RCOphth workforce census reveals serious NHS ophthalmology workforce shortages and growing role of independent sector providers

  • 28 Mar 2023
  • RCOphth

The Royal College of Ophthalmologists (RCOphth) has today published the results of its 2022 workforce census, highlighting the scale of staff shortages in NHS ophthalmology services and how they will continue to worsen over the coming years without immediate action. The report also finds increasing concerns regarding the impact of independent sector providers (private companies undertaking NHS-funded services) delivering NHS ophthalmology care.

Key findings from Facing workforce shortages and backlogs in the aftermath of COVID-19: the 2022 census of the ophthalmology consultant, trainee and SAS workforceare:

  • The vast majority of NHS ophthalmology services are facing significant capacity pressures, with over three quarters (76%) of units not having enough consultants to meet current patient demand and over half (52%) finding it more difficult to recruit consultants over the last 12 months
  • To keep up with patient demand, NHS eye units are increasingly relying on locums to cover gaps in their service. Two thirds (65%) are using locums to fill consultant vacancies. This reliance on locums is often not short-term, with a majority of eye units (57%) using locums to fill posts for longer than 12 months
  • These staff shortages are hitting patient backlogs across the UK. In January 2023, there were over 632,000 patients on ophthalmology waiting lists in England alone – 24,000 of whom were waiting over a year. 74% of eye units are more concerned about the impact of outpatient backlogs on patient care than they were 12 months ago and 63% estimate it will take at least a year to clear their outpatient backlogs
  • Workforce shortages in NHS eyecare services are set to worsen, with a quarter (26%) of consultants in the UK planning to leave the workforce over the next five years (the majority retiring), while 28% plan to work in independent sector providers – up from just 16% of the workforce currently
  • Amid the growing role played by independent sector providers delivering NHS-funded ophthalmology procedures, a majority of eye units (58%) say these providers are having a negative impact on patient care and ophthalmology services in their area. 


To address the significant challenges faced by ophthalmology services across the UK to deliver timely care with sufficient workforce capacity in place, RCOphth is calling on policymakers across the UK to:

  1. Commit to a phased increase in ophthalmology training places, working with training programme directors to ensure the right training capacity is in place
  2. Develop an eye care workforce plan, in collaboration with RCOphth and other stakeholders, to determine what workforce capacity is needed to meet current demand and future patient need
  3. Commission independent sector capacity in an intelligent planned way, learning the lessons from the last 18 months. Coordination at the national and regional level is essential to ensure capacity is provided where it can benefit patients, avoid destabilising NHS eye care, and make best use of scarce resources
  4. Explore simpler routes for progression for SAS doctors, acknowledging their desire for recognition and a clear career pathway
  5. Ensure ophthalmology units are properly resourced to meet patient need, particularly when decisions are made by trusts and health boards regarding provision of theatre space and training and deployment of the multi-disciplinary eye care team. 


Commenting on the publication of the 2022 workforce census, Professor Bernie Chang, President of The Royal College of Ophthalmologists said 

These findings paint a stark picture of the difficult challenges facing ophthalmology services across the UK. Despite continuing innovation in how we plan and deliver patient care, our ability to provide timely treatment is becoming ever more difficult given workforce shortages and long backlogs.
We now need joined-up action at all levels to ensure we have the appropriate workforce capacity in place for the coming years – at consultant and SAS grades, as well as non-medical roles that are part of the wider eye care team such as nurses, orthoptists, optometrists and ophthalmic technicians.  

This census also demonstrates that while additional independent sector capacity has helped tackle cataract backlogs, it does not address outpatient backlogs that present the higher risk to patients in terms of avoidable sight loss. Lack of appropriate planning in commissioning also risks comprehensive ophthalmology care and training. There must be greater coordination at the national and regional level to ensure additional capacity is provided where patients will benefit, without destabilising existing NHS eye units”. 


Sarah Maling, Chair of RCOphth’s Training Committee commented: 

“It is vital that RCOphth has undertaken this census to better understand the ophthalmology workforce. Despite a difficult few years, it is reassuring to know that ophthalmologists in training are generally happy with their training experience and plan to become NHS consultants. We will need to increase training places in the coming years, so that we have a pipeline of consultant ophthalmologists to meet growing patient need.

The concerns regarding the impact that growing independent sector provision is having on training delivery cannot be ignored . The College will continue working directly with NHS England and independent sector providers to ensure there are more surgical training opportunities for trainees.

It is also clear that SAS doctors want and need simpler routes for progression. We will continue to work with the GMC, with representation from our SAS committee, in its ongoing efforts to reform the CESR process”


We would like to thank all RCOphth members who took the time to complete the census survey in 2022. Your responses have allowed us to develop this detailed insight into the ophthalmology workforce, and will help us work towards addressing the challenges it identifies.

Thank you too to all those who made suggestions in free text comments of courses or clinical guidance that it would be helpful for the College to offer. We are reviewing all these ideas, such as guidance on virtual clinics, with a view to assessing what is possible for the College to provide. You may find it useful to explore our current clinical standards and guidance, and events and courses. 


For any comments or questions relating to the 2022 workforce census, please contact [email protected].