NHS under pressure - Scotland

This page is an overview of the main pressure points in the Scottish NHS.


NHS pressures waiting list

We also have analysis for NHS pressures in England, Scotland, and Northern Ireland. Note that available data is not always comparable across all nations.

Last updated in 11 April 2024


NHS backlog

Like other UK nations, Scotland is facing a significant backlog of care exacerbated by the pandemic, with waiting lists increasing sharply in March 2020 and growing fast ever since.

Waiting lists continue to grow

Elective care in Scotland is facing severe pressures. Waiting lists for both outpatient and inpatient treatments in Scotland increased sharply after the start of the pandemic and have continued to grow since.

In September 2023, the total number of patients waiting for treatment reached almost 684,000, the highest recorded figure since records began. This figure reduced slightly in December 2023, when there were over 680,000 patients waiting for treatment.

The proportion of outpatients who had been waiting more than 12 weeks stood at 60% in December 2023, compared to 27% in December 2019.

Similarly, the proportion of inpatients (or day cases) who had been waiting for over 12 weeks stood at 68% in December 2023, compared to 33% in December 2019.

However, even before the pandemic, the proportion of people waiting for over 12 weeks had been increasing, indicating that pressures on elective care preceded the pandemic.

Patients are waiting longer for cancer treatment

Services continue to operate significantly below the standard of 62 days from urgent referral to starting cancer treatment. In the quarter ending December 2023, only 71% of eligible people received treatment within this target, compared to 84% in December 2019. The 95% target for this measure has not been met since this data collection began in January 2012.

Performance against the 31-day standard, from decision to treat to treatment, is generally much better, with 94% of patients receiving their first cancer treatment within 31 days from the decision to treat in the quarter ending in December 2023.



A&E waiting times continue to increase

Emergency care in Scotland is also facing substantial pressures. A&E performance was already a major challenge prior to the COVID-19 pandemic: The A&E target of 95% of patients being admitted, transferred or discharged within 4 hours of arrival had not been met since July 2017.

However, from summer 2020 onwards, performance against the target has been worsening, reaching a low of 62% in December 2022. There has been little improvement in A&E waiting times since then. In February 2024, 67% of patients were admitted, transferred or discharged within 4 hours of arrival at A&E.


The diagnostics backlog continues to grow

The waiting list for diagnostic tests had been steadily growing for more than a decade and then increased dramatically due to the COVID-19 pandemic. In December 2023, there were over 144,000 ongoing waits for a key test, which is over 5 times as many as in September 2007 when records began.

People are also waiting longer for tests. Performance against the six-week wait standard had been declining in the years leading up to the COVID-19 pandemic and plummeted to 28.4% in April 2020. Since then, it has only partially recovered, and stood at 48.5% in December 2023.





Medical staffing (secondary care)

The medical workforce in Scotland has generally been growing, both in terms of headcount and in Full-Time Equivalent (FTE). In September 2023, there were 16,749 individual doctors employed in secondary care, or the equivalent of 15,058 full-time doctors (FTE). This is a 33% increase since December 2012, when this dataset began. Despite this growth, however, NHS Scotland is struggling to meet ever-increasing patient demand.

In the last decade, the number of consultant vacancies, as well as the consultant vacancy rate (the percentage of consultant posts which are unfilled), has grown. According to official data, there were 439 FTE (Full-Time Equivalent) medical and dental consultant vacancies in September 2023, representing around 6.9% of all consultant posts in Scotland. Though this number is lower than the peak of 532 (8.7%) reached in June 2021, it is more than 3 times as high as the number of vacancies in June 2012 (137 vacancies, or 3.1% of all posts).

The actual number of vacancies is likely to be even higher. In December 2022, BMA Scotland conducted FOI requests, which revealed that consultant vacancies are likely twice as high as official rates suggest.

There is also significant regional variation when it comes to consultant vacancies. For example, in June 2023, there were nearly 12 times as many consultant vacancies relative to the population in the Western Isles than there were in Borders.

Another key pressure point is agency spend on medical staff, which in 2023-24 prices, has increased by 10% in the past year – rising from £111.8 million in 2022 to £122.6 million in 2023.


Pressures in general practice

The overall number (headcount) of individual GPs in Scotland is increasing, with an addition of 271 GPs since 2017. However, this still suggests that the Scottish Government is not on track to meet its pledge to increase the headcount GP workforce by 800 by 2027.

Moreover, the number of FTE (full-time equivalent) fully qualified GPs has been decreasing, and there are now 197 fewer FTE GPs in Scotland than there were in 2013, a decrease of more than 5%.

The number of GP partners (performers) continues to fall. Since 2010, the number of GP partners has reduced by 628 to 3,151 in 2023.


GP practices are also experiencing high vacancy rates. During 2022/23, 42.3% of GP practices responding to the General Practice workforce survey reported a vacancy at their practice.

At the same time, the number of patients continues to rise year on year. In 2023, there were nearly 6 million patients registered with GP practices in Scotland, 7% more than in 2013.

This results in an ever-increasing workload for GPs. A single full-time GP is now responsible for 1,715 patients – nearly 200 more than in 2013, amounting to a 13% increase.

This problem is compounded by Scotland’s aging population, which comes with a growing burden of disease. The number of patients aged 65 and over has increased by 24% since 2008.

Please see our Sustainability crisis in General Practice in Scotland page for more detailed analysis.