Responding to the Scottish Government’s NHS Recovery Plan published this morning, BMA Scotland chair Dr Lewis Morrison, said:

 “That the Scottish Government has produced a recovery plan for the NHS is something we generally welcome. It goes some way to honestly acknowledging the scale of the problem NHS Scotland, and its staff, is facing. We must remember that we came into the pandemic already facing many of the problems the report outlines, which Covid has only exacerbated. This has to be a recovery plan full stop, not just one from Covid, and one which acknowledges the years of understaffing and under resourcing that are the backdrop to where we are now.

The evidence is clear the NHS is struggling and close to failing in places. It’s August, not winter, and elective work is being cancelled, A&E waits are high in places and demand for GP time has spiralled. As importantly many staff are simply exhausted after the last 18 months and any plan that asks even more of those staff will make that worse.

“Supporting staff is the first substantive chapter in this report and this does show that taking welfare concerns seriously has to remain front and centre of our approach to recovery.

“The plan puts significant emphasis on recruitment from overseas to build capacity, but there is a risk of over-reliance on that and other countries need their own doctors too. Expecting doctors from other healthcare systems to come here and “hit the ground running” isn’t practical or fair to them. Many will need time and support to orientate to a new country and a new healthcare system, not be thrown into the melee from day one.

“The crucial omission from this report is any plan to retain current staff, and how to address the huge vacancy crisis affecting many parts of the profession. We desperately need new staff too, but they won’t appear overnight, and focussing only on those newly recruited risks dropping the ball on measures to make ensure those currently in post have jobs that are sustainable and people won’t need to retire, leave or reduce their hours.  This means improving work-life balance, addressing years of pay erosion, pension taxation problems as part of ensuring doctors feel truly valued.

“The lack of explicit acknowledgement of the staff shortages is disappointing. We cannot hope to deliver what is currently demanded of our NHS – let alone an extra 10%. Striving to meet this commitment is unrealistic without the staff to do it, and it risks simply driving existing staff harder. That won’t work and it risks damaging those staff and making retention issues much worse.

““The plan rightly also focusses on primary care – and what support is in place for GPs. However we need to be clear that GPs, as with clinicians in other parts of the healthcare system, are having to manage overwhelming demand and ensure patient and staff safety. In that context they are already seeing patients face to face where appropriate and we must continue to allow those careful judgements to be made. We didn’t have enough GPs before the pandemic, and workload from Covid illness in the community, which is currently rising rapidly, falls on GPs both in and out of hours. We have to be careful of not making an already difficult situation worse and fuelling the already worrying increase in abuse GPs and their staff are facing.

“Similarly Video triaging in secondary care is also very complex – it could potentially result in multiple appointments for individual patients. Creating extra work unnecessarily is a real risk. It should not be for any government to tell patients and doctors how they must be seen, but for doctors and their teams and patients to agree the best way for their problems to be dealt with.

“Overall – this plan is in many ways only a start. It contains some good things, some things that need much more discussion, but it also has many worrying gaps. We need to see what it means in reality and additional plans for what is missing. Above all I would just encourage everyone to be honest, open and patient as we work together to help healthcare recover from what has been a hugely challenging period.”