We also have analysis for NHS pressures in England, Scotland, and Northern Ireland. Note that available data is not always comparable across all nations.
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 March 2023, the total number of patients waiting for treatment reached almost 627 thousand. This is nearly 2.5 times higher than in December 2012 and the highest recorded figure since records began.
As a result, waiting times for treatment increased sharply at the start of the pandemic, and they have only partially recovered. The proportion of outpatients who had been waiting more than 12 weeks stood at 53% in March 2023, compared to 25% in March 2020. Similarly, the proportion of inpatients (or day cases) who had been waiting for over 12 weeks stood at 68% in March 2023, compared to 35% in March 2020.
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
Performance against the 62-day standard, from urgent referral to treatment, continues to worsen: in the quarter ending December 2022, only 72% 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 better, though it has remained below target since mid-2022.
A&E waiting times continue to increase
Emergency care in Scotland is also facing substantial pressures. A&E waiting times show a clear post-pandemic backlog, with the percentage of people seen within 4 hours showing a decreasing trend since Summer 2020. In March 2023, it stood at 68%, well below the 95% target (which has not been met since July 2020).
The diagnostics backlog continues to grow
More and more people are waiting for key diagnostic tests. The waiting list for diagnostic tests has been steadily growing for more than a decade and increased dramatically due to the COVID-19 pandemic. In June 2023, there were more than 152 thousand ongoing waits for a key test, which is over 5.4 times more than 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% in April 2020. Since then, it has only partially recovered, and stood at 52% in March 2023.
Medical staffing (secondary care)
The medical workforce in Scotland has generally been growing, both in terms of headcount and in FTE (Full-Time Equivalent). In December 2022, there were 16,173 individual doctors employed in secondary care, or the equivalent of 14,595 full-time doctors (FTE). This is a 32% increase since December 2012, when this dataset began. Despite this growth, however, NHS Scotland is struggling to meet ever-increasing patient demand.
In addition, NHS Scotland has been struggling to recruit enough consultants. In the last decade, the number of consultant vacancies, as well as the consultant vacancy rate (the percentage of medical consultant posts which is unfilled) have grown. According to official data, there were 404 FTE (Full-Time Equivalent) medical consultant vacancies in December 2022, representing around 6.5% of all consultant posts in Scotland. Though this number is lower than the peak of 532 (8.7%) reached in June 2021, it is nearly 3 times as high as the number of vacancies in June 2012 (17 vacancies, or 3% 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
There has been a steady increase in the total number of individual (headcount) GPs in Scotland since 2011, but there has been a decline in GP partners (Performers).
Moreover, the number of FTE (full-time equivalent) GPs has been decreasing, and there are now 181 fewer FTE GPs in Scotland than there were in 2013, a 5% decrease. Additionally, since 2019, the FTE number of GPs has decreased by more than 3%. This suggests not much progress has been made on Scottish Government’s pledge to increase the headcount GP workforce by 800 by 2027.
GP practices are also experiencing high vacancy rates. During 2021/22, over one third of GP practices (37%) responding to the General Practice workforce survey reported a vacancy at their practice; the overall vacancy rate was 8.7% (8.7 vacant GP sessions for every 100 total GP sessions). This is a slight increase since the 7.7% vacancy rate seen in 2018/19.
At the same time, the number of patients continues to rise year on year. In 2022, there were 5.9 million patients registered with GP practices in Scotland, 6% more than in 2013.
This results in an ever-increasing workload for GPs. A single full-time GP is now responsible for 1,687 patients – 172 more than in 2013, amounting to an 11% 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.