Doctors in Scotland must change working patterns, report says

Changes are needed in the way doctors work if the ever rising demand for health care is to be met, a review of future medical workforce requirements in Scotland has concluded.

It says that more doctors will be needed in Scotland, but they will have to work differently. The report says that more effective partnership working is needed in primary care, together with a redesign of hospital services—including a separation of “cold units,” specialising in elective work, and “hot units,” handling acute and emergency cases. More integrated team working based on managed clinical networks will also be needed.

The report of the review, chaired by Professor John Temple, president of the Royal College of Surgeons of Edinburgh, says: “A solution that relies on securing yet more doctors to work much as they have done in the past looks increasingly untenable. Redesign of the delivery of services is in our view inevitable.”

The report acknowledges that the medical workforce is already under pressure and that these pressures will increase as a result of the European working time directive, which will reduce the working hours of doctors. It does not attempt to predict how many extra doctors will be needed in Scotland in response to these pressures, as this will depend on the way services are redesigned.

It makes 37 recommendations, including a number of practical measures designed to improve medical recruitment and retention. These include promoting medical careers to school students; special packages to attract doctors to rural areas; arrangements to accommodate the needs of doctors at the end of their careers to prevent them retiring early; and measures to make medicine a more attractive career option.

It also recommends that consideration should be given to increasing the number of medical students in Scotland, and it highlights the need to increase the social and academic diversity of students, as well as attracting greater numbers of mature students.

Scotland already has more doctors than England: 2.4 per 1000 of population, compared with 1.9 in England. However, the figure is higher in many European countries, which have around 3 per 1000. The report also says that the Scottish health service relies too much on doctors in training and needs to move to a position where medical care is delivered primarily by trained specialists, either consultants or general practitioners.

The report was welcomed by Dr Peter Terry, chairman of the Scottish committee for hospital medical services. He said: “This is only the start of this important debate, but it is a most useful and helpful contribution.”

The Scottish Executive has accepted most of the recommendations and has set up three working groups to examine how the proposed changes can be implemented.

Future Practice: A Review of the Scottish Medical Workforce is available at www.scotland.gov.uk/publications