In November 2022, The Royal College of Ophthalmologists Paediatric Sub-committee held a series of focus groups to explore the challenges facing paediatric eye care and identify possible solutions to secure the future of the workforce. Following the conclusion of these focus groups, the RCOphth has produced ‘Improving the visibility of paediatric ophthalmology: A workforce report‘ detailing key findings related to the challenges faced by the paediatric workforce. Alongside this report, several policy recommendations will now be explored by the College to meet these challenges. We summarise the findings and recommendations below, and set out how the College intends to take this work forward in the coming months.
Recruitment and retention issues, significant patient backlogs and clinician workloads, and difficulties adapting to new ways of working
While many of challenges contributing to capacity shortages in paediatric ophthalmology are not unique, it is a sub-specialty of particular concern, with the 2022 workforce census finding paediatric ophthalmology cited by a third (32%) of eye units as a sub-specialty with the most concerning patient backlog. ‘Expanding the visibility of paediatric ophthalmology: A workforce report’ outlines how difficulties in the recruitment and retention of SAS doctors and consultants, significant patient backlogs, and the new ways of working adopted during the COVID-19 pandemic are impacting capacity in paediatric ophthalmology.
Key findings from the report are:
- Broader ophthalmology recruitment and retention challenges affect the paediatric sub-specialty
Eye units continue to struggle to fill posts advertised for paediatric ophthalmology, resulting in a reliance on long-term locums, re-employing recently retired consultants or ceasing to provide a paediatric service entirely in some severe cases. Driving this lack of available workforce is a low uptake of paediatric ophthalmology as a sub-specialty by ophthalmologists in training due to – among other issues – a lack of confidence in dealing with children and often anxious parents.
Compounding the capacity challenges is difficulties in retention, with 26% of paediatric consultants set to leave the workforce in the next five years. This has a knock-on effect even in areas with high recruitment, as ophthalmologists leaving the profession frequently outpace recruitment of new staff resulting in no additional gains in workforce capacity.
A paediatric disease of particular concern is Retinopathy of Prematurity (ROP). Screening for this disease is a requirement for dedicated ophthalmologists, generally paediatric ophthalmologists, to undertake this role remains a significant workforce pressure.
- Pressured workloads and long patient backlogs compound new and existing issues
Tackling long patient backlogs despite workforce-related capacity pressures is resulting in many units increasing their reliance on the wider multidisciplinary team (MDT), allied health professionals (AHP), and advanced clinical practitioners (ACPs). Pressures are also underlining the lack of appropriate infrastructure in paediatric units.
The extension of ACP roles has provided welcome additional capacity in many instances. However, there have been incidents where previous ACP-related workload prior to the practitioner’s upskilling and role change has not been appropriately backfilled. This frequently results in an internal shift of capacity pressure without a net gain in overall unit capacity.
Alongside difficulties arising from new measures to help improve capacity such as the upskilling of ACPs, capacity pressures are also highlighting pre-existing issues with ophthalmology infrastructure. National service frameworks for children require separation of children from adult clinics, inherently building in limited capacity and flexibility. A lack of flexibility in theatre and outpatient clinics exacerbates workforce pressures as it can encourage inefficient ways of working.
- COVID ways of working have facilitated innovation alongside some unintended consequences which need rectifying
During the COVID pandemic, many paediatric eye units adopted new ways of working, with some measures – such as risk stratification – facilitating efficiency savings.
However, other measures – most notably remote consultation – continue to be in place despite mixed experience across paediatric ophthalmology. While in some instances this measure can be a tool to see a greater volume of patients, tackling underlying infrastructure challenges associated with paediatric ophthalmology, cases of incorrect implementation have led to missed or inaccurate diagnoses.
Cross-committee action to explore potential policy solutions
To meet these challenges, focus groups convened by the Paediatric Sub-committee identified several potential policy solutions, which have subsequently been recommended and discussed with relevant RCOphth committees. These recommendations include:
- Ensuring trainees and SAS doctors are regularly exposed to paediatric ophthalmology training to improve confidence and encourage them to sub-specialise
- Facilitate consultant job planning including adult cataract surgery where appropriate
- Secure legislative change to allow orthoptists to undertake independent prescribing
The Paediatric Sub-committee is working with colleagues across RCOphth – including Training Committee, Education Committee, and Quality & Standards Committee – to explore and develop these solutions where appropriate over coming months. We will provide updates on these workstreams as they develop.
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