NHS England released a Long Term Workforce Plan on June 30, which outlined a 15-year overview to address the shortfall in clinical staff across the UK. Key strategies focused on training more staff, retaining the workforce and reforming how services are delivered by increasing technological use and coordinating more multidisciplinary teams.
The NHS reported it will face a workforce gap of more than 260,000-360,000 staff by 2036/37 without immediate action and, therefore, has announced plans to increase medical school places from the current 7,500 places per year to 15,000 places by 2031.
In regard to the eye care workforce, it said: ‘Primary eye care providers have the knowledge and skills required to deliver more eye care services in the community. Working closely with secondary care specialists and using technological innovation, such as digitally enabled image sharing, to deliver more eye care services on the high street could help alleviate pressure in general practice and hospital eye services and improve patient outcomes.’
The College of Optometrists welcomed the plan and its recognition that the knowledge, skills and expertise of eye care providers can help resolve the demand on the system and said this calls to action recommendations from its Workforce Vision report.
The Royal College of Ophthalmologists (RCOphth) released an analysis of the plan and identified implications for ophthalmology and unanswered questions.
RCOphth policy manager Jordan Marshall (pictured, right) summarised: ‘A key takeaway of the NHS Long Term Workforce Plan is that the medical workforce in England will increase notably in the coming years; by 2031, we will have 15,000 medical school places, double the number today.
‘This increased pool of doctors should boost all specialties in the long term, including ophthalmology, with the commitment to “a commensurate increase in specialty training places”.
‘This type of long-term planning is crucial, but it will obviously do little to tackle the current pressures facing ophthalmology units. In the more immediate term, we will continue to make the case to policymakers across the UK that to deliver timely high-quality patient care we urgently need investment in NHS ophthalmology services, such as theatre and clinic space.’
Marshall added details of training places will be fleshed out in future iterations of the workforce plan, so it is essential that the NHS and primary optical bodies work together now to establish what increase in training places is needed in ophthalmology and the wider optical profession.
Training
While medical training places are to be increased by a third to 10,000 a year by 2028/29, with a focus on areas with the most shortage, and all training for clinical staff through apprenticeship routes will be boosted from 7% to 22% by 2031/32, the question of whether optical professionals will be included in these numbers is still unclear.
There has been no commitment to increasing specifically ophthalmology specialty training places in line with medical school places.
The RCOphth highlighted in its 2022 workforce census that 76% of units did not have enough ophthalmology consultants to meet current patient demand.
Marshall said: ‘We therefore hope and expect to see significant funded increases to the number of ophthalmology training places. The plan points to two key reasons why they did not cover specialties in this iteration: that “available data is not yet sufficiently granular” and the challenge of predicting “which specialist roles will be most in demand in 15 years’ time”.
‘As the plan will be refreshed every two years, RCOphth will therefore work with training programme directors and NHS England to establish what increase in training places is viable and needed to ensure we can better meet patient need into the future.’
Harjit Sandhu, managing director at The Association for Eye Care Providers (FODO), told Optician: ‘The NHS workforce plan sets out the case for change. If we are to meet healthcare needs in a sustainable way, the NHS must work differently. That is why we cannot read the workforce plan in isolation.
‘The NHS must continue to build on the solid foundations of the NHS sight testing service and ensure appropriate commissioning of enhanced primary eye care services to achieve these aims in every Integrated Care Board.’
Sandhu said FODO had invested heavily in training opportunities and supported the NHS plan to make healthcare apprenticeships a key pillar of the workforce plan.
‘This comes at a time when the eye care sector is also exploring GOC approved dispensing optician and optometry apprenticeships,’ he added.
Meanwhile, the College said that more immediate support is still needed: ‘Although encouraging that there will be a focus on improving clinical placements, capacity for both pre-registration optometrists and optometrists who are undertaking higher qualifications and independent prescribing urgently needs to be supported and planned for.
‘The College will be supporting the development of the optometry workforce, and the transition to the new integrated Masters degree qualifications, by facilitating and quality assuring extended work-based clinical placements, as well as developing supervisory capacity and capability in primary eye care settings across the UK.’
Retention
NHS England has targeted retention with the aim to decrease the leaver rate from 9.1% to a rate within the range of 7.4-8.2% over the next 15 years, resulting in the retention of up to 130,000 full-time staff.
It would achieve this by ‘better supporting people throughout their careers, boosting the flexibilities we offer our staff to work in ways that suit them and work for patients, and continuing to improve the culture and leadership across NHS organisations,’ said NHS chief executive Amanda Pritchard.
The RCOphth’s 2022 workforce census showed that 67% of ophthalmology units in the UK experienced difficulty retaining consultants in the 12 months prior and, in alignment with the NHS’ plan, recommended improvements for retaining staff.
Marshall highlighted two proposals identified in the plan that would make it easier for recently retired doctors to return to practice: the NHS Emeritus Doctor Scheme, allowing consultants to return to the workforce in an outpatient capacity from autumn 2023, and reforms to the legacy pension scheme by 2024.
Career diversification with ‘more flexibility and a broader range of career pathways’, improved childcare support and integrated occupational health and wellbeing services were also indicated in the plan.
The 2023 GOC Workforce survey also outlined the drive for more wellbeing and occupational health support in the healthcare sector upon research revealing GOC registrants were subject to bullying, harassment, abuse and discrimination at work.
Steve Brooker, GOC director of regulatory strategy (pictured, right), said: ‘If unhealthy workplace cultures and disillusionment are forcing registrants out of the profession, this will add to workforce shortages and ultimately frustrate the sector’s ambitions to deliver more enhanced clinical eye care services in the community.
‘We are reviewing our standards of practice and will carefully consider any necessary changes that would support registrants by improving workplace cultures.
‘This is a shared problem that needs to be met with a sector-wide coordinated effort. To this end, we will convene a meeting of sector leaders and experts to discuss these issues and plot the most effective steps in addressing them.’
AI and innovation
The NHS England plan outlined that it would take better advantage of available digital and technological innovations, including artificial intelligence (AI), to free up staff time.
‘AI has the potential to free up clinical time and improve accuracy and efficiency of diagnostics in services such as ophthalmology, imaging, pathology and dermatology by acting as a first reader on images and eventually automating some clinical decisions where safe to do so,’ the report said.
Sandhu commented: ‘The good news is that primary eye care is already ahead of the curve on much of what the NHS workforce plan suggests. We have always been an early adopter of technological change and rolling it out for the benefit of patients, for example with digital retinal photography and optical coherence tomography.’
In terms of technology, Marshall added that the development of a national electronic eye care referral system (EERS) would really help enable the delivery of joined-up care is, allowing optometrists to directly refer patients to ophthalmology.
‘An EERS would facilitate shared imaging standards across primary and secondary care, enabling high volume, efficient patient data sharing,’ he said.
The College is also encouraged by the plans’ focus on better image sharing between primary and secondary care; calling this a significant step forward in joint working with its medical, nursing and allied health professional colleagues.
NHS service need will be allocated based on yearly data, so collecting yearly data and updating workforce statistics for optometry and ophthalmology is crucial for meeting the optical sector’s needs.
‘Along with our partners in the eye care sector, we are seeking to complete our UK wide multi-professional eye care data modelling project by the end of the year, and we look forward to sharing the tool with NHS England to help ensure their workforce plans are informed by the best possible data and projections,’ said the College.
‘We welcome NHS England’s desire to work with professional bodies to deliver their plans and look forward to supporting them and ICSs to ensure better eye care for all, and an eye care workforce that is fit for the future.’