Work to improve Welsh eye care services through significant investment in regionalisation enters new phase

  • 19 May 2023
  • RCOphth

Following the independent Pyott Report which reviewed eye care services in Wales, important progress on significant investment in Welsh eye care infrastructure, including full regionalisation of services, is being made. We update on this work, which includes £150,000 funding from the Welsh Government to develop a National Clinical Strategy for Ophthalmology. This article also examines a new plan from NHS Wales to develop the health workforce and what it will mean for ophthalmology services.


As we updated you in 2022, the conclusions from the report that consultant ophthalmologist Andy Pyott led into eye care services in Wales were hugely significant. It highlighted many of the challenges facing Welsh eye care services, especially in North and West Wales, and outlined clear practical solutions. Key among these were full utilisation of the multi-disciplinary team, alongside the development of regional centres of excellence to ensure the future sustainability of eye care. The Pyott Report was clear that significant investment in ophthalmology in Wales was needed to prevent wholesale collapse of eyecare services in large areas of the country.

The report was well received by the Welsh Government when the RCOphth Wales Committee met with the Health Minister Eluned Morgan in 2022. Following the meeting, she challenged the eyecare community to ‘develop bold and ambitious plans…to be delivered at a pace to tackle the growing number of patients waiting for eye care and to transform the service here in Wales’.


What is happening now to develop regional centres of excellence?

Those bold and ambitious plans are now moving forward. Following further engagement with the Welsh Government, involving all eye care stakeholders such as the optometry sector and decision makers from every health board, there was clear consensus behind the importance of implementing the Pyott report recommendations.

That led to the welcome decision by the Welsh Government to allocate £150,000 towards developing a detailed blueprint examining how regionalisation of services could be implemented.

Known as the National Clinical strategy for Ophthalmology (NCSOphth), this will be a clinically-led process and in January 2023 RCOphth’s Wales Committee met to select regional and national clinical leads to guide the process. Catrin Bertalot from the North, Yih-Horng Tham from the South West and Rhianon Reynolds and James Morgan from the South East will coordinate regional clinical input and deliver the project with the support of NHS Wales Executive.

The project will be driven by ophthalmologists and focus on what in needed in secondary care to tackle the significant problems in delivering eye care across Wales. This commission follows on from a similar successful blueprint delivered by orthopaedics in Wales.

The work will be carried out at pace to address the urgency of the situation and is planned to be completed within 12 months. It will look at current delivery in detail – covering everything from pathways, capacity and estates – and then identify how change can drive a more efficient and sustainable ophthalmology service within the three regions. The project will also provide evidence to support the call for three regional centres of excellence.

The success of this work is dependent on the engagement of the ophthalmology community across Wales. After the completion of the NCSOphth, it is hoped that the Welsh Government will be able to deliver funding that can support the implementation of regionalisation and the investment needed in ophthalmology services.


How does this regionalisation work link with the wider priorities of NHS Wales?

In January the Welsh Government published its National Workforce Implementation Plan (NWIP). This plan describes how NHS Wales will prioritise the development of the non-medical workforce, both inside and outside of Hospital Eye Services, and regionalised services – both strong features of the Pyott report.

The NWIP also includes other actions that are relevant to ophthalmology, including:

  • Commission to identify workforce shortages – By July 2023 the Welsh Government will begin work to identify which professional roles have the most pressing workforce shortages.
  • Review of education and training – By July 2023, Health Education and Improvement Wales (HEIW) will review policy developments and intended changes in ways of working to inform the education and training commission plan for 2024/25. By September 2023, HEIW will also commission analysis to understand career decisions of Welsh healthcare graduates.
  • Developing a strategy for ‘Continuing Professional Development’ – By September 2024, HEIW will have developed a strategy for CPD across professional and occupational groups, increasing interprofessional learning and the specific needs of different roles.
  • Developing new roles and professions – The implementation plan references how the Allied Health Professional (AHP) Framework – which aims to shift AHPs to work directly in primary and community settings – will provide opportunities to explore the development of new roles and professions such as physician associates and Specialist doctors.


This plan should help to support the development of roles that can expand the capacity of the multidisciplinary eye care team in a relatively short timeframe. The plan also recognises ‘some training places have not increased at the same rates…addressing these inconsistencies will be a long term action than this Plan’, and acknowledges significant shortages in ophthalmic consultant staff.

The RCOphth looks forward to contributing to this future work to address shortages in training places, including the commission which the Welsh Government plans to undertake later this year to identify workforce shortages. Our 2022 workforce census found that half of NHS eye units in Wales did not have enough consultants to meet current patient need. It is therefore essential that steps are taken to address this capacity challenge now so that we have enough consultants in place in future to meet growing patient demand. The work to develop a NCSOphth will be the main vehicle toward achieving much-needed change in the way eyecare services are configured in Wales.

We will keep you updated with these developments around workforce policy in Wales as well as the ongoing work to develop regionalisation of Welsh eyecare services.


Commenting on these developments, Gwyn Williams Llywydd of the RCOphth in Wales, stated:

‘As the Pyott report made clear, inaction risks the collapse of eyecare services in Wales. This is especially true in the North and South West. There are significant challenges with our estates, including leaking roofs and crumbling infrastructure, and a serious and growing recruitment and retention issue. This strategy is the last chance we have to plan a viable future for eyecare in Wales. It is vital that the ophthalmology community across Wales gets involved in supporting this work’.