• Mike Burdon says there are not enough “doctors, equipment or space”
  • Adds lack of training posts has left specialty in “predictable mess”
  • Says many trusts have “their heads in the sand”

Ophthalmology has a fundamental capacity issue and the lack of training opportunities has left the specialty in a “predictable mess”, the president of the royal college has said.

Mike Burdon, a consultant ophthalmologist in Birmingham and Royal College of Ophthalmologists president, said “fundamentally there are not enough doctors, equipment or space”.

There are currently around 150 vacancies at consultant level in ophthalmology across the country, mainly filled by locums, which is a vacancy rate of more than 10 per cent. Advertisements for posts often lead to very few applications, sometimes a field of one, he added.

This is despite ophthalmology being a popular choice for junior doctors, who can struggle to get training posts in the specialty. The royal college has asked for more training posts in the past but has not been able to secure them from Health Education England.

“It is a predictable mess,” he said. “Most hospitals in the country would appoint another ophthalmic consultant tomorrow if they could.”

Last week’s Healthcare Safety Investigation Branch report said junior staff and locums could contribute to the follow-up problem by over-cautiously ordering follow-ups sooner than was necessary.

Meanwhile, the college labelled the workforce issue a crisis in 2018.

However, Mr Burdon added space is also a constraint. “If we are to train more people, we need to think about where they are sitting,” he said. Some trusts were struggling to offer consultants regular operating sessions because of pressure on theatres, he said.

He added that, while NHS England wants to reduce the total number of outpatient appointments, ophthalmic patients did often need to be monitored regularly. However, ophthalmology is a specialty that does lend itself to virtual appointment clinics and some services could be delivered outside the acute setting in community clinics, using a mix of different healthcare professionals with the right training and governance in place. Artificial intelligence could also be used to assist decision-making to reduce the pressure on consultants.

Mr Burdon added demand for ophthalmology services is expected to grow by about 6 per cent a year for the next 20 years, driven by three high volume areas — glaucoma, macular degeneration and diabetic retinopathy.

However, he said he does see signs of hope, and he believes NHSE is taking the issues seriously.

Mr Budon’s comments come as HSJ reveals dozens of patients have come to severe harm after waiting too long for a follow-up appointment. He said many trusts have “their heads in the sand” about the issues. Despite the focus on the issues meeting demand in ophthalmology, he added “there has not been a sensible initiative that I can see to address the problems”.



Updated: 20 January to clarify role of virtual appointments and appointments outside the acute setting.

Revealed: The trusts where patients lost their sight after follow-up delays