Future Medical Workforce Project: phase 1 report

Conclusion

Doctors across the NHS have told us about the pressures they face on a regular basis and the commitment with which they approach the delivery of high-quality care to their patients. They have described the challenges which erode their sense of enjoyment and feeling valued from a lack of access to rest areas, hot food and car parking to more significant barriers such as growing workloads, lack of time, resource constraints and pay. This is fuelling a rising sense of disempowerment and a perception of diminishing respect for the profession.

Within the profession it appears that these pressures are causing cracks to professional cohesion, as we heard of tensions across the primary secondary care interface as each group of clinicians navigate their role in managing patient risk. Doctors also highlighted the challenge of responding to patient expectations, at times misinformed by social media or unregulated sources, of access to care without limits. There was a call for more support in setting realistic expectations of what a publicly funded NHS can deliver, a need to avoid medicalisation of normal life experiences, and a need for a public discourse around personal responsibility for health.

Many acknowledged the resource challenges across the system but reported a lack of clinical influence and voice within management structures, and a system in a constant reactive “firefighting” response state.

We know that one of the most acute fears from doctors early in their careers are training bottlenecks. Doctors have told us that this affects recognition of a social contract related to the investment in their training and implied return of service to the NHS. While increasing more training posts may seem like the obvious solution, we must also be mindful of the risk of moving the bottleneck to the end of the training pipeline – with reports of people unemployed after long and intense training ultimately leaving the UK for jobs abroad. This highlights the need for better integrated local and national planning to ensure the training pipeline meets the population and service need.

We must also think about training capacity to ensure that our world leading postgraduate training programmes maintain their quality and that educators are appropriately valued, supported and recognised. This is true of our undergraduate education as well, with capacity and infrastructure challenges highlighted through the expansion of medical school places adding pressure to our clinical academic and educator workforce.

Capacity constraints are important when considering calls for more doctors as is the limited and reducing pool of school leavers (due to population dynamics). These dynamics will impact our future supply of doctors, as too will international recruitment which may reduce because of UK Government immigration changes and increased global competition for doctors.

It is also important to note that despite rising workforce numbers, productivity within the NHS is below pre-pandemic levels. There are multiple contributors to this, including the increasing complexity of patients alongside infrastructure and IT issues which hinder efficiency and effective working. Increasing the number of doctors, with no other changes, will not solve our problems, and there will be a need to explore and embrace new innovations and opportunities to ensure best care.

One of our challenges is ensuring a national provision of service. While more regionalisation of medical services is likely in the future, we must ensure that our remote and rural areas are attractive places to work and consider more incentivised approaches to get the workforce there.

Indeed, part of resetting the social contract with trainee doctors and ensuring retention of our ‘homegrown’ doctors could involve ensuring onward employment and jobs and greater geographic stability (through better alignment of training posts to future vacancies) but on the understanding that these jobs will be in places (and specialties) which match the care that patients and the people of Scotland need.

We must also think about what the role of the doctor will be in the future and ultimately what role we are training people for. There has been lots of discussion about the need for more generalist medics who can provide holistic care to the growing complexity of Scotland’s healthcare needs. Do we need to redesign our training pipelines to enable a broader generalist tier of medics who are supported in a consultant-led model? To do so effectively, we have heard that there needs to be greater clarity from Government and consistency within the NHS on what the role of a doctor is, and what the role and contribution of wider MDT members should be in delivering services.

It’s essential to strike a careful balance. On one hand, we must fully utilise the breadth and depth of doctors’ training—their ability to manage complexity, uncertainty and risk is a unique and invaluable asset to the healthcare system. On the other hand, focusing solely on what distinguishes doctors from other professionals risks placing an unsustainable burden on them, potentially leading to burnout and disengagement.

What has been outlined in the preceding chapters underscores the complexity of planning for the future NHS workforce and delivery of services.

The Scottish Government’s vision for the future of the NHS is set, now is the time to define the role of the doctor and plan for those doctors within that. This will impact not only those already in our workforce, with a need to better nurture and support our doctors to sustain fulfilling careers, but those entering our workforce too. Our education and training pipelines may need to change and how we work together at all levels to workforce plan also needs significant improvement. Without decisive action, the challenges currently affecting the medical workforce will not only persist but intensify by 2045.

There are no simple solutions—if there were, they would already be in place.

The discussions that we have had reveal the interconnections and contradictions that shape our current landscape. As we all consider the choices and changes we can make today to influence the workforce of tomorrow, these tensions become both our opportunities and our trade-offs. Navigating them thoughtfully will be key to building a resilient and responsive NHS for the future.

Next Steps

This concludes phase 1 of the project, an exploration of issues which have given us rich insights and a strong case for change.

Phase 2 of the project will commence in January 2026.

Recognising the importance of working together it is envisaged that profession-led workstreams, will be taken forward following the publication of this report for 6 months before updating and advising the new Scottish Government following the Scottish election in May 2026.

Insights and improvements identified in this report may be implemented, where possible, during this time, contribute to wider workstreams or be further explored to provide advice for the incoming government.