The College responds to the government's call for evidence on the 10 Year Workforce Plan
In our response, we have highlighted the critical role of primary eye care and the optometric workforce in delivering integrated, cost-effective NHS services.
Executive summary
In our response, we welcome the government’s three shifts for the NHS in England, which align with the strengths of primary eye care and long-standing priorities we have been championing1. However, the 10 Year Health Plan lacks detail on delivery, timelines, funding, and accountability for workforce development and service transformation. Achieving its ambitions requires a system-wide approach that makes best use of the existing primary eye care workforce, modernises commissioning, strengthens integration between primary and secondary care, and shifts spending from hospital-based care to community services delivered through neighbourhood teams.
The current optometric landscape
- There are almost 15,000 optometrists in England, 80% of whom work in primary eye care settings2
- They are registered health professionals and a core pillar of NHS primary care, acting as the “front door” of the NHS3 for most patients with eye concerns
- They conduct over 13 million NHS sight tests annually4 through 5,000 local practices equipped with modern diagnostic tools
- They detect eye and general health conditions, provide assessments, prescribe corrective lenses, and manage a wide range of eye diseases
- Optometrists working in secondary care provide core optometric functions and more specialist eye care, increasingly taking on the role that junior or middle ranking doctors in ophthalmology might have once had with eye care patients
Increased demand
Demand for eye care is projected to rise by 40% over the next two decades, with a projected 16% increase in glaucoma cases by 20355. Full integration of primary care optometrists into workforce planning is essential to avoid backlogs and preventable sight loss.
Optometrists can reduce NHS pressures
In many parts of the UK, primary care optometrists play a crucial role in reducing pressure on hospital eye services and preventing avoidable sight loss. They do so by:
- providing first-contact care for eye conditions
- delivering urgent eye care in community settings6
- carrying out routine eye examinations and sight tests
Optometrists with core competencies – as well as those with higher qualifications and independent prescribing rights – safely treat and manage a broad range of eye conditions across both primary and secondary care.
They also use up-to-date imaging technologies, such as Optical Coherence Tomography (OCT), to support diagnosis, ensure continuity of care, and improve efficiency across the system. This helps reduce demand on GP practices and ophthalmology departments while maintaining access to high-quality, local care.
Recognition for optometrists
The main barrier to better use of the primary eye care workforce is recognition. Despite clear evidence of the valuable contribution primary care optometrists make to preserving the nation’s sight, the 2023 NHS Long Term Workforce Plan omitted specific provision for optometrists. This is a missed opportunity to use their expertise to benefit patients and the NHS. Commissioners and colleagues in hospital eye services do not have an in-depth understanding of optometrists’ core knowledge, skills and competences.
Meeting the requirements of the 10 Year Workforce Plan
The optometric workforce also demonstrates strong alignment with the Plan’s strategic objectives:
- To nurture homegrown talent. Sustained increases in UK undergraduate admissions and growth in UK-qualified pre-registration placements demonstrate a strengthening domestic optometric workforce7. This trend reflects ongoing efforts to cultivate homegrown expertise and enhance national self-sufficiency within the optometric workforce.
- To retain skilled staff. The overall optometric workforce capacity has remained stable over time, supported by positive engagement with career development pathways and expanded access to postgraduate qualifications and advanced skills training. These factors contribute to enhanced professional fulfilment, workforce resilience, and improved retention8.
- To equip the workforce for a digital-first NHS. Optometrists are increasingly undertaking training in emerging and transformative technologies, including artificial intelligence and digital diagnostic tools. This means we can make a substantial contribution to the delivery of a digitally enabled, data-driven health service, consistent with the ambitions of a digital-first NHS9, 10.
Conclusion
We hope that the forthcoming 10-Year Workforce Plan will acknowledge, incorporate, and fully leverage the skills and competencies of optometrists to support integrated, cost-effective care and to facilitate the effective implementation of the 10-Year Health Plan for England.
Our full response
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Section 1: The three shifts
Digital and AI
Digital and AI
Harnessing digital innovation
Optometry is well placed to lead digital transformation. AI-assisted diagnostics and connected devices are emerging in eye care, supported by College interim guidance10. Tools such as Optical Coherence Tomography (OCT) enhance diagnostic accuracy, while collaborations like Moorfields Eye Hospital and DeepMind Health show AI’s potential for early disease detection11,12.
The College has long supported digital initiatives linking primary and secondary care, by co-developing the Primary13 and Secondary14,15 Care Minimum Data Sets, and co-chairing work with the Royal College of Ophthalmologists on DICOM imaging standards to improve interoperability16.
The following examples highlight how digital innovation has enhanced patient care and service delivery in eye health. These initiatives have led to demonstrable improvements in patient outcomes and system efficiency by shifting care closer to home, reducing demand on hospital services, and enabling more timely interventions.
Integrated digital referral and imaging pathways
Structured digital referral systems allow optometrists to submit comprehensive clinical information including patient history, visual acuity, and imaging directly to ophthalmology departments. These systems improve triage and advice and guidance, reducing unnecessary hospital referrals, and enabling optometrist-led care closer to home.
The NHS Gloucestershire Community Ophthalmic Link (launched in 2022) demonstrates how digital technology supports shifting care from hospital to community. The scheme:
- involves 66 optometry practices and 250 clinicians
- prevented 998 hospital referrals
- reduced hospital eye care waiting lists by 14%
- managed 264 patients entirely in primary care
- improved the quality of 859 referrals
- recorded 3,303 instances of better patient education
- delivered estimated annual savings of £250,000 for the NHS17
It received national recognition for its impact [18] and cited in the 10-Year Health Plan for England as a best practice example19.
In Scotland, attaching fundus images to electronic referrals:
- improved triage accuracy and prioritisation
- facilitated early detection of sight-threatening disease
- enabled appropriate allocation of patients to specialist clinics at first visit
- minimised patient inconvenience and reduced hospital “did not attend” rates
- prioritised timely care for serious pathology20
In NHS Fife between 2020 and 2022, a digitally enabled pathway for 2,276 glaucoma patients:
- resulted in 714 patients fully managed in primary care
- 482 patients discharged to routine monitoring under General Ophthalmic Services contract
- fewer than half required ongoing hospital follow-up
- reduced hospital workload while maintaining clinical safety21
Harnessing data for early disease detection
The Scottish Collaborative Optometry-Ophthalmology Network e-research (SCONe)22 is a community-acquired retinal image repository enabling ocular, cardiovascular and neurodegenerative disease prediction. It currently contains over 367,000 retinal images matched to over 36,000 patients who have attended their optometrist for an eye examination during which a retinal image was captured.
Retinal images are known to contain information about ocular, systemic and neurodegenerative pathology before the development of symptoms. Captured during routine optometric examinations, this resource is now supporting research into disease prediction and offers the potential to support the development of tools which could facilitate earlier diagnoses and the identification of patients at highest risk of rapid progression.
Rapid digital transformation during COVID-19
Historically, patients with eye symptoms turn first to GPs, yet most GPs lack specialist ophthalmic training and equipment. The COVID-19 pandemic accelerated the digital transformation of eye care.
The College of Optometrists supported the rapid development and rollout of the COVID-19 Urgent Eyecare Service (CUES), now the Community Urgent Eye Care Service. CUES integrated remote booking, video consultations, e-prescribing, and digital referrals. This service provided urgent access for patients with conditions such as red eye, sudden vision loss, or trauma, thereby preventing unnecessary attendances at GP practices or accident and emergency departments.
In Greater Manchester:
- over 70% of urgent eye cases were managed in primary care without referral to secondary care23
- remote consultations exceeded 60% during the pandemic
- ensured safe and effective triage, freeing up capacity for patients most in need
CUES has since set a new standard for how urgent eye care can be delivered, demonstrating the potential for digital pathways to deliver high-quality, efficient, and patient-centred services beyond crisis conditions. With continuous improvements in camera and internet technology, digital images will have an ever-increasing role in eye care as it continues to adapt to meet an increasing demand.
Barriers to digital integration
Despite these advances, barriers to digital integration remain. Many optometrists providing NHS-funded primary care do not have access to the NHS.net portal, an NHS email address, electronic patient records/shared care records or direct digital referral pathways into hospital eye services.
Digital connectivity must be improved to speed up diagnosis and treatments
Poor connectivity delays diagnosis and treatments, increases unnecessary costs for the NHS, and limits multidisciplinary collaboration.
Universal two-way IT connectivity between optometrists, GPs, and hospitals is essential. This would enable secure and efficient communication, facilitate referral feedback, and enhance clinical decision-making.
The College of Optometrists, in partnership with The Royal College of Ophthalmologists and other key organisations, has raised its growing concerns around inconsistent and incompatible digital systems across primary, secondary, NHS, and independent care settings. Without a coordinated approach, efforts to deliver integrated eye care and implement the three shifts of the 10 Year Health Plan for England will continue to face significant barriers. We call for national standards in electronic health records (EHRs) used in eye care24 that support continuity of care across settings.
Imaging standardisation
Clinical images are increasingly offered in primary and community eye care settings to detect and monitor eye disease. They can also help improve referrals to secondary care enhancing patient outcomes within shared care pathways.
However, multiple platforms are used across hospitals and optical practices, and the absence of agreed imaging standards means images often cannot be shared. This leads to patients undergoing repeat imaging, delays in diagnosis, and a higher risk of preventable sight loss, generating unnecessary costs for the NHS.
To address this, The College of Optometrists and the Royal College of Ophthalmologists are co-chairing a national Task and Finish group with NHS England, manufacturing industry and sector stakeholders to agree DICOM25 imaging standards for ophthalmic imaging in the UK.
Adoption of these standards by NHS England and device manufacturers will enable seamless sharing of clinical images, support faster and more accurate decision-making, and facilitate the safe use of AI in future.
Recommendations
Digital and AI skills matter, but upgrading core IT systems and data infrastructure is vital. The College of Optometrists calls for NHS-funded integration of optical practices into NHS digital systems23, and adoption of DICOM imaging standards.
To fully realise the benefits of digital transformation, we recommend:
- Investment in universal IT connectivity between optometry, GP, and hospital systems
- National rollout of e-referral and image-sharing platforms
- Access to shared care records for all primary care optometrists
With the right investment, primary care optometrists can play a bigger role in delivering timely, data-driven care that meets the ambitions of the NHS 10-Year Workforce Plan.
Innovation is not limited to technology; it also encompasses the rollout of proven new models of care.
Shifting care to the community
Shifting care to the community
A community-first, neighbourhood health model can transform eye care. Optical practices are accessible, well-equipped, and staffed by skilled professionals, making them ideal as the first point of contact for eye health concerns. They can complement Neighbourhood Health Centres without relocation. Enhanced services – urgent and minor eye conditions, cataract pre- and post-operative checks, and glaucoma monitoring – exist in many locations and could be scaled nationally, reducing pressure on GPs and hospitals while improving patient convenience. To achieve this, primary eye care services must be consistently commissioned across England, with Independent Prescribing optometrists able to prescribe via FP10s.
Hospital eye-care services are under increasing demand
- Eye care accounts for nearly 9% of all outpatient appointments in England26
- Demand is rising faster than hospital capacity27, 28
- Ocular emergencies constitute 1-6% of A&E attendances29, with up to 70% manageable in primary care30,31
Without systemic reform, ophthalmology services will struggle to meet rising demand, resulting in longer waiting times, growing backlogs, and avoidable sight loss. With an ageing population and constrained health budgets, new care models that improve access and outcomes are imperative33.
Optometrists, given their accessibility, expertise, and integration into local health systems, are ideally placed to alleviate these pressures by delivering more care in primary care settings.
The benefits of optometry-led enhanced services
Locally commissioned enhanced eye care services demonstrate how optometrists can deliver timely, accessible eye care with strong clinical outcomes. Delivering high-quality care closer to home also offers patients a choice of providers and flexible appointment times. By preventing vision loss and improving patients’ quality of life, the success of the below case studies illustrates the potential for primary care optometry to expand its role to deliver more treatment and long-term management of a greater range of eye conditions.
Optometry-led urgent and emergency eye care services
Services like the Minor Eye Conditions Service (MECS) and the Community Urgent Eyecare Service (CUES) allow urgent eye problems to be managed safely in primary care settings6, 34. Patient outcomes are excellent, and satisfaction is very high, as patients receive immediate specialist attention rather than waiting for GP or hospital appointments. These schemes require no additional qualifications beyond standard optometry training.
An economic analysis of MECS schemes in London between 2011 and 2014 found that GP referrals to hospital ophthalmology:
- were reduced by 30.2% in Lambeth and 75.2% in Lewisham, compared with a 3.1% increase in Southwark, which had no MECS scheme.
- costs increased by 2.5% in Lambeth, fell by 13.8% in Lewisham, and rose 3.1% in Southwark, demonstrating both clinical and economic benefits34
Despite their proven benefits, MECS and CUES are not yet uniformly commissioned across all regions, and awareness among the public and some health professionals remains limited. By using the existing primary eye care workforce and scaling up these services, policymakers and commissioners can alleviate pressure on GPs and hospital eye departments, reduce health inequalities in eye care access, and improve patient safety and experience.
Staffordshire enhanced services
Collaboration between NHS contractors, hospitals, and commissioners shifted more care from hospitals to primary eye care for glaucoma, cataracts, and paediatric care.
Between 2023–2024:
- 78.7% of glaucoma repeat measures
- 63.9% of glaucoma enhanced case finding
- 73.5% of CUES cases
were safely managed in primary care reducing patient anxiety and hospital workload35.
Community-based glaucoma monitoring services
Hospital capacity constraints cause avoidable sight loss as highlighted in a report from the Healthcare Safety Investigation Branch36. An estimated 22 people a month suffer severe or permanent loss of sight due to delays in follow-up appointments, due to insufficient capacity within HES37.
Primary care optometrists with a higher qualification in glaucoma can monitor and manage most patients safely38, 39, 40.
Community schemes show strong outcomes:
- In Cambridge, the Cambridge Optometry Glaucoma Scheme (COGS), launched in 2010, safely discharged 46.6% of patients, with a further 5.7% discharged after virtual review, safely reducing false-positive referrals. The scheme was later extended to long-term glaucoma management41
- In Leeds, since 2018, the Glaucoma Enhanced Case Finding service reduced unnecessary referrals with only 25% of patients requiring onward referral42
- In Mid and South Essex, between 2021 and 2025, community glaucoma monitoring pathways managed 54.4% of patients entirely in the community43
- In Greater Manchester, the Primary Eyecare Glaucoma Service achieved 93.8% suitability for primary care monitoring. There was a 97.8% agreement rate between primary and secondary care management plans. In addition, carbon emissions were reduced by two-thirds when patients were seen in primary care43
However, most citizens in England do not have access to primary care-based schemes to manage their lifelong glaucoma care, unlike in Scotland where there has recently been a nationwide implementation of an optometry led glaucoma service44.
Cataract post-operative care
Primary care optometrists play an essential role in post-operative cataract pathways. In many parts of England, patients return to their primary care optometrist for post-operative review following cataract surgery. This approach avoids the need for routine follow-up in hospital, reduces unnecessary travel for patients, and enables rapid detection of complications.
An evaluation of post-operative cataract services delivered by primary care optometrists as part of a shared care pathway in England demonstrated benefits for patients, optometrists and ophthalmologists45.
The audit demonstrated that:
- primary care optometrists could safely and effectively manage post-operative care, reducing the number of visits that the patient has to make to the hospital
- patients were highly satisfied with the service45
Enhanced optometric service pathways in Wales
A 2024 evaluation of seven enhanced optometric service pathways in Wales (2021–2023) showed that primary care optometrists can safely and effectively reduce wait times for neovascular age-related macular degeneration (nAMD) and glaucoma monitoring, decrease referrals, and free up hospital capacity. Integrating these services into primary care lowered waiting lists, maintained patient satisfaction, and proved cost-effective46.
Key findings of the evaluation:
- Shorter wait times: Suspected nAMD seen within 4–5 days; glaucoma monitoring within 5 days
- Fewer referrals: More cases managed in primary care, reducing hospital eye service demand
- Increased hospital capacity: Consultants focused on complex cases
- Maintained patient experience: Comparable satisfaction to hospital care
- Cost-effective delivery: Primary care integration reduced overall service costs
- Workforce readiness: Optometrists have the skills, qualifications, and willingness to deliver enhanced services
- Policy impact: Evaluation directly informed NHS Wales eye care contract reforms46
Recommendations
Evidence shows that enhanced primary care optometry-led services provide safe, effective care for most acute eye conditions, improving patient outcomes while reducing pressure on GPs and hospital eye departments6. Patients benefit through quicker access, expert management, and excellent experiences, all within their local community.
Importantly, these benefits have been achieved by drawing on the core skills of the existing NHS workforce of primary care optometrists47, 48 demonstrating the high level of expertise already available.
However, although the benefits of enhanced primary eye care are recognised49, 50, 51, to date local commissioning decisions have resulted in inconsistent availability across England.
The College of Optometrists recommends to:
- Expand optometry-led services
Primary care optometrists can deliver more routine, enhanced, and shared care without extra training, reducing hospital referrals and NHS waiting times. Those with higher qualifications or independent prescribing can manage complex cases.
Commissioners across England must recognise and utilise the full core skills and competences of primary care optometrists, as well as those with independent prescribing and higher qualifications, to reduce unnecessary referrals to secondary care, and increase capacity to manage low risk patients with long-term eye conditions outside of the hospital. - Establish optometrists as first port of call
Primary care optometrists can help manage the growing demand for eye care in a sustainable way, reducing pressure on the hospital eye service and benefiting patients and the wider NHS. Many patients with eye conditions can be appropriately managed within primary care optometry and only referred to the hospital eye service if clinically necessary.
Primary care optometrists are best placed to provide prompt accurate assessment, diagnosis and management that would reduce GP appointments and avoid unnecessary referrals into secondary care. They can build effective multidisciplinary working with secondary care to tackle the current postcode lottery of access to specialist eye care and reduce health inequalities. This will ensure patients can receive the right care they need quicker, closer to home, and will free up NHS hospital eye services to treat patients in need of more complex or urgent care. - Address clinical placement capacity bottlenecks
To meet the growing demand for accessible and timely care for more complex sight-threatening conditions, due to an ageing population, we also need increased numbers of optometrists with independent prescribing and/or higher qualifications in specialist areas of practice. The biggest barrier to achieving this is access to clinical learning placements. Innovative solutions are required to address the significant bottlenecks and develop the infrastructure necessary for improved placement capacity. The College of Optometrists would welcome an opportunity to share our expertise in pre-registration placement programmes to design such solutions. Please see our response in paragraph 4.1.
Strengthening prevention and public health
Strengthening prevention and public health
The Plan’s focus on smoking, diet, alcohol, and mental health is welcome but overlooks the vital role of routine eye examinations. For many, primary care optometrists are their only regular healthcare contact. Eye exams can detect conditions such as glaucoma, diabetic retinopathy, and hypertension early. Recognising optometry as a frontline player in prevention and embedding vision care into public health messaging from childhood through later life is essential.
Although the risk of developing many eye conditions increases with age, prevention is key to reducing avoidable sight loss, health inequalities, and pressures on the health system.
Up to 50% of moderate to severe vision impairment in Western Europe is preventable52, and lifestyle changes can lower the risk of sight loss53. Indicators like ethnicity and deprivation are also linked to worse eye health54.
Regular eye examinations in local optical practices enable timely interventions, preserve sight, detect systemic disease, and improve health outcomes. Primary care optometrists support preventative care through early detection, patient education, and innovative technologies.
Early detection and screening for eye diseases
- Every day, 250 people begin to lose their sight55
- Over two million in the UK live with severe sight loss, projected to reach four million by 205055
- Sight loss costs the UK £25 billion annually, rising to £33.5 billion by 205056
- Reducing eye condition prevalence by 1% per year could save £3 billion, increasing to £9.5 billion by 205057
Primary care optometrists can identify during routine eye examinations early signs of eye conditions that can lead to vision impairment if left untreated. The NHS Diabetic Eye Screening Programme (DESP) exemplifies the role of optometry in population-level prevention. Optometrists participating in DESP help detect diabetic retinopathy at an early stage, when treatment is most effective in preventing progression to blindness58.
Public health and prevention
Primary care optometrists provide lifestyle advice, detect systemic disease, and improve accessibility, especially in underserved areas. Eye examinations can identify high blood pressure, cholesterol, diabetes, and pre-diabetes, with signposting to appropriate care. Integrating eye care into NHS prevention programmes would enable systematic lifestyle interventions.
- Healthy Living Optical Practices scheme: Started in Dudley, expanded to Manchester, Nottinghamshire, and Derbyshire, primary care optometrists provide a range of health-related advice, including NHS health checks, smoking cessation services, alcohol screening and weight management. Initial results from the pilot proved to have a positive effect59
- Stroke prevention scheme: East Cheshire pilot screened patients aged 60 and over for undiagnosed atrial fibrillation during sight tests. Out of 329 patients, 31 were referred for further investigation, demonstrating low-cost screening in primary eye care reduces GP burden and identifies stroke risk60
- Cardiovascular screening scheme: In East Cheshire a stroke prevention pilot showed that low-cost atrial fibrillation screening in optical practices successfully identified individuals at risk, enabling timely referral and reducing the likelihood of adverse events. NHS England has begun piloting blood pressure checks in primary eye care settings in 15 ICBs, with over 100,000 checks expected in the next 12 months61
Understanding the importance of eye examinations
Public education is essential for better prevention. Optometrists provide advice on modifiable risk factors like smoking, diet, obesity, and UV exposure. Public health campaigns, such as those led by The College of Optometrists, help to raise awareness of the importance of regular eye examinations in maintaining overall health.
Eye health is linked to broader public health issues:
- smokers are up to four times more likely to develop AMD62
- poor diet or obesity increases risk of glaucoma, cataracts, and diabetic eye disease52
- visual impairment can worsen dementia63 and depression64
- older people with eye disease are three times more likely to limit activities due to fear of falling65
Public health campaigns encouraging routine eye examinations could help detect systemic conditions like diabetes and hypertension earlier, improving overall outcomes and reducing the financial burden on the NHS.
Improving access to eye care for all
The risk of developing many eye conditions increases with age; however, poorer eye health is also associated with inequalities related to ethnicity and socioeconomic deprivation54.
People living in socio-economically deprived areas face more barriers to accessing primary eye care and therefore present later to hospital eye services66. Commissioned primary eye care services in non-urban and deprived areas, with support to access regular and enhanced eye care, are essential to prevent sight loss and improve health outcomes.
Recommendations
To build on the existing and potential role of the optometric workforce in prevention and public health, The College of Optometrists recommends that:
- Eye health be embedded within national prevention strategies, alongside other major conditions such as cardiovascular disease and diabetes
- Access to regular eye examinations be promoted as part of a healthy lifestyle, particularly for high-risk and underserved groups
By enhancing the role of primary care optometrists in prevention, the NHS can reduce avoidable sight loss, improve quality of life, and alleviate the broader health and social costs associated with vision impairment.
Optometrists are a key part of the NHS workforce
Optometrists are a key part of the NHS workforce
Optometrists are a critical part of the NHS workforce, bringing advanced clinical skills and patient-centred expertise to modern eye care. They represent a flexible and highly trained workforce capable of delivering safe, timely care in primary care settings. Commissioners should make full use of the optometric workforce to reduce unnecessary referrals to secondary care and to manage low-risk, long-term eye conditions outside hospital settings.
Through continuing professional development (CPD), higher qualifications and advanced clinical training, optometrists are increasingly managing a wider range of conditions in primary care. Shared care pathways with hospital eye services improve patient outcomes. Evidence from audits and service evaluations (referenced in Section 1) confirms that such initiatives enhance access, reduce waiting times, and maintain high-quality care. Investing in optometry workforce development is essential to deliver sustainable, patient-centred care closer to home.
Training and qualifications
A high-quality eye care system requires a well-trained and supported workforce. Optometrists benefit from robust education and training.
- Continuing Professional Development (CPD: The College of Optometrists manages Docet67, which provides CPD provision to support the shift of care from secondary to primary care settings – for example, through its cataract and glaucoma modules, which prepare optometrists to deliver pre- and post-operative care and glaucoma monitoring. Docet plays a key role in keeping the workforce up to date with clinical and technological developments, supporting the 10-Year Workforce Plan through continuous professional growth. Through Docet, optometrists have access to:
- essential training such as Safeguarding Adults and Children
- core clinical competencies, including modules on glaucoma, cataract, AMD, Dry eye and MECS/CUES
- enhanced practice training with Independent Prescribing content
- preventative care, including modules on the effect of smoking, driving, nutrition, and UV exposure on the eyes
- Education and training reform: The General Optical Council’s (GOC) Education and Training Requirements (ETR) ensure graduates gain experience in patient interaction, teamwork, inter-professional learning, and workplace readiness. Optometrists are trained to apply an adaptive, personalised approach to care, considering patients’ social, clinical, and cultural needs, and to communicate and collaborate effectively with other health professionals.
- Investment in post-registration training: Funded training expands the number of optometrists capable of advanced primary care, reducing pressure on hospitals. Structured national training and clear career progression improve workforce capacity.
- Expanding clinical placement capacity: To meet growing demand for timely and accessible care for complex, sight-threatening conditions driven by an ageing population, more optometrists with independent prescribing and higher qualifications are needed. The key barrier remains the limited availability of supervised clinical placements within hospital eye services, which are already operating at capacity. The College has extensive experience in developing and delivering pre-registration placement programmes that could be adapted in partnership with NHS Trusts and Integrated Care Systems. Innovative approaches, including digital supervision, community-based placements, and blended training models, can help expand placement capacity and ensure that more optometrists are trained to meet future demand.
Emerging technologies and training
The College of Optometrists welcomes the recognition of the impact of technology on the NHS workforce and the delivery of care, including the use of artificial intelligence (AI). As technology advances, optometrists are increasingly able to deliver more care in new ways, closer to patients’ homes. Advances in diagnostics and treatments will enable earlier detection, better disease management, and improved outcomes for patients. Digital transformation – including telemedicine, AI, and remote monitoring – will further support accessible, community-based eye care, but investment is required to overcome barriers to implementation (see section 1).
Optometrists must be prepared for future technologies through appropriate education and training, enabling them to upskill and deliver more advanced clinical services to benefit patients.
The College of Optometrists has taken proactive steps to ensure that optometrists are equipped to use AI and technology effectively in clinical practice.
- Policy and guidance: The College’s Interim Position on AI in Eye Care10 published in 2025 emphasises that training is essential to equip clinicians with the skills needed to select and use AI tools safely. It also outlines key principles for AI adoption: evidence-based validation, transparency, regulatory compliance, ethical use, equitable implementation, and clinician accountability.
- Research: The College has set up an AI Expert Advisory Group to bring together eye care professionals, researchers, AI experts, patient representatives, and sector bodies. This group has contributed to a consensus exercise that will identify requirements for training, regulation, guidance, integration, and ethical implementation. Results and supportive guidance will be published in 2026.
- Future training: The College’s education pathways will continue to evolve, ensuring that students and qualified practitioners gain foundational skills in AI tools and simulations.
- Continuing Professional Development (CPD): The College’s CPD Hub includes AI-focused courses such as Artificial Intelligence in Optometry. These accredited programmes support safe and effective integration of technology into practice.
In addition, The College of Optometrists is promoting technology-enhanced education for optometry students and trainees. Through initiatives such as AI-led simulation tools, virtual patient systems, and Virtual Reality (VR) slit-lamp simulations, students can experience a broader range of clinical scenarios, preparing them for a professional environment where AI is increasingly prevalent.
With these initiatives, optometrists are better equipped to deploy technology in clinical practice, improving accuracy, speed, access, and overall quality of care. Simulation and virtual training tools further allow practitioners to engage with a wider range of cases, enhancing standards of care and ultimately benefiting patients through more advanced diagnostics, efficient workflows, earlier disease detection, and better outcomes.
Section 2: Modelling assumptions
Modelling the eye care workforce
Modelling the eye care workforce
Overview
The College of Optometrists supports the development of robust, realistic workforce models that reflect the growing role of primary care optometrists in delivering eye care now and in the future. The emergence of new technologies and new therapeutics and treatments will also fundamentally change how eye care is delivered by requiring new behaviours, capabilities, and services. Without contingency planning and investment to skill up the workforce to deliver these new services, the plan will not be future proofed.
Modelling the eye care workforce and demand for services: the UK Eye Care Data Hub
The College of Optometrists has led a collaborative initiative with organisations across the UK’s eye care sector to launch the UK Eye Care Data Hub5, developed by York Health Economics Consortium.
This models the future eye care workforce, spanning both primary and secondary eye care professions, up to 2038. The data hub models the expected changes in the eye care workforce over time, if recruitment, retention, education and training trends do not change. This vital insight supports eye care planners and commissioners across the UK to understand how the workforce will change over time, optimise the existing eye care workforce and identify priorities for future eye care workforce education, training and development to support new models of care.
The UK Eye Care Data Hub also forecasts the number of people expected to have a wide range of eye diseases and conditions.
The UK’s population is ageing:
- In 2022, there were around 12.7 million people aged 65 or over in the UK, making up 19% of the population
- According to the ONS’s population projections, by 2072 this could rise to 22.1 million people, or 27% of the population68
Such demographic changes are expected to drive an increase in demand for specialist eye care services, as the risk of many eye conditions increases with age.
The prevalence of eye diseases such as glaucoma, age-related macular degeneration (AMD), and cataracts is expected to rise considerably over the next decade:
- With a predicted increase in prevalence of 25.1% for late-stage AMD
- 16.6% for primary open-angle glaucoma
- and 17.2% for vision-impairing cataracts in England between 2025 and 2035
the demand for eye care services will grow significantly5
The number of optometrists in England is predicted to increase by 39.5% over the next decade to approximately 20,000 individuals5. It is therefore imperative that commissioners make better use of the optometric profession to better diagnose, treat and manage eye health and improve patient outcomes.
Modelling assumptions
The UK Eye Care Data Hub has been built using the workforce data available in 2023 and will be updated periodically as new data becomes available. The next update is due in Autumn 2025. The data sources and modelling assumptions used to develop the UK Eye Care Data Hub are detailed in the Data Sources resource that accompanies the data hub69. These are summarised below:
- Headcount. Data for the optometrist workforce is taken from the 2023 General Optical Council (GOC) register. Optometrists’ postcodes were used to assume where they were likely to work. Predictions take account of ONS population predictions. For ICBs and regions, the growth rate for the nation was calculated and applied to these sub-populations. The hub models the number of registered optometrists in England down to ICB level, but commissioners will need to apply local data and knowledge to determine where they are working (primary or secondary care) and how many are providing NHS services within primary care.
- High Qualifications. The model currently shows optometrists with:
- Glaucoma: Professional Certificate
- Glaucoma Higher Certificate
- Medical Retina Professional Certificate
- Medical Retina Higher Certificate
- Independent Prescribing
searchable down to ICS level. For the Professional Certificate in Glaucoma and the Professional Certificate in Medical Retina, the number of people gaining these between 2012 and June 2023, The College of Optometrists data was used and applied to the model. For other qualifications, data were available at a national and regional level from The College of Optometrists, but the numbers were too low to allocate at ICB level.
- Annual leavers. The percentage of leavers was calculated from the percentage of leavers registered in the past three years (using the average number leaving in the last three years) in a bespoke analysis provided by the GOC.
- Percentage full-time. The percentage of full-time and part-time workers was obtained from the GOC Registrant Workforce and Perceptions Survey 2023 and applied to the whole register population. Whilst data were available at a regional level, there was very little difference in percentages by region. Therefore, given the limitations of the data source, national values have been applied to sub-national levels.
- Average hours part-time. The average part-time hours were calculated based on average hours worked from the GOC Registrant Workforce and Perceptions Survey 2023 and the percentage of people working full time with an assumption of a 35-hour full-time working week. Data were available at the national level only, so national values have been applied to sub-national levels.
- Trainees. The GOC Approved Qualifications Annual Sector Report was used to obtain the number of trainees. The number of people starting a course in the last observed year was applied to future years. It was assumed the completion rate and the completion of the scheme of registration (for optometrists) is equal to that of the pass rate for subjects allied to medicine from HESA. It was assumed that optometrists join the workforce 12 months after completing a degree to allow for time to complete the Scheme for Registration. The duration of the training is assumed to be 3 years in England until 2024, with a further year to complete the Scheme for Registration. From 2024 onwards training is assumed to be 4 years in England, which will include a Scheme for Registration equivalent.
- Overseas entrants. The number of applicants who successfully joined the fully qualified registrants under the non-UK route was obtained from the GOC international registration consultation briefing. The average of the last three years was used for future years.
Modelling of workforce expansion and skills development in optometry
All of the following predictions are taken from the UK Eye Care Data Hub5.
Overall
- Over the next decade, the optometric workforce in England is expected to grow steadily, rising from approximately 15,000 in 2025 to almost 21,000 by 2035. This represents an increase of 40%, reflecting a steady and sustained expansion of the workforce over the decade.
- Between 2025 and 2035, there is a clear and significant upward trajectory expected across all higher optometry qualifications, reflecting both professional ambition within the workforce and growing demand for higher clinical capability in primary eye care.
Glaucoma Higher Qualifications
- The number of optometrists with the Professional Certificate in Glaucoma is projected to rise from 2,530 in 2025 to 5,402 in 2035, an increase of 114%.
- Similarly, the number with the Higher Certificate in Glaucoma more than doubles over the same period, from 348 to 780 optometrists, a 124% increase.
This expansion indicates that an increasing proportion of primary care optometrists will be equipped to participate in glaucoma diagnosis and monitoring, and shared management of low-risk glaucoma patients, supporting the national shift of routine care from hospital to community settings.
Medical Retina Higher Qualifications
- The number of optometrists holding the Professional Certificate in Medical Retina is expected to increase from 3,020 in 2025 to 8,518 in 2035 – a rise of 182%.
- The Higher Certificate in Medical Retina is also expected to increase, from 42 to 70 optometrists (67%).
This demonstrates the growing population of primary care optometrists who will be equipped to provide retinal services including the management of conditions such as diabetic retinopathy and age-related macular degeneration.
Independent Prescribing Higher Qualification
- The number of optometrists with the Independent Prescribing qualification is expected to grow from 1,486 in 2025 to 3,334 by 2035 – an increase of 124%.
The increased numbers of optometrists with prescribing responsibilities will contribute to improved access to timely treatment for urgent and acute eye conditions in the community and support the management of glaucoma patients in primary care.
These trends suggest that the next decade will see a substantial rise in the number of optometrists holding higher qualifications:
- By 2035, nearly three in ten optometrists are expected to hold a glaucoma qualification
- More than 40 percent are expected to hold a medical retina qualification
- Independent prescribers will make up one in six members of the workforce, indicating a steady movement toward a more clinically skilled and autonomous profession
The modelling also suggests a marked increase in the proportion of optometrists holding advanced clinical qualifications over the next decade. The share of those with specialist credentials rises more rapidly than the overall expected growth in the workforce, indicating not just workforce expansion but a notable upskilling of the profession. These developments point to a more clinically advanced, flexible and integrated primary care optometry workforce by 2035 that is enabled to deliver advanced care, supporting national efforts to decentralise eye health services and improve access to specialist expertise within the community.
Recommendations
Based on these models, the forthcoming 10 Year Workforce Plan should:
- reflect the current and future context of healthcare delivery, particularly the growing clinical contribution of optometrists
- recognise future workforce needs and ensure continued investment in training for skills required to meet the UK’s evolving eye care demands and the shift from hospital to primary care
- make further use of the UK Eye Care Data Hub, which will be continuously updated with new data as it becomes available, to model the expected eye care workforce and patient demand
Section 3: productivity gains from wider 10 Year Health Plan implementation
See responses in sections 1 and 2, above.
Section 4: culture and values
Culture and values
Culture and values
Communication and patient collaboration
Communication and patient collaboration are core components embedded throughout Docet’s training portfolio70. Courses are designed to strengthen optometrists’ ability to engage effectively with patients, ensuring that communication is clear, empathetic, and adapted to individual needs.
Training is tailored to specific patient groups, including children, older adults, and patients with additional needs, to help practitioners provide inclusive, person-centred care. Through scenario-based learning and reflective exercises, optometrists are encouraged to involve patients in shared decision-making, support informed consent, and build trust, all of which are essential to achieving better clinical outcomes and improving patient experience.
Staff retention and wellbeing
The College of Optometrists recognises that staff wellbeing is central to workforce performance and patient care. We have a range of wellbeing resources available to all optometrists on our website71. Fostering supportive work environments, promoting mental health awareness, and embedding wellbeing into professional practice better equip optometrists to deliver safe, effective care while sustaining their own health and career longevity.
Docet’s Sound Optometry podcast includes episodes with a focus on managing stress, preventing burnout, and maintaining resilience. These resources support optometrists in identifying early signs of stress, maintaining work-life balance, and adopting strategies to prevent burnout. By promoting wellbeing, Docet helps safeguard workforce capacity and retention, ensuring optometrists can continue to deliver safe and effective patient care.
Leadership and professional value
Optometrists recognise that embedding core values — including compassion, integrity, inclusivity, and patient-centred care — into everyday practice is essential for delivering high-quality eye care and fostering a positive workplace culture. These values guide leadership, decision-making, and service delivery, ensuring professionalism, collaboration, and patient-centred approaches are consistently prioritised. The College of Optometrists supports this through targeted CPD courses, professional guidance, and resources designed to embed inclusive and responsive practice across all levels of the workforce.
The College provides a comprehensive portfolio of CPD courses to reinforce leadership, professional responsibility, and patient-centred care. Examples include the Leadership and Accountability course, which addresses ethical decision-making and clinical accountability, and Teaching Leadership in Optometry, which explores methods for developing leadership skills in students and practitioners. The CPD Hub offers additional resources — webinars, online modules, and guidance — to ensure clinicians can embed professional values into both clinical and organisational decision-making.
The College’s Guidance for Professional Practice72 underpins CPD learning, ensuring clinicians understand how to foster open, supportive environments and incorporate feedback from diverse teams into everyday practice.
Leadership and professional values are also woven throughout Docet’s CPD offer. Training emphasises ethical practice, reflective learning, and the development of leadership qualities across all levels of the profession, not only for those in formal leadership roles. These modules encourage optometrists to demonstrate leadership through clinical decision-making, patient advocacy, and contribution to service improvement. By fostering a culture of professionalism, accountability, and continuous improvement, Docet supports the development of confident, adaptive clinicians ready to lead in evolving models of eye care.
Collectively, these resources ensure that optometrists are well-prepared to lead with integrity, uphold professional values, and deliver safe, inclusive, and patient-centred care across community and integrated care settings. This supports the objectives of the 10 Year Health Plan for England, continuously upskilling the workforce to meet future demands while maintaining high standards of care, inclusivity, and patient safety.
Section 5: Any additional comments
Additional comments
Additional comments
Optometry is a clinical, highly skilled profession uniquely positioned to meet rising demand for eye care. Strategic workforce planning must recognise and support primary care optometrists, ensuring their inclusion and full utilisation within the NHS 10-Year Workforce Plan to meet local needs and expand capacity across primary and secondary care.
Primary care optometrists can ease hospital pressure, improve timely access, and deliver care closer to home. Consistent commissioning of enhanced eye care pathways and shared management of low- to medium-risk patients will help reduce hospital backlogs and strengthen long-term system resilience. The success of the 10-Year Health Plan depends on realising the full potential of primary eye care through service commissioning, investment in higher qualifications, and IT integration.
Working collaboratively with secondary care, optometrists can take greater responsibility for chronic disease management, urgent care, and prevention – delivering equitable, cost-effective care for all.
Key priorities include:
- Strategic workforce development, including investment in independent prescribing, glaucoma and medical retina qualifications, protected learning time, and expanded clinical placements
- Embedding optometrists in ICS workforce planning to maximise roles in urgent care, long-term condition management, and case-finding pathways
- Scaling proven models such as CUES and MECS to ease pressure on hospitals and GPs
- Enhancing interoperable IT systems and data infrastructure for integrated, efficient care
The College of Optometrists stands ready to work with DHSC, education bodies, and commissioners to empower primary care optometrists to deliver safe, sustainable, and equitable eye care, supporting the NHS 10-Year Health Plan for England.
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