A workforce in crisis

Thursday 6th December 2018

Figures published this week by Scotland’s Information Services Division (ISD) on workforce planning for psychological services, the NHSScotland and CAMHS workforces have been met by a myriad of voices reiterating concerns that Scotland’s health service is very much in the midst of a staffing crisis.

Part three of the Government’s national health and social care workforce plan, published in April 2018, declared primary care services were in a strong position to respond to the changing and growing needs of Scotland’s population.

The warnings issues in response to this week’s workforce statistics stand in stark contrast to this assertion from Government. Two important voices for Scotland’s doctors, the British Medical Association (BMA) and Royal College of Physicians of Edinburgh (RCPE), have said Scotland’s healthcare workforce is far from being in a sustainable, let alone strong, position to meet the demands being placed upon it.

The BMA has said consultant vacancy numbers may be much higher than the ISD figures let on, while the General Medical Council has published research that sets out serious concerns about the effect of staffing shortages on the current workforce and the care provided to patients.


Within the broader workforce statistics published this week, six territorial NHS boards reported a decrease in staff numbers since 2017, while the rate of overall growth of staff employed by NHSScotland has slowed after seven consecutive years of annual growth.

A decrease of 8.7% over the past year in the number of medical and dental consultant vacancies is noted, creating the lowest vacancy rate since December 2016. For nursing and midwifery, eight territorial boards reported a reduction in qualified staff in post and 5.3% of posts across Scotland were vacant compared to 4.8% in September 2017.

The Conservatives have reacted to the medical staff training statistics published as part of the broader workforce numbers by warning the “GP crisis is set to worsen as doctors in training hit a 5-year low”. Noting a 2.1% drop since September 2017, Scottish health spokesperson, Miles Briggs, said: “These figures are going in the wrong direction at the worst possible time. We are in the grip of a GP crisis, while hospitals right across the country are struggling for doctor numbers”.

Scottish Labour health spokesperson, Monica Lennon, also declared the NHS was facing a “workforce crisis” with 2,794 unfilled posts across nursing, midwifery and consultant posts, and accused the Government of failing to plan properly while overworking current staff.


Both the British Medical Association (BMA) Scotland and the General Medical Council (GMC) have made their concerns clear. Research commissioned by the GMC and included in its report – The state of medical education and practice in the UK 2018 – draws attention to some of the steps taken by doctors to try to cope with patient numbers.

Chair of the GMC, Professor Sir Terence Stephenson, warned: “Doctors are telling us clearly that the strain that the system is under is having a direct effect on them, and on their plans to continue working in that system.”

Responding to the report, President of the Royal College of Physicians of Edinburgh (RCPE), Professor Derek Bell, said:

The GMC reinforce what the RCPE have been highlighting for years – that rota gaps in the UK are a major challenge for the medical workforce…While recruitment into medicine is vital, the UK Government and devolved administrations must pay equal attention to retention and training…It’s simply unreasonable to expect doctors to work under current conditions and pressures”.


Meanwhile, the BMA has said the pressures and concerns highlighted by the GMC’s report echo its own warnings about the scale of the workforce crisis. Highlighting a survey carried out by the BMA earlier this year which found 90% of doctors who responded said system pressures prevented the delivery of safe patient care, council chair of the BMA, Dr Chaand Nagpaul, cautioned many members of staff were working beyond their rostered hours, compounding a “completely unsustainable situation”.

The BMA also published its own analysis to demonstrate consultant vacancies in Scotland “are likely to be substantially higher than official figures show”. Claiming the actual vacancy rate may be 13.9% and not 6.8%, as stated by ISD, the BMA has attributed the difference to vacancies not filled through the recruitment process that have been temporarily removed from the overall established figure.

Dr Simon Barker, Chair of BMA Scotland’s Consultant Committee said:

Behind these figures are senior doctors who are pushed into covering the work of these vacant posts. These are professionals doing their absolute best, but under these conditions we risk burnout and stretching people beyond their limits.

We need urgent action to encourage people to enter the medical profession and…retain those who have dedicated their professional lives to this demanding career. A key first step to that must be having a full and accurate picture of the data available.”


We will need to wait until next week’s budget announcement to see whether Cabinet Secretary for Finance, Economy & Fair Work, Derek Mackay, offers any further financial assistance to try to address workforce issues. In January 2019 the Scottish Government publishes the long-awaited integrated health and social care workforce plan. Minister for Mental Health, Clare Haughey has given assurances a delivery plan related to all mental health commitments, included in the most recent Programme for Government, will be published by the 21st December. An update on the allocation of additional mental health professionals in a variety of healthcare settings is also not due until “early 2019”.