Doctors’ leader, BMA Scotland chair, Dr Iain Kennedy today (Tuesday 31st December 2024), warns that without “transformative and urgent” reforms the NHS in Scotland will struggle to see out another New Year.  
  
Dr Kennedy, who was speaking as he delivered his annual New Year message for doctors, cautions that all the evidence suggests that over the next 12 months, more and more people will find that the NHS is not able to provide the care they need, when they need it, forcing them to go private and putting the founding principles of our NHS at risk.     
  
This warning comes as BMA Scotland published the results of its annual winter pressures’ survey of more than 980 doctors which highlighted that:  

• 99% of respondents are extremely concerned (76%) or concerned (23%) about the impact of increased pressures on the NHS over Winter.  
• 70% believe the NHS is operating on a crisis mode all year round, with 29% believing it often operates on crisis mode.  
•  96% don’t think (84%) or are not sure (12%) if the NHS is staffed adequately to cope with the likely increase in demand this winter. 

The survey included the option for doctors to record experiences of where they work – with more than 575 sharing their concerns, with a major focus on the impact on patients. Examples include: 

• “It has become the norm to be operating at 115-120% capacity and have between ten and 20 admissions sleeping in the ED overnight in corridors. The system is broken and needs to be addressed as an emergency.”
• “It is therefore no surprise that in such a reduced capacity, bed and staffing model, that the NHS lurches from crisis to crisis falling further and further behind a basic acceptable standard of care.” 
•  “We feel like we are sinking. We are working hard to get patients fit for theatre, but the lack of elective beds means we continue to cancel patients. We can never get on top of elective surgery demand with the model we currently have.”
• (A GP)."Been crisis mode here for months. Critical incident in November. Feels like nobody in management - acute sector or community is listening or actually admitting the seriousness of the situation at all levels. This has and continues to have an impact on lives let alone safety and staff morale.”
• “Summer has winter level demands now, winter is another level and there is simply no capacity physically or emotionally to cope.”
• “As GPs, we often feel like we’re the last safety net in a crumbling system, and it’s hard to see how we can keep meeting the needs of our patients without immediate and meaningful support. The real worry is that without urgent action, this winter could be catastrophic for both patients and staff. The system needs more funding, better workforce planning, and a recognition of the central role that general practice plays in keeping the NHS afloat. Without this, the pressures we’re facing will only grow, and the long-term impact on patient care could be devastating.”
• “Unless urgent action is taken, this may be the last year of universal GP coverage in Scotland as practices, surviving beyond breaking point, collapse.”
• “Inadequate staffing, constant staff sickness and burnout. Insufficient beds. No funding for anything. Short sighted planning eg refusal to employ additional staff to replace retirements or fill maternity gaps but then having to spend more money on locums.”

Dr Iain Kennedy said:  
  
“We are only at the start of the winter period and yet we are already seeing examples of an NHS that is desperately struggling with the demands and expectations being placed on it. Doctors have spoken about consistent pressures being felt all year round, and we know patients are not accessing health care in a timeous manner. There has been warning after warning, and to be frank the time for words has now passed, in the coming year there needs to be action in the form of reform.  
  
“Our survey adds the stark, but very real experiences of doctors on the frontline, who are now facing, on a daily basis, moral distress and injury being unable to provide the care for our patients that we want and know they deserve. What was apparent in our survey was the frustration doctors feel at not being able to do the best we can for the people we care for, with patient’s needs featuring in 70% of written responses. Doctors are finding themselves working in a system that is neither prepared nor staffed adequately. They are struggling to cope in an NHS that is in constant crisis, which is both mentally and physically exhausting. While there are continuous pressures on the NHS we are only too aware that at this time of year there is always an additional winter surge, higher demand due to seasonal illness and bad weather, which just emphasises the inability of the health service to cope with what we ask of it.    
  
“We know the NHS is valued and that, politically, all agree with the founding principle of ‘free at the point of need’. What needs to be put in place are measures that protect our health service for the long-term, giving the system stability and patients peace of mind.  
  
“The measures need to be transformative; the NHS needs to be reformed, we cannot continue to simply plug gaps with short term funding, there needs to be a whole system approach, looking at primary, secondary and social care, how they are appropriately funded and how they interact.  We know that the pressures we are seeing on the acute services are linked to lack of resource in general practice and social care, so to help guide the overall reform we need an urgent, comprehensive workforce plan. This must map healthcare demand and set out in detail how we will get all the staff we need working in the parts of the system and places across Scotland where we need them.   
  
“Most concerning of all, is that of those who responded to our survey, 98% had no (86%), or were not sure if they had (13%), confidence in the Scottish Government to put the NHS on a sustainable footing. Doctors have heard a lot of warm words recently from the First Minister and his team about the NHS being at the heart of their recent budget, but words must be matched with a clear vision, a timetable for reform and action.   
  
“The NHS as we know it will struggle to see out another year, as its founding principles, which we all value so highly will be at risk with more and more people forced to go private or simply left to suffer as they cannot access the care they need, when they need it. It is not too late to turn this around and protect our NHS but now is the time to finally act and set out a clear plan to get to grips with the many complex issues we face.”  

 

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.