New RCOphth Workforce Census illustrates the severe shortage of eye doctors in the UK

  • 31 Jan 2019
  • RCOphth

A new 2018 census by The Royal College of Ophthalmologists (RCOphth) identifies gaps in recruitment of ophthalmologists and workforce planning amid a predicted 40% increase in demand over the next 20 years.

  • Over the next two years an extra 230 consultant and 204 Staff and Associate Specialist (SAS) posts are required
  • 67% of hospital eye units are using locum doctors to fill consultant posts, an increase of 52% since 2016
  • 85% of units are undertaking waiting list initiatives to attempt to manage demand
  • Around a quarter of the current workforce is nearing retirement

There is a severe shortage of ophthalmologists and clinic space to cope with the continuing increase in demand, caused by an ageing population and welcomed new treatments for previously untreatable conditions. Improved efficiency and the extension of roles for non-medical and community staff are not sufficient to meet the growing patient numbers affected by long term eye disease.

Jane Harcourt, Chair of the RCOphth Workforce Committee said “There is a widespread misconception that ophthalmology is a small specialty delivering mainly elective minor procedures and the risk of harm is low. This is not the case. Ophthalmology is a major service, dealing with nine million outpatient appointments every year and delivering 6% of all surgery in the NHS. The census highlights the continuing serious shortage of ophthalmologists and a widespread use of locums.

Ophthalmology is now the busiest outpatient specialty1, with a predicted increase in demand of 30-40% over the next 20 years2. The current training places available each year will fall far short of the 230 extra consultant posts required over the next two years.

Furthermore, the 2018 census figures show that recruitment to vacant posts is becoming increasingly difficult. Two thirds of hospital eye units are resorting to the extensive use of locum doctors to fill consultant posts. This can present safety risks to patients, as locums often work in unfamiliar environments and, in some cases, may be less experienced or qualified than would be expected of a permanent consultant. Hospital Eye units are undertaking waiting list initiatives to attempt to manage demand, but in 2017, the RCOphth and British Ophthalmological Surveillance Unit (BOSU), found patients suffering permanent and severe visual loss due to health service-initiated delays3.

Loss of sight is devastating, reduces quality of life and independence, affects employment, and increases the risk of other health related issues including falls, depression and dementia. This has a direct impact on health, social care and society with an overall economic burden of sight loss estimated to be £28billion in the UK.

Melanie Hingorani, Chair of the RCOphth Professional Standards Committee, calls for action to rectify the current situation. “Our patients deserve better. Policy makers, NHS leaders and commissioners must recognise and understand the significance of eye conditions and sight loss and give ophthalmology the priority it deserves – before hundreds more patients suffer permanent and avoidable loss of sight.

Whilst we welcome the NHS Long Term Plan 4,5 it does not address the lack of capacity in the workforce which will be required to achieve its ambitions. The RCOphth 2018 census highlights the importance of securing a long-term workforce strategy that invests in a sustainable ophthalmology service to meet the growing burden of demand and protect patients from preventable sight loss.

The Royal College of Ophthalmologists 2018 Workforce Census is available to view and download here.

An infographic of the headline statistics is also available here.


  1. NHS Digital, Hospital Outpatient Activity, 2017-18, Main Specialty
  2. The Royal College of Ophthalmologists, The Way Forward, 2017
  3. BOSU report shows patients losing sight to follow-up appointment delays, February 2017
  4. Academy of Medical Royal Colleges outlines priorities for NHS England’s proposed 10-year plan, October 2018 / The Royal College of Ophthalmologists response to the AoMRC regarding the NHS England 10-year plan, September 2018