Doctors in Scotland are bearing the brunt of apologising for system wide failings that are "simply letting patients down at all stages", BMA Scotland Chair Lewis Morrison said today.

Dr Morrison was speaking as he delivered his final report to the BMA’s Annual Representative Meeting before stepping down from his role at the end of the summer.

After leading the doctor’s union through the pandemic, Dr Morrison said the last years had been incredibly tough and that it was frankly "nothing short of a miracle" that the medical profession had endured and come through the challenges it faced.

However, he warned the direct and indirect effects of the pandemic have had the most profound impact on the physical and mental health of the profession – forcing some to leave already and many others to consider leaving medicine or seeking better terms, conditions and work life balance abroad.

In particular, Dr Morrison said the burden of having to constantly apologise to patients was having a real impact on many doctors, with NHS staff being left as the "messengers who bear the brunt for the myriad of things going wrong across the whole health system".

Setting out a series of measures needed urgently to support the medical profession, Dr Morrison in particular said honesty from politicians about the challenges our NHS faces, rather than focussing on unachievable targets, would be a start.

In his report, published in full today as the ARM enters its final day, Dr Morrison says:

"My message is simple – stop asking doctors to say sorry and give them the tools to make things better. There's an opportunity to be grasped here. If it isn’t, the medical profession and the people of Scotland will be the worse for it.

"Many of us have found ourselves saying sorry to patients and families a lot recently; most of the time we are being apologists for things that are simply not our fault. That doesn’t make it any less tough to be the messengers who bear the brunt for the myriad of things going wrong across the whole health system. And it's not just us – I know nurses, GP receptionists and all of us working in health care are in the firing line.

"We came into the pandemic with resources and staffing stretched so thin that it is nothing short of a miracle we have somehow endured. But not all of us have. The direct and indirect effects of the pandemic have had the most profound impact on the physical and mental health of the profession. Some of our colleagues are not at work because of that. Many others are considering whether healthcare in Scotland is a place in which a medical career is tenable and survivable and are considering whether other places may be better, reducing their hours or retiring earlier than they otherwise may have done. The pain of working in, and apologising for, a system that is simply letting patients down at all stages is hard to over-estimate.

"Years of underinvestment and a frankly complacent attitude to working conditions and recruitment have led us to where we are now. The rubber band that is our NHS was stretched so far and tightly before the pandemic that it has now snapped in many places. All of which might sound like an archetypal BMA moan about things being 'worse than they have ever been'. Except, of course, they are.

"So, what might be done? The first and immediate response is that if we as medics are going to have to spend years saying sorry for the state of the NHS in Scotland, we cannot be the only ones to do so. We need more honesty and frankly an explanation from Scottish Government on how they allowed the NHS to come into a pandemic so grossly understaffed and under-resourced. Why is it doctors and NHS staff who are constantly having to explain and apologise to the thousands who will wait months or years for their tests or to be seen – while politicians continue to bang on about ridiculous targets and timescales for treatment, which we all know are unachievable? The pandemic did not cause these problems whatever they might say; it simply exposed the truth and the extent of them. Some honesty about that would go a long way. It would also help us really start to get to grips with solutions."

And on looking for solutions and better support for the medical profession, Dr Morrison said focusing not just on recruiting, but also retaining staff was crucial:

"If you are going to retain staff whilst awaiting a proper recruitment plan that actually increases the medical workforce (and that's a no-brainer must do), then there's a shopping list and any action on each or all of them would make a difference.

"Don't cut our pay in real terms – as has happened for far too many years. If you want people to stay pay is a key part of the reward for doing so. It matters. Actually, do something about the pensions issue. Stop wringing hands and saying it's difficult.

"Don't prioritise clinical number crunching target-busting work over all the other things that doctors need to make their jobs and working lives fulfilling. The space to build and maintain teams, and teaching, training, research and quality improvement are not luxuries but essentials.

"Instead of leaving doctors in primary and secondary care to deal with – and apologise for - the healthcare needs of those waiting for diagnosis and treatment, actually do something to help those patients that doesn't pitch different parts of the profession against each other.

"Simple things, like hot food and drink and knowing what your hours will be more than a few days in advance shouldn't be too much to ask. Those issues got me into being a BMA rep 27 years ago, and the fact they have recently got worse not better is nothing short of scandal."

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.