Future Medical Workforce Project: phase 1 report

What workforce could we have in 2045?

Current medical education and training pipeline

Given the length of the training pipeline for doctors, decisions we take now will influence the shape and size of the medical workforce in 2045. This section outlines the current system of medical education and training and considers what the size of the future medical workforce could be based on a range of different assumptions.

Undergraduate Medical School Numbers

Every year, the Scottish Government convenes the Medical Undergraduate Group (MUG) to consider Scotland’s annual medical undergraduate intake. The group’s primary purpose is to ensure an appropriate supply of high-quality trained doctors to meet the needs of NHS Scotland’s medical workforce whilst avoiding, or minimising, the possibility of medical unemployment. To date the process of deciding on these numbers has not considered any other part of the clinical workforce.

For Academic Year (AY) 2026/27, the MUG met in May 2025 as part of a new process for workforce projections and health professions-controlled student intakes. This new process provides a holistic set of recommendations across all controlled healthcare subjects^[17] and will allow the Scottish Government to make timely funding decisions and provide assurances to universities further in advance, as well as balance intakes across each profession against future skill demands on the healthcare system.

Between 2015/16 and 2023/24 the Scottish Government has increased the annual intake of medical places in Scottish universities from 848 to 1,417.

To account for the increased output from Scottish Medical Schools, the Scottish Government has funded the addition of 252 Foundation places since 2021, taking the total establishment to 2203.

Speciality Training Posts

Additional specialty training posts to meet anticipated future service demand and consultant need are agreed by Scottish Ministers on an annual basis. The Scottish Shape of Training Transition Group, makes recommendations annually by considering medical workforce modelling and reviewing medical training establishments. This process has led to the creation of approximately 850 additional posts across multiple specialities since 2014, primarily to support a 1% growth in the consultant establishment (in line with the 2022 Workforce Strategy) while considering retirals and less than full time (LTFT) working. The current specialty training establishment is approximately 4870.

This process has led to the creation of approximately 850 additional posts across multiple specialities since 2014.

The number of specialty training posts advertised for recruitment each year is determined by the number of posts vacated by trainees (most commonly due to completion of training but also due to any resignations or inter-deanery transfers) and by additional posts created through the above process. In recent years around 1,100-1,200 posts have been advertised annually. Various recommendations and actions have been made in recent years to improve recruitment to underfilled and priority specialties. For example, through the Psychiatry Recruitment and Retention Working Group and the GP Recruitment and Retention Action Plan).

The transitions from Medical School to Foundation training and Foundation training to specialty training and onward to employment, represent key decision-making points for individuals in the medical education and training pathway.

NES Medical education and training model

NHS Education for Scotland (NES) have developed a model of the medical education and training pipeline to help us understand what our future workforce might look like under a range of assumptions. The model uses the most recent data available from multiple sources up to 2024 and then forecasts to 2045. More details about the model’s methodology and data sources can be found in Annex D.

This modelling can help us understand what we might expect the numbers of GPs and consultants to be in Scotland in 2045, based on current pathways and trends. Key elements which are considered are time to complete training, likelihood of moving between training stages and to employment and the mix of trainees in terms of age, sex and location of Primary Medical Qualification (PMQ)^[18].

If we assume that what we have seen over the recent period were to continue, Table 1 shows that GP headcount is projected to increase in the future to 5,357 by 2045 with changes within the overall make-up of the GP population. We see that the number of GPs with Scotland as their place of PMQ falls whilst those who are IMGs or from the rest of the UK increase as a proportion of the overall total. It should be noted that the mean WTE by age, sex and PMQ used to estimate WTE employment is based on a sample period (details in Annex C) and is held stable during the forecast period at around 75% of headcount on average.

Table 2 shows that over the same period, the Consultant headcount is projected to increase to 8,027 in 2045, with the proportion of those who have Scotland as their PMQ remaining stable. The WTE as a percentage of headcount is forecast to remain the same as during the sample period) – around 92% – as it is assumed that current working patterns for the consultant stock continue.

Illustrative Scenario Modelling

NES have created different scenarios based on models of different training dynamics and considered what impacts these have on GP numbers relative to the current baseline. These scenarios are purposefully extreme and are intended to provide an illustration of what alternative behaviours and pathways could provide in terms of future medical employment in Scotland. They do not represent current Scottish Government policy intentions.

Scenario One – Matching the current ratio of specialty training (ST) places, to Foundation Year 2 (FY2) output.

The first scenario looks at ensuring there are sufficient ST places for those completing F2. The intake target for Scottish medical schools for the academic year 2019-20 was 1,013^[21]. If these students graduated after five years, they could enter Foundation training in August 2025 and post-Foundation training in August 2027. By contrast, the intake target for Scottish medical schools for the academic year 2025-26 was 1,417^[22]. If these students graduated after five years, they could enter Foundation training in August 2030 and post-Foundation training in August 2032. This represents an increase in post-Foundation training posts of 404.

This scenario highlights that under a linear medical training pathway there is a need to increase postgraduate training places after FY2 to avoid training bottlenecks because of increasing medical school places. It is important to note however that specialty training is taken forward on a four nations basis and therefore the overall pool of candidates and the number of available posts will also be influenced by other UK Governments’ decisions on specialty training posts.

As noted above, currently the number of specialty training posts is set with a view to anticipated GP and Consultant vacancies, however there are some anecdotal reports of an increased risk of post CCT bottlenecks because recruitment is being impacted by the financial constraints NHS Boards and GP practices are working within. It is therefore important that national and local decision making is consistent with a well-defined objective so any increase in specialty training numbers to reduce one bottleneck does not inadvertently create another post training.

Finally, to note, under this scenario, there is little factoring in of the role and contribution of Specialty or SAS grade doctors to the NHS workforce.

Scenario Two – GP headcount to match consultant headcount by 2045.

The second scenario considers what increase in GP employment is needed to match consultant headcount by 2045; currently the baseline model forecasts in 2045 a ratio of 40:60 ratio of GPs to Consultants. Under this scenario we assume that the overall headcount remains the same as the baseline scenario by 2045 (13,384). In order to have parity in numbers, we need the number of GPs to increase at a steady rate to reach 6,692 in 2045 – an increase of 1,335 compared to the 2045 baseline model. It is important to note that by constraining the overall headcount, the consultant headcount forecast for 2045 would need to be adjusted downwards by 1,335 from 8,027 to 6,692 by 2045 to achieve 50:50 ratio of GPs to Consultants.

This scenario illustrates the scale of GP training required to reach this 50:50 workforce split. While 50:50 is an arbitrary (and false) target for illustrative purposes, there is agreement across the profession that more GPs are required to support Scotland population health needs.

We know that GP training capacity is limited, and while there may be scope for innovation to support increased capacity, increasing undergraduate and FY requirements for GP exposure also draw on overall capacity (both physical space and educational supervisor).

We also know that historically GP has been a less popular specialty for doctors finishing their FY years and while incentivised approaches have proven successful and fill rates are high, these challenges could persist with increased training numbers thus limiting the ability to deliver on this scenario.

Discussion with doctors suggests that alongside increasing the GP workforce, more consideration should be given to blurring the lines between primary and secondary care. Creative thinking about how secondary care services (including diagnostics, outpatients and long-term condition management) could be delivered in the community or through greater interface working, could be one way in which we overcome the exaggerated challenges this scenario illustrates and still provide high quality care for the people of Scotland.

Scenario Three – speeding up the transition from specialist training to employment.

The third scenario considers the impact of speeding up the transition from specialist training to employment. We assume that people take the same amount of time to complete GP training as is forecast in the baseline model, but those who complete their training and enter employment in Scotland do so within one year. Under this scenario, GP employment in 2045 would be 5,620, a 263 increase in headcount on the baseline.

This demonstrates the potential impact of better local and national planning to support transition into employment (while recognising personal circumstances may always require some lag/transition time) and a need to better match training posts to future vacancies and workforce needs.

Scenario Four – Increasing length of time to complete training programmes

A final scenario looks at the impact of increasing rates of less than full time (LTFT) training for those completing programmes. At present the highest LTFT rates are for women on GP training programmes. Using this as an example to show the greatest potential impact, the modelling show that there would be an initial reduction in inflow to GP headcount in the short term (from this cohort) which would then flatten out as growth rate of headcount returns to the baseline. By 2029, the maximum difference in the predicted inflow from trainees to employment as a result of spending longer on training programmes is minus five.

This scenario illustrates that while LTFT training is increasing and has an impact on rotas where those trainees are working at present due to a lack of WTE recruitment to training programmes, the concerns on inflow rates in terms of headcount into the workforce are likely overstated.^[23]