MORE than half of vacant consultant posts in NHS Scotland have been unfilled for six months or more, amid warnings from doctors leaders that the workforce is "stretched to its very limit".

The latest figures on staffing also reveal a record shortage of psychiatrists at a time when the health service is grappling with increasing demand for mental health services, as well as a dip in the number of doctors in training.

Read more: NHS Scotland 'too reliant' on locums to fill vacancies

BMA Scotland warned that the true scale of vacant posts was likely to be even higher, and called for urgent action on pension tax changes which are hitting senior consultants hardest, driving some to cut their hours or retire early. In some cases doctors are actually losing money from their retirement pots just for going to work.

It comes as the nursing and midwife workforce also showed a rise in vacancies, with one in 20 posts now empty and spending on agency cover up 10.9 per cent year-on-year to £26.2million.

The latest statistics from ISD Scotland show that 449 medical consultant posts were vacant as of March this year - the highest on record, and up from 418 a year ago.

Of these, 243 had been unfilled for at least six months.

Read more: U-turn as psychiatrists say patients should be warned of antidepressant withdrawal risk 

Recruitment appears to be particularly challenging for consultant psychiatrists, where vacancies have nearly doubled in the past four years. In March 2015, there were 43 empty posts.

By March 2019, this had climbed to a peak of 81 - of which 50 posts had been unfilled for six months or more.

Professor Derek Bell, President of the Royal College of Physicians of Edinburgh, said: "These posts must be filled – particularly those which have been vacant for s months or more.

“As the Scottish NHS continues to experience high demand, we must ensure that effective workforce plans and policies are in place, so that high quality patient care is maintained.

"Factors such as rota gaps, early retirement, medical student dropout rates, pension changes and Brexit all impact recruitment and retention in Scotland."

Dr Simon Barker, chair of BMA Scotland’s consultant committee, said the actual vacancy rate is likely to be running substantially higher than official figures show.

Data collected by the trade union under freedom of information last year suggested that real vacancies were running at double the level recorded by official statistics because they do not include posts which are empty but not being actively recruited for.

Read more: Number of young people waiting over 12 months for mental health care trebles 

BMA Scotland said official figures also masked a "heavy reliance" on locum doctors, and that "large, unexpected pension tax bills" are leading the most experienced NHS consultants to cut down their hours and give up extra work.

The situation is the result of complex pension tax changes imposed on higher earners by Westminster which has seen many doctors across the UK landed with tax bills running into tens of thousands of pounds.

On Monday, UK Health Secretary Matt Hancock pledged to review the system.

Dr Barker said: “These statistics are still hiding the real scale of vacancies among the consultant workforce. Previous analysis shows that a whole, large hospital could be staffed from vacancies left out of the figures.

"That demonstrates how far from reality today’s figures are likely to be. We need to get real about how many vacancies there are, and the BMA stands ready to help that process.

“Added to that, I am hearing from colleagues across Scotland that they have either received, or fear being hit by, pension tax bills running into tens of thousands of pounds.

"These bills result from complex tax rules that make estimating the ultimate impact extremely difficult.

In some cases it results in the utterly ludicrous scenario of doctors losing money for doing extra work. It is no surprise that doctors are changing their working habits as a result and either not taking on extra work, or cutting down the work they do.

Colleagues are reporting an increasing impact on ‘front door’ provision of safe services as well as waiting lists as a result.

“All this tells the story of a workforce stretched to its very limit. We simply don’t have enough doctors. Yet, perversely, those doctors in post, who are going above and beyond what is expected of them to cover gaps in the workforce, are then getting punished financially for trying to help keep the NHS working. Action simply has to be taken."

The Scottish Government has said it is looking at options "to mitigate the impact" of pension changes.

Meanwhile, figures also show a small drop of 0.3% in the number of doctors-in-training despite rising medical vacancies. There are 5946 doctors currently working towards becoming GPs or specialists, down from 5,964 in March 2018.

Health Secretary Jeane Freeman stressed that the number of consultants in post is up 50% compared to 2007, while the number of doctors-in-training has grown 10% over the same period.

She added: “We know that some Boards can find it more challenging to fill vacancies for certain consultant posts and in some parts of Scotland. However, it is not just about numbers – it’s also about investing in training and offering attractive and rewarding careers to those who commit to Scotland’s NHS.

We are improving how we recruit internationally, are examining how national and regional approaches might work and will be starting a co-ordinated recruitment campaign across health and social care this year.”