NHS in Scotland ‘financially unsustainable’ despite GP funding deal

The BMA has raised concerns over an independent watchdog’s conclusion that the NHS in Scotland is ‘financially unsustainable’ – while hailing a recent funding deal for general practice as ‘a positive start’. 

In its annual review of the health service’s finances, Audit Scotland – an independent public body responsible for auditing most of Scotland’s public organisations – said too many NHS health boards were struggling to break even, despite £20.6bn being spent on health last year (37.5% of the overall budget). 

Seven out of 14 NHS health boards required loans (or ‘brokerage’) from the Scottish Government in 2024/25, totalling £230m. Cumulative brokerage since 2019/20 now exceeds £500m, with only £7m of that amount having been repaid so far. 

The report said: ‘Even with increased funding, the NHS in Scotland is not in a financially sustainable position. NHS boards did achieve unprecedented levels of savings. But boards are still struggling to break even. 

‘Health spending is projected to continue to grow over the medium term but this will put pressure on other vital public services.  

‘The delivery of efficiencies and reform within the health and care system will play an important role in both the NHS’s and Scotland’s overall medium-term financial sustainability.’ 

Responding to the report, Dr Nora Murray-Cavanagh, deputy chair of BMA Scotland and an Edinburgh GP, said it revealed a ‘widening gap between ambition and delivery’ and ‘chronic mismatch between resource and demand’ in health services in Scotland. 

She said: ‘The finding that the NHS remains financially unsustainable even after unprecedented savings shows that “more of the same” is no longer an option.’ 

But Dr Murray-Cavanagh pointed to a recent funding deal agreed between the union and the Government as an example of how the shift into community health could be achieved. 

She said: ‘Additional investment is always welcome, but fundamental change—especially the long-promised and essential shift of care into the community—must be delivered.  

‘The recent funding deal for general practice is a positive start, but is only the first step. Community services need real resource while ensuring secondary care, already at breaking point, is protected.’ 

In October, the union ended its five-month dispute with the Government after accepting an offer increasing general practice funding by £249m annually recurring by 2028/29.  

The union’s GP committee accepted the Scottish Government’s offer including an initial £98m for general practice in the next financial year.  

The Government said that ‘subject to Parliament agreeing future budgets’ the funding will ‘help boost staff numbers and capacity’, support ‘day-to-day operations’ and ‘make it easier for people to access GP services’.  

Subject to ‘future budget processes’, an initial investment of £98m will be made available in 2026/27, with £183m being invested in 2027/28 and £249m following in 2028/29. 

Earlier this year, Audit Scotland found the Government had failed to deliver on several of its 2018 commitments to support GP practices.  

The watchdog said the proportion of NHS spending on general practice dropped from 7% to 6.5% between 2017/18 and 2023/24, while direct spending on GP practices decreased in real terms by 6% between 2021/22 and 2023/24.  

The 2018 GMS contract was the first time a Scotland-specific contract had been negotiated with the BMA, and it set out plans to bolster GP sustainability, address recruitment challenges, and free up GP time.  

At last month’s Scottish LMC conference, GP leaders voted to seek a new GMS contract to increase GP numbers to one per 1,000 patients.