The psychiatric workforce in Scotland

Psychiatric services in Scotland are under severe pressure as a result of increasing demand.

However, the workforce is not growing sufficiently to keep pace with this. Furthermore, there are significant problems retaining senior medical staff, as well as high vacancy rates across the country.

The Royal College of Psychiatrists in Scotland (RCPsychIS) published two reports in 2023 illustrating the gravity of the issues: the State of the nation report on the psychiatric workforce in Scotland, and the workforce census.

Slightly prior to the publication of the workforce report, however, we also published our 'Core to Higher Training Attrition Report' which explored the reasons behind thinning numbers progressing directly through the training pathway.  

Additionally, Scottish Health Board's increasing reliance on locum psychiatrists to fill substantive vacancies has gained increasing political and media attention and has been a focus for RCPsychiS this year. The Locum Psychiatry Survey - Report and Recommendations - was published in November 2024. 

Locum Psychiatry Survey - Report and Recommendations

The purpose of this research was to gain a better understanding, and be able to demonstrate, the reasons driving people to choose locum over substantive posts. Nearly all of the qualified individuals we surveyed (that weren’t currently in a substantive post) had left a substantive role to assume a locum position - citing stress, burnout, poor work-life balance, concerns around patient safety, and lack of support as key reasons for this move.

Despite the well-documented increasing demand for mental health services, the workforce has not grown to keep pace. In fact, NHS Scotland Workforce Census data shows that the number of general psychiatrists in WTE posts in March 2024 remains unchanged from a decade earlier (804), even when accounting for locum roles.

This stagnant growth has left clinicians working in untenable conditions, contributing to a critical loss of permanent staff and jeopardizing the safety and quality of treatment and care for patients. Both early-career and highly experienced consultants are being lost, undermining workforce stability at both ends of the career spectrum. 

State of the Nation

This report utilises a life span approach, starting with the basics, explaining roles and pathways before delving into the problems and crucially, trying to identify solutions.

Each section of the report describes and summarises the challenges at each career stage of the pathway. Each section then recommends solutions and actions, with a final set of overarching recommendations at the end of the report.

Dr Ihsan Kader, lead author of State of the Nation report, said it was vital that mental health services in Scotland are sufficiently resourced so patients could be treated by the most experienced psychiatrists when they needed them.

Dr Kader said:

“These are worrying times. Mental health services are at risk if we do not improve the outlook for trainees and working conditions for psychiatrists.

“There’s a growing trend of doctors opting to leave training and take up specialty doctor posts, take career breaks or work abroad instead of moving directly into higher training. This results in delays in consultants coming through into the workforce.

“Furthermore, we are not retaining our senior doctors who choose to retire early or choose other options due to the unmanageable workload and other pressures.

“However, psychiatrists are needed in the NHS workforce to deliver care and treatment to those in society with severe mental illness, and with an increase in those seeking help we need a larger workforce to keep up with demand. 

“After speaking to trainees on the ground to find out the reasons behind the numbers, we’re determined to make a real difference to allow these doctors to do well in their professions and stay in Scotland.

“We need to ensure that mental health services are sufficiently resourced and other pressures on senior doctors addressed so that patients are treated by the most experienced clinicians when they need them.

“We are calling for a complete review of psychiatric training, an expansion of posts across all grades and the promised funding into mental health services to ensure we recruit and retain psychiatrists and help our patients get the treatment they desperately deserve.”

Workforce Census

The workforce census is undertaken biennially, and provides an accurate picture of the psychiatric workforce through the quantity and quality of information obtained.

This data can assist evidence-based decision making and improved services to our communities. This census also seeks to better understand the growing prevalence of locum doctors and the impact this has on understanding of the true rate of vacancies in the specialty. Key findings are as follows: 

84.9% consultant posts were filled with substantive and locum consultants (across the boards that responded); down from 91.0% in 2021. 

The true vacancy rate (capturing both locum and vacant consultant posts) is 25.3% 

The proportion of vacant consultant posts continues to rise each census year.