Workforce planning for Scotland’s NHS is woefully sub-standard, with substantial shortages in the medical workforce nationwide a BMA Scotland publication has revealed.

Vacancy heatmaps, one for general practice and one for the consultant workforce, published today show that Scotland – as a whole – is significantly under-doctored and that no part of the country is immune to the challenges of recruiting and retaining doctors we need to care effectively for the people of Scotland.

Dr Iain Kennedy, chair of BMA Scotland, said he believes the heatmaps contextualise the longstanding and increasing medical workforce crisis facing the NHS in Scotland.

The heatmaps highlight:

• Problems are being acutely felt across both primary (GP, community based) and secondary (consultant, hospital based) care. Improvements must be made in both: one cannot operate effectively without the other and it is vital that we look at the NHS as a whole package.
• GP WTE vacancy rates range from 3.3 (GGC) to 12 (Orkney), with Shetland at 25 as an outlier – per 100,000 population.
• WTE Consultant vacancies range from 3.4 in the Borders to 40 in the Western Isles per 100,000 population. Other areas that are particularly struggling include the Highlands (30) Grampian (24.5) and Lanarkshire (21.5)
• There is a stark discrepancy between rural and urban, with health boards with greater rurality generally also having higher vacancy rates – however for consultants there may be other factors at play around different specialties and where they are based.

BMA Scotland is calling on the Scottish government to recognise these significant problems and build on our publication, be honest about the shortfall of doctors we have in our NHS and record actual vacancies across primary and secondary care, develop and deliver targeted solutions and begin the process of better workforce planning to improve recruitment and retention, and secure the future of Scotland’s NHS. The Scottish government must also move forward with its pledge to publishing projections of required workforce growth across health and social care – a commitment it made in its National Workforce Strategy and recent DDRB submission.

Dr Kennedy added: “These heatmaps show that while some places are faring far worse than others, these are all just different shades of bad. All areas are struggling with large workforce gaps – some are struggling more than others, but crucially what the heatmaps indicate is that no area is not facing a medical staffing crisis.

“It should be noted that the workforce crisis in GPs is actually more acute than depicted – this is because the Scottish government’s commitment to expand the workforce by 800 GPs by 2027 is desperately behind schedule, as stated by Audit Scotland earlier this year. We believe we need at least 1000 WTE additional GPs now, and if the government’s promise of 800 extra GPs were expressed as vacancies right now, the overall picture would better reflect the reality of the crisis the profession is in.

“Of course, the necessary funding and planning to recruit these GPs is not in place, so practices – while they have the workload to accommodate at least one more GP – aren’t able to bring in the GPs they need, hence they don’t show as vacancies.

“Despite the challenges they are facing, GP practices are providing more than 700,000 appointments a week for the people of Scotland – yet they are doing it with considerable gaps across the workforce. But they are demoralised and overworked, and there simply isn’t enough of them – they need urgent support, and these maps should both illustrate that and help plan for the future.

“The stark difference for both primary and secondary care between rural and urban areas is not new – but it is clear that we need a plan to urgently address these issues and the impact of rurality, while also acknowledging the serious problems being faced in the central belt boards. Just this week the Scottish government published its consultant vacancies stats that we do not believe reflect the full extent of the workforce shortages – with our own FOI data suggesting the vacancies are double that of the official figures.

“We are publishing these heatmaps just days before the junior doctors in Scotland reveal whether or not they will accept the pay offer made to them by the Scottish government – however whatever way they decide, their strong mandate for strike action remains in place for several more months, and these maps ultimately show what years of failing to properly plan to recruit and retain the medical workforce we need results in. Junior doctors are the senior doctors of the future – long-term there is no prospect of the picture these heatmaps represent improving if they do not feel properly valued.

“We hope these maps will be a starting point for the Scottish government to finally start seriously considering this particular aspect of medical workforce planning, and how we need to be flexible and adaptable from area to area, and across primary and secondary care. We desperately need to have a national conversation on the future of our health service and what we ask of it – only through having this open and honest discussion can we start to build a consensus around what we want our NHS to deliver, and effectively plan how we ensure it is staffed for a sustainable future.”

Notes to editors

The heatmaps can be found at the following links:

Full details on BMA website: Medical workforce heatmaps for Scotland (bma.org.uk)

GPs heatmap: https://public.flourish.studio/visualisation/12662872/ 

Consultants heatmap: https://public.flourish.studio/visualisation/12663449/