We recognise that our registrants work in a range of different settings, which include direct practice, management, education, research and roles in industry. We also recognise that the use of terminology can be an emotive issue.
Our registrants work with very different people and use different terms to describe the groups that use, or are affected by, their services. Some of our registrants work with patients, others with clients and others with service users. The terms that you use will depend on how and where you work. We have used terms in these standards which we believe best reflect the groups that you work with.
In the standards of proficiency, we use phrases such as ‘understand’, ‘know’, and ‘be able to’. This is so the standards remain applicable to current registrants in maintaining their fitness
to practise, as well as prospective registrants who have not yet started practising and are applying for registration for the first time.
These standards may change in the future We have produced these standards after speaking to our stakeholders and holding a formal public consultation. We will continue to listen to our stakeholders and will keep our standards under continual review. Therefore, we may make further changes in the future to take into account changes in practice.
We will always publicise any changes to the standards that we make by, for instance, publishing notices on our website and informing professional bodies.
We also expect you to keep to our standards of conduct, performance and ethics and standards for continuing professional development. We publish these in separate documents, which you can find on our website.
Registrant orthoptists must:
1.1 know the limits of their practice and when to seek advice or refer to another professional
1.2 recognise the need to manage their own workload and resources effectively and be able to practise accordingly
2.1 understand the need to act in the best interests of service users at all times
2.2 understand what is required of them by the Health and Care Professions Council
2.3 understand the need to respect and uphold the rights, dignity, values, and autonomy of service users including their role in the diagnostic and therapeutic process and in maintaining health and wellbeing
2.4 recognise that relationships with service users should be based on mutual respect and trust, and be able to maintain high standards of care even in situations of personal incompatibility
2.5 know about current legislation applicable to the work of their profession
2.6 understand the importance of and be able to obtain informed consent
2.7 be able to exercise a professional duty of care
3.1 understand the need to maintain high standards of personal and professional conduct
3.2 understand the importance of maintaining their own health
3.3 understand both the need to keep skills and knowledge up to date and the importance of career-long learning
4.1 be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem
4.2 be able to make reasoned decisions to initiate, continue, modify, or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately
4.3 be able to initiate resolution of problems and be able to exercise personal initiative
4.4 recognise that they are personally responsible for and must be able to justify their decisions
4.5 be able to make and receive appropriate referrals
5.1 understand the requirement to adapt practice to meet the needs of different groups and individuals
5.2 understand the need to take account of physical, psychological and cultural needs when planning and delivering treatment
7.1 be aware of the limits of the concept of confidentiality
7.2 understand the principles of information governance and be aware of the safe and effective use of health and social care information
7.3 be able to recognise and respond appropriately to situations where it is necessary to share information to safeguard service users or the wider public
8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction, and professional opinion to service users, colleagues and others
8.2 be able to communicate in English to the standard equivalent to level 7 of the International English Language Testing System, with no element below 6.5 *
8.3 understand how communication skills affect assessment and engagement of service users and how the means of communication should be modified to address and take account of factors such as age, capacity, learning ability and physical ability
8.4 be able to select, move between, and use appropriate forms of verbal and non-verbal communication with service users and others
8.5 be aware of the characteristics and consequences of verbal and non-verbal communication and how this can be affected by factors such as age, culture, ethnicity, gender, socio-economic status and spiritual or religious beliefs
8.6 understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed decisions
8.7 understand the need to assist the communication needs of service users such as through the use of an appropriate interpreter, wherever possible
8.8 recognise the need to use interpersonal skills to encourage the active participation of service users
8.9 recognise the need to modify interpersonal skills for the assessment and management of children
* The International English Language Testing System (IELTS) tests competence in the English language. Applicants who have qualified outside of the UK, whose first language is not English and who are not nationals of Switzerland, must provide evidence that they have reached the necessary standard. Please visit our website for more information.
9.1 be able to work, where appropriate, in partnership with service users, other professionals, support staff and others
9.2 understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team
9.3 understand the need to engage service users and carers in planning and evaluating diagnostics, treatments and interventions to meet their needs and goals
9.4 be able to contribute effectively to work undertaken as part of a multi-disciplinary team
9.5 recognise the need to participate effectively in the planning, implementation and evaluation of multi-professional approaches to healthcare delivery by liaising with other health or social care professionals
9.6 be aware of the orthoptist’s role in the promotion of visual health
by other health professionals
10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines
10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines
11.1 understand the value of reflection on practice and the need to record the outcome of such reflection
11.2 recognise the value of case conferences and other methods of review
12.1 be able to engage in evidence-based practice, evaluate practice systematically and participate in audit procedures
12.2 be able to gather information, including qualitative and quantitative data, that helps to evaluate the responses of service users to their care
12.3 be aware of the role of audit and review in quality management, including quality control, quality assurance and the use of appropriate outcome measures
12.4 be able to maintain an effective audit trail and work towards continual improvement
12.5 be aware of, and be able to participate in, quality assurance programmes, where appropriate
12.6 be able to evaluate intervention plans using recognised outcome measures and revise the plans as necessary in conjunction with the service user
12.7 recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes
13.1 understand the structure and function of the human body, together with knowledge of health, disease, disorder and dysfunction relevant to their profession
13.2 be aware of the principles and applications of scientific enquiry, including the evaluation of treatment efficacy and the research process
13.3 understand the concept of leadership and its application to practice
13.4 recognise the role of other professions in health and social care
13.5 understand the structure and function of health and social care services in the UK
13.6 understand the theoretical basis of, and the variety of approaches to, assessment and intervention
13.7 understand ocular alignment and binocular single vision and stereopsis, and the sensory and motor elements required to attain and maintain these
13.8 understand the principles of uniocular and binocular perception, and the anatomical substrate of these functions
13.9 understand refractive error and its effect on ocular alignment and visual development
13.10 understand binocular vision and the factors which can cause its disruption
13.11 understand ocular motility systems, the laws associated with them and their neural control
13.12 know the adaptive mechanisms that occur in order to compensate for strabismus and abnormalities of binocular vision
13.13 understand human anatomy and physiology, including the central nervous system, brain and ocular structures as it relates to the practice of orthoptics
13.14 understand human growth and development across the lifespan, as it relates to the practice of orthoptics
13.15 understand the effect of other acquired medical and neurological disorders on the eye, the visual and ocular motor systems including paediatric, endocrine, autoimmune, oncological and neurological disease
13.16 know about the range of ophthalmic conditions which can disrupt vision, binocular vision and produce eye movement disorders
13.17 know the factors which influence individual variations in human ability and development
13.18 know the detailed anatomical and physiological development of the visual system, and understand which components of the visual pathway and cortex relate to specific aspects of visual performance and visual perception
13.19 understand neuroanatomy and the effects of disruption of neural pathways on the visual system, cranial nerves and supranuclear control of eye movements
13.20 understand the development of anatomical substrates and their relevance to the development of binocular single vision and visual function
13.21 know how psychology and sociology can inform an understanding of health, illness and health care in the context of orthoptics and know how to apply this in practice
13.22 be aware of human behaviour and recognise the need for sensitivity to the psychosocial aspects of ocular conditions, including strabismus
13.23 know the principles governing binocular vision, its investigation and the significance of its presence or absence, and be able to apply them to clinical practice
13.24 know the principles governing ocular motility and their relevance to diagnosis and patient management, and be able to apply them to clinical practice
13.25 know the principles governing visual function and the development of vision, and be able to apply them to clinical practice
13.26 recognise the functional and perceptual difficulties that may arise as a result of defective visual, binocular or ocular motor functions
13.27 be able to plan, operate and evaluate appropriate vision screening programmes
13.28 know the principles governing the near triad of convergence, accommodation and pupillary response, and their relevance to diagnosis and patient management, and be able to apply them to clinical practice
14.1 be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely and skillfully
14.2 be able to formulate specific and appropriate management plans, and set timescales
14.3 be able to use diagnostic and therapeutic procedures to address anomalies of binocular vision, visual function and ocular motility defects resulting in a clinically defined outcome, which can be recorded and monitored in a manner appropriate to safe orthoptic practice
14.4 be able to effect change in visual stimuli resulting in a clinically defined outcome, which can be recorded and monitored in a manner appropriate to safe orthoptic practice
14.5 be able to change their practice as needed to take account of new developments or changing contexts
14.6 be able to gather appropriate information
14.7 be able to select and use appropriate assessment techniques
14.8 be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment
14.9 be able to use investigative techniques to identify ocular defects within a specific population to form a diagnosis and devise an appropriate course of action
14.10 be able to recognise and document any adverse reaction to treatment and take appropriate action in response to this
14.11 be able to conduct a thorough investigation of ocular motility
14.12 be able to diagnose conditions and select appropriate management
14.13 be able to diagnose a range of vision, binocular vision and ocular motility defects and all categories of strabismus
14.14 understand the principles and techniques used to perform an objective and subjective refraction
14.15 understand the principles and techniques used to examine anterior and posterior segments of the eye
14.16 understand the principles and techniques used to assess visual fields
14.17 understand the principles and techniques used in electrophysiological assessment of visual function and the visual pathway
14.18 be able to undertake or arrange investigations as appropriate
14.19 be able to identify where there is a clinical need for medical or neurological investigations
14.20 be able to analyse and critically evaluate the information collected
14.21 be able to identify pathological changes and related clinical features of conditions commonly encountered by orthoptists
14.22 be able to demonstrate a logical and systematic approach to problem solving
14.23 be able to use research, reasoning and problem solving skills to determine appropriate actions
14.24 recognise the value of research to the critical evaluation of practice
14.25 be aware of a range of research methodologies
14.26 be able to evaluate research and other evidence to inform their own practice
14.27 understand research in the fields of ocular motility, strabismus, amblyopia and binocular disorders and how it could affect practice
14.28 be able to use information and communication technologies appropriate to their practice
14.29 know the role, pharmacological action, clinical indications and contra-indications of ophthalmic drugs and how they may be selected and used in orthoptic practice
14.30 understand the principles and application of orthoptic and ophthalmological equipment used during the investigative process
14.31 know the tests required to aid in differential diagnosis
14.32 know the effects of orthoptic and ophthalmological intervention on visual development
14.33 know the means by which refraction and optics can influence vision and binocular vision
14.34 know the principles and application of measurement techniques used to assess binocular vision and other ocular conditions
15.1 understand the need to maintain the safety of both service users and those involved in their care
15.2 be aware of applicable health and safety legislation, and any relevant safety policies and procedures in force at the workplace, such as incident reporting, and be able to act in accordance with these
15.3 be able to work safely, including being able to select appropriate hazard control and risk management, reduction or elimination techniques in a safe manner and in accordance with health and safety legislation
15.4 be able to select appropriate personal protective equipment and use it correctly
15.5 be able to establish safe environments for practice, which minimise risks to service users, those treating them and others, including the use of hazard control and particularly infection control
15.6 know how to position or immobilise service users correctly for safe and effective interventions
These standards are effective from 1 March 2013.
Reviewing the standards of proficiency
We keep our standards under continual review, to look at how they are working and check whether they continue to reflect current practice. We also conduct a periodic review of the standards every five years.
In August 2022, we updated our standards of proficiency for the first time since 2015. The changes, which will come into effect on 1 September 2023, have been made following an extensive period of engagement with a wide range of stakeholders.
We will provide a host of resources and activities which will assist different stakeholder groups prepare ahead of the implementation date.
The revised standards set clear expectations of registrants’ knowledge and ability in a healthcare landscape which has changed and evolved in the wake of the COVID-19 pandemic. Updating them is a crucial component in fulfilling our purpose to promote excellence in the professions we regulate, and championing high quality care that the public can access safely and with confidence.