We’re now way beyond crisis point within our NHS – I know saying this to you, my colleagues, is like telling you grass is green or water is wet, but I feel even now, it cannot be said enough. I don’t truly believe the severity of the situation has sunk in with the higher powers, and so I will keep on saying it until it is finally, properly acknowledged.
Our recent BMA Scotland doctor vacancy heatmaps contextualise the longstanding and increasing medical workforce crisis facing the NHS in Scotland. Everything is simply just a different shade of bad right now – what they indicate, crucially, is that no area in Scotland is not facing a medical staffing crisis. Again this is something you already know – after all, you are living it every single day that you go to work and realise once again there is another gap in the rota, another session that needs to be covered, another locum that has to be called in.
The situation we are in – where doctors, and indeed the wider health service staff, are facing extreme burnout, where our patients don’t know how long they’ll be waiting for an appointment or an operation they may have already been waiting months or years for – is simply unthinkable, and yet here we are. Six years ago the Scottish government acknowledged the GP workforce needed to increase by 800 across the country by 2027 – numbers are dwindling and now colleagues in the BMA’s Scottish GP committee are telling me we need at least 1000 more – at least. And this year’s Audit Scotland report indicated that actually – despite the Scottish government claiming to be “on track” – only an additional 113 GPs have been recruited so far. In six years.
As it stands 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. I see colleagues who have put blood, sweat and tears into their jobs who are demoralised and overworked.
Our consultant colleagues across secondary care face the same problems. The only certainty that comes with each working day is that there isn’t enough time to get all the work done. A BMA Scotland FOI of Scotland’s health boards at the end of last year suggests there are 937 vacant consultant posts – that is enough people to staff an entire hospital. Just last week the Scottish government released its official workforce stats and as usual we do not believe they reflect the full picture. I know it is difficult for colleagues to stomach reports of record numbers of staff when we are all aware of the reality.
And while our heatmaps pointed out that the stark difference for both primary and secondary care between rural and urban areas is not new – they have made it startling clear that we need a plan – or rather the Scottish government needs a plan – to urgently address these issues and the impact of rurality, while also acknowledging the problems being faced in the central belt boards.
The system is buckling under extreme pressure – and we know it’s going to get worse in the next few weeks with the confirmation that our junior doctor colleagues will take strike action for 72 hours in July after they rejected a sub-inflationary pay offer from the Scottish government. I support our junior colleagues 100% in their fight to reverse pay erosion – they have suffered years of real-terms pay cuts, while working well above and beyond their grades in many cases, and while I share their hope that strike action might still be avoided, the withdrawal of services is the result of a complete failure to value and treat this key part of the NHS workforce properly or fairly over an extended period of time.
If these heatmaps and impending strikes do not signal an urgent need for the Scottish government to finally start seriously considering this particular aspect of medical workforce planning, along with proper remuneration, and how we need to be flexible and adaptable from area to area and across primary and secondary care, then there is no prospect of the picture these heatmaps represent improving at all. More strikes will happen, more people will leave.
We desperately need a national conversation on the future of the NHS in Scotland – an open and honest discussion that includes the public, to consider what the NHS can realistically offer under its current limitations, while ensuring it remains free at the point of need.
Right now we are struggling. There simply isn’t enough of us – that’s the long and short of it. I fear we are running on empty and we are not getting the support or understand we truly need. I am worried for what the short, medium and long-term futures hold. I am worried that bad behaviours will start to resurface as tensions run high and unmanageable targets are placed on the heads of hard-working staff. And so with that in mind, I think ahead to my inaugural ARM speech as BMA Scotland chair: poor behaviour – whether that be bullying, harassment or simply not supporting staff in our NHS is still a problem, and with rising staff vacancies and increased levels of demand from patients, I know colleagues will find themselves experiencing or witnessing behaviour they are concerned about. I want to ensure voices are heard and commitments are made to improve these situations – so I would ask you to spare a few minutes of your time to fill in a short and anonymous survey, highlighting your own experiences of witnessing and/or raising concerns around behaviour in the workplace. I have to be honest – I still fear the culture in our NHS neither values or even supports people who genuinely want to speak out and raise concerns. We are still far too focussed on blame rather than learning. But I need you to tell us that’s the case so we can highlight it and push for the change we need.
On a final note, I want to thank you all for everything you do to keep our NHS running as best it can during these truly trying times. Without you it wouldn’t exist at all.
Dr Iain Kennedy, chair, BMA Scotland
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