(Image: Jeff J Mitchell/Getty Images)
Scotland’s NHS reforms risk piling further pressure on overstretched doctors and undermining patient care unless workforce pressures are tackled alongside the shake-up, ministers have been warned.
Dr Lindsey Pope has warned that reform of the health service must address the conditions driving medics out of the profession, arguing that supporting the workforce is a “patient safety issue”.
The GP warned there was “always a risk with change that people just move things around” amid Scottish Government plans to reduce the number of territorial health boards from 14 to two.
It is part of plans to overhaul the way public services are delivered and will be the biggest shake-up of the NHS in decades.
First Minister John Swinney announced the plans in last month’s Programme for Government, stating they would streamline management and free up resources for frontline care, however very few details have been revealed about how the shake-up would work in practice.
The concerns are echoed by Raman Sankaran, chief executive of the Medical and Dental Defence Union of Scotland (MDDUS), who warned that the pressures facing medics “will not disappear” simply because Scotland has fewer health boards.
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He warned doctors and other healthcare professionals who were already stretched could be asked to absorb further disruption “often for years at a time” as services are reorganised.
Dr Pope, who is also a Professor of Medical Education at the University of Glasgow, told The Herald: “Reform could be a positive if we manage to do it well and we make sure we’re thinking about these things from the start because the system is under strain.
“All the evidence shows that if we look from patients’ perspectives, we hear that people are frustrated and stuck in systems, and we hear from clinicians all the time that they’re frustrated and struggling navigating workloads.
The Scottish Government has been told its NHS reforms could pile further pressure onto overstretched doctors. (Image: PA)
“From my perspective, when we look at the system, we need to think ‘who’s going to do the work, where does capacity come from, how are we going to support people working in the system to give them the conditions to deliver good quality care?’”
She said pressures on medics could affect the quality of care they were able to deliver, including the time and capacity available to make complex clinical decisions.
“This is a patient safety issue,” she said.
Dr Pope helped lead the independent expert report convened by MDDUS, Wellbeing by Design, which highlighted the impact of a workforce under pressure.
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The report raised significant concern around burnout and retention, with around 80% of doctors surveyed by the British Medical Association (BMA) stating they were at high or very high risk of burnout, while previous MDDUS research found four in five GPs experienced moral distress and 40% planned to leave the service.
Seven in ten GPs surveyed by MDDUS also reported compassion fatigue, with almost half of that group concerned it could make the care they provided unsafe.
Dr Pope said retention had been a concern for some time and pointed to general practice as an example of why increasing staff numbers did not necessarily translate into greater NHS capacity.
She said issues like working hours, conditions and unmanageable pressure were driving GPs away from the NHS, with “patients stuck in the middle and waiting longer or not getting what they need.”
Meanwhile, Mr Sankaran said: “The pressures on Scotland’s medical workforce did not appear because the country has too many health boards and they will not disappear because it has fewer.”
He said a measurable national target for burnout should be reported to Holyrood annually alongside figures on waiting times and spending.
Mr Sankaran added: “The wellbeing of doctors cannot be separated from the wellbeing of patients and yet the current system lacks the structures needed to protect staff.
“The reform of Scotland’s health boards presents a unique opportunity to put that right.”
A Scottish Government spokesperson said: “NHS reform will be shaped by the people who use and deliver health services across Scotland.
“The development of detailed proposals will be supported by a full business case and will include engagement with NHS boards, staff representatives, local government, integration authorities, social care partners, the public and trade unions.
“We highly value our NHS workforce and the First Minister has been clear that the Scottish Government’s commitment to the principles of Fair Work will be upheld during this reform process.”