The Scottish Academy of Medical Royal Colleges has considered concerns expressed about the medical workforce in Scotland and the issues related to these. The workforce challenges in the NHS now present a greater threat to health services than the funding challenges.

This paper is an attempt to set out and explain factors that are combining to create a situation where the imbalance of workforce and workload is unsustainable. It is intended as a working document to which additions and retractions can be made as the workforce climate changes in a politically unpredictable time.