Recruitment of specialist cancer doctors to the NHS in Scotland is "dire" with many training posts going unfilled, a leading expert has said.

Dr Frances Yuille, a recently retired breast cancer oncologist and chair of the Scottish Standing Committee at the Royal College of Radiologists (RCR), said much more needed to be done to attract young doctors and to retain senior clinicians longer towards the end of their careers.

Speaking to the online conference on Priorities for Cancer Provision in Scotland, Dr Yuille noted that "no one applied" for the vacancy after she stepped down from her role at the Edinburgh Breast Unit in NHS Lothian earlier this year despite it being a highly-rated centre.

She added that for the past decade there has been roughly one applicant per vacancy for consultant-level oncology in Scotland, with a median age of 54 UK-wide for consultant oncologists retiring from the NHS.

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Dr Yuille said: "When we asked what could have encouraged them to stay on longer, it was things like more flexibility, better IT, better administrative support, and having kinder working environments.

"In some hospitals they can't even get hot food and drinks during shifts - basic stuff.

"There needs to be a really people-focused view on how we look after our workforce."

She added that it was "untenable" that most consultant oncologists in Scotland were on 9:1 contracts - meaning that 90% of their working time in spent on clinical work, with just 10% allocated to training up junior doctors or in areas of service improvement.

This is at odds with the NHS in other parts of the UK, where the amount of time set aside for non-clinical duties is more generous, said Dr Yuille.

She highlighted the findings of the most recent workforce census carried out by RCR which forecasts that Scotland will have 22% shortfall in oncologists, compared to need, by 2027.

The Herald: The size of the NHS cancer workforce is not keeping pace with demand on the serviceThe size of the NHS cancer workforce is not keeping pace with demand on the service (Image: PA)

NHS Scotland currently has around 150 clinical and medical oncologists but needs another 15 now "to begin to deliver effective care".

However, the oncology workforce grew by just 1% in 2022, said Dr Yuille, compared to 5% for the UK as a whole.

"It's not going in the right trajectory at all," she said, adding: "As a group of clinical oncologists, we are not coping very well.

"We are stressed, burnt out.

"I don't think Covid's helped, but I think you can see from those numbers that we are working as hard as we possibly can and some of us can't work any harder than we are, and what's being asked of us is probably too much."

Regional variations staffing were also highlighted, with the conference shown data indicating that there are just 4.9 oncologists for every 100,000 people over the age of 50 in the north of Scotland cancer network region compared to 9.1 per 100,000 in the south-east region - which includes Edinburgh.

Despite growing demand on cancer services, Dr Yuille said it was very difficult to attract enough young medics into oncology training posts.

An expansion of oncology training posts forms part of the Scottish Government's cancer strategy, published last year, but Dr Yuille said fill rates have been "extremely low".

In 2023, the conference was told that just five out of 18 Level Three specialist training posts in clinical oncology had been filled, with only one junior doctor appointed to the four available training placements in medical oncology.

The Herald: Too few junior doctors were not taking up specialist training posts in oncology, the conference was toldToo few junior doctors were not taking up specialist training posts in oncology, the conference was told (Image: PA)

Dr Yuille added that figures updated over the weekend indicated that the cancer centres in Glasgow and Edinburgh had filled their remaining trainee places, but that Dundee had filled just one out of its four slots and Aberdeen had been unsuccessful in recruiting to any of its five remaining trainee places.

Dr Yuille said: "Young doctors are going elsewhere. The training programmes they are on are gruelling, and quite a few of them are dropping out.

"And there are quite big bottlenecks in the training programme...there hasn't been good thinking about the pull-through into specialities such as oncology."

She added that shortages of other healthcare professionals was also having a major impact.

"We have to think much broader than doctors, because nurses, radiographers, clinical scientists - we need all of these people to support the cancer pathway.

"At one point, one of the cancer centres could barely provide chemotherapy because they didn't have any nurses."

Professor David Morrison, director of the Scottish Cancer Registry at Public Health Scotland, noted that while survival rates were improving, Scotland and the rest of the UK tends to have worse outcomes than comparable countries. 

The Herald: Waiting times from referral to diagnosis and start of treatment have been deteriorating, but the conference was told that it is unclear how big an impact waiting times are having on survival rates Waiting times from referral to diagnosis and start of treatment have been deteriorating, but the conference was told that it is unclear how big an impact waiting times are having on survival rates (Image: PHS)

However, he told delegates that more work was needed to unpick how much this was due to longer waiting times or the case mix of cancer patients.

Prof Morrison said: "One of the paradoxes we see when we look at information on treatment: the simple description of how long patients wait from initial referral by a GP and then their survival and other outcomes, is that the longer you wait - in general - the better your survival.

"This waiting times paradox is because patients are managed in a way that reflects their urgency of need: patients who are sickest get seen quickest, but because they are sick their outcomes tend to be poorer.

"So simple descriptions of cancer waiting times don't necessarily shine a light on the impact of waiting times.

"What we need to do is adjust for and better understand just how sick patients are at the start of that journey to try to better understand how much - and in some cases if any - effect waiting times have on outcomes."