Gloucestershire Hospitals NHS Foundation Trust Job Description
Job title: Maxillofacial Prosthetist and Technologist (MPT)
Grade: Band 7
Location: Maxillofacial and Orthodontic Laboratory, based at Gloucestershire Royal Hospital.
Using specialist maxillofacial skills the state registered (at present with the General Dental Council) MPT provides and supports a comprehensive scientific & technological service to the specialist Consultants of Oral and Maxillofacial Surgery. In addition, if the Trust requires, provide this service to the specialist consultants of Ear, Nose and Throat, Oncology, Ophthalmology, General Surgery and Accident and Emergency.
This includes a scientific and technical service direct to patients for their rehabilitation by restoration using implants, splints and prosthesis (artificial restorations for patients with extreme surgical or congenital facial/body disfigurement).
Using specialist orthodontic skills the MPT provides a comprehensive, scientific technological service to the specialist consultants of Orthodontics to both hospitals within the trust, as well as for the Specialist Dental Officers employed by Cotswold and Vale Primary Care Trust. In addition, the multi-skilled Consultant MPT provides a technological dental prosthetic service to all the above hospitals/trusts.
The orthodontic service provides a service to correct and modify, by way of controlled tooth movement, abnormal tooth eruption, occlusion and malocclusion of patients.
The prosthetic dental service provides a service to restore the loss of individual tooth or any number of teeth and/or surrounding tissue in patients that have lost these structures.
Working primarily in the Maxillofacial and Orthodontic Laboratory but also in the Oral, Facial and Orthodontic Outpatients (both GRH and CGH) and theatres provides a service for the acute units of Gloucestershire Royal Hospital, Cheltenham General Hospital as well as Cotswold and Vale PCT. On occasions may be required to provide this service to other Hospital Trusts.
Influences the use of resources within the laboratory budget through recommendation of equipment, working systems, materials, chemicals and products used in the laboratory.
The post involves a weekly clinical workload seeing patients for technical and some clinical procedures. These duties are recorded as surgery hours and documented with the laboratory figures.
Deputy Director of Surgical Division
Oral and Maxillofacial and Orthodontic Consultants
General Manager of Head and Neck Services
Consultant Maxillofacial Prosthetic and Technology
2 years experience working in all areas of advanced orthodontic techniques within a NHS laboratory environment
To maintain state registration
Satisfies (by way of educational, professional/clinical training, qualifications and experience in all areas of clinical and technical maxillofacial work) the council of the Institution of Maxillofacial Prosthetist and Technologist in order to gain membership of this professional body.
Technical Knowledge and Skills Required Post holder will provide a comprehensive, scientific, technological and advisory service (primarily Maxillofacial with some Orthodontic and Dental Prosthetic) either directly to Patients, or on behalf of the Specialist Consultants of Oral and Maxillofacial Surgery, as well as the Specialist Consultants of Orthodontics. It also includes Specialist Dental Officers employed by Cotswold and Vale PCT and all Junior Staff under the instruction of the above. This to include:
The use of judgement and analytical skills to design, construct, interpret, understand and assess suitability of requested work and then design and provide options where necessary e.g. when suggesting to Consultants, Registrars, Senior House Officers, Dental Officers, a more suitable spring that might move a tooth in a desired direction within an orthodontic appliance.
The impression taking and laboratory design and construction of bespoke, complex, highly specialist appliances from raw materials in order to restore function and aesthetics for patients with traumatic surgical and congenital deformities to the head, neck, body and limbs. This also includes the impression taking, management and fitting of such appliances in potholder’s own clinic. In addition needs to take into account aesthetics, function, material science and compatibility of all components, materials and associated physiological, medical, psychological and related needs of the patient e.g.
Maxillofacial prosthetics associated with osseointegrated implantology
Appliances for the surgical and/or prosthetic reconstruction and rehabilitation following Mandibulectomies
Splints and/or coverplates for Hemi and Total Maxillectomy cancer patients and their post surgical rehabilitation
Participation (1 in 4) in a continuous, 24 hour emergency on call service for Oral and Maxillofacial trauma. Liaising with surgical staff over patients, their appliances and design including providing input in clinics and operating theatres when required e.g. dento-alveolar fractures/trauma, mandibular fractures/trauma and maxillary or mid-face fractures/trauma of types Le Fort I, II and III. The design and construction of;
Silver cast splints
Le Vant frames
Or any other associated treatments for the maxillofacial patient
Providing a full technological service for Orthognathic Surgery including full model and computer planning, pre and post surgical model planning and model surgery including mandibular, maxillary and bi-maxillary procedures. Organising case conferencing between Post Holder, Orthodontic Consultants and Maxillofacial Consultants which leads to the design and construction of splints, surgical wafers and other associated appliances for Orthognathic Surgery.
The design and construction, or ability to design and construct bespoke complex specialist Orthodontic appliances from raw materials e.g.
Design and construction of bespoke partial and full dentures including all the appropriate stages this requires. Could be manufactured in acrylic or cobalt chromium.
Competent in the use of specialist equipment e.g. high speed grinding, trimming and polishing for prolonged periods with intense concentration and using high levels of hand/eye co-ordination.
Use of highly developed skills of manual dexterity. E.g. to accurately bend and adapt specialist wires whilst working to very fine tolerances or the placement and subsequent working on osseo-integrated implants, using very high levels of accuracy, hand/eye co-ordination together with intense concentration. Or the fitting of post surgical splints or plates and/or prosthesis working to tolerances as fine as small fractions of a millimetre, manipulating appliances or multi-sectional silicone impressions within a facial surgery cavity e.g. multipart intra-oral and/or extra-oral prosthesis and intra-oral and/or extra-oral titanium craniofacial implants(facial prosthesis).
Competent in the use of a wide range of chemicals, specialist dental materials that require an understanding of the materials science of such products e.g. specialist orthodontic wires with differing alloy contents and, therefore, properties, Methylmethacrylate monomers and polymers.
Competent in the use of computerised systems i.e. furnace programming and model duplication machines.
The maintenance of accurate patient medical records and be competent in the use of database software and Windows operating systems.
Be able to use and keep updated in research and development techniques in order to maintain as well as develop own working methods and continue professional development.
Provide clinical and technical information regarding long term management of medical devices i.e. oro-facial prosthesis or care of osseointegrated implants.
Other Knowledge and Skills
To plan own work and then prioritise it in order to meet conflicting deadlines.
Competent in the participation of clinical trials/audits and equipment testing e.g. clinical audit of Clarke’s Twin Block appliances.
Competent in giving advice about own work or activities and/or workplace routines/protocols, not only to junior surgical/technical staff but to senior surgical/technical staff who lack the understanding or knowledge of such work or procedures. E.g. when called out on an emergency case by an Oral and Maxillofacial Surgery new/locum Senior House Officer. This member of staff needs to be taught/guided in the procedures/protocols that is required of that specific emergency. i.e. impressions(location of materials and tools), time spans for the completion of technical work(in order that theatre time can be booked) and when and where to locate the finished appliances.
To lecture Dental Surgery Assistants (from this Trust, other Trusts and Private Practices) by practical and verbal means as part of their professional qualification curriculum.
Hold practical tutorials for Senior House Officers, Registrars, Clinical Specialists and consultants that enhance their understanding of some of the complex technical procedures. They may also require practical tuition that will aid their clinical competence in the adjustment of orthodontic appliances and in practical tests to further their professional qualifications.
Communication and Working Relationships
Needs to attend regular meetings with the General Manager of Head and Neck Services, along with other technicians and Manager of the Maxillofacial and Orthodontic Laboratory.
Needs to attend occasional meetings with the Deputy Director of Service Delivery along with all laboratory staff.
Taking responsibility for own working practice, manages own patient caseload i.e. arranging patient appointments and directly treats such patients. Integrates this into laboratory (technical) workload.
Is required to attend, at very short notice, surgeries and/or theatres to assist consultants and clinicians in difficult cases, thus requiring the re-scheduling of planned daily duties. This would also cause interruption of existing laboratory/clinical duties almost certainly during periods of intense concentration. This to include;
Carrying out invasive procedures within specified time limits e.g. complex intra/extra oral or intra-ocular sectional impressions or fitting tissue/prosthetic abutments to osseointregrated implant fixtures.
Taking responsibility for own working practice, advises, develops, trials, researches, designs, constructs and fits custom made appliances related to Maxillofacial Technology to accurately fit patients in order to treat and correct congenital or surgical deformities of the head, neck and body.(This includes all of the appliances listed under ‘Technical Knowledge and Skills required’).
Enters relevant details into patient’s medical records and enters relevant data via medical device processing system. This includes producing letters/reports to patients and other healthcare professionals.
Working with patients and their relatives, establish patient requirements whilst respecting and protecting the dignity, rights and beliefs of the patient. This often involves overcoming barriers to understanding as patients that have undergone maxillofacial surgery have severe speech and/or hearing problems. Also the explanation of treatment plans or certain procedures and/or the care of complicated appliances/prosthesis can be problematic.
Provides specific support and advice for patients in the context of Maxillofacial Prosthetics e.g. Palliative care for head and neck cancer patients, children and their parents, patients with severe disfigurement, brain injuries or mental health issues.
Taking responsibility for own working practice, designs and constructs custom made orthodontic appliances to accurately fit patients in order to treat and correct skeletal deformities, malocclusion, abnormal tooth eruption and occlusion.
Taking responsibility for own working practice, designs and constructs custom made dental prosthetic appliances to accurately fit patients in order to restore normal dental function e.g. eat, speech, aesthetic function.
Help in the co-ordination of treatment plans and timetabling of procedures (both own, clinics and laboratories).
Troubleshoot problems encountered with patient or their appliances in order to correct conflicting design or manufacture or the adaptation of appliances due to physiological changes. E.g. Patients that are immediately post operative or soon after operative procedures can exhibit changes in and around the surgical site where appliances are being worked upon or fitted.
Carry out independent technical practise as defined by own training and education along accepted occupational guidelines including local trust policy e.g. IMPT good practice guidelines, laboratory guidelines, regarding cross infection/infection control procedures.
Observe and comply with current COSSH and Health and Safety legislation. Safely handle maxillofacial and orthodontic chemistry e.g. monomeric liquids and evaporative solvents. Safely handle, use and be responsible for laboratory equipment e.g. high speed cutting and polishing equipment.
Assist/train support services/service users as required.
Carry out role in compliance with medical device directive 93/42/EEC and in accordance with MHRA registration policy and departmental licence.
Organise own caseload diary and participate in Oral Surgery Department Outpatient clinics.
Most Challenging Part of Job
The Maxillofacial Prosthetist and Technologist is routinely presented with patients exhibiting severe, congenital or post cancer surgery with oral and/or facial disfigurement. This presentation can be from the Consultant Maxillofacial Surgeon and can be pre-surgical, during operative procedures or post-surgical. The post holder has to assess the patient, identify the needs and requirements of the patient and devise a treatment plan. This has to be thoroughly discussed with and explained to the patient their family and /or friends. Complex, sometimes multipart, impressions are taken in order to produce highly accurate models of the face and/or the surrounding tissues from which (by means of high levels of intense concentration manual dexterity and hand/eye co-ordination) custom made appliances/prosthesis are designed and manufactured for fitting in/on the patient’s mouth/face. Such appliances are made to very fine tolerances and are, therefore, highly accurate. The majority of which are of a complex nature i.e. made from many components all custom made for the individual patient and/or appliance/prosthesis.
Oral/Facial and Body prosthetics involves working with patients who are about to or have undergone major facial and body surgery to eradicate large head and neck tumours. This will inevitably involve palliative treatments and recurrence of tumours. In these circumstances it will be necessary for the post holder to inform the patient of treatment limitations.
Most types of Maxillofacial patient, after initial fitting, is then in the care of the post holder (usually for their life) and is reliant on them for their rehabilitation, future appliances (typically last for approximately 1 – 2 years) and continuing review and care. Because of the extreme levels of disfigurement, such appliances/prosthesis has a massive, positive, psychological effect on the patient and their families enabling them to reintegrate back into society. Without this service these patients would not be able to enjoy such a relatively ‘normal’ life.
Either during an out of hours emergency or during normal working hours provides technological support to the specialist consultants of Oral and Maxillofacial Surgery. The MPT can be faced with the task of assisting the surgeon in cases of severe trauma to the mouth, face and head. This could start in assisting the surgeon in the taking of impressions of the patient, either during operating procedures, in surgery or in the accident and emergency department. The MPT, in liaison with the consultant, then has to devise possible treatment plans in order to achieve a satisfactory outcome for the patient. This can mean working under intense concentration whilst under the pressure of meeting difficult deadlines e.g. performing technical work (arch bars, coverplates, gunning splints etc.) whilst the patient is under general anaesthesia, the appliance the MPT is manufacturing has to be completed in order for the surgeon to fit the appliance whilst the patient is still on the operating table. This means that the patient can be under general anaesthesia exclusively for the purpose of the manufacture of their appliance. (This can also be the case in numerous other appliances made by the MPT in non urgent cases). In situations where this is during normal working hours the MPT would be expected to interrupt his existing duties (possibly involving intense concentration) and integrate the emergency work into the normal workload.
Physical Effort and Working Conditions
Can be expected, on emergency call-outs, to attend the Accident and Emergency Department. This includes either coming into contact with or working with patients and/or friends and relatives that exhibit verbal and physical abuse. (The majority of emergency call-outs are for fractures caused by violence due to excessive alcohol consumption).
Required to lift weights, including and up to 25kg (with help if necessary). Over 25kg with the use of mechanised lifting equipment. This activity may happen up to 10 times a week for short periods. E.g. bags of specialist plasters including Plaster of Paris, Crownstone, Crystical R and Pumice.
Can be expected to work invasively within open wounds and with body odours.
i.e. patients with active tumours and or purulent discharge.
Post holder can be expected to be occasionally/frequently exposed to uncontrolled body fluids in the form of saliva, mucous, vomit and blood e.g. taking impressions either in clinic or theatre and the subsequent handling of such impressions or contained within impressions sent into the laboratory. This is an everyday occurrence.
Be able to stand or sit for prolonged periods in restricted positions e.g. standing whilst casting impressions, trimming models, polishing appliances using machinery for grinding and polishing, on average 10-15 hours per week. Sitting in restricted position whilst trimming/grinding using high speed trimming/grinding equipment whilst using intense concentration, on average 5-10 hours per week.
Post holder can be expected to be exposed to respiratory irritants and moderate levels of dust which is unavoidable but controlled and monitored, average of 10 hours per week.
10.JOB DESCRIPTION AGREEMENT
Job Holder’s Signature: Date:
Manager/Head of Department
GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST Confidentiality
In the course of your employment, you may have access to, see or hear confidential information concerning the medical or personal affairs of patients and or staff. Unless acting on the instruction of an authorised officer, on no account must such information be divulged or discussed except in the performance of normal duties. Breaches of confidence, including improper passing of registered computer data, will result in disciplinary action, which may lead to dismissal. You should be aware that regardless of any action taken by your employing authority, a breach of confidence could result in a civil action for damages.
In addition, records, including VDU screens and computer printouts of registered data must never be left in such a manner that unauthorised persons can obtain access to them. Written records must either be destroyed or retained in safe custody when no longer required, VDU screens should always be cleared when unattended.
Terms and Conditions of Service
The principle terms and conditions of your appointment will be those set out in the Agenda for Change national agreement as amended from time to time by the NHS Staff Council. These terms and conditions are set out in the NHS Terms and Conditions of Service Handbook, which is available on the Trust’s intranet and NHS Employers web site.
Health and Safety
It is the duty of every employee to work in such a way that accidents to themselves and to others are avoided, and to co-operate in maintaining their place of work in a tidy and safe condition, thereby minimising risk. Employees will, therefore, refer any matters of concern through their respective line managers.
As part of your employment you may be required to record Patient Information (computerised or on paper). You have a responsibility to ensure that information is entered accurately, completely and consistently. It is particularly important that patients’ demographic details are kept up to date. Problems should be reported to your Manager.
This job description is not intended to form part of the contract of employment or to be a complete list of duties and responsibilities, but is a good guide for information to the job. It will be periodically reviewed in the light of developing work requirements in the department. The officer in the post will be expected to contribute to that review.
Gloucestershire Hospitals NHS Foundation Trust operates a no smoking policy. Smoking is not permitted anywhere within the buildings and grounds of all Trust sites. These restrictions include all areas up to the boundaries of all sites,
As part of it’s commitment to Equal Opportunities in employment, Gloucestershire Hospitals NHS Foundation Trust has a policy on Job Sharing. Under this policy all posts, unless exempted, are open to Job Share.
Should you wish to apply for this post on a job share basis please write “Job Share” on the application form in the box “Application for the post of”.
Shortlisted Job Share applicants may be invited to attend for a second interview with a potential partner so that working arrangements etc can be discussed,
Copies of our leaflet “Job Share Policy – a Guide for Staff” are available on request from the Personnel Department
This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Criminal Records Bureau to check for any previous criminal convictions.