NHS Long Term Workforce Plan: the profession’s response

On the last day of June, NHS England released its Long Term Workforce Plan, setting out intentions for the next 15 years to address vacancies across the NHS.

The plans will see training places for areas such as adult nursing and GPs increased, as well as new focuses on placements and additional education.

Optometry is not referred to by name in the plans, however, it is acknowledged that primary eye care providers “have the knowledge and skills required to deliver more eye care services in the community.”

The report continues: “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.”

OT reached out to stakeholders across the profession for their reaction to the plans.

Addressing shortages in ophthalmology

Emma Spofforth, AOP chairman and secretary and clinical lead of Essex Local Optical Committee (LOC), suggested the plan opens up the ability to train more “much needed” clinicians, with a shortage of ophthalmologists and ophthalmic nurses in eye care that “this plan will help to address.”

“I would like to see more support for specific specialities such as ophthalmology,” Spofforth said, suggesting that she would like to see a greater encouragement for junior doctors to sample ophthalmology in their foundation years.

“However, the Workforce Plan will take time to take effect and it is essential the NHS embraces the support already well-qualified optometrists can offer,” she continued. “Optometrists qualified in Independent Prescribing (IP) and those with various other higher qualifications are under-utilised in the primary care setting.”

It is essential the NHS embraces the support already well-qualified optometrists can offer

Optometry absent in the plans

Kiki Soteri, head of clinical services at Leightons Opticians & Hearing Care, acknowledged the recognition primary eye care received in the report as having the knowledge and skills to deliver more services in the community, but highlighted: “The lack of detail highlights a gap where optometry and optical representation were absent.”

“Whilst the regulators for medicine, dentistry, pharmacy and nurses (GMC, GDC, GPC, HCPC) were involved in the consultation, the GOC as our professional regulator was conspicuously absent in the report,” Soteri emphasised, adding that neither the College of Optometrists nor ABDO were mentioned.

Speaking anecdotally about responses to the workforce plan, Soteri noted some senior doctors have reservations about the workability of the plan to reduce entry-level training from five to four years.

“I am not so reserved but remain realistic about the size of the challenge and opportunity,” she said. “Any reduction in the duration of time that doctors spend attaining registrable medical degrees will need to be counterbalanced by a sizeable workforce already holding the knowledge, skills, behaviours and infrastructure to provide timely, patient-centred care.”

Soteri shared: “These are things that GOC-regulated professionals like optometrists already offer, and any training programmes to deliver eye care services need to acknowledge and accredit for prior learning so that optometrists are not required to retrain and re-evidence what they can already do, thus creating artificial barriers.”

Leightons offers tailored foundation training for newly-qualified optometrists and new joiners to offer core services and also have the opportunity to develop in IP.

The lack of detail highlights a gap where optometry and optical representation was absent

Supporting higher level qualifications

Andrew Bridges, director of professional services at Leightons Opticians & Hearing Care, highlighted some of the challenges facing primary eye care providers in funding, commissioning, and higher qualifications.

“For community-based eye care providers to support the NHS, there will need to be sustainable funding for primary care to deliver this appropriately in practice, and standardised protocols at a national level, to remove the disparity of care in the current system, which currently can vary locally,” he said. “Some practices are situated near the boundaries of a number of Integrated Care Boards and have to alternate between multiple schemes to understand the eligibility of their practice database, which is time consuming and can lead to disappointment.”

Bridges highlighted: “Primary eye care providers have delivered much needed Minor Eye Conditions Services, Primary Eyecare Assessment and Referral Services, and COVID-19 Urgent Eyecare Services schemes, easing burden on GPs, eye casualty departments etc.”

While CPD grant claims are available for optometrists, they are not for dispensing opticians, Bridges said, something that should be addressed.

"Suitably accredited contact lens opticians do not have access to CPD grants to support them in their training to meet the accreditation requirements. Dispensing opticians do not have funding for higher level qualification for example in LVAs," he continued, adding, “With the expected 20% increase in over 65s from 2020 to 2030, there will be a significant rise in demand for such services which can be delivered on the High Street, and at a level beyond core competency.”

Steps have been taken to support the connection of primary and secondary care, Bridges acknowledged, but emphasised that this should not solely be limited to platforms for digital clinical image sharing, but also in access to nhs.net emails.

“Additional support for innovative integrated qualifications for optometrists and dispensing opticians needs to be in place to increase the number of training places to meet the increasing primary care eye care demand,” Bridges suggested, adding: “This should also enable access to such valued vocations for those not able to access or fund the traditional routes from school leaver to second time round careers.”

Primary eye care providers have delivered much needed MECS, PEARS and CUES schemes, easing burden on GPs, eye casualty departments etc

Enhanced services in the community

Paul Morris, Specsavers director of professional advancement, told OT: “We have long called for more enhanced services in the community and for optometry to work more closely with ophthalmology because it benefits patients and the NHS.”

Illustrating the point, Morris noted that Specsavers clinicians support the NHS through services such as glaucoma monitoring and referral refinement services in the community.

“We see ourselves as being able to work very closely with ophthalmology and other stakeholders to provide more care in community practice,” he said.

Suggesting that more patients have been seen in the community who might otherwise have been seen in hospital or by a GP, Specsavers shared that the number of patient interactions through enhanced optical services provided by its teams has more than doubled over the last four years.

Nearly one million clinical eye health appointments were seen by Specsavers between March 2022 and February 2023, compared to 453,000 in 2018–2019.

Morris concluded: “We would echo the College of Optometrists’ statement about safeguarding the training placements for optometrists and optometry students who can provide many of the services alongside ophthalmology. We are also excited by technological innovations, but that is always underpinned by good solid clinical foundations.”

We have long called for more enhanced services in the community and for optometry to work more closely with ophthalmology because it benefits patients and the NHS

Plans welcomed for ophthalmology but clarity required

A workforce census published in March 2023 by the Royal College of Ophthalmologists (RCOphth) revealed that 76% of units do not have enough consultants to meet current patient demand.

Jordan Marshall, RCOphth policy manager, called the publication of the plans a “relief,” adding that increasing the pipeline of doctors in England “can only be a good thing.”

While the clarity is welcome, Marshall said: “Funding has often been the sticking point when it comes to workforce planning however, so it is important to note that the plan only confirms funding for the initial expansion to 10,000 places by 2028.”

A commitment from future governments would be required to ensure the plans are delivered beyond this initial date.

The plan promises a ‘commensurate increase in specialty training places,’ focused on areas with the greatest need.

Marshall commented: “The commitment to increasing specialty training places in line with medical school places is encouraging for ophthalmology, although disappointingly there is no detail on this yet.

“Ophthalmology is one of the most over-subscribed training programmes, while in 2021 Public Health England found that England had just 2.5 consultant ophthalmologists per 100,000 population, well below the recommended 3–3.5 level needed to deliver hospital eye services,” he added.

With NHS England emphasising that the plan is iterative and will be refreshed every two years, RCOphth said it will 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.”

Marshall also noted that RCOphth would be seeking clarity on what proposals to reduce the length of degree programmes and expand medical apprenticeships would mean for ophthalmology.

Referencing the plan’s inclusion of technology – particularly the potential of artificial intelligence in ophthalmology – Marshall said: “As an image-based specialty ophthalmology is likely to be a leader in the use of AI, and it will be important to share learnings and best practice across the profession and beyond.”

He added that “fundamental improvements” are still needed in exchanging digital images between systems, and noted that RCOphth is working with the College of Optometrists to support the standardisation of ophthalmic imaging systems.

With the workforce plan noting the potential for more eye care services to be delivered from the High Street to alleviate pressure on GPs and hospital eye services, Marshall noted that RCOphth continues to work with the optometry community to support the delivery of collaborative eye care services.

“What would really help enable the delivery of joined-up care is the development of a national electronic eyecare referral system (EERS), 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 explained.

What would really help enable the delivery of joined-up care is the development of a national electronic eyecare referral system

Tackling the ophthalmology backlog

Phil Ambler, England country director for the Royal National Institute of Blind People (RNIB), welcomed the 15-year plan to address NHS staffing shortages, commenting: “Addressing staff shortages is essential to tackling the unacceptable backlog of people waiting for eye care.”

Tackling eye care backlogs and relieving the pressure on ophthalmology services needs to be made an urgent priority

More than 630,000 people are currently on NHS waiting lists for ophthalmology services, Ambler said: “Demand is at an all-time high, and is only set to increase as the population ages and the number of people with sight-affecting conditions like diabetes rises.”

“While we recognise the impact of the new plan is going to take some years to be felt, tackling eye care backlogs and relieving the pressure on ophthalmology services needs to be made an urgent priority as part of the plan’s implementation,” he continued.

Maximising the primary care workforce

A spokesperson for the Local Optical Committee Support Unit (LOCSU) shared that the plan “validates the sector’s current direction of travel.”

“There is clear recognition within the plan of how the primary care workforce can be maximised to improve access for patients and bring care closer to home,” the spokesperson highlighted.

LOCSU emphasised that the primary eye care workforce has demonstrated agility and an ability to deliver more services on the High Street – which will alleviate pressure on GPs and the hospital eye service.

“It is disappointing the valuable eye care workforce is not fully recognised within the plan; there is so much that can be delivered through the skilled primary eye care workforce,” the spokesperson emphasised.

LOCSU added that the commitment to update the plan every two years provides an opportunity to work with other sector bodies in developing future plans and increasing the focus on eye care.