THE Scottish Government must be “more transparent about what progress is or is not being achieved” on the NHS, Scotland’s public spending watchdog warns today.

Audit Scotland said a goal of 800 extra GPs, by headcount, by 2027 is “not on track” despite repeated assurances to the contrary by Health Secretary Humza Yousaf.

It comes after warnings that a growing shortage of GPs willing to fill out-of-hours shifts was leaving the service at risk of collapse, and record numbers of GP practices closing their lists to new patients in an effort to cope with demand at a time when the workforce has shrunk in real terms.

Mr Yousaf has previously said he is “very confident” that the pledge - first made by then-Health Secretary Shona Robison in 2017 - will be met despite warnings from Audit Scotland in 2019 that it would be “challenging to achieve”.

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In its latest update on the NHS, the watchdog said: “One key target that is not on track is the Scottish Government’s plans to increase the GP workforce by 800 (headcount) by 2027...This remains a risk to the recovery of primary care.

“Since 2017, excluding GP trainees, the GP workforce has increased by 113 (headcount).

"Public Health Scotland estimates that GP [whole-time equivalent] decreased by 26.4 between 2017 and 2022.”


In addition, Audit Scotland said a target to recruit 1000 extra mental health staff into GP practices and community health centres is "at risk" after £65 million was cut from primary care and £38m from mental health budgets "to fund proposed pay deals for NHS staff".

Audit Scotland also criticises claims in an update report published last October that “significant progress” had been made against the targets set out in Government’s original NHS Recovery Plan - despite the fact that “progress against key aims of increasing outpatient, diagnostic, and inpatient and day case activity is missing from the update”.

By the end of 2022/23, NHS Scotland was expected to be carrying out 58,000 extra outpatient appointments compared to pre-pandemic levels and 27,500 extra inpatient or day case procedures.

However, Audit Scotland notes that “current activity is running well below NHS Recovery Plan targets” based on data available for April-September 2022.

READ MORE: Key targets omitted from 'progress report' on Scotland's NHS Recovery Plan 

Targets to eradicate 18-month waits for operations by the end of September this year, and year-long waits for outpatient appointments by the end of March, will be “particularly challenging” due to knock-on effects of “severe winter pressures” in December and January.

The watchdog also noted that these ambitions - first outlined in July 2022 - were described as applying to “most specialties”, but that “no specific information was given to the public about what was meant by ‘most specialties’”.

HeraldScotland: Elective activity remains below pre-pandemic levels despite the NHS Recovery Plan, published in August 2021, originally forecasting an increase during 2022/23Elective activity remains below pre-pandemic levels despite the NHS Recovery Plan, published in August 2021, originally forecasting an increase during 2022/23 (Image: Audit Scotland)

The report also highlights the potential impact of delays in rolling out the new National Treatment Centres (NTCs).

The network of 10 elective surgery hubs, specialising in treatments such as joint replacements, are expected to deliver capacity for an extra 40,000 day case and inpatient procedures by 2026 - equivalent to 72 per cent of the increase envisioned by the Recovery Plan - with health boards boosting in-house activity by 15,500.

However, the three NTCs originally scheduled to open in 2022 - in Fife, Forth Valley, and Highland - were delayed and are now due to open in the first half of 2023, along with an expansion of the elective service provided by the Golden Jubilee Hospital.

Costs for the Fife NTC in Livingston have also ballooned from £70.9 million to an estimated £184m.

Audit Scotland notes that “timescales for the remaining NTCs are yet to be defined”, adding: “Any further delays to the completion of the NTC programme will make it difficult to reach the target of 55,500 additional inpatient and day case procedures by 2025/26.

"Some NTCs are unlikely to open until late 2027 or early 2028."

There are also "national shortages of staff to fill some of the key roles needed for the delivery of inpatient and day case services, including theatre nursing staff and anaesthetic staff", although the Scottish Government is helping boards to recruit internationally and upskill or redeploy existing staff where possible.

The report adds: "If NTCs are not fully and sustainably staffed, there is a risk that the increases in activity set out in the Recovery Plan will not be fully achieved."

However, Audit Scotland noted that recruitment of the 1,500 extra staff needed for the NTC network remained "on track", with 30% of posts filled by November 2022.

READ MORE: NHS recovery? Fewer operations on the NHS in 2022 than a year ago

The watchdog also warns that the cost of implementing the planned national care service could be "much higher" than expected and "represents a significant unknown financial commitment".

The reforms, which would see responsibility for social care transferred from councils to a centralised NHS-style service, are currently predicted to cost half a billion to deliver and have faced a backlash from trade unions, opposition parties and charities who fear that money will be diverted from frontline services to fund its start-up.

It comes as Mr Yousaf - who is bidding replace Nicola Sturgeon as SNP leader and First Minister - said he would be open to discussing with opponents "some areas where we could compromise".

A spokesman for the Royal College of Physicians Edinburgh said that "serious consideration must be given to whether we continue with the current proposals for a National Care Service" given "stretched" public finances.

Audit Scotland also raises concerns over staffing levels, vacancy rates, and retention, noting that a shortage of nurses in particular has led to a 93% rise in spending on bank and agency nursing staff since 2017.


Simon Barker, deputy chair of the BMA’s Scottish Council said the report "paints a bleak picture", adding: “An apparent refusal on the Scottish government’s part to truly reflect how challenging it has been for NHS boards to recover is both frustrating and demoralising for staff who continue to do everything they can for their patients with extremely limited resources."

Colin Poolman, director of the Royal College of Nursing Scotland called for an "open and honest discussion about the ongoing level of investment, and new ways of working, that will be required to meet the growing demands on Scotland’s health and care services".

Stephen Boyle, Auditor General for Scotland, said: "Money is tight but investment is needed in recovery.

"That means ministers have to prioritise which NHS aims can realistically be delivered. And they need to be more transparent about the progress they're making."

HeraldScotland: Health Secretary Humza Yousaf said the Covid pandemic had been the 'biggest shock' in the history of the NHSHealth Secretary Humza Yousaf said the Covid pandemic had been the 'biggest shock' in the history of the NHS (Image: Getty)

Mr Yousaf said NHS investment and workforce numbers are at "historically high levels" and insisted that the Government has "never hidden the scale of the task" of NHS recovery after the Covid pandemic, which he described as "the biggest shock in its history".

He said: “That recovery, outlined in our £1 billion plan, is backed by record investment and has delivered real success, including the Covid-19 vaccination drive and a significant reduction in the number of two-year outpatient waits.

"We are determined to build on this and will report on progress annually, ensuring updates are as specific as practicable."

He added: “We are working with boards to clear the backlog of planned care, despite the impact of the pandemic and recent winter pressure on long waits.

"Our National Treatment Centre programme will provide the single biggest increase in planned care capacity ever created in the NHS.

"The Scottish Government will consider the report recommendations as we continue to build our recovery from Covid-19.”