The leader of the BMA in Scotland is warning that the growth of two-tier healthcare is "beyond question" as representatives of the trade union from across the UK gather in Belfast.

Dr Iain Kennedy, a GP and chair of the BMA's Scottish council, will tell delegates attending its annual conference that the NHS is in the grip of a perma-crisis, with winter-style pressures continuing “365 days a year”.

Dr Kennedy will also warn that Scotland is “sleepwalking” into losing an NHS that is free at the point of use.


It comes little over a week before the nation heads to the polls to vote for the next UK Government, with Labour seemingly on track to secure a substantial majority of seats.

Health and the NHS is devolved, meaning that whichever party ends up in Downing Street will be responsible solely for the running of the NHS in England.

However, healthcare policy and funding have been repeatedly raised during the campaign - including in Scotland - given that spending decisions taken at Westminster affect the amount of money available to spend on public services north of the border.

The SNP - currently in power at Holyrood - is pushing for the next UK Government to increase health spending by £16 billion a year, equivalent to an extra £1.6bn for Scotland through Barnett consequentials.

UK-wide, A&E performance and cancer waiting times have worsened significantly over the past five years and the number of people waiting for planned operations has reached a record high.

The GP workforce has declined and in many areas of the country, patients are unable to register with an NHS dentist and have been left with no option but to pay for private treatment instead.

In Scotland, the number of private GP surgeries has more than tripled since the pandemic as people struggle to get timely appointments with a family doctor, and there are around 7000 patients who have been waiting over two years for an inpatient or day case procedure on the NHS compared to 300 in England where eradicating very long waits was prioritised.

The number of patients in Scotland self-funding their own treatment in private hospitals rose by 84% between 2019 and 2023.

Access to dental treatment on the NHS has become more challengingAccess to dental treatment on the NHS has become more challenging (Image: PA)

Addressing the BMA's Annual Representatives Meeting (ARM) in Belfast later today, Dr Kennedy will warn that Scotland’s NHS "is in a state of permanent crisis", noting that more than 58,000 patients have waited more than 12 hours in a Scottish A&E department since he last addressed the conference in April last year - a 24-fold increase compared to five years ago.

Dr Kennedy will add: “This massive deterioration in performance is completely outwith the control of our doctors who work tirelessly in traumatic circumstances.

“And these figures are a warning light that the whole health and social care system is not coping with the demand.

“Long waits are forcing those who can afford it, to go private. A two-tier health service in Scotland is now beyond question.

"If you can stump up the cash, then you can get the care you need.

“But we all value an NHS free at the point of use.

“Yet, Scotland is sleepwalking into sacrificing this principle, threatening the very existence of the national health service as we know it.”

Neil Gray, who was appointed as Health Secretary in May - replacing Michael Matheson - has said he is "open to ideas" on how to improve the health service and has committed the Scottish Government to a "national conversation" on the future of NHS and social care services.

However, Dr Kennedy says a plan for direct engagement with the public and stakeholders "lacks both clarity and urgency".

Dr Sandesh Gulhane, a GP and Scottish Conservative shadow health secretary, said: “The double whammy of the SNP’s dire workforce planning and the failure of Humza Yousaf’s flimsy recovery plan has left staff stretched to breaking point and it is patients who are paying the price.

“With the NHS’s peak winter period well behind us, we should be seeing drastic improvements, but under the SNP our health service faces winter pressures all year round.

“My colleagues in the BMA have been very clear that unless drastic action is taken then the existence of the NHS as we know it is under threat.”

Thousands of people in Scotland have been waiting for operations on the NHS for over two yearsThousands of people in Scotland have been waiting for operations on the NHS for over two years (Image: Getty)

Scottish Labour health spokeswoman, Jackie Baillie, said: “Dr Iain Kennedy and the BMA couldn’t be any clearer about the perilous state of our NHS.

“Waiting lists are growing, staff are overstretched, and patients are being forced to consider private treatment but the SNP insist there is no crisis.

“Our NHS doesn’t need to be protected by John Swinney and the SNP – it needs to be rescued from them."

Health Secretary Neil Gray said: “The principles of a health service free at the point of need are sacrosanct.

"I have been clear, reform to how health services operate has never been more urgent and our vision for transformation focuses on early prevention and intervention and improving population health.

“We greatly value our health workforce and want to hear from them, including BMA Scotland, on how best to reform services – we will collect views through a series of direct engagements with staff and key stakeholders over the next year.

“We are making progress in clearing the backlog of long waits for planned care and continue to work closely with Boards to improve A&E performance.”