Scotland’s doctors feel undervalued, overburdened and increasingly unable to deliver the level of care patients deserve, according to a major Scottish Government report that lays bare the profession’s growing crisis and its hopes for the future.
The Future Medical Workforce Project report, published following engagement with more than 2,000 doctors and medical students, warns that without urgent cultural and structural reform, problems faced by the medical profession will worsen.
The report concludes: “Without decisive action, the challenges currently affecting the medical workforce will not only persist but intensify by 2045.”
The project forms part of wider NHS renewal efforts and seeks to anticipate what the medical workforce must look like by 2045.
The report warns of significant pressures in balancing service delivery with training and managing increasing workloads. It emphasises that any plans for the future should take into consideration the importance of ensuring doctors feel valued and inspired by their profession and able to sustain fulfilling careers.
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However, in the report, doctors describe currently feeling an erosion of professional autonomy, worsening working conditions and a breakdown in trust between clinicians, managers and the public.
The report highlights widespread frustration that doctors are “holding all the responsibility but none of the control” in an overstretched system where they carry risk for delays, under-resourcing and systemic failures.
Many senior doctors said they face the distress of being seen by patients as "gatekeepers" rationing care, despite not being responsible for the constraints.
One specialty trainee wrote that doctors and patients alike are being forced to assume risk “because our health system cannot support the increased levels of investigation which have become the norm in modern medicine.”
Survey data suggests morale is lowest early in careers.
Only 49% of Foundation Year 2 and Core trainees feel the doctor’s role is valued by society, compared with higher ratings among more experienced clinicians.
Doctors also described a growing sense of “moral injury”
Across focus groups, clinicians repeatedly reported feeling unable to provide the quality of care they aspire to, leading to what the report calls “moral injury.”
The report states: “As doctors are often the face of the NHS to the public, they describe the moral injury of being left to face the blame, distress and backlash when there are inadequate services, delays or cancellations while managers are hidden from view.”
Lengthy waits, poor continuity, and lack of capacity in both primary and secondary care leave doctors feeling complicit in patients’ suffering, according to the report.
One GP described the emotional burden: “I’m so privileged to be a doctor…but the system is so stretched that you can’t always do your best for people.”
Facing an ageing population and rising multimorbidity, most doctors support a shift toward stronger generalist skills. But many warn that broadening responsibilities without structural reform risks deeper burnout.
Some consultants argue that specialties themselves may need to become more generalised, including in cancer care, while others fear that generalism may be seen as less prestigious or less sustainable.
Doctors also expressed scepticism that promised shifts toward community-based care will be delivered, citing past failures and the need to strengthen primary care capacity first.
The report reveals sharp divisions over expanding the role of non-medical staff such as advanced nurse practitioners, physician associates and specialist allied health professionals.
Some clinicians praise the contribution of expanded MDT roles, but others warn of risks to patient safety, continuity and trainee development.
One core trainee wrote: “They do not hold a medical degree and cannot act at a level of equivalence… I worry about the responsibility placed on doctors to make decisions based on these assessments.”
Resident doctors report that on-the-job teaching has declined steeply as senior clinicians struggle under heavy workloads. Junior doctors say administrative burden, rota instability and lack of geographical stability undermine confidence and belonging.
The report notes a “strong call for political consensus,” with many clinicians urging an end to the NHS being used for political point-scoring. Instead, they want long-term workforce planning, modern IT infrastructure, better administrative support, stable teams, and genuine clinical involvement in decision making.
Doctors overwhelmingly said job fulfilment comes from feeling valued by patients (97%) and colleagues (98%), not pay though many highlighted concerns about pension rules, job security and the long-term sustainability of consultant and GP roles.
Health Secretary Neil Gray said: "Our doctors are the backbone of our NHS and it’s vital that we plan now to ensure we have the right workforce in place to meet Scotland's healthcare needs in the decades ahead.
“I have been clear of the need to listen closely to doctors at every career stage, and I am grateful for their honesty and insight which is invaluable in shaping our next steps.
"Scotland's population is changing. People are living longer and many of the cases we see in hospitals are now more complex. The decisions we make today will shape our future medical workforce and we are committed to empowering our doctors with positive working environments, manageable workloads and the resources they need to continue providing excellent care.
“We have invested a record £21.7 billion in our NHS this year and reached a historic deal with GPs by investing £531 million over the next three years.
"The next phase of this project will turn these insights into action, working in partnership with the profession to deliver meaningful change that supports the medical workforce and improves care for patients across Scotland."
BMA Scotland has said that without decisive action care across Scotland is at “serious risk”.
Dr Nora Murray-Cavanagh, Deputy Chair of BMA Scotland, said : “While this report is just stage one of a longer-term piece of work, the reality is the Scottish Government has still not delivered a plan to ensure the NHS medical workforce is able to meet the needs of the population.
“Of course it is welcome that the Scottish Government have devoted time and effort to listening to what doctors are saying. And the report is stark and doesn’t shy away from outlining the huge challenges being faced. But without the kind of decisive action and meaningful change we have been calling for, the ability for the NHS to deliver safe, sustainable care across Scotland remains at serious risk.
She added: “With doctors often being the public face of the NHS, they describe the ‘moral injury’ of being left to face the blame, distress and backlash when there are inadequate services, delays or cancellations while managers are hidden from view. As we have previously highlighted, this is an unacceptable and intolerable burden which is contributing to burnout and doctors leaving the profession.
“While it is right that pay and terms and conditions of doctors are for other forums, we also have to acknowledge they are key issues that need addressed and improved when thinking about the future of the medical workforce. The document fails to look closely at the impact of the roles of PA and AAs are causing in the system, both on patient safety and on capacity for resident doctor training. BMA Scotland believes it is vital this is addressed – only doctors, with their full medical training can deliver what we rightly ask of doctors. There are no shortcuts or short term fixes."
Dr Murray-Cavanagh said action is now needed following the report.
She said: “With an election approaching, and stage two of this work not starting until the new year, we are deeply concerned this whole project will ultimately turn out to be a listening exercise which won’t deliver the solutions and practical work we urgently need.
“The report rightly acknowledges the complexity of the issues, but these are far from new problems and have been allowed to develop over a period of time due to inadequate planning. That means we are beyond the point of simply setting out the scale of the challenge. We will engage fully with stage 2 of this work and will be pushing to ensure this finally is the moment the Scottish Government addresses medical workforce planning effectively. That means dealing with the issues this report identifies and crucially mapping demand against factors including population growth and health to ensure empowered doctors working in well staffed teams are at the heart of an NHS that is sustainable in the long term.”
