The government has responded to a report by the Health and Social Care Select Committee, agreeing that if medical school places are to be expanded ‘there would need to be the appropriate number of specialty training places subsequently made available for graduates’. With the upcoming Long Term Workforce Plan in England expected to announce increases to medical school places, this clarity is important in potentially paving the way for a much-needed expansion in ophthalmology specialty training places.
Action on workforce planning poised to move forward
The question of how we plan and deliver the health and care workforce we need to meet ever-growing demand has been high on the agenda for a number of years. We have seen attempts to introduce legislation in Parliament that would require government to undertake workforce plans, and numerous reports from think tanks and Parliamentary committees highlighting the problem. RCOphth has also brought attention to the severe workforce shortages facing ophthalmology with the recent publication of our 2022 workforce census.
Now progress could finally be on the cards. As we reported to you last month, the government is committed to publishing a Long Term NHS Workforce Plan ‘shortly’. This plan will include ‘independently-verified forecasts for the number of doctors, nurses and other professionals that will be needed in 5, 10 and 15 years’ time’.
Consensus on the need for more specialty training places a positive sign for ophthalmology
RCOphth believes it is essential that we plan not just for how many new medical school places we need, but also the foundation and specialty training places that will have to be created to provide pathways for developing doctors.
That is why we are encouraged by the government’s response to a Health and Social Care Committee report on the health and care workforce, published this week. Reflecting a point RCOphth stressed in our submission to the committee, the government confirmed that if medical school places are to be expanded, ‘there would need to be the appropriate number of clinical placements throughout the country and specialty training places subsequently made available for graduates’. It reinforced this point later in the response, saying ‘Any future expansion in postgraduate training should be made on the basis of need within certain specialties’.
We know that ophthalmology is one of the most over-subscribed training programmes, and with severe workforce shortages and projected rapid increases in patient need in the coming years, the case for increasing the number of ophthalmology specialty training places is clear.
The number of doctors in ophthalmology training grades has increased by 41 Full Time Equivalent since 2021, just under 5%. While these increases are welcome, they are not enough to meet demand. Our census found that at the end of 2022 over three quarters (76%) of NHS ophthalmology units did not have enough consultants to meet current patient demand. We also have almost 200,000 more patients waiting to see an ophthalmologist today, following initial referral, compared to 2018.
In 2021, Public Health England highlighted that England had 2.5 consultant ophthalmologists per 100,000 population, well below the recommended 3-3.5 level needed to deliver service in hospital eye units. Achieving that minimum recommendation would require an additional 250 consultant ophthalmologists today, and that shortfall will quickly become much more severe without action given our rapidly ageing society.
RCOphth will be working in the coming months to establish how training places in ophthalmology can be increased in a viable phased way, bearing in mind the constraints that many ophthalmology units will face around trainer capacity, the quantity of procedures suitable for training and other capacity challenges.
We also recognise that there are other ways we can expand workforce capacity, alongside increasing training places. Our 2022 census found a clear desire among SAS doctors for simpler routes for progression in ophthalmology. The work being led by the GMC to reform the CESR process, which RCOphth is contributing to, should support this ambition. We also need to enable other eye and healthcare professions, including optometrists, orthoptists, nurses and technicians, to develop their skills so they can play enhanced roles in the delivery of ophthalmic care. Support from NHS England to expand our Ophthalmic Practitioner Training Programme would be an important boost, as would investment in technician and image grader roles that could increase capacity quickly.
The movement towards clearer health workforce planning in England will be welcomed by everyone across the NHS, and if undertaken effectively has the potential to deliver more consultant ophthalmologists that we so urgently need. RCOphth will continue to work with policymakers to make the case for the importance of delivering these increases, a vital step in enabling us to meet patient need into the future and prevent avoidable sight loss.
