Psychiatry Recruitment and Retention Working Group: final report

Annex A - Psychiatry Working Group recommendations

Response to Phase 1 Recommendations

All recommendations related to education and training will be considered as part of the next phase of Medical Education Reform being led by NHS Education for Scotland, which will link to the stakeholder-led Future Medical Workforce phase 2 work on Medical Education and Training Reform, to take forward relevant actions and progress advice for Scottish Government on next steps. This will also include consideration of the recommendations and improvements identified through the NHS England review into postgraduate training.

Response to Phase 2 Recommendations

Recommendation 1: Implementation group to be established. Stakeholders to include Scottish Government, NES, CWS, RCPsychiS, SMMPG and Health Board/IJB representation.

Scottish Government response: Accept in principle

Comments: It has been agreed in principle that Scottish Government will host an extraordinary meeting of the Working Group in early 2026. The Group can agree next steps on how best to monitor delivery of the agreed recommendations within this report – which avoids any unnecessary duplication.

It should also take into consideration the governance arrangements for areas of work such as the Future Medical Workforce project.

Recommendation 2: Develop Governance routes to drive implementation of recommendations (including at Board level).

Scottish Government response: Accept

Comments: Scottish Government accepts the responsibility to determine what governance routes will help drive implementation of the agreed recommendations.

It is the responsibility of Boards to determine their own governance arrangements.

Recommendation 3: There should be a move away from the recruitment of consultant psychiatrists on 9:1 job plan, recognising the challenges unique to the speciality.

Scottish Government response: Delivered

Comments: The Job Planning Guidance was issued on 18 September 2025. It is the responsibility of Boards to implement the guidance provided.

Recommendation 4: All existing substantive Consultant psychiatrist posts should move away from 9:1 job plans if desired by the individual. Noting the need to recognise and respond to clinical capacity.

Scottish Government response: Delivered

Comments: As noted in recommendation 3.

Recommendation 5: Recognising the impact such a move could have on broader capacity - Boards should consider how alternative approaches to service delivery and staffing models taken forward through the development of Target Operating Models/Service Specifications could be utilised to ensure no detriment to patients.

Scottish Government response: Accept in principle

Comments: Scottish Government is committed to working with partners, professional groups, stakeholders and people with lived experience to deliver improvements to mental health and wellbeing support in Scotland.

As part of the Health and Social Care Service Renewal Framework, we are laying the foundations for Scottish Government and partners to work collectively to develop the Target Operating Model for mental health. This blueprint will allow all national and local partners to strategically plan and deliver a wide range of sustainable, person-centred mental health (and mental wellbeing) services, which deliver consistent patient outcomes across Scotland. The Target Operating Model will be underpinned by robust data on population need and meaningful outcome measures.

Psychiatrists already play a valued role in supporting the mental health needs of our population, and we will value the insights and experience they will bring to the renewal of mental health services in Scotland.

It would be the Boards responsibility to consider the impact of changes to Job Plans on service delivery.

Recommendation 6: Tripartite Joint Negotiation Committee to consider evidence and recommendations made in this report.

Scottish Government response: Delivered

Comments: The report was shared with Joint Negotiation Committee for awareness in September 2025.

Recommendation 7: To work alongside local service plans, in the context of planned retirement and job planning, discussions with employees should take place for psychiatrists over 50 years old. Taking into consideration experience, skills and length of service.

Scottish Government response: No Scottish Government response required. Lead: Health Boards/IJBs.

Comments: Once for Scotland policies already exist to support conversations between employees and employers within NHS.

This includes a retirement policy: https://workforce.nhs.scot/policies/retirement-policy-overview/

The second phase of the Future Medical Workforce Project will focus on making improvements:

• 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.

Recommendation 8: Supports the development of explicit guidance on what a reasonable workload looks like in psychiatry. Develop Target Operating Models/Service specifications for general adult and older adult services, in order to define the remit, scope and role of services and the workforce capacity to meet the demand.

Scottish Government response: Accept in principle

Comments: Specifically in relation to TOM/Service Specification as set out in recommendation 5.

Scottish Government looks forward to receiving the guidance from Royal College of Psychiatrists in what a reasonable workload looks like in psychiatry.

Recommendation 9: Share the updated job planning guidance from RCPsychiS (once available) with stakeholders including HR Directors within Health Boards and IJBs. Guidance to be mapped against target operating models to understand demand/workforce ratio.

Scottish Government response: No Scottish Government response required. Lead: RCPsychiS.

Comments: Scottish Government supports sharing the guidance from RCPsychiS once it is available.

Recommendation 10: External advisors to highlight non-compliance to recruiting Boards and the implementation group if this guidance is not taken into consideration.

Scottish Government response: No Scottish Government response required. Lead: External Advisors.

Comments: This would have to be in the first instance raised and reported through the recruiting Board. We would need to understand from Senior Medical Managers in Psychiatry what the most appropriate governance route would be for reporting.

Recommendation 11: Seek to reduce and move towards stopping an over reliance of under-qualified locums in psychiatry through the implementation of the recommendations in this report which tackle some of the wider systemic issues which have resulted in the use of locums.

Scottish Government response: No Scottish Government response required. Lead: Health Boards/IJBs to consider.

Comments: We will continue to work closely with Boards to ensure that agency staff are only used as a last resort, enabling us to secure value for money and support the delivery of high quality patient care.

The use of temporary staff in an organisation as large and complex as NHS Scotland will always be required to ensure vital service provision during times of unplanned absence, sickness and increased unforeseen activity.

It is critical that we seek to secure best value whenever we are delivering services within NHS Scotland, allowing us to maximise the impact that our investment has on the quality and availability of patient care.

Accordingly, we are working with colleagues across NHS Scotland to explore how we can reduce our reliance on agency.

Recommendation 12: Recommends the term ‘Consultant Psychiatrist’ is reserved for doctors on the Specialist Register. Doctors in locum appointments who do not hold specialist qualifications should be titled ‘Speciality Doctor’ or ‘Speciality Doctor working in a Consultant role.’

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: While the Scottish Government sets the strategic policy direction for NHS in Scotland, operational matters including staffing - are in the first instance the responsibility of the relevant NHS board.

If Boards and IJBs wish to operationalise this recommendation, there may be Terms and Conditions issues that will need to be given consideration in the relevant partnership forums.

Recommendation 13: Increase the number of substantive roles through supporting speciality grade locum doctors to make the transition to Consultant through the Portfolio Pathway programme.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: While the Scottish Government sets the strategic policy direction for NHS in Scotland, operational matters including staffing - are in the first instance the responsibility of the relevant NHS board.

Recommendation 14: Maintain relevant links across Scottish Government and Board Medical Directors to ensure progress is made in addressing reliance on locums in psychiatry.

Scottish Government response: Accept in principle

Comments: Through our recently concluded Medical Locum Task & Finish Group we worked with a range of colleagues from across NHS Scotland, including Medical Directors, to explore potential additional measures designed to limit locum use where possible and to ensure that best value was secured whenever locum engagements were entered into. Building on the Group’s work, additional guidance was provided to support all NHS Scotland Boards in the adoption of robust approval arrangements for all locum engagements.

It is recognised that reducing locum usage is ultimately reliant on efforts to increase the capacity of NHS Scotland’s own workforce to deliver services. Through our recently established Future Medical Workforce Project we are engaging with the medical profession to support more effective workforce and career planning, building on targeted actions including those being led by the Centre for Workforce Supply through their Medical Network. Broader changes to the way we deliver services, described through our Service Renewal Framework, will also create opportunities for our medical workforce to respond effectively to the future demands we face.

Recommendation 15: Consultants returning to posts after retirement should be offered emeritus consultant titles.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: While the Scottish Government sets the strategic policy direction for NHS in Scotland, operational matters including staffing - are in the first instance the responsibility of the relevant NHS board.

If Boards and IJBs wish to operationalise this recommendation, there may be Terms and Conditions issues that will need to be given consideration in the relevant partnership forums.

Recommendation 16: Recommends Health Boards ensure that psychiatrists roles are embedded and empowered within local decision-making structures. This will require SPA time for effectiveness.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: This recommendation links to Job Plan recommendations as well as work on governance and the development of a TOM for mental health services.

Recommendation 17: Supports the ongoing considerations that are underway by Scottish Government to develop a service specification/ target operating model for mental health services.

Scottish Government response: Accept

Comments: As noted in recommendation 5.

Recommendation 18: Psychiatrists should be represented in these considerations and given suitable opportunity by Scottish Government to contribute.

Scottish Government response: Accept

Comments: As noted in recommendation 5.

Recommendation 19: Recognising the guidance from RCPsych in the updated “Safe patients and high-quality services: a guide to job descriptions and job plans for consultant psychiatrists (CR207)” on the necessary support required to undertake psychiatric duties - Health Boards/ IJBs should improve the working environment of the psychiatrist in order to meet their professional needs. Including the consideration of working spaces (and need for confidentiality) the need for support staff, funding for Continued Professional Development (CPD), and cover for study leave.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: Engagement with Health Boards indicated that there is already work underway that supports improvements in working environments and in workplace culture. This work is applicable for all NHS workforce.

Recommendation 20: In line with Job Plan recommendations, Health Boards/ IJBs to ensure that non-clinical time is protected to ensure that psychiatrists have suitable time for professional and personal development (including study time), research, support and supervision.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: This recommendation links to Job Plan recommendations and recommendation 19.

Recommendation 21: Taking into account the individual, Health Boards/ IJBs should use flexible working policies to support people throughout their careers including the latter stages of their careers.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: Once for Scotland policies already exist to support conversations between employees and employers within NHS.

This includes flexible work policies.

Recommendation 22: Recommends that this extends to Health Boards/IJBs considering support for late career breaks, sabbaticals, sensitive and flexible late career planning, cease on-call in pre-retirement years, flexible working to support and retain consultants in the last 5-10 years of their careers. Using experience and breadth of knowledge to focus on the role beyond clinical work.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: Once for Scotland policies already exist to support conversations between employees and employers within NHS. This includes policies for: career breaks, flexible working; retirement and secondment.

Recommendation 23: Support the RCPsychiS intention to produce a retention charter and when published in Summer 2025 asks that Boards should consider adoption.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments: Once the resource is available it would be for Boards to consider adoption.

Recommendation 24: Supports plans for the further development and improvement of Psychiatry webpages hosted by NES. This requires clinical expertise to ensure information remains accurate and up to date and provides information and signposting for those seeking to live and work in Scotland as a psychiatrist.

Scottish Government response: Delivered

Comments: Continuous development work will be required to ensure that webpages remain up to date and accurate.

Recommendation 25: Ongoing commitment from Scottish Government to support future events that promote careers in psychiatry. NES to continue to promote psychiatry careers by maintaining relevant information on the CWS TURAS hub, as well as the NHS Scotland Careers website and social media channels as appropriate.

Scottish Government response: Accept in principle

Comments: Scottish Government commits to supporting each event based on a developed business case that illustrates how the event will promote careers in psychiatry.

CWS have made a commitment to keep all information up to date.

Links to recommendation 24 for webpages.

Recommendation 26: CWS (NES) continue to provide direct engagement and support to Health Boards to progress international recruitment options within psychiatry. CWS also provide, promote, maintain and support a ‘Once for Scotland’ approach where practical and appropriate to do so, whilst creating and maintaining supporting resources as needed.

Scottish Government response: No Scottish Government response required. Lead: Centre for Workforce Supply (CWS).

Comments- Response from CWS: CWS continues to provide direct support to Boards on medical IR on an ad hoc basis and shares best practice in this space via the CWS Medical network, resources on the TURAS workforce hub and a series of learning sessions (webinars) across 25/26.

Recommendation 27: Depending on outcome of recommendation 26, Scottish Government should consider additional future funding to support international recruitment of psychiatrists as part of a ‘Once for Scotland’ approach.

Scottish Government response: Accept in principle

Comments: Each funding request will be fully considered using a cost-benefit business case, that also takes affordability into account, alongside other priorities.

Recommendation 28: Health Boards/IJBs should consider funding international recruitment with a view of offsetting upfront costs via long term savings made against locum usage. CWS can continue to support Boards in developing their business case for this recruitment route via their International Recruitment Support Pack of resources and bespoke, direct support within existing capacity.

Scottish Government response: No Scottish Government response required. Lead: Boards/IJBs to consider.

Comments- Response from CWS: CWS continues to support Boards to explore medical IR through sharing of good practice resources and advice (including those around developing a business case for IR). It does this through ad hoc direct conversations with Boards, a wealth or resources on the TURAS Hub, a series of online learning sessions and through linking interested Boards with other Boards across Scotland who have successfully undertaken medical IR.

Recommendation 29: Promote the recruitment resources developed by CWS and hosted on the CWS Medical TURAS hub.

Scottish Government response: Delivered

Comments - Response from CWS: CWS has a number of medical workforce improvement resources on their TURAS hub which they (and Scottish Government) can continue to promote via the CWS Medical network, the series of learning sessions (webinars) that they will be running throughout 25/26 and other key stakeholder meetings as appropriate.

Recommendation 30: Develop a robust evidence base and business case for additional targeted incentives to aid retention of psychiatrists in rural areas. Consider the drivers of decisions made by prospective NHS consultant psychiatrists and whether additional targeted incentives from those that already exist would aid in the recruitment and retention of psychiatrists in rural Scotland.

Scottish Government response: No Scottish Government response required. Lead: RCPsychiS and SMMPG.

Comments: Business cases once developed will be considered on affordability and intended impact.

Recommendation 31: Develop a robust evidence base and business case for additional targeted incentives to aid recruitment in other hard to recruit areas such as areas of severe urban deprivation.

Scottish Government response: No Scottish Government response required. Lead: RCPsychiS and SMMPG.

Comments: Business cases once developed will be considered on affordability and intended impact.

Recommendation 32: Scottish Government and NES should work together to ensure consistent data collection and recording of workforce data through use of WTE figures and recording locum posts as vacancies.

Scottish Government response: Accept in principle

Comments: NES already produces consistent workforce data on the five GMC psychiatry specialties. This is published as headcount and WTE in the quarterly Official Statistics, so trends can be seen over time and by region/health board.

Posts filled by locums are not vacant posts and are not advertised vacancies, and NES do not record or report them as vacancies (by definition).

As part of the Mental Health and Wellbeing Workforce Action Plan, Scottish Government commissioned NES to undertake improvements to mental health and wellbeing workforce data, including on equalities. This aims to better align current and future population needs and individual workforce, pre-registration education and practice based learning requirements. This work is being undertaken in a phased approach, and will initially focus on the core workforce based within the NHS. In future phases of the work, there may be opportunities to consider expanding the scope of data collated.

Recommendation 33: Scottish Government and NES to publish workforce data broken down by speciality and region including reference to trends.

Scottish Government response: Accept in principle

Comments: Linked to recommendation 32.

NES provide the workforce planning tool, which allows internal users to examine regional trends and estimate the workforce gap between NHS demand and employment.