Facing the facts, shaping the future

Our response to Public Health England’s consultation on a draft health and care workforce strategy, January 2018

23 January 2018

The consultation

The draft strategy document looks at all the health and care professions, mainly working in the NHS, and suggests that in the absence of increased productivity or service redesign the NHS will need an additional 190,000 posts by 2027. In a section on allied health professions, the report cites optics/orthoptics as the NHS staff professional group with the second highest growth 2012-2017 (20.3%) and also with the highest vacancy rate in March 2017 (10.8%).

In a short response to the draft strategy document we point out that the majority of optometrists work in community practice where there are also recruitment issues. Any planning for the future NHS workforce in optics needs to take this into account.

The AOP's response

Background

The Association of Optometrists (AOP) is a membership body representing over 80% of the UK’s c.13,000 optometrists. The majority of these professionals are not NHS employees. They work in community optical practices – more commonly referred to as Opticians – carrying out sight tests and prescribing glasses etc. These practices also provide NHS-funded sight tests and spectacles to those who qualify (funded through the General Optical Services (GOS) budget) and, where commissioned by their local CCG, provide a range of extended NHS primary care services such as Minor Eye Conditions Services (MECs), glaucoma monitoring, cataract follow-up etc.

A minority of optometrists are employed by the NHS in Hospital Eye Services. The AOP hosts a Hospital Optometrists Committee which provides an opportunity for hospital optometrists to meet to discuss clinical and policy issues.

Small numbers of optometrists work in both settings, often as locums. Locum workers are a growing proportion of the optometric workforce.

The AOP welcomes HEE and PHE’s initiative to develop a health and care workforce strategy and recognises that it is a huge undertaking covering a large number of significant professional groups.

While the draft strategy includes optics in in its discussion of allied health professions, we think it would also be helpful for it to take account of the wider optometric workforce involved in delivering NHS and private services in the community. We are doing some work in this area which we want to draw to your attention.

Key elements of the response are:

We note the points made about optics
We add further information about the pressures on NHS eye services and recruitment/workforce issues more generally in optics
We describe the questions we are seeking to answer through a forthcoming workforce survey
We offer the suggestion that our findings may be of use to PHE/HEE in the deeper development of a strategy in relation to the optical workforce

Key points on optics in the draft strategy

Orthoptics and optics are mentioned in the draft strategy in the section on the Allied Health Professions (p 119 onwards). It is noted that this sub-group of AHPs has grown by 20.3% since 2012 (the second largest growth among the AHP groups) and that at March 2017 there was a 10.8% vacancy rate, the highest among the groups. The point is made that “the NHS is still not attracting its proportionate share of the overall growth in registered AHPs”.

It is suggested that recruitment and retention might be assisted by the creation of careers that allow practitioners to work in different settings – NHS and private – leading to richer roles that use their skills fully.

Further information about the optometry workforce

PHE is probably aware of the background to the expansion in numbers of hospital posts in optics. Eye health is the second commonest reason for attendance at outpatients and the aging population means an increase in the number of people living with eye conditions such as Age Related Macular Degeneration (AMD). Demand on hospital eye services has grown considerably in recent years and is expected to grow further. PHE is probably aware of the Royal College of Ophthalmologists’ research suggesting that capacity issues within hospital eye departments are leading to as many as 22 people a month losing vision¹ . The Royal College has recognised the potential wider role of optometrists and other non-medical members of the hospital eye service team^{2, 3}

There has been an expansion in the number of university places for optometry over the last five years. Eleven institutions now offer an optometry course. The major employers in the sector, particularly Specsavers and Boots, have played a part in sponsoring the expansion. Nonetheless, there are some parts of the country where it is difficult to recruit optometrists to work in community practice (which includes delivering NHS-funded services). Employer respondents to the AOP’s 2016 Health and Wellbeing survey cited recruitment problems as the biggest pressure they face.

NHS Digital produces annual figures for the ophthalmic workforce by area, by profession, by gender and per 100,000 population⁴. Tab E3 of the Excel version of this report shows figures for ophthalmic practitioners per 100,000 population by NHS regional team area in England (2008-2016). It shows an overall rise of 4.3 per 100,000 in workforce during this period. The figure in 2016 varied between 18 practitioners per 100,000 people in Wessex (Dorset, Hampshire, Isle of Wight) to 25.9 in Greater London.

However, it is hard to relate these figures to demand. Numbers of private sight tests are not available at all and the published GOS data is not broken down geographically in the same way as the workforce data. It is therefore not possible to relate the regional variation in number of practitioners to the demand for GOS tests or identify whether the figures relate to uptake of sight tests in different parts of the country.

The most comprehensive evidence currently available about the characteristics of the optometric workforce is from the survey conducted on behalf of the optical bodies by the College of Optometrists in 2015⁵.The results did not lead to a definite conclusion about supply of optical professionals, although regional differences were clear. (Analysis by recruitment consultants Prospect Health found the North and South East of England to be areas of shortage⁶.) The study also concluded that there might be a “net loss of capacity” within a few years if respondents’ career plans were representative of the profession as a whole.

The study found a substantial increase in locum working since the equivalent 2010 study (rising from 10.5% to 17.5%). It also found substantial differences in remuneration between women and men that could not be fully explained by age, seniority or working hours.

A recommendation from the study was that optical sector bodies should “examine the factors influencing workforce distribution, demographics and capabilities”.

AOP carried out a survey of health and wellbeing of optometrists in late 2016. We took the opportunity to ask a couple of exploratory questions about optometrists’ career aspirations and willingness to travel or relocate in order to achieve their goals.

Nearly half of employee respondents said they planned to stay in the profession until they retire, but nearly a quarter said that they expected to stay only another one to five years. We also asked what distance people would be prepared to travel to achieve their career goals. The largest number, around a third, said they would travel 11–20 miles, with a further third being prepared to travel 21–50 miles. Only 15% would be prepared to travel over 50 miles. This figure relates closely to the answer to the question: Would you be prepared to relocate to achieve your career aspirations? Only 15% of employees of independent optical practices and 23% of employees of multiples said that they would.

AOP’s planned work on workforce

Responding to the concerns of employers in the sector and building on the evidence described above, the AOP is currently planning a survey of the optometric workforce. We want to understand more fully the factors that influence the career decisions of our members, including whether to work in hospital or community practice, whether to increase their clinical skills, whether to move location for the right job etc.

We intend to use the findings of the survey to help employers develop successful recruitment and retention schemes, and to provide our members with information and education resources to help in their career planning.

We notice that PHE is undertaking deep dives into the workforce issues of some of the smaller professions and suggest that optics may be a candidate for similar work given the pressures on hospital eye services, combined with vacancy levels and recruitment issues in both NHS and community/private providers which are competing for the same workforce.

We would like to offer assistance to any such thinking and would welcome a chance to talk to relevant PHE/HEE staff in the next couple of months as we plan our survey.

If you would like any more information, please contact a member of the policy team on [email protected].