Consultant vacancies in NHS Scotland are more than twice as high as official statistics suggest, as doctors' leaders called on the Scottish Government to face up to the "true scale of the problem".

Data released under freedom of information reveals that a total of 1,076 consultant posts have no permanent doctor in place, compared to the 439 vacancies counted by official workforce statistics.

This includes roles being temporarily filled by a locum as well as posts which have not yet been advertised or where recruitment efforts have been abandoned.

These are routinely excluded from the official vacancy tally.

It comes weeks after new safe staffing legislation took effect in Scotland which places a legal obligation on health boards and social care providers to ensure that there are enough trained staff in post to deliver safe care.


Dr Alan Robertson, chair of the Scottish consultants' committee at BMA Scotland - which obtained the FOI responses - said the law is unworkable without "honest" data.

He said: "You need to know what the gaps are before you can work out your workforce plan to fill the gaps.

"If you're the person on the ground, without a colleague next to you, it really doesn't matter what the reason is."

He added: “The failure to acknowledge the true scale of the problem reflects our wider concerns about the culture of fear, blame and lack of openness that often dominates debate about our NHS which can prevent proper, open discussion on solutions."

The FOI data suggests that the whole-time equivalent vacancy rate for consultants is actually 15.2%, meaning that one in six posts is either unfilled or has a medical locum in place.

This is up from 14.3% when the BMA last requested the data in December 2022 and compares to the 6.9% vacancy rate thrown up by official statistics.

Research published on Wednesday in the BMJ warned that a reliance on locums was "potentially harmful to patient safety" because they tended to be working in unfamiliar departments with less support from colleagues or a lack of access to vital computer systems.

Dr Robertson, a consultant cardiologist based in Tayside, said it was also "false economy" given the high cost of locums compared to permanent staff.

Annual spending on agency medics by NHS Scotland has soared from £67 million to nearly £120m over the past decade.

The Herald: Official statistics on consultant vacancies do not include posts filled by locums, not yet advertised, or where recruitment efforts have been abandonedOfficial statistics on consultant vacancies do not include posts filled by locums, not yet advertised, or where recruitment efforts have been abandoned (Image: Turas/NHS)

The Herald: Spending on locums is on the riseSpending on locums is on the rise (Image: Turas/NHS)

Meanwhile, consultants' salaries have fallen by 25% in real terms compared to 2008 due to successive sub-inflation pay increases.

The Scottish Government is under pressure to match the pay offer recently accepted by consultants in England.

This includes a £3000 uplift for those who have been consultants for between four and seven years, as well as reductions in the time it takes for consultants to reach the top of their pay scale.

Dr Robertson said the current situation - combined with Scotland's higher income tax rates - means that senior clinicians are now worse off in Scotland than England.

He said this, combined with opportunities overseas, is contributing to the rise in vacancies.

He said: "Potentially, it's an issue of people moving elsewhere. Ireland - there's a much more attractive package there.

"I know a couple of A&E consultants who have gone to Dubai. A lot of A&E consultants have gone to Australia because - as well as the money - it's better working conditions.

"There's also the issue of whether we are retaining trainees as they come through.

"I've also had a couple of emails over the past few months from consultants in England who were thinking of moving to Scotland who are not anymore.

"The increase in tax, for some people it was the final straw.

"Previously, we were in a situation in Scotland where people - before tax - were actually paid slightly better than in England, whereas now we're in the situation where it's worse, so we need the Scottish Government to actually come up with a plan.

"They're big on the recovery of the NHS and waiting times - but if we don't have the staff, I don't see how that's going to happen."

The Herald: Dr Robertson said recent tax changes had deterred some consultants from moving from England to ScotlandDr Robertson said recent tax changes had deterred some consultants from moving from England to Scotland (Image: Getty)

Scotland's six-tier income tax system levies 45% on workers earning £75,001 to £125,140, and 48% on those with salaries in excess of £125,140.

In England there are only three income tax bands - 40% on £50,271-£125,140, and 45% on earnings over £125,140.

Consultants in NHS Scotland, who qualified from 2004 onwards, have a starting salary of just under £97,000, rising to just under £129,000 following 20 years' experience.

A spokesman for the Scottish Government said its workforce figures meet the official statistics code of practice.

He added: “NHS Boards are clear that all advertised vacancies within the NHS are reflected within official figures.

“Our workforce in NHS Scotland is our most important and highly valued asset.

"The Scottish Government has noted the new offer to Consultants from the Department for Health and Social Care, has been accepted by the BMA and HCSA trade unions in England.

"We are carefully considering the details of this, and the implications for Scotland’s health service.

"We must however have transparency on the funding arrangements supporting this pay offer and the extent of any consequentials we would expect to receive for Scotland.”