Funding to help practices retain and recruit key staff
An additional £13.6 million will be invested in General Practice this financial year to support GPs to retain and recruit key staff, Health Secretary Neil Gray has announced.
Speaking at the annual conference of BMA Scotland’s Local Medical Committees, Mr Gray confirmed the immediate funding for 2024-25 will address known financial pressures, support staff costs and enable GPs to take on partners and salaried GP staff.
Mr Gray said: “I recognise the significant financial and workload challenges facing both the NHS as a whole and General Practice, especially during this period of high demand, and understand the significant strain this places on GPs.
“My focus remains firmly on finding ways to recruit more GPs, even within the constraints of the current financial climate, and that is why I am allocating an additional £13.6 million for General Practice this financial year to support staff costs. This additional funding will help GPs to underpin business decisions and provide high-quality patient care.
“Sustainable reform of the NHS means we must look to shift more care to primary and community care with a relentless focus on better outcomes for people.
The Scottish Government reform programme will develop the means to credibly restore, and further increase GP and wider primary care spend, within the overall health budget.
“This will be a long-term endeavour but this strategic shift is crucial. Our reform plans over the next period will look to explore this in partnership with key stakeholders including the GP profession.”
Addressing the separate issue of next year’s UK National Insurance contribution increases, Mr Gray added: “The UK Government’s decision to increase national insurance contributions will have a major financial impact on GPs.
“I have been very clear that this is completely unacceptable and the UK Government must fully cover the costs. Scotland’s GPs should not be paying the price for UK Government decisions.”
The Scottish Budget for 2025-26 will be published on 4 December.
New Reform Scotland research on orthopaedic waiting lists and times
BMA Chair says workforce “running on empty”
Reform Scotland announces major debate on improvements needed to NHS ahead of 2048 centenary
Reform Scotland today releases research that reveals sharply rising waiting lists and times for orthopaedic procedures in Scotland’s hospitals. Freedom of Information requests to health boards obtained comparable figures on waiting lists and times in orthopaedics, and the specific data for hip operations.
The paper also marks the launch of a major Reform Scotland research programme that will explore the changes required if the struggling NHS is to reach its 2048 centenary in better health.
Dr Iain Kennedy, chair of BMA Scotland, said: “It is a system bursting at the seams, with a workforce running on empty – there are not enough of us to give our patients the time and care they need and deserve.
“The time for platitudes has long passed – we need action, and we need it now.”
The full paper – NHS 2048: Future-proofing Scotland’s health and social care – can be read here. It reveals that:
11 health boards have seen at least a doubling in the wait time for a hip operation from point of decision. This includes an increase from 163 days to 386 in Greater Glasgow & Clyde, and an increase from 114 days to 360 in Lothian.
The waiting list for a hip operation has more than tripled since 2019 in Ayrshire & Arran, Dumfries & Galloway, Fife, Grampian, Lothian and Tayside
Well over 10,000 people are on the waiting list for a hip operation, up from just over 3,000 in 2019.
While the increase in waiting times is deeply worrying, waiting times data only covers the point from when a decision to treat was made. As a result, patients will in reality be waiting far longer. There is further data on orthopaedic operations in general, showing around 45,000 on a waiting list.
Reform Scotland, a non-partisan think tank, is calling for an open, constructive and mature conversation about improving the NHS in time for its centenary, and has been joined in that call by Dr Iain Kennedy.
Dr Iain Kennedy said: “The figures in this report from Reform Scotland are shocking, yet not surprising. BMA Scotland has been warning for some time that the NHS in Scotland simply cannot deliver what is expected of it under its current limitation.
“It is a system bursting at the seams, with a workforce running on empty – there are not enough of us to give our patients the time and care they need and deserve.
“The time for platitudes has long passed – we need action, and we need it now. We are in a year-round crisis with our NHS and workforce planning is abysmal.
“The Scottish Government must move forward with their commitment to have a cross-party national conversation on the future of our health service – an open and honest discussion that also involves the profession and the public.
“Enough is enough, we cannot continue on this path if we want to futureproof our NHS for generations to come.”
Jacqui McMillan, a consultant surgeon in the West of Scotland, said: “Reform Scotland’s report is a stark warning of how bad things have become.
“As an orthopaedic surgeon I am working as hard as ever, and yet my waiting list seems to be growing longer. Seeing my patients in pain and knowing how long they are likely going to have to wait for their operation breaks my heart.
“Having to tell patients they could be waiting for more than a year for an operation they need in order to get through a day without pain is really difficult.”
Chris Deerin, Director of Reform Scotland, said: “We need a mature, constructive debate to identify and build consensus around specific measures that will help our health and care services in both the short and long term.
“The electorate can cope with this discussion. They know that the health service is ill – they live with the consequences every day. Are the politicians up to it, though? Can they set aside petty party differences and work together to save this vital public service?
“If we are to maintain a taxpayer-funded, free-at-the-point-of-need system up to the NHS’s centenary in 2048, reform is required in order to make the best use of the resources we have.
“Reform Scotland will provide a platform for that discussion to take place.”
Agreement will see largest Junior Doctor pay investment for 20 years
A record 12.4% pay increase for junior doctors and dentists in training for 2023–24 has been accepted British Medical Association (BMA) Scotland members.
Together with the pay raise of 4.5% awarded in 2022–23, this amounts to a total increase of 17.5% over two years.
The deal also includes a commitment to future years pay, contract and pay bargaining modernisation and it brings to an end the threat of industrial action.
Health Secretary Michael Matheson said: “I am very pleased that BMA members have overwhelmingly voted to accept this record pay deal for Junior Doctors. This is the single biggest investment in Junior Doctor pay since devolution, and maintains our commitment to make Scotland the best place in the UK for Junior Doctors to work and train.
“Due to the meaningful engagement we have had with trade unions, we have avoided any industrial action in Scotland – the only part of the UK to avoid NHS strikes.
“We will now implement this pay uplift, and will work with BMA to take forward the other aspects of the deal including contract and pay bargaining reform.”
This pay deal represents a £61.3 million investment in Junior Doctor pay – the largest in the last 20 years and the best offer in the UK – and means a doctor at the beginning of their career would receive a salary increase of £3,429 in 2023–24.
For those at the end of their training the rise would be £7,111 over the same period.
Industrial action suspended as improved offer to be put to union members
A record 12.4% pay increase for junior doctors and doctors in training for 2023/24 has been agreed with the British Medical Association.
Following discussions with Health Secretary Michael Matheson this afternoon, BMA Scotland have agreed to suspend strike action while they consult their members on this deal.
Coupled with the pay raise of 4.5% awarded in 2022/23, this amounts to a cumulative increase of 17.5% over two years.
The deal also includes a commitment to future years pay, contract and pay bargaining modernisation.
Health Secretary Michael Matheson said: “Following months of negotiations with BMA Scotland, I am delighted that we have agreed a pay deal for 2023/24 for our Junior Doctors. BMA have agreed to suspend strike action in Scotland while they consult with their members.
“I hope this investment and the significant commitments we have given around pay and contract reform will show Junior Doctors how much we value them, and that we are determined to ensure that Scotland is the place for Junior Doctors to work and train.
“Some patients may have been contacted to say their treatment has been cancelled. We are working hard with health boards to make sure appointments that can go ahead do, and that any others are rescheduled as soon as possible.”
Next week’s planned Scottish junior doctor industrial action has been suspended after the latest period of intense negotiations ended with BMA Scotland agreeing to put an improved offer from the Scottish Government to its members.
This year, Junior Doctors will receive a pay rise of 12.4%. For the following three financial years, Junior Doctors will receive a guaranteed minimum pay uplift of inflation every year. Over this three-year period, the Scottish Government has committed to negotiate further annual pay rises on top of inflation that must, “make credible progress on the path towards pay restoration”.
In addition, BMA Scotland will enter contract negotiations with the Scottish Government from Autumn 2023 with the aim of improving the working and training conditions of Junior Doctors in Scotland by April 2026.
As part of these negotiations, they will agree a new Pay Review mechanism, the aim of which is to reach a “mutually agreeable path to achieve pay restoration and prevent erosion recurring in the future”.
This mechanism once established should complete the process of restoring Junior Doctor pay and ensure it is protected against any recurrence of pay erosion in the long term.
On this basis, the BMA’s Scottish Junior Doctor Committee (SJDC) yesterday agreed unanimously that it would recommend members accept the offer in a consultative vote in the coming weeks.
Speaking after a full meeting of the committee, where the decision to put the offer to members was made, Dr Chris Smith, chair of SJDC, said: “This has been an intense period of negotiation with the Scottish Government.
“At this stage, our negotiating team feel they have reached the limit of what can be achieved this year and do not think strike action would result in a materially improved offer. As a result, we have agreed to suspend next week’s strikes and put this offer to our members.
“This offer commits the government to working with doctors to restore our pay and prevent pay erosion from occurring in the future.
“This is an unprecedented shift from the Scottish Government, which is a recognition of the huge decline in real terms pay that doctors have experienced over the past fifteen years, and the huge amount of work needed to undo the damage this has caused to the NHS.
“By agreeing to address the way our pay has been cut, and setting out a clear mechanism for doing so, the Government is making a serious, welcome commitment to ensuring that pay for Junior Doctors in Scotland is restored to a fair level.
“The agreement is clear that the increases above inflation over the next three years must be substantial enough in real terms to make credible progress on the path towards pay restoration.
“We will now deliver wide ranging and comprehensive details of the offer to members over the coming days and will open a fresh consultative vote as soon as we can.
“While we have suspended next week’s strikes, our mandate to strike still has months to run, so all options will remain open. Indeed, regardless of the outcome of the consultative vote, the collective power junior doctors have demonstrated by consistently and powerfully speaking up on behalf of the profession should ensure that we are never again taken for granted as we have been for the last 15 years.”
The Scottish Government says the pay deal represents a £61.3 million investment in Junior Doctor pay – the largest in the last 20 years and the best offer in the UK – and means a doctor at the beginning of their career would receive a salary increase of £3,429 in 2023/24. For those at the end of their training the rise would be £7,111 over the same period.
Junior doctors across Scotland have been offered a 14.5% pay uplift over the two year period 2022-24, following negotiations with BMA Scotland.
This represents a £61.3 million investment in junior doctor pay – the largest in the last 20 years and the best offer in the UK.
If accepted, the new and final offer will be a pay raise of 6.5% in 2023/24, as well as an additional 3% towards an already agreed 4.5% uplift in 2022/23. This amounts to a cumulative increase of 14.5% over two years and matches the recent pay award accepted by nurses and other NHS workers in 2023.
This offer means a doctor at the beginning of their career would receive a total salary increase of £3,834 over two years. For those at the end of their training the rise would be £7,951 over the same period.
Health Secretary Michael Matheson said: “After weeks of intense negotiations I’m delighted our government and BMA Scotland have come to an agreement on pay which they will now put to their members.
“Recognising the incredible work that junior doctors do, we have offered a fair and progressive rise which will mean a pay increase of 14.5% over two years – the best offer on the table in the UK.
“We have taken their concerns regarding pay, and the need to modernise pay bargaining more broadly, extremely seriously. It’s now up to junior doctors to reflect on this final offer, and I hope they will accept.”
‘Sticking our heads in the sand – or using the NHS as a political football to exchange snappy soundbites – will not cut it anymore‘
The number one “quick fix” priority for Scotland’s NHS as we move into 2023 must be the retention of our invaluable healthcare professionals, the chair of BMA Scotland said today (Wednesday, Dec 28th).
Dr Iain Kennedy said any plan for further recruitment, investment in the systems and aspirations of improvement will “fall flat on its face” unless there is a laser like focus on keeping the experienced staff our NHS already has.
Dr Kennedy, who was speaking as he delivered his annual festive message for doctors, added that the need for an open discussion on the NHS is now greater than ever.
His renewed call for a national conversation on the future of the health service comes as BMA Scotland shares more than 100 testimonies from doctors about what working in the NHS is like at the moment and their concerns for what the future holds.
Comments included:
“There have been a number of critical incidents in the last six months involving unsafe staffing levels. The acuity of the workload has increased. Patients are generally getting sicker and more complex, but we have less resources or time to care for them. It’s hard to keep them safe. I wouldn’t want to be an inpatient at the moment, and hope everyone in my family remains well for the foreseeable.”
“It feels unsafe – because it is. It’s not safe for patients, and it’s not safe for staff either. I have gone from being a passionate committed GP to being a shadow of my former working self. I want to leave the profession and I am devastated by this.”
“Things are very bad. Chemotherapy can only be delivered four weeks after seeing a consultant because of a chemotherapy nurse shortage. Radiotherapy preparation scans can only be done two weeks after seeing a consultant because of lack of radiotherapy staff/physicists – and it’s another two or more weeks before radiotherapy can actually be delivered.”
Dr Kennedy said: “The NHS is haemorrhaging crucial staff – staff who we urgently need now more than ever before – and the government must step up to stop it. They can talk as much as they want about recruitment of staff, of investment in the system or of plans for improvement, but every single one will fall flat on its face unless there is a laser like focus on keeping the staff we have.
“That is why the retention of healthcare professionals – keeping them in the service – needs to be the number one priority in terms of the quick fixes to help us just make it through this winter with the NHS in Scotland somehow intact.
“I desperately want to be optimistic and forward looking, to set out some hope for the future – for the medical profession that I am so proud to be a part of, and the Scottish health service that I am equally proud to work in.
“But it’s not easy to find that indication of a brighter future – especially after reading the, frankly, harrowing comments from some of my NHS colleagues about what they are experiencing day in, day out. No one working in the health service would give me any credibility if I gave an upbeat description of the way our NHS will, or can, get better and how the working conditions of those caring for the people of Scotland will miraculously improve.
“All the statistics tell us that it’s a desperate state of affairs. Things are as bad, or worse, than they have ever been. Winter is a meaningless term now – this entire year has been winter.
“But looking beyond the statistics, looking at the people behind the statistics, the picture being painted is even more grim and concerning. The experiences my colleagues have shared speak louder than anything I could say, and anything any official stats could imply.
“We face crises across workload, workforce, working conditions, pay and pensions – all of these are hitting efforts to retain doctors, which we are already short of across both primary and secondary care. Hospitals have too many vacancies – indeed the current vacancy rate for consultants alone is 14.32% – and GP practices are falling over, with the Scottish Government not even close to being on target to deliver their promised 800 additional GPs by 2027.
“In the face of everything else pay and pensions are – incredibly – fairly quick fix issues. The government can make a decision to improve pay for NHS workers. And the UK Government can finally once and for all sort out the pension taxation issues that penalise senior doctors across primary and secondary care and force them to cut hours or face massive and unexpected bills.
“These two things will make a difference in staff retention – junior doctors will feel more valued and be more likely to stay in the NHS instead of looking to move abroad where they will be paid more and have a better work life balance.
“Senior doctors will be less likely to reduce their hours and more likely to work waiting list initiatives if they know they won’t receive a huge tax bill for doing so. We are beyond crisis point now – urgent action is needed to save our NHS and that simply must focus on investing in the workforce.
“Looking beyond that, of course we need to finally get a proper long-term workforce plan in place. But even more fundamentally we need, as a whole society, to grasp the nettle, face up to hard truths that have been brushed under the carpet for too long, and have a proper grown up, depoliticised national conversation about the future of the NHS in Scotland.
“Sticking our heads in the sand – or using the NHS as a political football to exchange snappy soundbites – will not cut it anymore.
“It’s clear we need to reflect on what we ask of our NHS and the levels of funding we, as a country, are prepared to provide to meet those asks, and to ensure the health service stays true to its founding principles and remains free at the point of delivery. The current approach of pushing insufficient resources harder and harder, then blaming staff when standards fall has failed and is failing patients every single day. I know doctors across Scotland are suffering moral injury as a result.
“Let’s stop putting healthcare workers in the impossible and insidious position of having to constantly be apologising and being the bearer of bad news.
“We need politicians on all sides to be brave and act – by bringing us together and finally actually properly talking about a plan for a future NHS we can all confidently get behind. And a better NHS will be better not just for Scotland’s doctors, but for the many people who rely on it for care.”
More mental health and wellbeing services will be provided within GP practices and community settings, backed by investment of up to £40 million a year.
Under the new system, patients who need mental health support will find a range of professionals available through their doctor’s surgery, rather than having to rely solely on their GP or a referral elsewhere. These could include mental health nurses, psychologists, peer support workers, occupational therapists, and link workers.
Funding of £1.5 million has already been made available from the Mental Health Recovery and Renewal Fund. This will increase annually to support implementation of the new Mental Health and Wellbeing Primary Care Services, reaching an expected £40 million per year by 2024-25.
This could amount to more than £100 million by the end of this Parliament, substantially increasing the mental health workforce and transforming how support is delivered.
Minister for Mental Wellbeing Kevin Stewart said: “Mental ill health is one of the major public health challenges in Scotland. We know the pandemic has had a significant impact, which is why mental health has remained a priority throughout our response to COVID-19.
“Around a third of all GP consultations now has a mental health component. But the range and complexity of issues requires a more varied and comprehensive response.
“This new multi-disciplinary model will deliver our commitment to provide 1,000 additional dedicated mental health staff by 2026, supporting communities to improve their mental health.”
Deputy chair of BMA Scotland’s GP Committee Dr Andrew Cowie said: “Scotland’s mental health has suffered significantly throughout the COVID19 pandemic, and we welcome the additional mental health staff that will allow for our patients to access support within their communities.
“GP practices are most people’s first point of contact and it is important that there is a range of help and services available there. This is a welcome initiative and we look forward to working with the Scottish Government to develop the scheme and ensure all patients in Scotland can access better mental health in their communities.”
Local Planning Guidance, to support integration authorities and local partners to plan and implement the new services, will be published on the Scottish Government’s website this week.
Services will also link to community support such as addiction services, food banks and benefit support, through a link worker dedicated to each GP practice.
