NHS Scotland vacancy crisis: Medics lift lid on 'immense pressure' on staff as patients left unattended

Medics in the NHS have sounded the alarm on Scotland’s vacancy crisis, with GPs under “immense pressure”, patients in hospitals being ignored by overworked staff, and carers being asked to take blood samples.

A GP from Perthshire and a nurse from Lothian have lifted the lid on the effects of NHS Scotland’s staffing shortages, which is crushing morale and undermining patient care.

The nurse, who wished to speak anonymously for fear of recrimination from her local health board, said she is working 13-hour shifts in both care home and hospital settings.

Over her years working in the NHS, she said “staffing has reduced while demand has stayed the same”, causing problems for morale and stretching staff across more and more patients.

“Morale is lower, certainly than it was ten years ago”, she said. “We are more short staffed. Staff are leaving that aren’t replaced, or replaced with a different skill mix.”

The NHS worker said as well as nurses with less qualifications or experience being brought in to replace people from higher NHS employment bands, some of the core work of nurses was being delegated to carers.

“I noticed taking bloods – and things that used to be a nurse’s job – is now being knocked down a band,” she said. “Because of the lack of resources things get knocked down to lower bands.”

The experienced nurse added: “I do see the staffing not as great, and the morale not as great. At the hospital, some of the wards don’t have two staff nurses as there should be. [It’s the] same on nights – there should be two and they’re sometimes running without that.”

The nurse also explained that at the main hospital in her area, patients are being left calling for help on wards.

“When I started my career, when a buzzer went off, you answered it,” she said. “When I got to the hospital, there were buzzers going off everywhere and people weren’t answering. I wouldn’t want my relatives to be cared for there.”

The nurse said the problems were due to the inability of the local health board to recruit or retain staff, due to the conditions already caused by low staffing levels.

The Royal College of Nursing’s (RCN) Scotland director, Colin Poolman, said NHS Scotland was “straining under ever increasing demand, staff shortages and lack of investment”.

“Long before the pandemic, we warned about the need to ensure workforce planning and investment match the projections of increased demand as we live longer, many of us with multiple long-term conditions,” he said.

“Earlier this month RCN members met with MSPs at Holyrood to discuss the challenges facing the nursing workforce and during the conversation members shared difficult stories about their experiences of care and the damaging impact on patient safety and dignity, as well as their own mental and physical well-being.

“The Scottish Government and NHS boards must act now to protect patient safety, address staff shortages and demonstrate that nursing is valued as the safety critical profession it is.

“The commitments, secured by the RCN in response to our mandate for strike action, to invest in nursing and in the safety and sustainability of our NHS and social care services must be delivered.”

The concerns are echoed in general practice, which is facing its own vacancy crisis.

The dismal state of Scotland’s GP surgeries was revealed last week, with figures published exclusively by the Scotsman showing nearly one in ten surgeries in Scotland are now refusing to accept new patients, eight practices are returning their contracts to the NHS and the nation has lost around 100 practices over the past decade.

Dr David Shackles, a Perthshire GP and joint chair of the Royal College of General Practitioners’ Scotland council, has witnessed first-hand the pressures on general practice.

“The headcount of GPs going down a bit, but there been a 3 per cent reduction in the number of whole-time equivalents,” said Dr Shackles, referencing the number of full-time hours worked by GPs, which can include several part-time GPs making up one whole time equivalent.

“That is due to a number of factors, one of which is workload pressure. The problem in general practice is the intensity of the work. So although some doctors might talk about doing less than full time working, doctors who are working six or seven clinical sessions will actually be working full time hours by the time they get the work done.”

GPs are leaving the profession in droves, while patient numbers are swelling due to an ageing population and demographic changes.

As a consequence, there are now 1,687 patients for every full-time-equivalent GP. The impact differs by region – in NHS Lanarkshire, the figure is 2,201 patients per GP, which is the highest in Scotland.

Dr Shackles said: “People ask us why they are struggling to see their GP at the minute and that's about capacity and demand. There aren't enough GPs to fulfil the demand we've got at the moment.

“Hence our desire, which [First Minister] Humza Yousaf mentioned when he was elected, to have this national conversation with the public about how we use our service, what is going to be there, and how we can get the best value from it.

“The number of GPs has never, ever kept pace with what we need and there just hasn’t been investment in getting GP numbers increased.”

Scottish Conservative shadow health minister Sue Webber said: “It’s little wonder the morale of frontline NHS staff is so low, when they are stretched to breaking point and can see little sign of things improving because vacancies are not being filled.

“The shortage of nurses and GPs is the product of years of inadequate workforce planning by a succession of SNP health secretaries, including Humza Yousaf.

“We are paying the price for their failure now, with a 6,000-plus shortfall in nurses in Scotland’s NHS and a GP crisis that’s nationwide, but particularly acute in rural and remote Scotland.

“Unless ministers address this, things will get worse and worse, as overstretched staff suffer burn-out and go off sick, creating a vicious circle for those that remain and, of course, suffering patients.”

A Scottish Government spokesperson said: “The safety of patients and wellbeing of our staff is of paramount importance and we are doing everything possible to support them and fill vacancies.

“Under this Government, the number of qualified nurses and midwives in our NHS has increased by over 5,000, and nursing levels in Scotland are proportionately 37 per cent higher than in NHS England.

“We value our nurses and midwives’ professionalism, skill and dedication, particularly in recent difficult circumstances. This is reflected in a pay deal worth more than £1 billion over the last two years, ensuring nurses and midwives in NHS Scotland continue to be the best paid in the UK.

“GP numbers are at a record high in Scotland, with the number working here being proportionately around a third higher than in NHS England.

“To support doctors, we have recruited over 3,220 healthcare professionals into multi-disciplinary teams. We are committed to investing £170 million, a year to help grow these teams and to further increase the number of GPs in Scotland.

“A £20,000 bursary is offered as an incentive to GPs to increase rural and other hard to fill vacancies and trainee recruitment last year was the most successful year of any of the last five, with 99 per cent of GP training posts filled.”