Scotland's health secretary is promising to work with doctors to develop a plan that ensures Scotland has the right medical workforce to meet its healthcare needs in the years to come. The commitment comes following the completion of the first stage of the government's Future Medical Workforce project. But the doctors’ trade union says it is concerned too little is being done in the meantime to get the basics right.

In the summer, the government kicked off what it called a ‘national exploratory initiative’ to examine what a future medical workforce should look like, led by an advisory group that included representatives of the NHS, regulators and medical royal colleges.

In August it issued an invitation to doctors at every stage in their career to help shape reforms to the profession, with over 2,000 taking part in a national survey and focus groups.

Speaking following the publication of a report into the initial engagement phase, Health Secretary Neil Gray thanked doctors for their "invaluable honesty and insight" saying their views will help shape the decisions to come:

"The next phase of this project will turn these insights into action, working in partnership with the profession to deliver meaningful change that supports the medical workforce and improves care for patients across Scotland," he said.

The report outlines significant challenges faced by the profession as it seeks to deal with balancing increased workloads with ensuring every doctor has access to the training and support they need at each stage in their career.

The report’s authors heard that the pressure on the NHS is leading to an ‘erosion of respect’ for the role of doctors, not least as they are seen as the ‘gatekeepers withholding access to services in the context of waiting lists and under-resourced services’.

Doctors, the report says, ‘describe the moral injury of being left to face the blame, distress and backlash when there are inadequate services, delays or cancellations, while managers are hidden from view’.

The report acknowledges that, although workforce numbers have increased, productivity has not returned to pre-pandemic levels. While accepting the long term potential of AI and technology to address that, respondents suggested that the priority, given the current outdated and poor IT infrastructure many doctors are having to use, had to be to ‘get the basics right first’.

The report found three quarters of respondents agreed that the role of a doctor may need to change in the coming years, but many struggled to define what their work – and the NHS – will look like in even 15 years’ time. Others were sceptical about NHS reform, questioning whether ambitions to deliver more care closer to home and improve remote and rural services, can be realised.

An honest reflection

Professor Andrew Elder, Chair of the Academy of Medical Royal Colleges and Faculties in Scotland welcomed the report, and the high level of engagement behind it, saying:

“Whilst multi-professional working is key to delivering high-quality care, we welcome the clear focus on the role of the doctor, and the report accurately and honestly reflects both the hopes and detailed concerns of doctors and underlines the central contribution they must continue to make to patient care.”

The doctors trade union, the BMA, says that while it is pleased that the process of long-term workforce planning that they have long called for is now underway, it must not be a delaying tactic.

Dr Nora Murray-Cavanagh, Deputy Chair of BMA Scotland said, with the first stage report having set out the issues "in black and white”, action must now follow to address them:

"With an election approaching, and stage 2 of this work not starting until the new year, we are deeply concerned this whole project will ultimately turn out to be a listening exercise which won’t deliver the solutions and practical work we urgently need.

“The report rightly acknowledges the complexity of the issues, but these are far from new problems and have been allowed to develop over a period of time due to inadequate planning.

“That means we are beyond the point of simply setting out the scale of the challenge.

“We will engage fully with stage 2 of this work and will be pushing to ensure this finally is the moment the Scottish government addresses medical workforce planning effectively. That means dealing with the issues this report identifies and, crucially, mapping demand against factors including population growth and health to ensure empowered doctors working in well-staffed teams are at the heart of an NHS that is sustainable in the long term.”

Phase 2 of the project begins in January. The government says this second phase will focus on supporting clinical teams, improving workforce planning, redesigning training pathways and understanding the opportunities associated with redesigned services.

From the outset, ministers have acknowledged that, given how long it takes an individual from beginning medical school to reaching a consultant level role, decisions taken now will influence the shape and size of the medical workforce in 2045.

 

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