“Vital and essential” needs of eye care workforce discussed in Parliament

AOP CEO, Adam Sampson, and clinical and professional director, Dr Peter Hampson, spoke alongside the President of the College of Optometrists, Professor Leon Davies; President of the Royal College of Ophthalmologists, Bernie Chang; head orthoptist and eye team lead at Guy’s and St Thomas’ Hospital Trust, Liz Tomlin, and consultant ophthalmologist, Seema Verma, at the event, which was held at the Houses of Parliament.

APPG co-chair, Marsha de Cordova MP, began the session by speaking about the Government’s soon to be published workforce plan, emphasising that “it is really important that it [the workforce plan] takes in the vital and essential needs of our sector, particularly when it comes to optometry and ophthalmology.”

Here is a summary of the session.

1 “We believe that optometry should be at the heart of patient-centred eye care in the UK”

 
Leon Davies, president of the College of Optometrists, started the meeting by outlining his desire for optometrists to be positioned at the heart of a patient-centred eye care workforce.

“At the centre of our vision is a belief that patients in all four nations of the UK should be able to access all eye care services via their primary eye care optometrists in the first instance, with optometrists established as the first contact practitioners,” Davies said.

He highlighted that the pandemic allowed optometrists to prove their skills, and that “we all now have a unique opportunity to build on these achievements to address the backlog and build cost-effective, clinically safe, sustainable eye care services for the benefit of our patients.”

He added that the College’s desire is to “develop the workforce of the future to provide enhanced levels of eye care in the community.”

Services, including higher qualifications, must be commissioned and collaboration with universities should be facilitated, he said. Data should be used to inform workforce planning in order to meet patient need and improve outcomes.

“In order to improve eye care services and patient outcomes, it is clear the way forward is to help services to better utilise multidisciplinary eye care teams, including making the most of the full core skills and competencies of optometrists,” Davies added.

2 “We have severe workforce shortages”

 
The president of the Royal College of Ophthalmologists (RCOphth), Bernie Chang, spoke about the workforce challenges currently being faced by ophthalmology.

The RCOphth’s Workforce Census, which sought to explore workforce morale and future intentions, was shared with members in December 2022 and published in March this year. 

The results were clear, Chang shared: severe workforce shortages, with fewer than a quarter of hospital eye units having enough consultants and many relying on locum cover.

While 84% of respondents said they needed at least one more consultant, the shortage meant only 40% were actively recruiting for one.

Retention was highlighted as a problem, as was the ophthalmology backlog, which has grown 50% since April 2020.

Ophthalmology only makes up 2.6% of the total number of consultants and 1% of doctors in UK, but 8% of all NHS outpatients, Chang said.

He also shared that 63% of RCOphth members believe it will take a year to clear the backlog they are facing.

There is also concern that independent sector provision will affect the financial stability of eye services, Chang shared.

“Shortages of the workforce, which puts pressure on those who are on the shopfloor, is one of the main reasons why they feel less fulfilled,” he added. “There is a clear correlation between how satisfied they feel in their jobs and their intention to work in the NHS. The happier they are in the NHS, the more likely they are to stay. That’s common sense.”

More ophthalmologists, investment in IT and in estate, intelligent commissioning and planning at Integrated Care Board level and a national eye care workforce plan to avoid patients losing sight are essential in addressing these concerns, Chang concluded.

3 “AI is a buzzword at the moment, but in reality, it's another way of saying: how do we increase productivity within the existing workforce?”

The AOP’s clinical and professional director, Dr Peter Hampson, spoke about the Association’s research into the UK eye care workforce, collated from corporate and NHS England data, the Office for National Statistics, and the General Optical Council (GOC) register.

Pairing this data with existing information the AOP has on the approximately 82% of UK optometrists who are members offers up “a fairly robust data set,” Hampson said.

“We can model the rate at which the number of optometrists will increase based on current trends of GOC data, based on trends of how we think the number of optometry schools are able to change over the next two, five or 10 years, and how population will change in the demographic areas,” he said.

Modelling in order to see changes in productivity has also been possible, Hampson added: “AI is a buzzword at the moment, but in reality, it's another way of saying: how do we increase productivity within the existing workforce?”

He continued: “If we increase that burden on practitioners, do they have the capacity to cope?”

AOP data suggests there is the right number of optometrists, Hampson suggested, but that the spread across the country is unbalanced – there are fewer optometrists outside the cities that house optometry schools, for example, and there is a shortage in rural areas: “That’s going to be one of the challenges that we have to tackle: how we get optometrists where we need [them] to be.”

“There are enough optometrists to deliver this care,” Hampson said, adding, however, that time to build capacity if we want to do even more, needs to be factored in. In five years, he believes that the optometry workforce will be in a position to take on a “significant amount” of work that was previously being carried out in hospitals.

4 “There is a strong desire from the workforce to increasingly have flexible working”

AOP chief executive, Adam Sampson, spoke about potential future workforce challenges that the profession should be aware of.

Sampson emphasised that the first point to address when it comes to the optometry workforce is the changing demographic of the profession: almost three quarters of respondents to the Association’s student survey were female, he revealed.

“We now have a strongly female entry into the profession, which is a distinct change and in the long-term will provide us with some interesting challenges about retention and career progression,” Sampson said.

A “huge appetite” for flexible working was evident in the most recent AOP member survey, he added: “There is a strong desire from the workforce to increasingly have flexible working, and if you layer that on top of the fact that a female workforce in due time may have a desire for parental responsibilities and so on, there are some challenges for us coming down the track.”

Sampson noted that the AOP has also seen recent growth in the number of locum members, which could create financial challenges for employers.

In terms of motivation and job satisfaction, AOP members have clearly expressed a desire to carry out an increased amount of clinical work, Sampson shared.

There is a strong desire for more enhanced skills, he said, and this is a key part of how the existing optometry workforce can be retained.

A market-led approach needs to be taken when commissioning services, Sampson added, and IT connectivity needs to be embraced in order to reach hard to access areas.

5 “We are passionate about the NHS and the drivers for change”

Seema Verma, consultant ophthalmologist at St Thomas’ Hospital, spoke about the hospital’s ophthalmology department both before and during the COVID-19 pandemic, citing issues including an increasing workload, limited medical workforce, increased waiting times, and irreversible sight loss.

Ophthalmology was already the busiest outpatient department in the NHS before the pandemic, Verma said, adding that her department already had 22 patients per month becoming sight impaired due to delays in outpatient follow-up appointments before COVID-19 restrictions were put in place.

“The workforce has always been the challenge,” she said.

Fragmentation of referral patterns and treatment pathways, optometrists not always being in the places where they are needed, competing interests and funding challenges within the NHS, and issues with IT connectivity between primary and secondary care are all identifiable issues “which we have known about for a long, long time,” Verma added.

In 2014, she shared, the Minor Eye Conditions Service (MECS) was commissioned in South East London, by commissioners who were invested in upskilling practitioners in the community.

A “massive collaborative effort” has seen solutions including community optometry clinics, regular teaching and upskilling by consultants, an audit to identify problems, and optometrists being trained to work in specialist clinics so they can manage more in the community, Verma shared.

“We’re all here because we want to make a change,” she said, noting that there are multiple opportunities available to work in different ways – for example, with the potential of remote consultations.

6 “The only way forward for workforce development is funding, time and space to upskill the non-medical workforce”

 
Liz Tomlin, head orthoptist at Guy’s and St Thomas’ Hospital, explained that MECS optometrists regularly attend specialist clinics, where they have been able to develop strong relationships with consulting ophthalmologists – allowing them to take their extended knowledge out into their community.

“It is a two-way process,” she said, adding that specialist clinics now also take place within the community.

“We love having optometrists in our clinics,” she said, “but it’s a rare beast that comes to work for the NHS five days a week.”

One day a week contracts for optometrists to work in the hospital while remaining in community practice for the other four days are helpful, she explained.

Training unregistered ophthalmic technicians to assist in clinics has also been beneficial in easing workforce pressures over the past decade, Tomlin said, adding that Guy’s and St Thomas’ Hospital now has 35 technicians trained up to perform tasks including greeting patients, testing visual fields, and taking scans.

On-the-job training takes six months, and the ability to have ophthalmic technicians pre-testing before patients see the ophthalmologist makes for “a much more effective appointment,” she said, adding that the process has allowed for the creation of diagnostic hubs, for example, for macular problems.

One of these hubs, when fully staffed, “will give us another 400 appointments per week, and really cut those waiting times,“ Tomlin said.

She believes that “The only way forward for workforce development is funding, time and space to upskill the non-medical workforce.”