Busiest outpatient speciality 'relying on' locums and outsourcing

The figures from the Royal College of Ophthalmologists suggested 85 per cent of ophthalmology departments are undertaking waiting list initiatives and outsourcing to the private sector to cope with rising demand from patients.

The college’s findings are from its second workforce census, which received responses from 75 per cent of all the UK’s 135 trusts and health boards with ophthalmology services. 

Meanwhile, the number of consultant posts in the speciality filled by locums almost doubled to 127 in 2018, up from 66 when the survey was last run in 2016. The proportion of posts filled by locums rose to 67 per cent in 2018, up from 52 per cent. 

Among the census’ main findings were:

• Overall, 77 per cent of units in the UK contain unfilled consultant posts;
• Forty-two consultant posts are completely vacant; and
• An extra 230 consultant posts are required to meet the rising demand for ophthalmology services during the next two years.

Last October, the royal college told HSJ there was a “mismatch between capacity and demand”, after eye patients were harmed due to long waits for follow-up appointments at University Hospital Southampton Foundation Trust.

The speciality accounts for more than 8 per cent of all NHS outpatient appointments and 6 per cent of all NHS surgery. Currently, around 1.5 million people in England have reduced vision, but NHS England estimates this number will double in the next 30 years. 

The college’s census revealed 66 per cent of departments’ waiting list initiatives were undertaken in-house with the trust’s own staff.

Fourteen per cent were carried out in-house by independent sector staff, 12 per cent were carried out by a private provider, and 8 per cent were carried out by an alternative NHS provider.

Melanie Hingorani, chair of the college’s professional standards committee, told HSJ waiting list initiatives have become “business as usual” for trusts during the last few years. Such schemes were only occasionally used previously.

“Most people are regularly being asked to work weekends and evenings,” she added. “We don’t have the number of ophthalmologists affected, but we know from what people tell us that it’s changed considerably over recent years.”

The census warned of a “serious shortage of ophthalmologists” and a “widespread use of locums which… can create significant risks to patients”.

Ms Hingorani said the situation has become so bad that locums end up spending years in consultant posts, despite not being required to be on the specialist register (ie: fully qualified) unlike permanently appointed consultants.

Guidance published by the Department of Health and Social Care states locums should be in post for no longer than a year. 

Ms Hingorani said district general hospitals were more likely to struggle than teaching hospitals because of difficulties smaller trusts faced attracting staff. 

“The other point is that there are 200 posts that haven’t got a permanent appointment in place, and in addition to that we think we will need another 230,” she said.

“So, we are going to need more than 400 consultants and we’re only able to certify 60-70 per year so we are never going to catch up.

“We haven’t got a hope of getting enough people qualified per year. We know that we could train more, because there are hospitals that would train more people, but we’re not allowed to do that.”

Health Education England sets the number of training places. 

Ms Hingorani continued: “There has been, to some degree, an expansion of training posts, but they have gone to what are considered really high-profile areas, like accident and emergency, GPs and mental health.

“There is also a tendency for people to think ophthalmology doesn’t kill people, so areas such as diabetes and cardiovascular must be more important. Therefore they ignore the wider impact that eye health can have on the rest of the system.”

She said it was difficult to persuade HEE to fund more training places when “everyone is begging for more money”, but added HEE had said the college had presented an “incredibly compelling case”.

An HEE spokeswomen said the organisation “recognises the important work of ophthalmology in delivering high-quality care for patients”. 

The spokeswoman added: “Following the publication of the long-term plan we are working with partners to understand what workforce issues need to be addressed, including future demand and service plans, as part of the development of the system-wide workforce implementation plan.”