Inadequate consultant expansion: Consultant vacancies in Scotland are running at the level of about 140, more than half of which have been vacant for more than six months. The impact on the consultant workforce of the Calman reforms and the New Deal for junior doctors, and the pressures created by the drive towards a consultant based service, have been immense. These initiatives necessitate a very large and expensive expansion of consultant positions which will require to be driven for many years by a large pool of trainees. The effect of the 48 hour maximum working week is very difficult to calculate within the conventional numbers to which the NHS has become accustomed. Unfortunately, it is difficult to see how the consultant establishment can be increased in the medium term when, for example, the recently published report of the Acute Services Review for Scotland is assuming a long-term rate of consultant expansion of 2.5 per cent per annum.

  Recruitment and retention crisis in general practice: There are serious recruitment problems in general practice. In Scotland until five years ago, the training establishment of 335 GP registrar places was almost three times the recruitment of Principals into general practice in Scotland. In 1997, only 225 doctors completed vocational training in Scotland and less than 200 sought certification by the JCPTGP. There is a particular problem concerning recruitment to rural practices.

  The need to train more doctors: While we welcome the Government's acceptance of the Campbell Committee's recommendation for an additional 1,000 medical students, the full effects will take years to work through the system. We still believe that an increase of 1,500-1,600 might have been more appropriate, given the Committee's findings on wastage and expansion.

  Problems with national strategic planning of medical workforce: Medical workforce planning is carried out independently in Scotland but within the context of a UK and European market for doctors. Vacancies for career posts for doctors are determined by individual NHS trusts and by general practices. Health boards and the Scottish Medical Practices Committee set broad limits to the number of posts which can be created but estimates for future needs are not currently placed within an overall planning strategy. However, the White Paper Designed to Care gives health boards responsibility for linking service requirements to consultant workforce planning, which may lead to a more coherent approach to planning the number of doctors needed to deliver the hospital service.

  The SODH intends to establish a Scottish Integrated Workforce Planning Group to provide strategic long term advice on healthcare needs and workforce demands. This will complement the existing Scottish Advisory Committee on the Medical Workforce (SACMW), which advises the Secretary of State for Scotland on all matters relating to medical workforce planning in Scotland other than terms and conditions of service matters. Concern has been expressed about the effectiveness of SACMW and it is currently being reviewed.

  Reliance on doctors from European and other countries: In Scotland, less than 15 per cent of the medical workforce are doctors who qualified overseas. We would point out that there is a large amount of medical unemployment in the rest of the EEA which is not mirrored in the UK. If freedom of movement becomes more of a reality over the next 10 years, this will militate against the self-reliance objective.

  Junior doctors' hours of work: According to the NHS Management Executive's monitoring exercise, 102 posts in Scotland (2.7 per cent) did not comply with the contracted hours target as at 31 March this year compared with 81 (2.1 per cent) in September 1997. 263 posts (7.5 per cent) did not comply with the actual hours target compared with 198 (5.4 per cent) in September 1997. 33 per cent of trusts failed to meet the three non-hours standards of accommodation, catering and security. The health service in Scotland continues to rely heavily on SHOs in the delivery of 24 hour care.

  Medical academic staff: the problems identified in the earlier BMA evidence are applicable to Scotland. There are particular concerns that the staffing reductions in academic departments, together with the increasing emphasis on the need for high quality research if a department is to continue to exist, lead to a lack of appreciation of the vital and valuable teaching work which such departments undertake.

  Measures to improve recruitment and retention in the medical workforce: More emphasis needs to be placed on the retention of already trained staff and on the need for more research into the causes of wastage. The key is a flexible training and employment system.

September 1998