Many staff feel they are facing “never-ending” waves of Covid and non-Covid pressures, the BMA union said, while the Royal College of Nursing has warned nurses are “dreading” winter.
Health boards around the country have been facing “exceptional” pressure in recent weeks, with some hospitals saying demand has been higher than at any point during the pandemic.
Non-urgent surgeries have been cancelled in many areas because of this, but the Royal College of Surgeons warned that if this trend continues into winter, these cases will become increasingly urgent, as some patients have been waiting for 18 months for treatment.
The “main worry” for doctors, said Dr Lewis Morrison, Chair of the BMA in Scotland, is that winter will see a large wave of non-Covid viruses, including flu, other coronaviruses, and Respiratory Syncytial Virus (RSV).
“If you get enough people having that then it can pressurise healthcare,” he said.
“I think that's the main worry, in terms of workload, that we are going to get a bad winter for viruses full stop.”
Some members of the public have higher expectations of the NHS than resources are able to deliver, Dr Morrison said, which leads to additional strain on staff.
“There's a combination of staffing issues plus demand on healthcare plus uncertainty about how much acute illness there will be over the winter,” he said.
"I think quite a lot of us are very worried.”
Professor Michael Griffin president of the Royal College of Surgeons, said he is confident some services will be able to continue over the winter, including cancer operations.
But he is “concerned” about winter, and warned that many health boards are under more pressure because patients are coming in with more advanced illnesses, that have not been tended to before now because of the pandemic.
"I think winter is going to be difficult, I think there's going to be a very up and down bumpy ride,” he said.
“I think that with the other viruses coming to the fore, including flu, which basically got completely subsumed by Covid last year, we are going to see a heavy toll on the NHS.
“The anxieties that we as surgeons have is that this may well mean that many surgical wards have to be taken over by medical wards, to deal with these viral infections in the elderly. That will necessarily mean fewer elective operations.”
Patients needing non-urgent surgeries also face this problem, he said, with cases becoming increasingly urgent.
“Somebody waiting for a hip replacement can’t walk. And over the last 18 months they've been sitting at home, unable to walk, putting on weight, putting more strain on the heart,” he said.
“The patient is no longer as fit as they were 18 months ago, and it's a real challenge to treat. These patients become more urgent by the minute, because they are immobile, and the same applies to knee replacements and so on.
“We can't sit back and say it's okay we've got the cancer operations covered, we've got to deal with what we call the non-urgent procedures, that are becoming far more urgent.”
Prof Griffin wants to see designated non-Covid diagnostic hubs set up, to allow screenings such as ultrasounds, x-rays, endoscopies and colonoscopies to take place in an environment where they will not be cancelled because of high Covid transmission, as all patients would be screened before entry.
The same model should be used for non-urgent surgical centres, he said.
Prof Griffin also called for health workers who came out of retirement to help with the Covid-19 effort to be incentivised to stay on and help with clearing the elective treatment backlog.
Dr Morrison called for more “flexibility” in the NHS to cope with high pressures without cancelling operations.
"There isn't another answer unless somebody is going to magic up extra staff,” he said.
Staff are exhausted, he said, after facing successive waves of Covid with short gaps in between, and other issues adding pressure.
“Just when you think maybe things are settling down, and some aspects do, some other pressure pops up and becomes another reason why it just feels like it's never ending,” he said.
“The palpable sense of fatigue across a large percentage of the healthcare workforce is really obvious at the moment.”
A Scottish Government spokesperson said: "As we look to recover from the impact of Covid-19, it is clear that staff are still very much in need of both practical and emotional wellbeing and mental health support.
"In recognition of this, we announced an increased budget of £8 million to provide ongoing support for the wellbeing of health and social care staff across Scotland.”
They added: “The remobilisation of the NHS is one of our number one priorities and we will publish a national recovery plan for the NHS in the next few weeks.”