Scotland hospital doctors warn political parties against complacency on post-Covid ‘cliff edge’ on staffing

Hospital doctors’ union HCSA Scotland has warned that the country faces a post-pandemic cliff edge on medical staffing as the impact of Covid compounds issues of vacancies, falling pay and morale. 

In a plea to political parties it warns against complacency over challenges linked to the pandemic, coming on top of historical pressures, which threaten to undermine the drive to clear the backlog of work facing NHS Scotland running into tens of thousands of procedures. 

The union’s research has highlighted how the aftermath of the pandemic could drive doctors to change working patterns, cut back on hours or leave the profession altogether. 

Launching its Doctors Deserve Better pay campaign on the eve of the Scottish elections, HCSA cautioned that the new government will have a short window to try to avert a sudden deterioration in staffing levels. 

It is calling on all Scotland’s main political parties to commit to three immediate steps to avert a future staffing crisis: 

  • A meaningful pay rise for hospital doctors of all grades, alongside NHS colleagues, to aid short-term retention 
  • A review of the remuneration to address long-term understaffing for all grades 
  • A commitment to protect staff from burnout when planning catch-up elective treatment activity in Scotland. 

HCSA research has revealed the risk of significant changes to working patterns by hospital doctors, many of whom have postponed life decisions such as maternity or retirement during to the pandemic, threatening a “double whammy” on staffing levels in coming months as the immediate demands of the pandemic ease. 

Others are considering cutting their hours to part time or leaving the profession altogether as a result of the intense pressures over the past 12 months. 

One Scottish A&E trainee doctor told HCSA how staff shortages were having a damaging impact. 

“Eighty percent of my day-to-day struggles can be put down to lack of staffing. Most of us are less-than-full-time but we are counted as full-time for planning. We’re always covering gaps. This inevitably leads to burnout and multiple mental health issues, people changing specialties or changing jobs.” 

HCSA Scotland Council member Dr Bernhard Heidemann said politicians risked showing themselves to be out of touch. He said: “There is a sense of detachment where we see pledges from politicians to increase elective work to record levels without plans to shore up our fatigued workforce. 

“Delivering excellent care in greater volumes requires a solid bedrock of NHS staff, not the shifting sands we now see due to low morale, complacency over understaffing and the failure to acknowledge the impact of reducing real-terms income on recruitment and retention. 

“NHS staff are not robots, we are people. We cannot simply take for granted that people will pick themselves up and plough on as if nothing has happened in these past 12 months. 

“Instead of taking steps to acknowledge serious staffing and morale issues, doctors are being told to gear up for more after a gruelling year with little or no recognition for their commitment. 

 “Our call is simple - Scotland’s doctors deserve better. That means steps on pay to tackle recruitment and retention, and it means greater respect for the precarious state of doctors and all their NHS colleagues.” 


  1. A significant and meaningful pay rise for hospital doctors of all grades for 2020-2021
    HCSA’s Doctors Deserve Better campaign calls for a pay award that supports recruitment to the NHS, facilitates retention of current doctors and respects the hard work and experience of hospital doctors. There are already 373 equivalent Consultant vacancies within medical specialties in Scotland, and we know the dire implications of understaffing for our members in rural areas. HCSA warns that we are facing a cliff edge as doctors make life changes that were postponed due to the pandemic, such as retiring or reducing hours. Pay should be seen as an important mechanism for retaining doctors and attracting more to work within NHS Scotland. We would welcome a commitment from the Scottish Government to implement the DDRB recommendation in full as a minimum, and to look to take a similar approach to the Welsh Government who have suggested they will not seek to cap NHS pay recommendations. 

  2. Pay equity with other nations for all grades of doctor
    Significant parts of the NHS in Scotland are suffering from shortages of hospital doctors. HCSA is calling on the Scottish Government to review the remuneration package for doctors with the aim of ensuring it is competitive with Scotland’s neighbours to boost recruitment and retention. 

  3. A focus on workforce well-being
    HCSA welcomes political party pledges to invest in re-mobilising the NHS as we emerge from the pandemic. However, HCSA is concerned that a rush to “return to normal” will lead to burnout of doctors, which in turn could worsen the staffing crisis, and impact on quality of care for patients. HCSA would caution that it will be unrealistic for the Scottish Government to expect treatment activity to reach or exceed pre-pandemic levels within 2021. Doctors, already facing huge backlogs, will need a period of adjustment to refresh their skills, address training needs and access emotional support following the winter pressures.