Future Medical Workforce Project: phase 1 report

Joint Foreword

Earlier this year, we published the Population Health Framework for Scotland alongside our Service Renewal Framework for health and social care in Scotland for the next 10 years.

These documents highlight the challenges Scotland faces including the ongoing threat of infectious disease, the need to improve the proportion of life spent in good health and reduce health inequalities, the provision of sustainable health and care services and the health impacts of climate change. They set out the need to transform our health and care service to deliver the high-quality care that people need. At the heart of these services are the dedicated people who make up Scotland’s NHS. As we transform how services are delivered, our health workforce will be key to achieving lasting change that leads to improved health outcomes.

The need to understand what opportunities lie ahead for our medical professionals is the starting point for this work.

We have spoken with doctors from all over Scotland, at all stages of their careers, including those currently studying to become doctors, to think ahead to 2045 and consider the fundamental questions: what is the role of a doctor and what do we need that role to become in the future?

Given the length of the training pipeline for doctors, decisions we take now will shape Scotland’s medical workforce in 2045. Together with NHS Education for Scotland, we have modelled potential workforce scenarios, providing illustrative examples of how different choices – such as increasing the proportion of GPs or accelerating the transition from specialist training to employment – could affect the future workforce

This report is shaped by the voices of Scotland’s doctors: over 200 doctors attended focus groups and over 1800 doctors shared their views through a national survey. Their honesty, insight, and passion are reflected in this report and offer insights on the opportunity to shape a workforce that is resilient, adaptive, and forward-looking.

In reporting their views with honesty, we do not shy away from the difficult choices and trade-offs which face us when planning for the future. Within these pages you will see the scepticism and frustration expressed by many doctors in Scotland as well as the joy and pride that they have for their work.

Our doctors shared with us:

• The joy and sense of privilege that they share in caring for their patients alongside the pride they take in their work, and the deep sense of purpose their profession brings.
• The pressures that they are facing − balancing service and training, managing workload, and seeking both professional and personal fulfilment, often in the context of increasing service pressures and limited resource.
• The challenge senior doctors face in managing the risks associated with care of patients alongside their responsibility to the wider system to manage resources wisely. They can be seen by patients as gatekeepers who ration care and may be held responsible for distress or frustration caused by delays or system failures outwith their control. This lack of voice and influence is impacting their sense of value.
• The conflict within organisations and indeed within the profession as clinicians across primary and secondary care try to navigate the system to benefit their patients.
• That planning for the future is not only about workforce numbers and roles but about nurturing a profession to feel empowered and sustain fulfilling careers. If doctors feel valued, enjoy positive working environments, manageable workloads and have access to the core resources and support to allow them to provide high quality patient care, then the job becomes both attractive, and fulfilling.
• That there should be thoughtful and considered discussions on the appropriate use of multi-disciplinary teams, potential of consultant-led services and embedding more holistic care principles, as well how to best enable doctors to fully practice realistic medicine.
• The value and skill of our educators and trainers who support our students and resident doctors but also the need for improvements to the planning, design and management of training so as to ensure we attract, support, benefit and retain those who have chosen medicine as a career and meet the healthcare needs of Scotland.

We heard strong calls for political consensus and for the NHS to stop being treated like a political football. The issues detailed here are too important to become election campaign promises. The future of Scotland’s medical workforce depends on constructive dialogue, shared vision, and collective action.

Moving forward must be a shared endeavour. NHS Scotland, higher education institutions, the General Medical Council, British Medical Association, Medical Royal Colleges and Government all play a vital role in supporting doctors throughout their careers and delivering care for the people of Scotland. We will therefore be extending an invitation to sector leaders and all political parties to discuss the findings and the onward next steps, including work to:

• Support clinical teams so doctors feel valued and supported in their roles, enabling high quality care.
• Plan locally and nationally to address workforce challenges and increase geographic stability and job security for individuals navigating their careers.
• Redesign training pathways and workforce models to enable greater flexibility and equip doctors with the skills needed to support Scotland’s health needs.
• Understand the opportunities and risks associated with redesigned services and optimised clinical workforce models.

Working together, we can create the environment within our healthcare system to enable compassionate, innovative, and sustainable care: care that is careful and kind and ensures that the next generation of doctors feel valued, motivated, and equipped to meet the challenges ahead.

Professor Sir Gregor Smith, Chief Medical Officer

Neil Gray MSP, Cabinet Secretary for Health and Social Care