Scotland's NHS risks losing doctors to England and other countries amid increasing workload and burnout – Dr Lewis Morrison

Last week the Scottish government announced a pay uplift of three per cent for doctors.
Low morale and burnout are real problems in the NHS (Picture: Sergei Gapon/AFP via Getty Images)Low morale and burnout are real problems in the NHS (Picture: Sergei Gapon/AFP via Getty Images)
Low morale and burnout are real problems in the NHS (Picture: Sergei Gapon/AFP via Getty Images)

Each year’s pay award provokes different reactions from colleagues – from a shrug of shoulders, to begrudging acceptance, to understandable disbelief at how little we seem to be valued.

Superficially this year is better than some years but the current inflation rate makes it debatable whether or not it’s a pay rise at all.

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For those who have suffered financial hardship during the pandemic, any public discussion about doctors’ pay can appear insensitive given our good job security. But for many doctors, the NHS is their only employer and ensuring good pay and conditions is therefore in all our interests if we want a properly doctored NHS in general practice and hospitals.

Workload pressures during this pandemic have been relentless – and with all the reports of July and August feeling more like winter already, there’s more to come.

Burnout and poor morale are a reality. Recruitment and retention of senior doctors especially has been in “crisis” for years, and rising workload intensity and vacancies were a serious problem before the pandemic.

Comparison with others’ jobs is also arguably less important than with doctors in other countries. If Scotland wants to train, attract and keep the doctors it so clearly needs, it has to compete with the Australias, New Zealands and even Englands of this world – and those comparisons can often look pretty unfavourable in terms of pay and workload.

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Some doctors have regularly, and usefully, spent time in other countries, but as the pandemic recedes many more may do that, and right across the profession, not just in the early years after qualification.

If more go, they may never come back. We also know that many doctors are considering retirement or reducing their workload in response to pre-pandemic pressures which Covid has simply exacerbated.

There’s a very real risk of Scotland losing many of its doctors if action isn’t taken and that would threaten the viability of some general practices and hospital departments.

So with this year’s pay award done and dusted, what else must be done? A genuine plan (not a plan for a plan) for better recruitment, retention and training of doctors would be a start, and it is years overdue.

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Relying on overseas and recently retired doctors can only be a small part of that plan – the real solutions have to be ones that build the Scottish medical workforce at beginning, middle and end of their career.

Having the colleagues we need rather than forever covering for vacancies would go a long way. And any Covid recovery plan has to focus on the staff and their welfare as much as all the work that needs to be done.

This is a time to look forward, not back (there will plenty of opportunities for that). Focusing solely on a single year’s pay award would miss the overall picture I’ve outlined above, but I’ll nonetheless finish by saying that in medicine, “you get what you pay for” is still applicable.

Dr Lewis Morrison is chair of BMA Scotland and a consultant geriatrician

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