Which deanery should you apply to for ophthalmology ST1?

There is one round, and it is national

The Royal College of Ophthalmologists puts it plainly: "National recruitment to OST is coordinated by NHS England South West on behalf of the College." There is one application, assessed one way, and it is not submitted to a region.

This catches people out because most of the rest of medical training does not work like this, and because the language has not caught up. Candidates still talk about applying to the Severn deanery or the North West deanery, and the regional schools of ophthalmology still exist and still run the training. What no longer happens is a separate application to each of them.

So a search for ophthalmology ST1 in a particular region is a reasonable thing to type and a difficult thing to answer, because the honest answer is that the region is not a thing you apply to. It is a thing you rank.

What you actually choose, and when

You apply once. Later in the process, once posts are known, you preference them: the College confirms that "Applicants can preference posts across England, Scotland, Wales and Northern Ireland."

Two consequences follow, and they are the reason this distinction is worth understanding rather than just noting. The first is that geography costs you nothing at application. Preferencing a post in one region does not reduce your chance of another, because you are ranking a list rather than choosing a door.

The second is that your score is what decides which of your preferences you get. Preferencing is how you say what you want; the self-assessment and the interview are what decide how much of that list you can actually reach. A candidate who scores well and preferences widely has a real choice. A candidate who scores poorly and preferences narrowly may have none.

What genuinely differs between regions

Three things, and all three matter after you have a number, not before.

• Where you live and work for seven years. OST is run-through from ST1 to ST7, so this is not a rotation you re-choose in two years' time. It is the longest-running consequence of the whole application.
• Which hospitals are in the rotation, and therefore what subspecialty exposure and surgical volume you get, and how far you drive to get it.
• How many posts each region has in a given round. This is published with the vacancy list each cycle and changes year to year, so it is worth reading the current list rather than a figure from a guide written for a previous round.

What does not differ, and it is nearly everything else

The application form is the same. The self-assessment domains, the caps and the point ladders are the same. The evidence rules are the same. The person specification is national. The interview is the same interview, held centrally.

This is worth stating flatly because it changes what preparation is worth doing. There is no regional variant of the portfolio to prepare for, no deanery whose interviewers weight things differently, and no version of the scoring you can optimise for by picking somewhere less popular. The work that improves your position is the same work regardless of where you want to end up.

Competition is published nationally, not by deanery

NHS England publishes competition ratios for every specialty, and for Ophthalmology ST1 it publishes one row for the whole round. In the 2025 round that row read 2,197 applications for 102 posts, a ratio of 21.54.

There is no official per-deanery ratio for ophthalmology, which is the second reason this page is one page. Anyone offering you a regional competition figure has either computed it from something that is not published or is quoting a different specialty. Treat a specific regional ratio with suspicion unless it names its source.

What the national figure does tell you is the shape of the problem. At roughly twenty applicants per post, the difference between an offer and no offer is made in the self-assessment score and the interview, and geography is a question you get to answer only after that.

So what should you do with a region in mind?

Keep the region, and stop treating it as an application decision. Visit if you can, ask the trainees there what the rotation is actually like, and note which posts you would rank highly when the list appears. None of that is wasted, and all of it is more useful at preferencing than it is now.

Then spend the preparation time on the thing that decides whether your preferences are worth anything. Score your portfolio honestly against the real domains, early enough that the gaps you find are gaps you can still close, and prepare for the interview that everyone sits regardless of where they want to work.