Doctors' and Dentists' Remuneration - 2025-2026 pay round: Scottish Government's written evidence

F. Workforce Planning

76. The Health and Social Care: National Workforce Strategy^[22] sets out our vision for the health and social care workforce. The strategy supports the ambition of recovery, growth and transformation of our workforce and the actions we will take to achieve our vision and ambition. This includes our commitment to increase the number of GPs by 800 by 2027.

77. In November 2024 we shared with the profession our GP Recruitment and Retention Action Plan^[23] which sets out in more detail our package of measures to deliver on the commitment to increase the number of GPs by 800. This includes 20 key actions across the GP training pipeline and career pathway, including increasing the number of General Practice Specialty Training (GPST) placements through to improving the fellowship programme for early career GPs and reviewing and developing the retention initiatives to support GPs to remain in practice. Progress will be monitored on an ongoing basis using publicly available data as metrics and delivery against key milestones.

Projecting future GP requirement

78. We are committed to taking an evidence informed approach to building and developing a sustainable workforce that best meets the needs of the Scottish population. As part of that, workforce modelling for Phase Two of the 2018 GMS Contract will provide updated evidence on the GP capacity required to meet future population need.

Incentive Schemes

79. We incentivise GPs into taking up harder to fill posts, mainly those in rural and deprived areas, through our £10,000 'Golden Hello' scheme. This scheme offers a bursary of up to £10,000 to every GP taking up an eligible post. ‘Golden Hellos’ for Scottish GPs are set out in chapter 11 of the annual Statement of Financial Entitlements (SFE)^[24]. Golden Hellos can also be paid to new GP performers if the local Health Board believes the practice is experiencing significant difficulties around recruitment and retention. These are just for GPs in GMS practices with the exception of Golden Hellos for remoteness and rurality which are for all practices regardless of contractual status.

Figure 6 - Table setting out the rate of Golden Hello payments

Reason

Recruitment Difficulty

Payment

£5,000 (minimum)

Reason

Remoteness or Rurality

Payment

£10,000

Reason

Deprivation

Payment

£7,500 - £12,500

80. The rate of payment for part time GPs, with a time commitment fraction of less than 4 sessions per week is 60% of the full payment.

81. The Scottish School of Primary Care will be evaluating the Golden Hello scheme to assess the role that financial incentives play in supporting GP recruitment and retention.

GP Partners

82. The number of GP Partners has reduced since 2017 from 3151 in 2017 to 2479 in 2023. This reflects a broader trend towards fewer and larger practices incorporating multi-disciplinary teams to provide a wider range of services.

83. We recognise from our work with GPs that becoming a Partner can present challenges and require the development of new skills. We are currently considering working with Royal College of General Practice (RCGP) to identify options for GPs to ensure that they are ready for partnership when opportunities arise.

Vacancy data

84. While the number of practices reporting vacancies has remained stable (just over a third) the vacancy rate has increased from 7.7 vacant GP sessions for 100 total GP sessions in 2019 to 12.1 in 2023^[25].

85. 2023 marks the first year that NHS Education for Scotland (NES) have published the General Practice Workforce Survey, they caution that “this definition differs from the vacancy rates reported elsewhere in NES’s workforce statistics and may tend to overestimate vacancy rates, particularly in smaller boards. Extra caution is therefore advised when referring to the vacancy rates published here. NES will work with partners and users of these GP workforce statistics to further develop the data collection and analysis for vacancy information, in line with the development of this publication towards Official Statistics status.”

86. We continue to work with NES and engage with GP representatives and other stakeholders to understand the trends in GP vacancies and to take appropriate action to address identified challenges.

Data Gap on Vacancies

87. The 2018 GP Contract has resulted in an increase in data collection. As part of this it is mandatory for practices to provide workforce data – including on GP and practice staff vacancies through the General Practice Workforce Survey. This data supports future workforce planning by providing a baseline on total complement of the workforce if all posts were filled, enabling us to better understand workforce projections against increases in population health need. NES remain committed to increasing the quality of reporting and interpretation of vacancy data, particularly in Scotland’s smaller Boards where estimates are more challenging and open to variation.

88. The General Practice Workforce survey is now being run on an annual basis. The next publication is due to be published by 10 December 2024.

NHS Scotland Workforce

89. NHS Scotland’s staffing levels have seen record high levels over the last few years. This has since contributed to twelve consecutive years of staffing increases. 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, especially in rural areas of the country.

90. The recent levels of growth are not expected to continue either in the short or long-term considering the difficult fiscal situation and the projected population growth statistics.

National Workforce Strategy for Health and Social Care

91. National Workforce Strategy for Health and Social Care was published March 2022, and set out a new framework to shape Scotland’s health and social care workforce over the next decade.

92. We remain committed to delivering the National Workforce Strategy and achieving the overall vision for “A sustainable, skilled workforce with attractive career choices and fair work where all are respected and valued for the work they do”.

93. Whilst no formal update has yet been published, we have made significant progress in a number of areas. We remain committed to providing a fuller update to the strategy at an appropriate time.

94. The timing of any such update will be influenced by our commitment to reform of Health and Social Care in Scotland alongside the National Conversation which will shape the NHS for the future thereby shaping the workforce we will need to support this.

Workforce Data

95. 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

96. NHS Scotland’s staffing levels are up by around 33,000 WTE. This is a 26% increase (from 127,061.9 WTE at Sept 2006 to 160,065.7 WTE at June 2024).

97. Numbers of medical and dental staff in post have risen from 10,823.1 WTE in Sept 2007 to 15,566.5 WTE in June 2024. This represents an increase of 43.8%.

98. There are 8,976.0 WTE medical and dental staff (excluding doctor’s in training) in post at end June 2024 - an overall increase of 74.2% (3,824.3 WTE) since Sept 2007.

99. There are 6,130.1 WTE medical and dental consultants (incl director-level consultant) employed by NHS Scotland at June 2024 – an overall increase of 60.6% (2,313.9 WTE) since Sept 2007.

100. Doctors in Training up 16.2% since Sept 2007, or 919 WTE (from 5,671.5 WTE as at Sept 2007 to 6,590.5 WTE as at June 2024).

DDRB remit groups

101. There are 346.3 WTE community dentistry staff in post at end June 2024 - an overall decrease of 1% (2.6 WTE) since Sept 2007.

102. There are 74.9 WTE dental public health staff in post at end June 2024 - an overall increase of 160% (46.1 WTE) since Sept 2007.

103. For medical and dental specialties, the median age is 39. 11.7% of staff within this job family are aged 55 and over.

Vacancies

104. A vacancy as set out in the official statistics is defined as "a post which has been cleared for advert after being through the redeployment process (internal or external advert) and remains a vacancy until an individual starts in the post".

105. NHS Scotland is a large organisation, employing 160,065.7 staff (WTE) (as at June 2024). Given the natural turnover of staff in an organisation of this size, it will always carry some vacancies.

106. Medical and dental consultant vacancy rate (as a percentage of establishment) is 7.1% (457.5 WTE) as at June 2024, this is a decrease from 8.0% (513.4 WTE) as at June 2023.

107. Medical and Dental Consultant Vacancy rate of six months or more (as percentage of establishment) is 3.9% as at June 2024, an increase from 3.3% as at June 2023.

108. As at June 2024, the number of vacant consultant posts in dental specialties was 6.9 WTE, a decrease of 20.7% (1.8 WTE) from June 2023. Of these, 3.6 WTE have been vacant for 6 months or more, representing a 6 months or more vacancy rate of 3.7%.

Staff Turnover

109. For medical and dental staff across Scotland, the turnover rate in 2023/24 was 12% (calculated as the number of leavers divided by staff in post as at 31 March 2024).

110. Care should be taken though, as this figure includes doctors in training which can skew the data. The turnover rate for medical and dental consultants was 4.3% in 2023/24.

111. 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 2023-June 2024.

112. The number of medical and dental staff leaving the NHS in the last financial year increased by 7.5% on the previous year.

113. The number of medical and dental staff joining the NHS in the last financial year increased by 1.6% on the previous year.