Startling workforce gaps show why SAS doctors cannot be left behind on pay 

Hello again everyone!

I said in previous blogs I would keep you up to date with our pay discussions with Scottish Government. Unfortunately, at this stage there has been no substantial progress not least as the Scottish Government has been distracted by the change in First Minister. But there is some good news as Neil Gray will be continuing as Cabinet Secretary for Health, meaning that we do not need to start the conversation from the beginning.

Mr Gray’s long-awaited mandate on pay – which he says includes the pay metric and is crucial to beginning talks, has been further delayed, and the Scottish Government is unwilling or unable to start discussions before this is in place. Please be assured that we have, and continue to, make the point that this time scale is unacceptable, and that doctors in Scotland are getting increasingly angry and that industrial action, while always a last resort, is becoming an increasing possibility.

Putting the situation in Scotland into an even starker light, the SAS Committee in England have received an improved offer from the Westminster Government, which they feel is sufficient to put to a ballot. At BMA Scotland we’ll be analysing the offer, and its impact here if it is accepted. However, it does open the possibility that headline pay for Specialists would be higher in England than in Scotland, and we will need to assess whether take home pay for Specialty Doctors would then be higher at every pay point.

While there are many great things about living and working in Scotland, being paid less than a colleague in England while working in an NHS under huge financial pressure is definitely not one of them. Other elements of the offer are also worth considering such as new Specialist posts being advertised internally in the first instance as a way of improving progression for Speciality doctors. This is definitely something we have and continue to be keen to explore in Scotland.

This whole situation will not improve the recruitment and retention crisis in the Scottish NHS. Alan Robertson, Chair of Scottish Consultants Committee, has already highlighted the true vacancy rates figures from the recent BMA FOI inquiry.  While numbers are startling for consultants the numbers are even higher for SAS doctors. Currently vacancy rates are over 20% for our grade, and a significant number of these unfilled posts are not even under active recruitment, so departments and services are running with vacancies that they are simply not able to fill.

This kind of permanent mismatch between demand and capacity illustrates the strain our NHS is under and the knock on effect is felt by patients, but also doctors who are simply not able to always deliver the quality of care they want to, through no fault of their own. In the vacancies our FOI exposed, nearly 25% are covered by locum staff, which means insecurity for the doctor, expense for the Health Board and no continuity for patients. It simply isn’t an effective or efficient way to run a health service.

As a starting point, I urge the Scottish Government to finally start recording and properly monitoring the SAS workforce – and that includes a full and proper measure of vacancies. Only by doing so can we actually start planning the workforce we need and mapping that against demand.

That will also help us solve the issue of the vacancies themselves. On that, while improved pay will not solve all of these issues, as there remains a doctor shortage in the UK, it would clearly help Scotland compete and meet the Scottish Government’s aspiration of making Scotland the best part of the UK to be a doctor. It is also a relatively simple starting point – and one we can build on to actually finally deliver properly for doctors and make jobs more fulfilling and the NHS a better place to work. Without this action, we face these gaps in the workforce simply getting worse.

Dr Sine Steele is Chair of BMA Scotland’s Specialist, Associate Specialist and Specialty Doctor Committee