PATIENTS are at risk from a "dangerous" shortage of doctors in some areas with overstretched hospital departments "barely able to provide a service" due to vacancies, a medical leader has warned.

Heatmaps created by BMA Scotland show the "stark difference" between rural and urban staffing, but the trade union stressed that no part of the country has escaped recruitment and retention problems.

Its analysis shows that consultant vacancies range from 3.4 in the Borders to 40 in the Western Isles per 100,000 population.

Also struggling is the Highlands (30) Grampian (24.5) and Lanarkshire (21.5).

READ MORE: Why is the NHS under strain - and just how bad is it? 

Similar patterns were found for general practices, with vacancy rates highest in Shetland (25 per 100,000) and Orkney (12 per 100,000) to a low of 3.3 per 100,000 in Greater Glasgow and Clyde.

Dr Iain Kennedy, a GP in Inverness and chair of BMA Scotland, said: "I don't think the patients or public understand just how dangerous the situation is at the moment and I don't think there's an understanding about how abject the failure of workforce planning has been.

"In my career of just over 20 years I've seen it get far worse.

"I can remember maybe 15-20 years ago, there were maybe one or two GP practices in Highland that struggled to recruit a doctor and it only seemed to be Highland where GP practices were collapsing or we were struggling to find hospital doctors.

"That situation has escalated - we now have 16 GP practices in Highland where independent contractor GPs have handed back their contracts to the health board, and the health board are really struggling to keep these services going.

"And that situation has spread throughout Scotland - we're seeing huge problems with practices collapsing in Grampian, but we also have practices collapsing in our popular urban centres like Edinburgh.

"While there is definitely a significant issue with remote and rural, there is no part of Scotland that isn't affected by the doctor vacancy situation in general practice and in hospitals.

"That's part of the problem - if we can't fill the posts in Glasgow and Edinburgh, it makes it even more difficult to fill the remote and rural posts.

"Some hospital departments have so many doctor vacancies that they are barely able to provide a service."

It comes after figures this week revealed that NHS Scotland had spent a record £560 million year on bank and agency staff to plug rota gaps for doctors, nurses and midwives - an increase of 34 per cent compared to 2021/22.

For the first time in a decade, more staff left the health service in Scotland than joined it in the past year, with around 4000 registered nurse posts empty as of March 2023 along with 447 consultant posts.

READ MORE: Medic blames NHS Highland 'dysfunction' for doctor exodus

The Herald:

The Herald has previously reported on concerns over extreme shortages of consultant physicians at the Lorn & Island hospital in the Highlands, with one former senior clinician blaming "dysfunctional" management for doctors quitting.

Separate figures obtained by The Herald also reveal gaping workforce shortages at other rural district generals such as Dr Gray's in Elgin, where six consultant physician roles have been unfilled for two and a half years and a seventh for 14 months.

Only one permanent consultant physician remains in place, with support from four agency locums.

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Dr Kennedy said: "One of the things that I'm hearing is that health boards don't seem to have the ability to do things differently in their area.

"It's my understanding that rural health boards can't offer more incentives to doctors to come and work in these hard-to-reach areas, and that doesn't seem right - if it were any other walk of life or industry, organisations would do all they could to attract people.

"We know doctors are less inclined to work in remote and rural areas and what the research shows is that one of the chief reasons for that is actually because of the greater clinical risk.

"The skillset you need to work in a remote and rural area is greater. You're often much more exposed, and have much less support from the ambulance service, A&E departments and so on."

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A Scottish Government spokesman said it is "making good progress" on its pledge to recruit at least 800 new GPs by 2027, despite a report this year from Audit Scotland warning that the target is "not on track".

He added: “A £20,000 bursary is offered as an incentive to GP speciality trainees in hard to fill vacancies including certain rural areas and trainee recruitment last year was the most successful year of any of the last five, with 99% of GP training posts filled.

"We also created 35 additional GP training places this year and are actively considering the need for further uplifts.

”NHS Scotland is a large organisation, employing 156,178.7 staff (WTE) in March 2023.

"Given the natural turnover of staff in an organisation of this size, it will always carry some vacancies. 

"Last year we recruited a record number of trainee doctors, and the number of available medical school places at Scottish universities has increased by 67% since 2016.

"Over the last 12 months consultant vacancies have reduced by 8.2%.”