Analysis: You can only cut so far, then the patient simply expires

People are living longer, with more complex medical conditions which take more time and resources to look after.

At the same time, offering instant access to general practice is not deliverable. Something has to give.

The problem is that that is very difficult for politicians to admit, as they are worried about saying publicly that we can’t provide everything. That is not a vote winner.

In my view they have to grasp the nettle and I think the public are more sophisticated than we often give them credit for. They understand the difficulties the NHS has and must be involved in discussions about how we go forward.

I cannot see how we can accept the government’s contention that the reductions in NHS staff we are seeing will not impact on patient care.

I think clinical staff are working above and beyond their job descriptions. Where we can take out some staff is clearly in the layers of management. The idea that there are lots of clinical staff who are underemployed in the NHS in Scotland is not believable.

We have been making efficiency savings for several years and are now at the point where quality is going to suffer if we go any further.

The idea that you can do year-on-year efficiencies with increasing demand and static or reducing resources is not credible.

There are always options when it comes to making cuts – I would say I don’t think health is where we should start.

Nobody can be under any illusion about how bad things are, and what we need to do is engage with the public and explain the reality.

Doctors are well placed to lead these discussions and also to advise on the decisions being made. Unfortunately, we’re not being given that opportunity.

• Dean Marshall is chairman of the British Medical Association’s Scottish GPs committee