Associate Feature: We are long past the time for action

Our NHS is in a precarious state. We’re barely into autumn yet we’ve been in the middle of winter pressures since early summer. Our hospitals are full. We don’t have enough beds. We don’t have enough doctors. We don’t have enough nurses. We are on our knees.

In the few weeks since I was elected chair of the BMA’s Scottish Council I’ve had countless colleagues tell me how concerned they are about the future of Scotland’s NHS. There is absolutely no doubt about it: the NHS is in crisis.

As I see it, there are five key priorities (indeed five major crises) that must be urgently addressed if we are to get our NHS to where we want it to be. And a wider discussion needs to be had about what exactly we want from our NHS and what it can be expected to deliver within its current limitations.

Top of the list for almost every doctor I’ve spoken to is pay – doctors have been given a pay award lower than what has been offered to all other NHS workers. Doctors are also in the unique position where they cannot reject the pay award, unlike our colleagues in other parts of the health service. Like everyone else at this time, it is a substantial real-terms pay cut – and that comes following a long period of sustained pay erosion, so it’s little wonder doctors feel devalued and unsupported. 

Another major issue impacting doctors is pensions: too many senior doctors are being forced to give up working for the NHS earlier than they are ready, or cut their hours, due to the ridiculously complicated and counter-intuitive pension tax rules that end up penalising them for extra work. This is ultimately a matter for the UK Government, but we desperately need the Scottish Government to do all it can within its limitation to mitigate the impact. We cannot afford to lose any more doctors but unless this is fixed permanently, we will see an exodus of senior doctors sooner rather than later.

Affecting all healthcare workers across the NHS is working conditions. It covers a myriad of issues, both large and small, and will mean different things for different parts of the workforce. But simply put the NHS must be a better and more enjoyable place to work. Staff deserve a more supportive culture and steps need to be taken to help workers do their jobs. That might be getting a locker to store your things, hot food out of hours, easy and safe access to parking, better rotas (delivered on time), or feeling safe to speak out on issues such as bullying. These things affect how we – doctors – and our colleagues feel, and all will help us more effectively look after patients.

Workforce is a major concern: I’ve mentioned it above – we don’t have enough people. Years of ineffective workforce planning has now left us dangerously short of doctors in hospitals and general practice. NHS Scotland lacks meaningful workforce data in primary care, consistently undercounts senior doctor vacancies. We are long past the time for action – and we know it’s patients who are suffering as a result.

And finally, workload – it’s tied closely to workforce of course. The fewer people we have, the more we struggle to cope with spiralling workloads. As a working GP I hear and see it regularly from colleagues, and anyone working in healthcare knows the scale of the challenge in our hospitals, with backlogs building up and waiting times lengthening. The risk of burnout is high as everyone is going above and beyond what can reasonably be expected of them.

So that’s where we are – it’s grim reading, but it is the state of our NHS.

This article is sponsored by BMA Scotland.