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The standards of proficiency for orthoptists

These standards set out safe and effective practice in the professions we regulate. They are the threshold standards we consider necessary to protect members of the public. 

Professionals must meet all the standards of proficiency to register with us and meet the standards relevant to their scope of practice to stay registered with us.

A note about our expectations of you

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.

If your practice is called into question, we will consider these standards (and the standards of conduct, performance and ethics) in deciding what action, if any, we need to take.

The standards of proficiency 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.

We also expect registrants to meet the HCPC standards of conduct, performance and ethics and standards for continuing professional development.  

Your scope of practice

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 the 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.

More information on scope of practice

Meeting the standards

It is important that you meet these standards and are able to practise lawfully, safely and effectively. However, we do not dictate how you should meet the standards. There is normally more than one way in which each standard can be met and the way in which you meet the 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 the 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 the 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’ and ‘know’. 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.  

Standards of proficiency

These standards are effective from 1 September 2023.

The standards include generic elements, which apply to all our registrants, and profession-specific elements, which are relevant to registrants belonging to one of the professions we regulate. 

The standards are not hierarchical and are all equally important for practice.

  • The generic standards, which apply to all professions, are written in bold text.
  • The profession-specific standards are written in plain text.

At the point of registration, orthoptists must be able to:

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  • 1.1 identify the limits of their practice and when to seek advice or refer to another professional or service

    1.2 recognise the need to manage their own workload and resources safely and effectively, including managing the emotional burden that comes with working in a pressured environment

    1.3 keep their skills and knowledge up to date and understand the importance of continuing professional development throughout their career


  • 2.1 maintain high standards of personal and professional conduct

    2.2 promote and protect the service user’s interests at all times

    2.3 understand the importance of safeguarding by actively looking for signs of abuse, demonstrating understanding of relevant safeguarding processes and engaging in these processes where necessary

    2.4 understand what is required of them by the Health and Care Professions Council, including, but not limited to, the standards of conduct, performance and ethics

    2.5 respect and uphold the rights, dignity, values and autonomy of service users, including their role in the assessment, diagnostic, treatment and/or therapeutic process

    2.6 recognise that relationships with service users, carers and others should be based on mutual respect and trust, maintaining high standards of care in all circumstances

    2.7 understand the importance of and be able to obtain valid consent, which is voluntary and informed, has due regard to capacity, is proportionate to the circumstances and is appropriately documented

    2.8 understand the importance of capacity in the context of delivering care and treatment

    2.9 understand the scope of a professional duty of care, and exercise that duty

    2.10 understand and apply legislation, policies and guidance relevant to their profession and scope of practice

    2.11 recognise the power imbalance that comes with being a healthcare professional, and ensure they do not abuse this for personal gain


  • 3.1 identify anxiety and stress in themselves and recognise the potential impact on their practice

    3.2 understand the importance of their own mental and physical health and wellbeing strategies in maintaining fitness to practise</strong>

    3.3 understand how to take appropriate action if their health may affect their ability to practise safely and effectively, including seeking help and support when necessary

    3.4 develop and adopt clear strategies for physical and mental self-care and self-awareness, to maintain a high standard of professional effectiveness and a safe working environment


  • 4.1 recognise that they are personally responsible for, and must be able to justify, their decisions and actions

    4.2 use their skills, knowledge and experience, and the information available to them, to make informed decisions and/or take action where necessary

    4.3 make reasoned decisions to initiate, continue, modify or cease treatment, or the use of techniques or procedures, and record the decisions and reasoning appropriately

    4.4 make and receive appropriate referrals, where necessary

    4.5 exercise personal initiative

    4.6 demonstrate a logical and systematic approach to problem-solving

    4.7 use research, reasoning and problem-solving skills when determining appropriate actions

    4.8 understand the need for active participation in training, supervision and mentoring in supporting high standards of practice, and personal and professional conduct, and the importance of demonstrating this in practice

    4.9 coordinate a complete service user pathway, where appropriate, and in line with local guidelines


  • 5.1 respond appropriately to the needs of all groups and individuals in practice, recognising that this can be affected by difference of any kind including, but not limited to, protected characteristics,* intersectional experiences and cultural differences

    5.2 understand equality legislation and apply it to their practice

    5.3 recognise the potential impact of their own values, beliefs and personal biases (which may be unconscious) on practice and take personal action to ensure all service users and carers are treated appropriately with respect and dignity

    5.4 understand the duty to make reasonable adjustments in practice and be able to make and support reasonable adjustments in their and others’ practice

    5.5 recognise the characteristics and consequences of barriers to inclusion, including for socially isolated groups

    5.6 actively challenge these barriers, supporting the implementation of change wherever possible

    5.7 recognise that regard to equality, diversity and inclusion needs to be embedded in the application of all HCPC standards, across all areas of practice

    * The Equality Act 2010 defines the protected characteristics as age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership and pregnancy and maternity. Equivalent equality legislation in Northern Ireland protects age, disability, gender, race, religion or belief and sexual orientation.

  • 6.1 adhere to the professional duty of confidentiality and understand when disclosure may be required

    6.2 understand the principles of information and data governance and be aware of the safe and effective use of health, social care and other relevant information

    6.3 recognise and respond in a timely manner to situations where it is necessary to share information to safeguard service users, carers and/or the wider public

    6.4 understand the need to ensure that confidentiality is maintained in all situations in which service users rely on additional communication support (such as interpreters or translators)

    6.5 recognise that the concepts of confidentiality and informed consent extend to all mediums, including illustrative clinical records such as photography, video and audio recordings and digital platforms


  • 7.1 use effective and appropriate verbal and non-verbal skills to communicate with service users, carers, colleagues and others

    7.2 communicate in English to the required standard for their profession (equivalent to level 7 of the International English Language Testing System, with no element below 6.5*)

    7.3 understand the characteristics and consequences of verbal and non-verbal communication and recognise how these can be affected by difference of any kind, including, but not limited to, protected characteristics,* intersectional experiences and cultural differences

    7.4 work with service users and/or their carers to facilitate the service user’s preferred role in decision-making, and provide service users and carers with the information they may need where appropriate

    7.5 modify their own means of communication to address the individual communication needs and preferences of service users and carers, and remove any barriers to communication where possible

    7.6 understand the need to support the communication needs of service users and carers, such as through the use of an appropriate interpreter

    7.7 use information, communication and digital technologies appropriate to their practice

    7.8 understand the need to provide service users or people acting on their behalf with the information necessary, in accessible formats, to enable them to make informed decisions

    7.9 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 applying through the Swiss Mutual Recognition Route (SMR) must provide evidence that they have reached the necessary standard. More information is available here: Statement on English language proficiency requirements for internationally trained health and care professionals.

    ** The Equality Act 2010 defines the protected characteristics as age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership and pregnancy and maternity. Equivalent equality legislation in Northern Ireland protects age, disability, gender, race, religion or belief and sexual orientation.


  • 8.1 work in partnership with service users, carers, colleagues and others

    8.2 recognise the principles and practices of other health and care professionals and systems and how they interact with their profession

    8.3 understand the need to build and sustain professional relationships as both an autonomous practitioner and collaboratively as a member of a team

    8.4 contribute effectively to work undertaken as part of a multi-disciplinary team

    8.5 identify anxiety and stress in service users, carers and colleagues, adapting their practice and providing support where appropriate

    8.6 understand the qualities, behaviours and benefits of leadership

    8.7 recognise that leadership is a skill all professionals can demonstrate

    8.8 identify their own leadership qualities, behaviours and approaches, taking into account the importance of equality, diversity and inclusion

    8.9 demonstrate leadership behaviours appropriate to their practice

    8.10 act as a role model for others

    8.11 promote and engage in the learning of others

    8.12 understand the need to engage service users and carers in planning and evaluating diagnostics and therapeutic interventions to meet their needs and goals

    8.13 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

    8.14 recognise the orthoptist’s role in the promotion of ocular health by other health professionals


  • 9.1 keep full, clear and accurate records in accordance with applicable legislation, protocols and guidelines

    9.2 manage records and all other information in accordance with applicable legislation, protocols and guidelines

    9.3 use digital record keeping tools, where required


  • 10.1 understand the value of reflective practice and the need to record the outcome of such reflection to support continuous improvement

    10.2 recognise the value of multi-disciplinary reviews, case conferences and other methods of review


  • 11.1 engage in evidence-based practice

    11.2 gather and use feedback and information, including qualitative and quantitative data, to evaluate the response of service users to their care

    11.3 monitor and systematically evaluate the quality of practice, and maintain an effective quality management and quality assurance process working towards continual improvement

    11.4 participate in quality management, including quality control, quality assurance, clinical governance and the use of appropriate outcome measures

    11.5 evaluate care plans or intervention plans using recognised and appropriate outcome measures, in conjunction with the service user where possible, and revise the plans as necessary

    11.6 recognise the value of gathering and using data for quality assurance and improvement programmes


  • 12.1 understand the structure and function of the human body, together with knowledge of physical and mental health, disease, disorder and dysfunction relevant to their profession

    12.2 demonstrate awareness of the principles and applications of scientific enquiry, including the evaluation of treatment efficacy and the research process

    12.3 recognise the role(s) of other professions in health and social care and understand how they may relate to the role of orthoptists within the integrated teams that serve communities

    12.4 understand the structure and function of health and social care systems and services in the UK

    12.5 understand human growth, physical and mental, and human development across the lifespan, as it relates to the practice of orthoptics

    12.6 understand the development of anatomical substrates and their relevance to the development of binocular single vision, visual function and visual perception

    12.7 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 function and visual perception

    12.8 understand neuroanatomy and the effects of disruption of neural pathways on the visual system, cranial nerves and supranuclear control of eye movements

    12.9 know the factors which influence individual variations in human ability and development

    12.10 demonstrate awareness of human behaviour and recognise the need for sensitivity to the psychosocial aspects of ocular conditions, including strabismus

    12.11 know how psychology and sociology can inform an understanding of health, illness and healthcare in the context of orthoptics, and know how to apply this in practice

    12.12 understand the theoretical basis of, and the variety of approaches to, assessment and intervention

    12.13 understand ocular alignment and binocular single vision, and the sensory and motor elements required to attain and maintain these

    12.14 know the principles governing visual function and the development of vision, and be able to apply them to clinical practice

    12.15 understand the factors which can cause the disruption of binocular vision

    12.16 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

    12.17 understand the principles of uniocular and binocular perception, and the anatomical substrate of these functions

    12.18 understand refractive error and its effect on ocular alignment, visual perception and visual development

    12.19 know how convergence, accommodation and pupillary response affect investigation, diagnosis and service user management, and be able to apply them to clinical practice

    12.20 understand ocular motility systems, their neural control and how typical and atypical anatomical structures influence them

    12.21 know the principles governing ocular motility and their relevance to diagnosis and management, and be able to apply them to clinical practice

    12.22 know the sensory and motor adaptive mechanisms that occur in order to compensate for strabismus and abnormalities of binocular vision

    12.23 recognise the functional and perceptual difficulties that may arise as a result of defective visual, binocular or ocular motor functions

    12.24 understand the effect of other acquired disorders of the body on the eye, the visual and ocular motor systems including paediatric, endocrine, autoimmune, oncological, trauma, psychological and neurological disease

    12.25 know about the range of ophthalmic conditions which can disrupt vision, binocular vision and produce eye movement disorders

    12.26 understand the principles and application of orthoptic and ophthalmological equipment used during the investigative process 

    12.27 plan, operate and evaluate appropriate vision screening programmes

    12.28 demonstrate safe use of medicines, including being able to undertake drug calculations accurately

    12.29 understand pharmacological principles which include pharmacodynamics and pharmacokinetics of medicines relevant to their practice and how these may be altered by certain characteristics

    12.30 understand the legal context relevant to the use of exemptions in legislation for the sale, supply and administration of medicines, as well as current local and national policy and guidance concerning medicines use

    12.31 understand the differences between the sale, supply and administration of medicines using exemptions, other supply or administration mechanisms and prescribing mechanisms

    12.32 understand when to sell or supply medicines using exemptions, based on a relevant examination, assessment and history taking

    12.33 understand the different non-pharmacological and pharmacological approaches to modifying disease management relevant to their practice and the risks and benefits of each option

    12.34 understand the potential for medicines to have adverse effects and how to minimise them including effects caused by medicines given in error

    12.35 monitor response to medicines and modify or cease treatment as appropriate within their professional scope of practice, including referral to another professional

    12.36 apply the principles of evidence-based practice, including clinical and cost-effectiveness, to the supply and administration of exemption listed medicines relevant to their practice

    12.37 understand antimicrobial resistance and the roles of infection prevention and control

    12.38 understand the importance of shared decision-making with service users to encourage self-care and adherence with medicines advice


  • 13.1 change their practice as needed to take account of new developments, technologies and changing contexts

    13.2 gather appropriate information

    13.3 analyse and critically evaluate the information collected

    13.4 select and use appropriate assessment techniques and equipment

    13.5 undertake thorough, sensitive and detailed patient medical history, including an appropriate medication history

    13.6 undertake or arrange investigations as appropriate

    13.7 conduct appropriate assessment or monitoring procedures, treatment, therapy or other actions safely and effectively

    13.8 recognise a range of research methodologies relevant to their role

    13.9 recognise the value of research to the critical evaluation of practice

    13.10 critically evaluate research and other evidence to inform their own practice

    13.11 engage service users in research as appropriate

    13.12 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

    13.13 know the principles and application of measurement techniques used to assess binocular vision and other ocular conditions

    13.14 conduct a thorough investigation of ocular motility

    13.15 take a comprehensive case history

    13.16 know the tests required to aid in differential diagnosis

    13.17 identify where there is a clinical need for medical, neurological, social or psychological investigations or interventions

    13.18 use investigative techniques to identify ocular defects within a specific population to form a diagnosis and devise an appropriate course of action

    13.19 diagnose conditions and select appropriate management

    13.20 diagnose a range of vision, binocular vision and ocular motility defects and all categories of strabismus

    13.21 identify pathological changes and related clinical features of conditions commonly encountered by orthoptists

    13.22 understand the principles and techniques of, and be able to perform, an objective and subjective refraction

    13.23 understand the principles and techniques used, and be able to perform, an examination of the anterior and posterior segments of the eye

    13.24 understand the principles and techniques used, and be able to perform, visual field assessments

    13.25 understand the principles and techniques used in electrophysiological assessment of visual function and the visual pathway

    13.26 formulate specific and appropriate management plans, and set timescales

    13.27 know how to apply orthoptic and ophthalmological intervention appropriately at different stages of visual development and ageing

    13.28 know how to use optical methods to influence vision and binocular vision

    13.29 recognise and document any adverse reaction to treatment and take appropriate action in response to this

    13.30 know the role, pharmacological action, clinical indications and contra-indications of ophthalmic drugs and how they may be selected and used in orthoptic practice

    13.31 understand research in the fields of ocular motility, strabismus, amblyopia and binocular disorders and how it could affect practice


  • 14.1 understand the need to maintain the safety of themself and others, including service users, carers and colleagues

    14.2 demonstrate awareness of relevant health and safety legislation and comply with all local operational procedures and policies

    14.3 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

    14.4 select appropriate personal protective equipment and use it correctly

    14.5 establish safe environments for practice, which appropriately manage risk

    14.6 know how to position or immobilise service users correctly for safe and effective interventions


  • 15.1 understand the role of their profession in health promotion, health education and preventing ill health

    15.2 understand how social, economic and environmental factors (wider determinants of health) can influence a person’s health and wellbeing

    15.3 empower and enable individuals (including service users and colleagues) to play a part in managing their own health

    15.4 engage in occupational health, including being aware of immunisation requirements


  • We first published standards of proficiency for orthoptists when our Register opened in July 2003.

    We review the standards regularly to look at how they are working and to check whether they continue to reflect current practice in the professions we regulate. Our most recent review began in 2019 and included a formal consultation and close collaboration with key stakeholders, registrants and professional bodies. The revised sets of standards for all 15 professions were formally approved by our Council in March 2022 and came into effect on 1 September 2023. 

    The profession-specific standards for orthoptists were developed with the input of the relevant professional bodies and the views of stakeholders during our consultation work. We are confident that the standards are fit for purpose and reflect safe and effective professional practice in orthoptics.

  • As part of our commitment to ensuring the standards remain relevant to current professional practice, will continue to listen to our stakeholders and keep the standards under regular review.

    This may result in updates to the standards in future, which may include corrections, amendments or changes to ensure the standards remain relevant.

    This 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.  

  • This document contains minor amendments to typographical errors, meaning it may differ slightly from previous versions published on our website.

    The publication code for these standards is 20230901POLPUB ORSoP.

What's changed?

On 1 September 2023 the updated standards of proficiency came into in effect, which included changes to the standards for all professions and changes to profession-specific standards. 

To see the changes between the previous and updated sets of standards, download the comparison table for orthoptists.

You can also view information on the key changes for all professions, access helpful resources or view comparison tables for the other professions


Standards and guidance
Professional standards
Page updated on: 01/09/2023