Review Body on Doctors' and Dentists' Remuneration 2023 to 2024: Scottish evidence

F. Workforce Planning

National Workforce Planning

92. NHS Scotland's staffing levels have benefitted from a long-term trend of workforce investment and growth. This has since contributed to ten consecutive years of staffing increases, with record levels of medical and dental consultants – as well as other key staff groups – in place. Nevertheless, Scotland's healthcare services continue to face a number of challenges including an increased demand for services and global shortages in some medical specialties. These were existing challenges but have, of course, been heavily exacerbated by the Covid-19 pandemic.

Three Year Workforce Plans and Guidance

93. DL 2022 (09) National Health and Social Care Workforce Strategy: Three Year Workforce Plans, issued in April 2022, provided guidance to NHS Boards and HSCPs on completion of their Three-Year Workforce Plans, including the key information and analysis that should be set out in those plans.

94. It was expected that NHS Boards and HSCPs workforce plans would align with the key policy commitments set out in the NHS Recovery Plan, considering, where relevant, projected recovery needs in Social Care services, in anticipation of the development of the National Care Service.

95. In developing Three Year Workforce Plans NHS Boards and HSCPs were asked to address upcoming workforce demand, taking into account:

• their current workforce, (undertaking a gap analysis comparing projected demand with current workforce capacity);
• their assessment of workforce needs to fill any identified gaps;

96. Additionally, organisations were asked to use the 5 Pillars in the Workforce Strategy (Plan, Attract, Train, Employ, Nurture) as a framework in Three Year Workforce Plans, to:

• Detail the actions which organisations will take to recruit and train staff in sufficient numbers to deliver the future workforce;
• Describe the current workforce and issues affecting the quality of staff experience, wellbeing and actions to support the retention of current staff;
• Identify any short/medium-term risks to service delivery in meeting projected workforce requirements and outline actions in place to mitigate shortfalls.

97. NHS Boards and HSCPs were required to submit a draft copy of their plan to the Scottish Government by 31 July 2022. Subsequently an analysis process was undertaken and feedback given to organisations in advance of publication of final versions on organisations' websites by 31 October 2022.

98. Assessment of NHS Board and HSCP workforce plans has highlighted variability across Boards/HSCPs in the maturity of local planning processes and in their readiness to undertake demand-led workforce planning that specifically considers known future demand for services over a multi-year time period, and then quantifies that demand as WTE workforce.

99. The plans submitted have however provided a good narrative assessment of current demand pressures and key areas of shortfall, including information about prospective workforce supply concerns across a variety of job families.

National Workforce Strategy for Health and Social Care

100. A key requirement to delivering the Scottish Government's NHS Recovery Plan is having the right workforce in place at the right time, and therefore we developed a supporting workforce strategy to enable us to do this.

101. Our National Workforce Strategy, published 11 March sets out a new framework to shape Scotland's health and social care workforce over the next decade, placing training, wellbeing, job satisfaction and the principles of Fair Work at its heart.

102. This high level, holistic and longer term Strategy outlines the changing demands on health and social care; our workforce, vision, values and outcomes. It provides context on current challenges and opportunities and establishes a strategic framework of support for individual services in the development of their own service level strategies – with focus on coherence, sustainability and transformation of service delivery.

103. In the strategy the Scottish Government committed to publishing, for the first time, projections of required workforce growth across health and social care. These projections will be published in early 2023 which will provide level conclusions from projections modelling. We will also include in this publication our high-level assumptions (including any mitigating factors we have made assumptions about) and methodology used in development of the projections model. These projections are iterative and will respond to and change depending on emerging evidence and data.

104. Whilst it remains important to understand the gaps in our workforce, the experience of Covid has highlighted the need for a paradigm shift in the way we plan for the future health and social care needs of the population of Scotland and the workforce that delivers the services needed.

105. We are consulting and engaging with stakeholders to take forward and prioritise the actions articulated in the Strategy. Where appropriate, new actions will be developed as we work towards achieving our vision for the health and social care workforce.

106. As part of this strategy, we committed to increasing the number of medical school places by 100 per annum over the lifetime of this Parliament, whilst also doubling the number of Widening Access places over the same period. This will result in an additional 500 medical school places and 120 Widening Access places, ensuring a healthy supply of trainee doctors for further training at postgraduate level. We have also committed to expanding the number of trainee doctor posts in line with medical workforce modelling intended to achieve a planned and sustainable medical workforce to meet current and future needs.

Workforce Data

107. While the Scottish Government continues to set a strategic approach to workforce planning, it is vital to ensure that the right workforce is in place to deliver health services across Scotland. The most recently available national workforce statistics are outlined below:

NHS Scotland since 2006

108. NHS Scotland's staffing levels have increased by over 28,900 whole time equivalent (WTE) since 2006 - a 22.7% increase (from 127,061.9 WTE at September 2006 to 155,913.5 WTE at September 2022).

109. There are 6,032 WTE medical and dental consultants (including consultant directors) in post at end September 2022 - an annual increase of 2.2% (129.9 WTE), and an overall increase of 65.9% (2,395.4 WTE) since September 2006.

DDRB remit groups

110. Numbers of medical and dental staff in post have risen from 11,343.1 WTE in September 2008 to 15,348.1 WTE in Sept 2022. This represents an increase of 35.3%.

111. For medical and dental specialties, the largest age group was 35-54, the median age is 38. 11.2% of staff within this specialty are aged 55 and over.

Vacancies

112. NHS Scotland is a large organisation, employing 155,913.5 staff (WTE) (as at September 2022). Given the natural turnover of staff in an organisation of this size, it will always carry some vacancies.

113. For certain consultant posts (Radiology, Geriatrics, Psychiatry), and in certain parts of Scotland, Boards can find it more challenging to fill vacancies. Some specialties such as Radiology and for nursing specialties – continue to experience international shortages.

114. The number of vacant consultant posts decreased by 10.7% (47.3 WTE) between September 2021 and September 2022 to 392.8 WTE, creating a vacancy rate of 6.2%. Of these vacancies, 198.9 WTE (3.2% of the establishment figure) had been vacant for six months or more at the census point.

115. The number of vacant consultant posts in medical specialties was 380.5 WTE, a decrease of 12.5% from September 2021. Of these, 198.9 WTE (3.2%) had been vacant for 6 months or more.

116. As at September 2022, the number of vacant consultant posts in dental specialties was 12.3 WTE.

117. For medical and dental staff across Scotland, the turnover rate in 2020/21 was 11.7% (calculated as the number of leavers divided by staff in post as at 31 March).

Staff Turnover

118. Official data on turnover (staff leaving and joining NHS roles) is published on an annual basis at June. The most recent data on turnover is for the period June 2021-June 2022;

119. The number of medical and dental staff leaving posts in the last financial year increased by 17.2% on the previous year.

120. The number of medical and dental staff joining posts in the last financial year decreased by 2.8% on the previous year.

Sustaining the Medical Workforce in Scotland - update

121. The Scottish Government's National Health and Social Care Workforce Plan's recruitment, training and education commitments included (i) 100 more training places for GPs from 2019 and (ii) 50-100 additional medical undergraduate places by 2021:

122. Complete - In October 2015, the First Minister announced an increase of 100 additional GP Speciality Training (GPST) posts, raising the number of established training places from 300 to 400. An extra GPST recruitment round was introduced in 2016 to accommodate this increase.

123. These extra posts are now embedded within the GPST trainee

establishment which now stands at 1,176 (spread across 3 years of GPST).

124. A further 35 GPST places were agreed to recently by the Cabinet Secretary for Health and Social Care following recommendations made by the Scottish Shape of Training Transition Group. These posts will be recruited to in 2023.

125. To incentivise GPST posts that are typically hard-to-fill (remote, rural and deep-end practices), a £20k bursary is offered to trainees applying for these posts. If accepted, the bursary bonds the trainee to that post for the duration of their 3 year training programme.

126. Across the 2022 recruitment rounds, a total of 98 GPST posts were advertised with the bursary attached, 94 of which filled (96% fill rate).

127. (ii) Complete – 100 additional medical school places have been created. These consist of:

• 60 places which commenced in 2019-20 (30 each at Aberdeen and Glasgow Medical Schools) and have a GP focus. A further 25 places have been added at Aberdeen commencing in the academic year 22/23, taking the total to 85 places.
• 25 places which commenced in 2020-21 on Edinburgh University's HCP-Med course, designed for experienced healthcare workers who are more likely to remain and work in NHS Scotland.From 22/23 onwards the HCP-Med Course will have an additional 5 places – so 30 places in total.
• 15 additional places on the ScotGEM programme from 22/23 onwards, taking the total to 70 places. ScotGEM is run jointly by the universities of St. Andrews and Dundee and course has a similar focus on generalist as well as remote and rural working.

NHS Recovery Plan

128. We published the NHS Recovery Plan in August 2021, which sets out our plans for health and social care over the next 5 years. Backed by over £1 billion of funding, the plan will support an increase in inpatient, day case, and outpatient activity to address the backlogs of care, which will be supported by the implementation of sustainable improvements and new models of care. The first annual progress update was published on 4 October NHS Recovery Plan: annual progress update - gov.scot (www.gov.scot). This update detailed the progress being made against the actions to address the backlog in care and meet ongoing healthcare needs for people across Scotland.

129. We are making good progress against the NHS Recovery Plan and have continued to find innovative and sustainable solutions to the challenges services are experiencing.

130. Some of the key achievements detailed in this plan include:

• By the end of August, over 75% of outpatient specialities had either no, or fewer than ten patients waiting longer than two years for their treatment.
• We have invested significantly to increase the NHS Scotland workforce to historically high levels, with staffing up by 8.9% since the onset of the pandemic (December 2019), and by 1.7% in the last year.
• Scotland led the rest of the UK on 1st, 2nd, 3rd and booster doses of the Covid-19 vaccine, and delivered one of the most successful vaccination programmes in the world last winter.

131. Following this update, the full published document is now available to view on the Scottish Government website.

132. We anticipated that the first year of the NHS Recovery Plan would continue to bring challenges. As such, many of the commitments will be delivered on a phased basis as we progress towards the end of the lifetime of the Plan.

133. Our Recovery Plan takes us to the end of the Parliamentary term, and as a sensible and competent government we will refine our deliverables as actions are completed and circumstances evolve, while our fundamental ambitions remain the same:

• Everyone in Scotland gets the right care, at the right time, in the right place based on their individual circumstances and needs.
• Prevention, early intervention, proactive care and good disease management keeps people in Scotland healthy, active and independent.
• Communities, third sector & public sector work together to improve health and wellbeing and reduce health inequalities in local communities.

134. Whilst we remain absolutely committed to our ambitions, we must not underestimate the scale of the challenge facing government, and our NHS, in the years to come.

Long Wait Targets

135. Pausing of non-urgent activity during the pandemic has inevitably led to a build-up of numbers waiting for treatment, and services continue to experience significant pressure as a result of this.

136. You will appreciate that at the present time the NHS cannot mobilise services to the degree and speed we all wish to see, and has to balance competing demands and pressures, making the best decisions they can in difficult circumstances. None of this is easy nor is it taken lightly.

137. Despite this, the data shows a significant increase in the number of inpatient and day-case patients seen compared to the previous quarter, an increase of 7.6% (3,531 patients), and the number of patients waiting over 2 years decreased slightly (2,900 on 31 March 2022 to 2,721 on 30 June 2022).

138. We know that excessively long waits have grown as a result of the pandemic, which is why we now need to focus on treating people that are waiting too long for treatment. In response to this, the Cabinet Secretary for Health & Social Care introduced a new set of targets for NHS Scotland to address the backlog of planned care in July 2022. Key targets aim to eliminate:

• Two-year waits for outpatients in most specialities by the end of August 2022
• 18-month waits for outpatients in most specialities by the end of December 2022
• One-year waits for outpatients in most specialities by the end of March 2023
• Two-year waits for inpatient / day-cases in most specialities by the end of September 2022
• 18-month waits for inpatient / day-cases in most specialities by the end of September 2023
• One-year waits for inpatient / day-cases in most specialities by the end of September 2024

139. With regards to the first outpatient target, a recent statistical publication from Public Health Scotland shows that Boards have made good progress and two year waits are clear in more than half of outpatient specialities.

140. On 19 October 2022, PHS published performance data relating to the target to eliminate 2-year waits for IPDC in most specialties by end September 2022, which showed 13 of 30 specialties had no patients waiting more than two years, and 60% (18 of 30) had fewer than ten patients waiting more than two years.

141. Since the introduction of new targets in early July, almost 53,500 patients were seen in the quarter to the end of September - the highest number in one quarter since the start of the pandemic.

142. We need to rebuild a system that can live with the virus, which does not impact on the delivery of acute services such as planned care. We are committed to working with NHS Boards to deliver our ambition to protect, stabilise and recover planned care. This includes maximising theatre productivity, optimising Golden Jubilee National Hospital capacity, and regional working.

143. Patients will be offered appointments as local to them as possible but some may be offered alternatives outwith their local health board area to reduce their waiting time, for example, the Golden Jubilee University National Hospital or at National Treatment Centres as they become operational.

144. While the aim is to eradicate all long waits in all specialities, it is important to note that a small number of patients may be unable to have their procedure within these timeframes for personal or clinical reasons.

National Treatment Centres

145. The National Treatment Centres (NTC) Programme is central to the Scottish Government's NHS Recovery Plan which sets out actions to address the backlog in planned care as a result of Covid and to meet ongoing healthcare needs for people across Scotland.

146. The phased opening of the National Treatment Centres has been accelerated to support NHS Covid recovery and help the increase in demand that is anticipated to arise from demographic changes.

147. Following the opening of the NHS Golden Jubilee Eye Centre in November 2020, we have four NTC's due to open over the next year – NHS Fife, NHS Forth Valley, NHS Highland and the second phase of the NHS Golden Jubilee. These four centres will open on the following dates, providing a total capacity of eight additional orthopaedic theatres; an additional inpatient/daycase ward; five endoscopy rooms and two general theatres, initially providing over 12,250 additional procedures, dependent on workforce:

• NTC Fife is planned to open early next year in 2023 bringing additional capacity of one orthopaedic theatre, and around 500 procedures in 2023/24.
• NTC Forth Valley is planned to open in Spring in 2023 bringing additional inpatient/daycase ward capacity, supporting around 1,000 procedures in 2023/24.
• NTC Highland is also planned to open in Spring 2023 bringing additional capacity of two orthopaedic theatres, and around 1,350 procedures in 2023/24.
• NTC Golden Jubilee Phase 2 is planned to open late summer 2023 bringing additional capacity of five orthopaedic theatres, five endoscopy rooms and two general theatres, and around 9,400 procedures in 2023/24.

148. Timescales for the other NTCs (Tayside, Grampian, Lanarkshire, Lothian, and Ayrshire and Arran) will be defined as part of the ongoing business case development.

149. The Scottish Government remains committed to recruiting an additional 1500 staff by 2026 to ensure that elective care needs are met through the NTCs. We are supporting boards to utilise a range of recruitment and retention options. We routinely engage with all NTC projects to monitor the progress of recruitment and to identify areas of emerging risk which may require intervention.

150. We acknowledge that significant medical workforce is required to meet the delivery of elective care through the NTC programme, given the challenges in filling these roles via domestic recruitment, we are working with boards to increase international recruitment as well as building links with Royal Colleges to expand international training and recruitment of medical staff.

Primary Care

151. A key change in the 2018 GP Contract is that GPs will become more involved in complex care and system wide activities, necessitating a refocusing of GP activity. As we refocus the GP role, we expect GPs to be less involved in more routine tasks, with these tasks being delivered by other health professions in the wider primary care multi-disciplinary team.

152. In August 2021 the Scottish Government published its NHS Recovery plan to drive the recovery of our NHS, not just to its pre-pandemic level but beyond. The recovery plan is backed with over £1 billion of targeted investment over the next 5 years to increase NHS capacity, deliver reforms in the delivery of care, and get everyone the treatment they need as quickly as is possible.

153. As part of this we are investing in Primary Care through the Primary Care Improvement Fund to provide General Practice and their patients with support from a range of healthcare professionals in the community.

154. This supports the implementation of the new GP contract, creating more capacity for GPs to deal with complex medical care in the community through working as part of an expanded multidisciplinary team.

155. We also launched a new GP recruitment campaign this June, as part of our commitment to increase the number of GPs in Scotland by 800 by 2027. The campaign seeks to encourage GPs from the rest of the UK to relocate to Scotland, highlighting the flexible, supportive, collaborative and multi-disciplinary working environment available here.

Data Gap on Vacancies

156. The 2018 GP Contract means an increase of data collection. As part of this it is mandatory for practices to provide workforce data – including on GP and practice staff vacancies. This will facilitate future workforce planning. Scottish Government published The Primary Medical Services (GP Practice Data) (Scotland) Directions 2019 on 23 September 2019.

157. Scottish Government are working in partnership with SGPC to run the General Practice Workforce survey on an annual basis from the 2022/2023 financial year.

Recruitment and Retention – particularly for remote and rural

158. We support rural general practice with a comprehensive package of measures:

• We have significantly enhanced recruitment incentives by investing £400,000 in recruitment incentives for rural GP posts across Scotland, and £200,000 for relocation costs for GPs moving to rural posts in 2022/23.
• We have increased GP relocation packages from £2,000 to £5,000 and widened eligibility for recruitment incentives from island practices to all remote and rural practices.
• We invested £117,252 to build change management support across island Health Boards.
• The Pre-Hospital Emergency Care (PHEC) Funding of £24,000 to pre-hospital emergency care transitionary arrangements for all Argyll and Bute practices for the full financial year.
• The Scottish Government allocated £198,000 to NHS Shetland to support the Rediscover the Joy in General Practice Project. A collaboration of four rural Health Boards, Shetland, Orkney, Western Isles and Highland, to develop a scheme to attract experienced GPs to work in rural practices on a flexible basis for a maximum number of weeks a year. GPs employed on the scheme would be provided with BASICs training and mentorship.
• We have increased GP relocation packages from £2,000 to £5,000 and widened eligibility for recruitment incentives from island practices to all remote and rural practices.
• The Scottish Government has allocated £176,000 to NHS Highland to support the Scottish Rural Medicine Collaborative to develop recruitment and sustainability measures.
• Support for the GP for GP Scheme. This is a scheme which provides a confidential service in NHS Highland to General Practitioners and their families at times of stress or illness, when they have difficulty going to their own GP. In the past it has supported Highland GPs with problems such as stress, depression, inability to cope, marital problems and bereavement. This scheme has been extended to remote and rural GPs across Scotland.
• A £53,000 grant is provided to BASICS Scotland to support the provision of a comprehensive, co-ordinated network of trained and equipped BASICS Scotland responders.
• In line with the 2021/22 Programme for Government, scoping work has been carried out this year to create a new centre for rural and remote health and social care, funding NES £90,000 for the preparation of the business case.

159. The programme is taking forward proposals that promote Scottish general practice as a positive career choice, support medical students to actively choose general practice, inspire doctors in training to select speciality training in general practice, and encourage our alumni to stay in/return to Scotland, as well as those wanting to work in rural and economically deprived areas.

Generation 'Y' – more choosing to be salaried

160. The new GP contract has been designed to make becoming an independent contractor more attractive to young GPs. This includes stabilising practice and individual GP Partner income, reducing the risks of becoming a GP Partner and reducing GP workload.

161. However, the Scottish Government recognises that there is still an important, continuing role for salaried GPs. The new GP Contract maintains the specification that salaried GP Contracts should be on terms no less favourable than the BMA Model Contract.

Recruitment & retention

162. We have supported NHS Boards in building effective infrastructure to facilitate international recruitment, including the establishment of the Centre for Workforce Supply (CWS) which supports the development and implementation of resource strategies and services across the system.

163. Recruitment to remote & rural areas in Scotland can be challenging, that is why we will develop a Remote and Rural Workforce Recruitment Strategy by the end of 2024, as seen in the National Workforce Strategy for Health and Social Care^[21]. The strategy will support employers to ensure that the health and social care needs of people who live in remote and rural communities are met.

International recruitment

164. We have provided £1m recurring funding to boards to increase in-house recruitment capacity to enabled international recruitment utilisation. The Scottish Government recognises that international recruitment must be ethical cannot impact the health systems of developing countries. That is why all international recruitment must be carried out in accordance with the Scottish Code of Practice on International Recruitment of Health and Social Care^[22]. The code protects the healthcare systems of developing nations whilst evidencing our commitment to ethical recruitment.

165. Work is ongoing to build links between board, Royal Colleges and NHS Education for Scotland to expand both international training and recruitment schemes for medical staff. Particularly, working to streamline the process involved to assist boards with Medical Training Initiatives (MTI) as an ethical educational exchange to benefit all.

166. We recognise that both IMGs and boards can and will benefit from building relationship links to other countries for future learning opportunities, as well as building pipelines for future vacancies.

167. The Scottish Government views that MTI's can provide support to NHS boards in a several ways such as utilising MTIs to increase healthcare professionals for service provision, enabling a reduction in locum spend. In addition, MTIs can improve patient continuity of care and provide valued resources for NTCs on a rolling basis.

168. Given the existing and continued pressures faced nationally by NHS Scotland, we work closely with the Bridges Refugee Programme, who support refugee healthcare workers in gaining the relevant registration to practice in the UK.

NHSScotland workforce statistics - HCHS Staff (Headcount) by Specialty, Sex & Age Group, Sep 2022

	20 to 24	25 to 29	30 to 34	35 to 39	40 to 44	45 to 49	50 to 54	55 to 59	60 to 64	65+	All ages
All specialties	822	3,049	2,933	2,311	2,085	1,892	1,694	1,375	599	260	17,020
Female	531	1,783	1,673	1,345	1,164	969	791	593	196	50	9,095
Male	291	1,266	1,260	966	921	923	903	782	403	210	7,925
All medical specialties	735	2,894	2,838	2,186	1,993	1,805	1,599	1,293	562	246	16,151
Female	474	1,668	1,609	1,266	1,099	906	740	549	185	48	8,544
Male	261	1,210	1,225	926	891	896	857	742	378	200	7,586
All dental specialties	87	156	96	125	93	87	96	83	37	14	874
Female	57	116	66	79	65	63	51	44	11	4	554
Male	30	56	37	41	31	27	46	41	26	10	345

Note

An employee may hold more than one appointment in NHSScotland, and is counted under each area they work in as well as in the overall total - therefore, the sum of all headcounts within individual categories may not equal the overall headcount total.

Average basic and total pay for M&D staff - 2021/22

NHSScotland workforce | Turas Data Intelligence - Management Information

Grade	Sex	Basic pay	Total pay	Year WTE	Average basic pay	Average total pay	Gender difference in av. basic pay	Gender difference in av. total pay
Consultant	F	241,382,402	283,027,487	2,402.5	100,472	117,806	2,622	7,657
	M	339,861,404	413,602,276	3,296.6	103,094	125,463
	Total	581,243,806	696,629,763	5,699.1	101,989	122,235
Doctor in Training	F	111,407,207	172,087,969	2,952.4	37,734	58,287	1,541	-261
	M	100,240,463	148,099,010	2,552.3	39,275	58,026
	Total	211,647,669	320,186,979	5,504.7	38,449	58,166
Staff grade	F	39,278,306	42,073,674	536.1	73,272	78,486	251	722
	M	27,754,109	29,900,367	377.5	73,523	79,208
	Total	67,032,415	71,974,041	913.6	73,375	78,785
Other grade	F	50,439,435	84,370,199	821.8	61,374	102,661	2,094	17,273
	M	42,246,841	79,833,008	665.6	63,468	119,934
	Total	92,686,277	164,203,207	1,487.5	62,311	110,390
Total	F	442,507,350	581,559,329	6,712.8	65,920	86,634	8,094	10,788
	M	510,102,817	671,434,661	6,892.0	74,014	97,422
Overall total		952,610,167	1,252,993,989	13,604.8	70,020	92,099

Source: NES pay bill file 2021/22 from Scottish Workforce Information Standard System (SWISS)

Note

"Doctor in Training" includes Foundation Years 1 & 2 and Specialty training (SpR, StR etc).

Gender difference in average basic and total pay uses the male amount as the starting point - so a positive difference means the male amount
is higher than the female amount.

Gender differences in average basic pay

The biggest difference in average basic pay is in the "Consultants" grade group where males earn on average around £2,620 more than females.

Gender differences in average total pay

The biggest difference in average total pay is in the "Other" grade group where males earn on average around £17,270 more than females.

NHSScotland workforce statistics - Consultant Vacancies and Establishment1, by Specialty2, Sep 2022

NHSScotland - Consultant Vacancies by Specialty - Trend to 30 September 2022

	Sep-06	Sep-09	Sep-10	Sep-11	Sep-12	Sep-13	Sep-14	Sep-15	Sep-16	Sep-17	Sep-18	Sep-19	Sep-20	Sep-21	Sep-22
All Specialties	272.3	166.0	139.0	112.5	143.1	213.1	339.3	345.5	389.9	430.5	398.1	483.1	377.4	440.1	392.8
All Medical Specialties1	262.3	160.0	138.0	111.2	141.1	207.4	332.3	336.7	378.8	420.9	393.2	475.6	373.4	434.9	380.5
Emergency Medicine	6.0	4.0	2.0	2.0	7.3	15.5	20.3	19.8	15.7	17.5	11.1	17.9	17.7	8.7	8.0
Clinical Laboratory Specialties	36.4	28.7	31.2	18.8	30.7	37.0	58.0	45.7	68.7	85.7	70.2	68.3	46.8	43.2	47.4
Medical Specialties	66.4	42.0	33.5	32.0	30.7	57.6	94.4	112.9	104.3	114.5	110.5	111.2	108.2	96.7	108.0
Geriatric Medicine	9.0	4.0	8.5	7.0	3.0	11.0	12.0	10.0	8.0	18.8	18.0	23.9	20.3	13.4	13.8
Psychiatric Specialties	52.8	36.3	15.5	8.0	8.7	25.2	37.3	40.3	41.8	58.8	65.1	78.4	69.7	96.8	71.4
Surgical Specialties	47.5	19.0	19.0	27.6	22.0	28.1	50.0	47.7	65.6	65.1	72.1	91.7	51.1	76.7	58.8
Paediatrics Specialties	16.8	16.0	14.0	13.0	15.9	13.0	19.0	20.8	33.2	25.1	16.0	21.5	13.7	28.9	15.0
All Dental Specialties	10.0	6.0	1.0	1.3	2.0	5.7	7.0	8.8	11.1	9.6	4.9	7.5	4.0	5.2	12.3

Source: ISD Scotland National Statistics, NHS Scotland Workforce (up to Sep-18); NES Official Statistics, NHS Scotland Workforce (Sep-19 onwards)

1. The sum of the individual sub-specialties will not equal the "All Medical Specialties" total as only a selection of sub-specialties have been presented here.

Consultants - Includes Consultants and Directors of Public Health. Excludes Clinical/Medical/Dental Directors as vacancy data for these posts are not published.

- Zero, x Not applicable

NHSScotland - Consultant Establishment¹ by Specialty - Trend to 30 September 2022

	Sep-06	Sep-09	Sep-10	Sep-11	Sep-12	Sep-13	Sep-14	Sep-15	Sep-16	Sep-17	Sep-18	Sep-19	Sep-20	Sep-21	Sep-22
All Specialties	3,896.9	4,418.4	4,514.1	4,541.1	4,619.3	4,797.7	5,230.0	5,372.2	5,564.4	5,620.2	5,755.6	5,865.0	5,964.8	6,214.8	6,294.8
All Medical Specialties2	3,806.4	4,321.0	4,414.5	4,440.0	4,514.5	4,690.7	5,126.6	5,273.3	5,457.3	5,518.0	5,659.8	5,770.6	5,876.5	6,124.9	6,201.5
Emergency Medicine	81.8	98.8	130.4	135.8	151.7	170.0	223.6	227.1	232.1	240.0	240.4	252.7	271.0	279.7	288.9
Clinical Laboratory Specialties	552.1	589.9	597.6	591.9	589.4	603.5	660.6	668.8	703.2	718.5	712.3	717.1	707.3	728.1	749.4
Medical Specialties	859.5	905.2	1,003.0	1,014.8	1,021.4	1,078.3	1,222.1	1,267.0	1,342.7	1,369.6	1,435.7	1,425.2	1,476.8	1,511.4	1,549.4
Geriatric Medicine	127.9	141.4	149.0	148.5	147.6	156.3	172.0	173.1	177.2	189.3	201.0	206.5	207.1	204.2	206.3
Psychiatric Specialties	497.4	562.0	542.8	550.3	533.5	552.1	572.5	582.7	596.5	591.2	598.0	607.0	614.3	644.5	612.7
Surgical Specialties	751.6	857.8	879.0	883.8	870.3	862.2	956.3	1,002.5	1,032.0	1,039.8	1,035.5	1,098.9	1,104.4	1,168.0	1,173.6
Paediatrics Specialties	184.0	304.7	230.0	235.7	239.7	245.4	297.7	319.3	339.8	334.7	367.1	370.9	379.7	408.1	411.4
All Dental Specialties	90.5	97.4	99.6	101.1	104.7	107.1	103.4	98.8	107.1	102.3	95.8	94.4	88.2	90.0	93.3

Source: ISD Scotland National Statistics, NHS Scotland Workforce (up to Sep-18); NES Official Statistics, NHS Scotland Workforce (Sep-19 onwards)

1. Establishment value is calculated as: staff in post + total vacancies
2. The sum of the individual sub-specialties will not equal the "All Medical Specialties" total as only a selection of sub-specialties have been presented here.

Consultants - Includes Consultants and Directors of Public Health. Excludes Clinical/Medical/Dental Directors as vacancy data for these posts are not published.
- Zero, x Not applicable

NHSScotland - Consultant Vacancies as a Percentage of Establishment by Specialty - Trend to 30 September 2022

	Sep-06	Sep-09	Sep-10	Sep-11	Sep-12	Sep-13	Sep-14	Sep-15	Sep-16	Sep-17	Sep-18	Sep-19	Sep-20	Sep-21	Sep-22
All Specialties	7.0%	3.8%	3.1%	2.5%	3.1%	4.4%	6.5%	6.4%	7.0%	7.7%	6.9%	8.2%	6.3%	7.1%	6.2%
All Medical Specialties	6.9%	3.7%	3.1%	2.5%	3.1%	4.4%	6.5%	6.4%	6.9%	7.6%	6.9%	8.2%	6.4%	7.1%	6.1%
Emergency Medicine	7.3%	4.0%	1.5%	1.5%	4.8%	9.1%	9.1%	8.7%	6.8%	7.3%	4.6%	7.1%	6.5%	3.1%	2.8%
Clinical Laboratory Specialties	6.6%	4.9%	5.2%	3.2%	5.2%	6.1%	8.8%	6.8%	9.8%	11.9%	9.9%	9.5%	6.6%	5.9%	6.3%
Medical Specialties	7.7%	4.6%	3.3%	3.2%	3.0%	5.3%	7.7%	8.9%	7.8%	8.4%	7.7%	8.5%	7.3%	6.4%	7.0%
Geriatric Medicine	7.0%	2.8%	5.7%	4.7%	2.0%	7.0%	7.0%	5.8%	4.5%	9.9%	9.0%	11.6%	9.8%	6.6%	6.7%
Psychiatric Specialties	10.6%	6.5%	2.9%	1.5%	1.6%	4.6%	6.5%	6.9%	7.0%	9.9%	10.9%	12.9%	11.3%	15.0%	11.6%
Surgical Specialties	6.3%	2.2%	2.2%	3.1%	2.5%	3.3%	5.2%	4.8%	6.4%	6.3%	7.0%	8.3%	4.6%	6.6%	5.0%
Paediatrics Specialties	9.1%	5.3%	6.1%	5.5%	6.6%	5.3%	6.4%	6.5%	9.8%	7.5%	4.4%	5.8%	3.6%	7.1%	3.6%
All Dental Specialties	11.0%	6.2%	1.0%	1.3%	1.9%	5.3%	6.8%	8.9%	10.4%	9.4%	5.1%	7.9%	4.5%	5.8%	13.2%

Source: ISD Scotland National Statistics, NHS Scotland Workforce (up to Sep-18); NES Official Statistics, NHS Scotland Workforce (Sep-19 onwards)

Consultants - Includes Consultants and Directors of Public Health. Excludes Clinical/Medical/Dental Directors as vacancy data for these posts are not published.

- Zero, x Not applicable

NHSScotland workforce | Turas Data Intelligence

NHSScotland workforce statistics - HCHS Medical & Dental Staff ( WTE) by Group1,2,3,14<

	Sep 08	Sep 09	Sep 10	Sep 11	Sep 12	Sep 13	Sep 1419	Sep 15	Sep 16	Sep 17	Sep 18	Sep 19	Sep 2017	Sep 21	Sep 22
All HCHS medical and dental staff	11,343.1	11,328.4	11,440.3	11,960.7	11,943.9	12,181.4	12,698.9	12,812.1	13,117.7	13,239.3	13,531.6	13,745.6	14,411.4	14,837.2	15,348.1
Consultant4	4,234.4	4,252.5	4,375.1	4,428.5	4,476.2	4,584.6	4,890.7	5,026.7	5,174.5	5,189.8	5,357.5	5,382.0	5,587.4	5,774.7	5,902.0
Director (Clinical, Medical & Dental)5	48.3	53.9	59.2	76.9	82.6	81.2	83.6	74.7	129.2	134.5	127.2	123.2	114.5	127.4	130.0
Doctor in Training (with NTN)1,2,6,15,16	3,173.8	3,222.7	3,076.9	3,667.7	3,591.6	3,739.9	3,951.4	3,893.7	3,359.0	2,978.2	3,228.7	3,670.1	3,859.6	3,762.2	3,767.1
Doctor in Training (no NTN)1,2,7,8,15	545.9	461.2	589.5	308.8	278.8	197.0	246.6	205.3	716.7	1,177.9	874.9	796.2	686.5	787.3	884.3
Foundation house officer year 21,2,9,12	914.0	828.0	861.8	784.0	800.7	787.5	886.2	786.5	778.1	790.6	852.2	926.5	927.1	894.1	977.5
Foundation house officer year 11,2,9,12	899.4	963.3	824.7	956.0	988.5	1,072.3	883.5	1,036.6	978.7	998.3	847.7	866.6	852.0	939.3	1,002.8
Specialty doctor10	1,047.6	1,008.7	1,057.9	1,080.0	1,050.8	1,042.9	1,058.5	1,056.4	953.8	939.5	935.8	936.9	939.8	931.6	941.4
Senior dental officer	75.7	70.8	85.2	88.0	87.3	77.7	82.8	90.8	98.5	91.0	79.6	82.9	94.9	88.9	88.3
Dental officer	225.1	224.0	190.8	201.7	184.5	184.5	196.6	174.1	174.2	179.0	192.4	181.6	169.9	174.8	175.1
Other1,2,11,13,15	179.0	243.3	319.1	369.0	403.1	413.8	419.0	467.2	755.0	760.5	1,035.5	779.7	1,179.7	1,357.0	1,479.6

Source: ISD Scotland National Statistics, NHS Scotland Workforce (up to Sep-18); NES Official Statistics, NHS Scotland Workforce (Sep-19 onwards)

NHSScotland workforce | Turas Data Intelligence

Note

1. From the 30 September 2018, the employment model for Doctors in Training (DiT) has changed affecting both the DiT grade and Other grade. As such, trend information for DiT (including Foundation house officer year 1 and year 2),

Other and therefore Medical overall figures should be interpreted with caution. The key changes underlying the published data are:

a) New data source: DiT data is reported by merging a new data source, Turas People (TP) provided by NHS Education for Scotland (NES), with the original data source (SWISS). TP has been utilised to facilitate reporting by board of placement however it does not include all DiT (for example, DiT who are out of programme, i.e. on long term leave). This data, which was previously included in all published figures, continues to be sourced from SWISS.

b) Data quality: ISD have worked with NHS Boards to cleanse the DiT data available in SWISS. This has identified that some staff were being inaccurately recorded as DiT and as such have inflated figures prior to 30 September 2018. Quality assurance across SWISS and Turas People is also an ongoing exercise.

2. Prior to 30 September 2018, staff recorded as Locum Appointment in Training (LAT) and Locum Appointment in Service (LAS) were excluded. Following a quality assurance exercise, ISD and NHS Boards agreed to include these locum posts from 30 September 2018 onwards. This change impacts trend data for the Doctor in Training grade (due to inclusion of staff on a LAT grade), Other grade (due to inclusion of staff on a LAS grade) and the total Medical figures. As such, trend information for DiT, Other and therefore Medical overall figures should be interpreted with caution.

3. From June 2014 a number of boards have migrated to the new national HR system e:ESS. This affects medical grade and medical specialty, changes may be seen as boards review their data during the migration process.

4. Staff in the consultant group include consultants and directors of public health.

5. Staff in the director (clinical, medical & dental) group include assistant chief administrative dental officer, assistant clinical director, chief administrative dental officer, clinical director and medical director.

6. Staff in the doctor in training (with NTN) group include registrar, senior registrar, specialist registrar, and specialty registrar.

7. Fixed term specialty training and general practice specialty training grades are available from September 2007 only.

8. Staff in the doctor in training (no NTN) group include core training, MTI, GPST and specialty registrar (core training).

9. From September 2005 house officers are known as foundation year 1 and from September 2006 senior house officers year 1 have been renamed as foundation year 2.

10. Staff in the specialty doctor group include associate specialist, clinical medical officer, hospital practitioner, limited specialist, part time dental practitioner para 107 app., part time medical practitioner para 94 app. [clin ass], senior clinical medical officer, specialty doctor and staff grade.

11. Staff in the other group include clinical fellow, dental advisor [CSA only], dental core training - grade 1, dental core training - grade 2, general professional trainee - dental, other, prescribing advisor, salaried GDP, salaried GP and Sessional GP out of hours.

12. According to local systems, NHS Forth Valley report that FY1 = 45.0 WTE and FY2 = 30.5 WTE as at 31 December 2016. According to local systems, NHS Tayside report that FY1 = 96.0 WTE and FY2 = 89.5 WTE as at 31 December 2016 ISD are working with NHS Boards to address technical issues ensuring locally uploaded data is available in the national database.

13. NHS Education for Scotland figures for HCHS dental staff other grades were inaccurately reported for March 2017, June 2017 and September 2017 due to a recording issue which has now been resolved. This also affected NHS Education for Scotland HCHS medical and dental staff other grades.

14. As from the 1st April 2016 NHS Grampian's medical and dental figures include medical leadership and support roles such as GP Appraisers, GP Sub Committee Members, Clinical Leads, Medical Director, most of these have a low WTE.

15. From March 2018, the grades of some medical staff in National Waiting Times Centre have incorrectly been recoded from Other to Doctor in Training (with NTN). This is being investigated locally.

16. From August 2018, NHS Education for Scotland (NES) will be the lead employer for all GP, Public Health and Occupational Medicine trainees. Several Boards have been 'early adopters' to this change with a number of their new and existing trainees already switching over with NES now reported as their employer as at March 2018 and June 2018. This is the reason for the increase reported in the latest GP trainee figures for NES. Boards involved in the early adoption (Ayrshire & Arran, Borders, Dumfries & Galloway, Forth Valley, Grampian, Highland, Lanarkshire and Tayside) may show an overall decrease in trainee doctors in several specialties as a result.

17. A process of accelerated recruitment was undertaken to help NHSScotland to manage the COVID-19 pandemic. This involved a several thousand nursing students, from both their 2nd and 3rd year of study, and doctors in their final year of university study, being brought in to work for NHSScotland. Some NHS Boards in order to process the onboarding of these individuals quickly only added their details to the NHS Payroll system, and did not add them to eESS the NHS HR system. In order to accurately count Staff in Post statistics we take data from both systems and if individuals are not recorded on both they are excluded from our statistics. Therefore the Staff in Post numbers reported here are likely to be an under representation.

18. Public Health Scotland is the new national public health body that launched 1 April 2020. It brings the functions of Health Protection Scotland and Information Services Division (formally within NHS National Services Scotland) together with NHS Health Scotland. As a result, from June 2020 there will be a reduction in NHS National Services Scotland staff and NHS Health Scotland will no longer have any staff.

19. Historical data from 2014 onwards has been updated to reflect improvements in dtaa processing in the official statistics. These changes only affect the distribution of figures for doctors in training with/without NTNs.