One junior doctor is providing medical cover for more than 100 patients at night in some Scottish hospitals amid evidence that unsocial working hours are becoming increasingly difficult to staff.

Fears have been raised over the so-called 'twilight' rotas of working in the late evenings and overnight as it is revealed that the ratio of on-site doctors is as high as one to 117 beds in one Glasgow hospital.

Consultants and junior doctors are warning it is becoming increasingly difficult to find enough medical staff to man the night shifts, describing last minute searches for locums and volunteers.

Herald View: Junior doctors under too much pressure  

Gavin Tait, a surgeon for NHS Ayrshire and Arran, said: "There is a view now certainly among my colleagues that this is as bad as it has been and it is really now getting to the point where you do not know who is going to be looking after you in hospital at night. You do not know who the juniors are."

There is one on-site doctor to 117 beds at the Gartnavel General campus in Glasgow, which includes the Beatson West of Scotland Cancer Centre.

Edinburgh Royal Infirmary has 104 beds per junior doctor over night, including graduates in their first year out of medical school, and Crosshouse Hospital in Kilmarnock is not far behind with 99 beds per doctor over night at weekends.

However, district general hospitals in other areas appear to have more generous medical back-up. In the early hours of the morning Borders General and Ninewells hospital in Dundee have one doctor to 65 beds while at St John's Hospital in Livingston there is one doctor for every 71 beds.

Mr Tait said in recent weeks NHS Lanarkshire staff had contacted his health board on a Friday seeking junior doctors who would work for them that weekend because they were short.

Dr Chris Sheridan, chair of the British Medical Association's Scottish Junior Doctors Committee, said he had been called at 4.45pm on a Friday and asked to stay on late or work the following morning being told: "We are really desperate, we are phoning everyone."

He continued: "Certainly right up to the wire people are working to get shifts covered."

Doctors tend to be very busy at night covering a broad range of health issues, sometimes in unfamiliar departments, he said, adding: "If there are gaps in rotas or there are locums who are unfamiliar with the hospital and systems and take a bit of time to get up to speed, it presents challenges for everyone."

Asked why there was a shortage of junior doctors he said some were going overseas to work, while others wanted time out because the growing number of elderly patients meant the workload was intense. He said: "Being a medical registrar is massively stressful and a lot of responsibility and because it is very busy and very intense, some people take pause for a moment and think do I want to do this or do I need to get more experience?"

Junior doctors who look after the needs of patients on hospital wards at night are part of a team which includes advanced nurse practitioners and they can also contact consultants for advice and support.

NHS Greater Glasgow and Clyde said: "Each 'hospital at night' (HaN) team is based on a number of factors including the range and complexity of clinical services on the site, not solely by the number of beds. There is close and continual monitoring of each of the HaN teams to ensure that on each individual hospital site these teams provide safe and appropriate care."

Gartnavel General, they added, had seen overnight activity reduce by around 75 per cent since services relocated to the Queen Elizabeth University Hospital and had no high dependency unit.

Jim Crombie, chief officer for acute services with NHS Lothian, said their night teams were made up of people with complementary skills who could ring doctors from every speciality for help if necessary.

He added: “NHS Lothian has a lower Hospital Standardised Mortality Ratio than the national average and in both the Western General Hospital and Royal Infirmary of Edinburgh, the figures are significantly lower."

Dr Jane Burns, NHS Lanarkshire acute divisional medical director, said planned vacancies in their rotas were covered by re-arranging their own staff or employing locums.

Health Secretary Shona Robison said: “As part of the multidisciplinary hospital at night team, which includes senior medical and nursing leadership, junior doctors work in a supervised environment carrying out tasks and procedures which allow them to learn and develop as doctors. They have regular reviews with clinical and educational supervisors which allow them to provide feedback on all aspects of their training and working lives."

She added that there were more staff working for NHS Scotland than ever before.