Doctors' and dentists' remuneration (DDRB) review body - 2022-2023 pay round: evidence
Written evidence submitted to the review body on Doctors’ and Dentists’ Remuneration (DDRB) by the Scottish Government for the 2022 to 2023 pay round.
F. Workforce Planning
National Workforce Planning
79. At the outset of the Covid-19 pandemic, NHS Scotland's staffing levels had benefitted from a long-term trend of workforce investment and growth. This has since continued to nine 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 health 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.
Workforce planning track record
80. Scotland was the first nation in the UK to publish a national health and social care workforce plan. The National Health and Social Care Workforce Plan (published in three parts from 2017 to April 2018), produced a number of recommendations to bring about improvements in workforce planning across health, primary care and social care.
81. The National Health and Social Care Integrated Workforce Plan was published in December 2019. This was developed in partnership with the Convention of Scottish Local Authorities, setting out how health and social care services will meet growing demand to ensure the right numbers of staff, with the right skills, across health and social care services.
82. Despite the widespread disruption caused by the Covid-19 pandemic, all workforce commitments from the these plans have continued to be implemented. A number of these commitments, such as the creation of an additional 100 medical undergraduate places and 100 GP specialist training places, have been completed, with remaining commitments progressing towards published target dates.
Updated Workforce Planning guidance
83. Along with the Integrated Plan, guidance on workforce planning was circulated to all health and social care organisations in Scotland - including Local Authorities, Integration Authorities, NHS Boards, voluntary sector and independent sector organisations.
84. The guidance was produced to help organisations to work together in integrated ways to; monitor trends in supply and demand, factor in demographic and other changes affecting the workforce, including retirement, inform recruitment strategies across different geographic areas and professions and to help bring further intelligence and co-ordination to the student intake process
85. In recognition of the disruption to national, regional and local workforce planning caused by the Covid-19 pandemic, the Scottish Government produced updated guidance informing NHS Boards and Integration Authorities of changes to the publication timescales for local Workforce Plans.
86. This guidance instructed Boards and Integration Authorities to develop, publish and deliver three year Workforce Plans covering the period 2022-2015. This new timescale for workforce planning is intended to create more effective alignment between service and workforce planning across Scotland.
87. Boards and Integration Authorities were also asked to produce preceding one year workforce plans covering 2021-2022. These have been received by the Scottish Government, with local intelligence on workforce planning activity drawn out and detailed feedback offered, ahead of the new cycle of three year plans.
Scenario Planning
88. A series of case studies and scenarios were published alongside the Integrated Plan, covering health and social care professions which are particularly affected by growing demand. These scenarios allow modelling of the numbers needed for future years, in response to growing demand.
89. Building on this progress, the further development of common methodologies for evidence-based workforce planning at national, regional and local levels remains a key ambition for the Scottish Government. The Scottish Government is working with NHS Education for Scotland (NES) to build a National Collaborative for Evidence Based Workforce Planning, which will set out a framework outlining two overarching sets
90. The Scottish Government will be responsible for setting the strategic national, workforce planning priorities, policies and assumptions on which health and care workforce planning scenarios and forecasts will be based.
91. NES will coordinate the identification, capture and linking of consistent and comprehensive workforce data which is fundamental to deliver and support a more responsive and accessible evidence base for policy and decision making.
92. Further to this, scenario planning continues to be embedded within the Scottish Government's processes for setting place numbers on funded medical (and nursing) education courses. The Scottish Government works with NHS Boards, including NHS Education for Scotland, royal colleges and education authorities to set place numbers based on a number of factors, including anticipated workforce demand;
93. Between 2015-16 and 2020-21 the controlled intake for medical students has grown by 22% and in 2021-22 it further increased to a record high 1,117.
Covid-19 response
94. Since the outbreak of the COVID-19 pandemic, workforce planning efforts have largely reoriented to respond to the widespread disruption to models of service delivery. Starting with efforts to immediately increase staffing capacity in spring 2020, action has taken place to continually invest in NHS workforce capacity, as well as staff wellbeing, during an extremely challenging period for those working in frontline services.
95. In March 2020, the Scottish Government launched the Health and Social Care Covid-19 Accelerated Recruitment Portal, in partnership with NHS Education for Scotland (NES). The Portal allowed returning professionals, as well as medical and nursing students, to take up roles in health and social care settings. Candidates who registered through the Accelerated Recruitment Portal were processed for deployment by NES, with individual Health Boards then provided with the opportunity to deploy candidates as required, according to their clinical need.
96. Additionally, the Scottish Government worked proactively with the General Medical Council, the Nursing and Midwifery Council and other bodies representing Pharmacists, Allied Health Professions and Dentists, to put emergency powers into practice in order to maintain emergency registers of available staff.
97. The Scottish Government has asked NHS Boards to produce local Mobilisation Plans, underpinned by the Re-mobilise, Recover and Re-design Framework.[9] The Scottish Government has worked continuously with NHS Boards to ensure the development of Mobilisation Plans involves effective, anticipatory workforce planning.
98. In August 2021, the Scottish Government published the NHS Recovery Plan,[10] which set out key ambitions and actions to be developed and delivered over the next 5 years in order to address the backlog in care and meet ongoing healthcare needs for people across Scotland. The Plan, which is backed by over £1 billion of investment, introduced numerous dedicated workforce commitments as well as investment to support Boards' capacity for recruitment. This includes £11 million for recruitment campaigns and the creation of a Centre for Workforce Supply.
99. The Centre for Workforce Supply is operational as of November 2021. It has been established to provide labour market intelligence, to work with the UK Government to access new and existing bilateral agreements for workforce supply, and to provide practical advice and support to health boards with the on-boarding of overseas staff.
100. In recognition of the distinct pressures facing health services in winter 2021/22, a further package of £300 million was announced in October 2021. Actions announced through this Winter Plan[11] focused on four key principles: maximising capacity, supporting staff wellbeing, supporting effective system flow, and improving outcomes. The Plan introduced further measures to enhance workforce numbers and to support capacity for domestic and international recruitment.
101. The Winter Plan also announced funding to strengthen multi-disciplinary working through multi-disciplinary teams made up of staff from professional groups across health and social care. An additional £20 million has been made available for the remainder of this financial year and on a recurring basis to enable both the establishment of new multi-disciplinary teams and the strengthening of existing teams.
102. The NHS Recovery Plan and Winter Plan contain a combined £12 million of investments in supporting staff wellbeing.
National Workforce Strategy
103. A key requirement to delivering the Scottish Government's NHS Recovery Plan is having the right workforce in place at the right time. A new supporting workforce strategy is being developed to enable this, for publication in early 2022.
104. This high level holistic Strategy will outline our shared vision for the workforce, which supports a tripartite ambition of recovery, growth and transformation. It will also set out the actions we are taking in partnership with the workforce, to achieve that vision. It will provide context on current challenges and opportunities and establish 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.
105. 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.
106. Once published, the Scottish Government will enter a period of consultation and engagement 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.
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 and 2020
108. NHS Scotland's staffing levels have increased by over 27,000 whole time equivalent (WTE) since 2006 - a 21.4% increase (from 127,061.9 WTE at September 2006 to 154,307.8 WTE at September 2021).
109. Medical & Dental consultant (incl. director-level consultants) numbers have increased by 62.3% in this time, (from 2,265.6 WTE to 5,902.1 WTE).
110. NHS Scotland's overall and medical and dental consultant workforces have grown by 5.2% (7,676.9 WTE) and 3.5% (200.1 WTE) respectively in the year to September 2021.
DDRB remit groups
111. Numbers of medical and dental staff in post have risen from 11,343.1 WTE in September 2008 to 14,837.2 WTE in Sept 2021. This represents an increase of 31.0%.
112. For medical and dental specialties, the largest age group was 35-54, the median age is 39. 11.4% of staff within this specialty are aged 55 and over.
Vacancies
113. NHS Scotland is a large organisation, employing 154,307.8 staff (WTE) (as at September 2021). Given the natural turnover of staff in an organisation of this size, it will always carry some vacancies.
114. 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, continue to experience international shortages.
115. The number of vacant consultant posts increased by 16.6% (62.7 WTE) between September 2020 and September 2021 to 440.1 WTE, creating a vacancy rate of 7.1%. Of these vacancies, 193.0 WTE (3.1% of the establishment figure) had been vacant for six months or more at the census point.
116. The number of vacant consultant posts in medical specialties was 434.9 WTE, an increase of 16.5% from September 2020. Of these, 190.0 WTE (43.7%) had been vacant for 6 months or more.
117. The number of vacant consultant posts in dental specialties was 5.2 WTE. Of these, 3.0 WTE (58.0%) had been vacant for 6 months or more.
118. For medical and dental staff across Scotland, the turnover rate in 2020/21 was 7.8% (calculated as the number of leavers divided by staff in post as at 31 March).
Medical Agency Locum Spend
119. In the last financial year Medical Agency Locum Spend decreased by 15.0% on the previous year; decreasing from £102,892,247.50 in 2019/20 to £87,600,972.56 in 2020/21.
Staff Turnover
120. 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 2020-June 2021;
121. The number of medical and dental staff leaving posts in the last financial year decreased by 30.1% on the previous year.
122. The number of medical and dental staff joining posts in the last financial year increased by 43.0% on the previous year; with record high numbers of joiners reported in 2020/21.
123. The Scottish Government is not complacent about the need to retain NHS Scotland's dedicated and skilled workforce. Refreshed guidance for local workforce planning (see 'Updated Workforce Planning Guidance') has been produced light of the challenges emerging from the pandemic. Instruction to Boards for this work has been clear that workforce wellbeing and retention will be key to health and social care system recovery. Boards have been asked to closely monitor their local situation in respect of staff leavers and age profile; and to implement mitigating actions where necessary.
124. The Scottish Government's Winter and Recovery Plans provide a combined £12 million to provide ongoing support for the wellbeing of health and social care.
Sustaining the Medical Workforce in Scotland
125. 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:
(i) 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. Since then, the annual medical trainee recruitment rounds have met this commitment; 400 GPST posts are either advertised or made available to trainees to be filled across 3 different recruitment rounds.
These extra posts are now embedded within the GPST trainee establishment which now stands at 1,184 posts (spread across 3 years of GPST). 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 pathway.
(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.
- 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.
- 15 additional places on the ScotGEM programme which is run jointly by the universities of St. Andrews and Dundee. The course has a similar focus on generalist working.
The Waiting Times Improvement Plan
126. In October 2018, the Scottish Government published the Waiting Times Improvement Plan, which sets out a range of actions that will deliver major change in access to care
127. At the start of the pandemic, work on the delivery of the Waiting Times Improvement Plan was effectively suspended as NHS Board concentrated on responding to the demand of COVID-19. Throughout the pandemic NHS Boards have ensured that urgent, maternity and vital cancer services continue as usual and have worked hard to ensure vital cancer care remains in place where clinically agreed.
128. The Cabinet Secretary for Health and Sport published a national Clinical Prioritisation Framework for Supporting Elective Care in November 2020,[12] which sets out the principles that NHS Boards will follow when considering decisions on prioritising their elective waiting lists during the pandemic.
129. Waiting times and backlogs for treatment remain a significant challenge for NHS Scotland, as Board's continue to respond to the pandemic as well as high levels of wider service demand. The Scottish Government is working with Health Boards to get those who have had treatments or procedures postponed due to COVID-19 the care they need as quickly as possible.
130. The Scottish Government published the NHS Recovery Plan (see 'Covid Response') in August 2021. Backed by over £1 billion of funding, the Plan will support an increase in inpatient, daycase, and outpatient activity to address the backlogs of care, which will be supported by the implementation of sustainable improvements and new models of care.
Electives Centres
131. The National Treatment Centres 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.
132. The Scottish Government is investing over £400 million in a network of 10 National Treatment Centres (NTCs) which will be delivered by 2026. The seven Centres which formed the original National Treatment Centres Programme will be located in NHS Golden Jubilee; Fife; Forth Valley; Highland; Grampian; Lothian and Tayside. The Elective Centres programme will also create two additional National Treatment Centres in NHS Ayrshire & Arran and NHS Lanarkshire and replace the Edinburgh Eye Pavilion.
133. The first new Centre, which provides specialist eye services, opened at NHS Golden Jubilee in November 2020. The second phase of the Golden Jubilee expansion will be complete by Summer 2023. The next Centres will open in Fife, Forth Valley and Highland in 2022, and the remaining six centres are projected to be complete between 2023 and 2026. The full network of NTCs will be completed and operational by the end of this Parliament.
134. When fully operational, the NTCs will provide capacity for over 40,000 additional surgeries and procedures across 12 specialties, including cataracts, hip and knee surgery. To deliver this, by 2025, at least an additional 1,500 staff will be recruited to work in the NTCs.
| Sep 08 | Sep 09 | Sep 10 | Sep 11 | Sep 12 | Sep 13 | Sep 14[19] | Sep 15 | Sep 16 | Sep 17 | Sep 18 | Sep 19 | Sep 20[17] | Sep 21 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Consultant[4] | 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 |
| 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 |
| 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 |
| 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 |
| Foundation house officer year 2[1,2,9,12] | 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 |
| Foundation house officer year 1[1,2,9,12] | 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 |
| Specialty doctor[10] | 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 |
| 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 |
| 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 |
Notes
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
| 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 | 679 | 3,097 | 2,841 | 2,174 | 2,119 | 1,944 | 1,727 | 1,427 | 619 | 247 | 16,874 |
| Female | 442 | 1,798 | 1,628 | 1,278 | 1,185 | 968 | 788 | 619 | 191 | 51 | 8,948 |
| Male | 237 | 1,299 | 1,213 | 896 | 934 | 976 | 939 | 808 | 428 | 196 | 7,926 |
| All medical specialties | 676 | 2,971 | 2,753 | 2,063 | 2,016 | 1,854 | 1,619 | 1,313 | 582 | 232 | 16,079 |
| Female | 440 | 1,711 | 1,564 | 1,201 | 1,105 | 911 | 725 | 567 | 175 | 45 | 8,444 |
| Male | 236 | 1,260 | 1,189 | 862 | 911 | 943 | 894 | 746 | 407 | 187 | 7,635 |
| All dental specialties | * | 126 | 88 | 111 | 103 | 90 | 108 | 114 | 37 | 15 | 795 |
| Female | * | 87 | 64 | 77 | 80 | 57 | 63 | 52 | 16 | 6 | 504 |
| Male | * | 39 | 24 | 34 | 23 | 33 | 45 | 62 | 21 | 9 | 291 |
Notes:
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.
* denotes suppression for small groups, to protect confidentiality
NHSScotland workforce | Turas Data Intelligence
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
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.
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| All Medical Specialties1 | 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
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
| 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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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% |
| All Medical Specialties1 | 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% |
| 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% |
| 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% |
| 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% |
| 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% |
| 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% |
| 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% |
| 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% |
| 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% |
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
| WTE | Headcount | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2011/12 | 2012/13 | 2013/14 | 2014/15 | 2015/16 | 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020/21 | 2011/12 | 2012/13 | 2013/14 | 2014/15 | 2015/16 | 2016/17 | 2017/18 | 2018/19 | 2019/20 | |||
| Medical and dental staff (HCHS) | |||||||||||||||||||||
| Scotland | Joiners | 507.3 | 553.3 | 570.9 | 753.8 | 831.5 | 729.6 | 745.1 | 1,013.0 | 892.1 | 1,275.7 | 644 | 685 | 715 | 932 | 1,013 | 878 | 878 | 1,171 | 1,091 | 1,447 |
| Scotland | Leavers | 431.6 | 408.7 | 425.1 | 477.4 | 458.4 | 532.1 | 626.4 | 680.5 | 854.8 | 594.4 | 602 | 555 | 599 | 659 | 645 | 708 | 808 | 864 | 1,024 | 772 |
| Scotland | Turnover | 7.0% | 6.5% | 6.7% | 7.3% | 6.8% | 7.5% | 8.6% | 9.3% | 11.2% | 7.8% | 8.1% | 7.4% | 7.9% | 8.5% | 8.1% | 8.5% | 9.5% | 10.0% | 11.5% | 8.6% |
| East Region | Joiners | 84.6 | 138.8 | 128.3 | 261.1 | 164.6 | 195.6 | 128.1 | 279.6 | 215.6 | 305.7 | 93 | 201 | 183 | 345 | 194 | 225 | 160 | 323 | 268 | 355 |
| East Region | Leavers | 90.7 | 84.5 | 79.3 | 88.0 | 119.6 | 126.5 | 128.8 | 125.6 | 231.3 | 125.7 | 121 | 115 | 114 | 141 | 171 | 179 | 190 | 166 | 280 | 166 |
| East Region | Turnover | 6.6% | 6.2% | 5.7% | 6.1% | 7.4% | 7.7% | 7.5% | 7.4% | 12.6% | 7.0% | 7.4% | 7.1% | 6.7% | 8.0% | 8.7% | 9.0% | 9.3% | 8.2% | 12.9% | 7.7% |
| North Region | Joiners | 199.9 | 150.9 | 205.7 | 208.3 | 201.4 | 197.2 | 205.6 | 254.9 | 245.1 | 284.9 | 276 | 178 | 257 | 248 | 263 | 271 | 256 | 311 | 308 | 351 |
| North Region | Leavers | 143.1 | 142.0 | 149.1 | 184.3 | 167.8 | 160.0 | 179.9 | 171.8 | 222.4 | 212.2 | 210 | 198 | 198 | 243 | 242 | 216 | 235 | 221 | 277 | 289 |
| North Region | Turnover | 8.5% | 8.2% | 8.6% | 10.3% | 9.3% | 8.8% | 9.7% | 9.2% | 11.5% | 10.9% | 10.0% | 9.1% | 9.2% | 11.0% | 10.9% | 9.7% | 10.3% | 9.6% | 11.5% | 11.9% |
| West Region | Joiners | 245.5 | 281.0 | 259.5 | 313.7 | 455.6 | 352.1 | 439.6 | 465.2 | 454.3 | 716.8 | 309 | 330 | 303 | 379 | 506 | 402 | 486 | 532 | 538 | 774 |
| West Region | Leavers | 214.9 | 209.5 | 218.3 | 245.6 | 209.0 | 291.4 | 314.7 | 403.2 | 415.3 | 302.1 | 297 | 282 | 314 | 324 | 285 | 352 | 391 | 499 | 488 | 368 |
| West Region | Turnover | 7.1% | 6.9% | 7.1% | 7.8% | 6.5% | 8.5% | 9.0% | 11.2% | 11.4% | 8.3% | 8.3% | 7.8% | 8.6% | 8.9% | 7.7% | 9.0% | 9.9% | 12.3% | 11.9% | 8.9% |
| National/Special | Joiners | 5.8 | 19.2 | 11.4 | 26.0 | 76.6 | 54.1 | 25.8 | 58.6 | 42.4 | 47.9 | 6 | 20 | 13 | 32 | 147 | 64 | 50 | 73 | 57 | 64 |
| National/Special | Leavers | 10.7 | 10.3 | 12.7 | 13.3 | 16.7 | 29.0 | 53.6 | 23.9 | 50.0 | 28.1 | 15 | 14 | 15 | 18 | 20 | 52 | 59 | 39 | 63 | 38 |
| National/Special | Turnover | 8.1% | 8.1% | 9.2% | 9.7% | 11.2% | 13.8% | 22.8% | 11.4% | 20.5% | 11.8% | 9.8% | 9.7% | 10.0% | 12.2% | 12.3% | 18.0% | 19.6% | 13.4% | 19.3% | 11.9% |
| All staff | |||||||||||||||||||||
| Scotland | Joiners | 5,311.2 | 8,881.7 | 9,309.5 | 9,855.2 | 9,550.4 | 9,712.1 | 9,602.5 | 9,872.7 | 11,129.7 | 16,250.7 | 6,942 | 11,112 | 11,299 | 11,850 | 11,534 | 11,504 | 11,425 | 11,721 | 13,197 | 19,764 |
| Scotland | Leavers | 7,678.1 | 7,000.7 | 7,165.4 | 7,871.6 | 8,428.7 | 8,390.9 | 8,831.3 | 8,513.7 | 8,575.0 | 7,138.7 | 9,868 | 8,926 | 9,194 | 9,975 | 10,560 | 10,543 | 11,053 | 10,646 | 10,673 | 9,092 |
| Scotland | Turnover | 6.0% | 5.6% | 5.6% | 6.1% | 6.4% | 6.3% | 6.6% | 6.3% | 6.3% | 5.2% | 6.5% | 6.0% | 6.1% | 6.5% | 6.8% | 6.8% | 7.1% | 6.8% | 6.7% | 5.7% |
| East Region | Joiners | 1,057.7 | 2,272.8 | 2,429.7 | 2,579.9 | 2,287.5 | 2,545.2 | 2,667.5 | 2,804.7 | 2,979.9 | 3,797.8 | 1,379 | 2,817 | 2,961 | 3,105 | 2,747 | 3,003 | 3,184 | 3,310 | 3,489 | 4,527 |
| East Region | Leavers | 1,791.8 | 1,620.7 | 1,809.6 | 1,909.9 | 2,214.8 | 2,175.1 | 2,158.9 | 2,211.2 | 2,293.9 | 1,902.1 | 2,311 | 2,057 | 2,317 | 2,442 | 2,747 | 2,763 | 2,737 | 2,756 | 2,856 | 2,399 |
| East Region | Turnover | 6.6% | 6.1% | 6.6% | 6.8% | 7.8% | 7.6% | 7.5% | 7.6% | 7.7% | 6.3% | 7.0% | 6.4% | 7.1% | 7.3% | 8.1% | 8.1% | 8.0% | 7.9% | 8.1% | 6.7% |
| North Region | Joiners | 2,027.6 | 3,418.6 | 2,819.1 | 3,085.9 | 2,816.0 | 3,003.8 | 2,561.8 | 2,644.5 | 2,995.3 | 4,325.9 | 2,642 | 4,323 | 3,495 | 3,755 | 3,493 | 3,674 | 3,122 | 3,235 | 3,651 | 5,561 |
| North Region | Leavers | 2,154.1 | 2,314.2 | 2,348.3 | 2,658.1 | 2,773.0 | 2,629.6 | 2,829.6 | 2,721.3 | 2,426.6 | 2,114.9 | 2,824 | 3,003 | 3,028 | 3,395 | 3,504 | 3,316 | 3,572 | 3,426 | 3,059 | 2,708 |
| North Region | Turnover | 7.0% | 7.6% | 7.4% | 8.3% | 8.5% | 8.1% | 8.6% | 8.4% | 7.5% | 6.5% | 7.6% | 8.2% | 7.9% | 8.8% | 9.0% | 8.5% | 9.1% | 8.8% | 7.9% | 6.9% |
| West Region | Joiners | 2,149.7 | 2,957.7 | 3,879.4 | 4,006.6 | 4,316.4 | 4,123.0 | 4,187.8 | 4,326.5 | 4,969.8 | 6,387.2 | 2,767 | 3,678 | 4,652 | 4,757 | 5,085 | 4,814 | 4,883 | 5,047 | 5,801 | 7,851 |
| West Region | Leavers | 3,472.7 | 2,931.1 | 2,995.4 | 3,376.5 | 3,677.5 | 3,752.9 | 3,921.6 | 3,700.6 | 4,047.8 | 3,496.9 | 4,425 | 3,684 | 3,769 | 4,183 | 4,533 | 4,601 | 4,786 | 4,546 | 4,931 | 4,335 |
| West Region | Turnover | 5.9% | 5.1% | 5.2% | 5.8% | 6.2% | 6.3% | 6.5% | 6.1% | 6.7% | 5.7% | 6.4% | 5.4% | 5.6% | 6.1% | 6.5% | 6.6% | 6.8% | 6.5% | 7.0% | 6.1% |
| National/Special | Joiners | 503.6 | 835.7 | 960.3 | 1,106.1 | 1,194.7 | 1,043.9 | 1,155.2 | 1,069.6 | 1,285.9 | 2,882.8 | 679 | 985 | 1,068 | 1,274 | 1,427 | 1,140 | 1,316 | 1,218 | 1,469 | 3,106 |
| National/Special | Leavers | 671.1 | 724.2 | 772.0 | 833.4 | 810.3 | 829.2 | 887.2 | 837.1 | 884.8 | 705.1 | 818 | 900 | 962 | 991 | 972 | 1,006 | 1,058 | 999 | 1,042 | 858 |
| National/Special | Turnover | 6.0% | 6.5% | 6.9% | 7.3% | 7.0% | 6.9% | 7.3% | 6.8% | 7.0% | 5.5% | 6.5% | 7.3% | 7.7% | 7.9% | 7.6% | 7.6% | 7.9% | 7.3% | 7.5% | 6.0% |
Notes
Leavers are defined as employees who were in post as at 31 March year n and not in post at 31 March year n+1.
Joiners are defined as employees who are in post as at 31 March year n+1 and were not in post at 31 March year n.
Turnover is calculated as the number of leavers divided by staff in post as at 31 March year n.
Medical figures exclude training grades. This is to avoid the distortion caused by the frequent rotation of staff in training placements.
Please note all historical data has been revised in line with the revision of the published official statistics. More details can be found in the accompanying revision statement:
Microsoft Word - Revision Statement v2 (nhs.scot)
GP Workforce Planning in Scotland
135. 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.
136. To achieve this, the training needs of GPs and members of the wider primary care multi-disciplinary team, will need to be considered, developed and delivered. The National Health and Social Care Workforce Plan: Part 3 Primary Care sets out plans for the development and training of GPs and the wider primary care multi-disciplinary team and was published April 2018[13]
137. This was backed up by the publication of Scotland's first Integrated Health and Social Care Workforce Plan for Scotland in December 2019. The plan set out our aim to ensure everyone in Scotland receives the high-quality health and care services they need, at the right time and in the right place.[14]
Data Gap on Vacancies
138. 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.
139. Scottish Government are working in partnership with SGPC to run the General Practice Workforce survey on an annual basis as from the 2022/2023 financial year.
140. In addition to this as per the recommendation of MOU2, Scottish Government have convened a task and finish group to look at the future workforce requirement for Primary Care. This group will report to the GMS Oversight Group.
Recruitment and Retention – particularly for remote and rural
141. We support rural general practice with a comprehensive package of measures:
142. We invested £400,000 to support IT improvements across remote and rural Health Boards, £117,252 to build change management support across island Health Boards, and £300,000 to support rural dispensing practices.
143. The Pre-Hospital Emergency Care (PHEC) Fund of £100,000 was set up to reimburse remote and rural GP Practices for having GPs and practice employed practitioners (with BASICS training) on call for their expertise in an event of emergency near them.
144. The Scottish Government allocated £72,050 to NHS Shetland to support the Rediscover the Joy in General Practice Project. This is 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. GPs employed on the scheme would be provided with BASICs training and mentorship.
145. 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 2020/21.
146. 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.
147. The Scottish Government has allocated £150,000 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.
148. A £57,700 grant is provided to BASICS Scotland to support the provision of a comprehensive, co-ordinated network of trained and equipped BASICS Scotland responders.
149. 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
150. 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.
151. 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.
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