Extended Roles for Nursing and Non-Medical HCP

Ophthalmology services are in serious difficulties due to demand for care being greater than the service capacity we have.  It is crucial that we optimise our use of the whole multidisciplinary clinical team and many units are pursuing or wish to pursue expansion of roles and use of non-medical workforce at the top or their skill set and abilities. However, there is no overall national plan or support for this work, and units and staff are often working in isolation to try and achieve change. The joint Royal College of Ophthalmologists, College of Optometrists and BIOS national OCCCF (Ophthalmic Common Clinical Competency Framework) training for hospital based non medical staff is due for launch later in 2019 which should help to offer some consistency in training for key areas of glaucoma, AMD, cataract and emergency care.

The UKOA is undertaking work to try and improve this situation and provide practical help to units and practitioners to change to achieve what they need to deliver safer care using the whole team well.

We have collected numerous examples of protocols, policies, competencies, guidelines and other documents from around the UK. These are being used to create editable generic national documents and packs for implementing advanced practice and extended roles in all UK units – containing details of training, competencies, supervision, protocols for care and risk assessments. We recommend you edit and amend these packs with your own trust details and requirements as required.  We have published documents for non-medical advanced practice for paediatric clinics, intravitreal injections and cataract pre- and post-op clinics, have draft documents on botulinum toxin injections and community cataract pathways, and will shortly upload draft documents on external/corneal clinics, YAG laser procedures and surgical care practitioners.


UKOA Paediatric Disease and Subspecialty Specific Competency Sign Off Documents – WORD Version

UKOA Cataract clinics practice pack – WORD version

UKOA Botulinum toxin injection practice pack

UKOA YAG laser capsulotomy practice pack

UKOA Paediatrics practice pack

UKOA Intravitreal Injections practice pack – WORD Version

UKOA Clinical practice pack for non-medical practitioners:  Corneal cross linking – PDF Version

UKOA Clinical practice pack for non-medical practitioners:  Corneal cross linking – WORD Version

UKOA Glaucoma laser treatment practice pack>

UKOA DRAFT PRACTICE PACKS: for comments and input from members please:

UKOA Glaucoma level 1 practice pack

UKOA Glaucoma level 2 practice pack

UKOA Glaucoma level 3 practice pack

UKOA PERI-OPERATIVE & SURGICAL PRACTICE: for comments and input from members please:

Surgery and perioperative practice pack 

UKOA Surgery and perioperative practice pack competencies and protocols 


UKOA Community optometry cataract specification

UKOA Community optometry cataract protocol

Moorfields Community optometry cataract patient leaflet

UKOA Community optometry cataract pathway

Our NATIONAL SURVEY on EXTENDED ROLES and ADVANCED PRACTICE for non-medical staff has completed initial, the survey is now closed. Analysis of the findings is being undertaken and will shared due course. Please email us if you would like to submit details of the work in your unit.

This extensive survey will be published and used as a basis for informing safe expansion of roles through shared consistency in banding, protocols, practices, training and competencies.

Please share with us any documents you have, get in touch to join in the work, or let us have any comments or suggestions on this workstream by emailing ukoa@rnib.org.uk

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