THE NHS is facing the worst crisis in its 72-year history, doctors' leaders in Scotland have warning, saying the entire system could 'overheat' because of the combined pressures of winter and Covid and the weight of public expectation.
Dr Andrew Buist, Chairman of BMA Scotland's GP committee, said he believed the SNP government was reluctant to give a true picture of the increasing limitations of a public service that remains a source of national pride because of fears that 'opposition politicians will make capital out of it'.
He raised concerns about a new 'talk before you walk' plan aimed at reducing pressure on A&E units this winter which will mean patients are required to call to report symptoms before turning up in all but the most serious cases.
He said: "More consideration needs to be given to the urgent care proposal set out by the Scottish Government, and it should at least be piloted and evaluated in the first instance, particularly given the extra pressure it may put on primary care.”
He said it was of some concern that the public 'is no longer afraid of Covid' which would have medical consequences and said for the NHS to cope, it required an acceptance that it must prioritise patients with the most significant problems.
Health Secretary Jeane Freeman is due to update parliament on the government's winter plan on Thursday.
Mr Buist said: "We are heading into the most difficult period the NHS has experienced since it started in 1948.
"I'm quite worried about the current situation and what may come next.
"We are facing a very difficult four of five months, until we have a Covid vaccine - the whole system is going to overheat and I've said this to Jeane Freeman, we need to have a conversation with the public about their expectations.
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"The government is worried that if they say well you need to reduce your expectations, waits are going to be longer - if it's something minor you might just need to manage it yourself - they are worried that the other political parties will make capital out of that.
"Until we get a Covid-19 vaccine normal expectations about the NHS will have to change for the next six months. It's important that we prioritise our resources for patients with significant problems.
"Of course waiting lists are going to get longer. The public is not afraid (of Covid).
"There will be medical consequences. When the dust settles and we look at the death rate - and in every country in the world - the death rate from other conditions, heart disease, cancer this is going to take a huge toll.
"The hospitals are working at about 50% productivity - the elective work - because of social distancing."
Mr Buist said a winter plan that will see patients asked to call before they go to A&E will be 'a very difficult message' to get across to the public.
Scottish Conservative Health Spokesman Donald Cameron: “While it's plainly important not to overburden our A&E departments, especially in the winter, we must always send out a message that they are ready to treat patients.
“This policy must be implemented very carefully indeed, especially given the potential consequences for GP practices if people are diverted there."
The Academy of Medical Sciences, an independent research body looking at health policy, published a report in July warning that 'intense preparation' was needed to help prevent the health service being overwhelmed over winter, including ensuring facilities can maintain Covid-19 and Covid-19 free zones.
Mr Buist said: "It is crucial to keep GP practices as Covid free as possible, which is why we believe the top priority at this time should be the development of a dedicated community enhanced Covid pathway building on the success of the existing community pathways, that will safely divert respiratory activity away from A&E and General Practice."
Public health expert Linda Bauld said evidence that flu cases were lower in Australia as a result of Covid-19 measures could help ease some pressure on the NHS this winter.
She said: "Of course people are very worried. We know from Australia that they have seen lower influenza rates so it might not be as bad as we think but I think people are right to be worried, they are right to be concerned and they are right to prepare.
Ultimately, Mr Buist called on Scotland's political parties to put aside their differences and unite to help manage the public's expectations about the NHS.
He said: "We need all the political parties to come together but to say we will do our best for the public but our capacity will be down."
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A Scottish Government spokeswoman said: “Our NHS remains open with public health measures in place to protect staff and patients.
“We are working with operational and clinical leaders as part of the Mobilisation Recovery group, which consists of representatives from the Royal College of Nursing, the British Medical Association, the Royal College of General Practitioners, the Royal College of Emergency Medicine, the Academy of Medical Royal Colleges and Faculties alongside other key stakeholders, to ensure people can access the right care in the right place, from the right healthcare professionals, this winter.
“As we have repeated throughout the pandemic, everyone should continue to attend regular check-ups and appointments when invited to do so.
"Everyone who is registered with a GP practice in Scotland, or who lives in Scotland, is also encouraged to use their local pharmacy if they have a minor illness or common condition.”
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