BMA Scotland Urges Ministers to Abandon Plans to Slash Health Boards from 14 to Two

Scotland's largest doctors' union has formally called on the Scottish government to scrap its flagship proposal to drastically reduce the number of regional health boards, warning the restructure risks diverting money and attention away from a health service already under severe strain.

The British Medical Association's Scottish Council voted on Wednesday to oppose the plan, which would see the country's 14 existing boards consolidated into just two Strategic Health Boards covering the west and east of mainland Scotland, with separate arrangements still to be decided for the three island boards.

Dr Nora Murray-Cavanagh, who took over as chairwoman of BMA Scotland only weeks ago, said the organisation wanted ministers to "withdraw and rethink its whole approach" and instead deliver more immediate support to patients. She stressed that doctors fully accept the case for change, but argue this is the wrong reform at the wrong time.

"Our position is not one that argues NHS reform isn't necessary – no-one thinks we can simply go on as we are," said Murray-Cavanagh, a GP based in Wester Hailes, Edinburgh. "As doctors, we know better than most the precarious state of services across Scotland."

The proposal was unveiled a month ago by First Minister John Swinney as part of his Programme for Government, and was described by him as the "most significant structural reform of our NHS in the devolution era." Under the blueprint, NHS administration would be reorganised around two large regional bodies, which ministers say would simplify management and remove duplication between boards.

The Scottish government argues that the current 14-board structure creates unnecessary geographic and bureaucratic barriers, leading to unwanted variation in care depending on where a patient lives. Ministers insist that pooling planning and management functions would free up resources for frontline treatment and deliver more consistent standards across the country.

Murray-Cavanagh, however, said no serious evidence had been presented to show the merger would improve patient outcomes. She warned it would instead set Scotland on a "costly, time consuming, resource-sapping reorganisation" at a moment when the health service can least afford disruption.

She added that the union's council members spoke passionately during Wednesday's meeting about the potential impact on their working lives and on the people they treat, and that the absence of proof that reorganisation would practically improve care sat "at the core of everything."

The BMA is the first medical organisation to publicly demand that the government reconsider. While the doctors' union has spent years warning that the NHS cannot survive without fundamental change, it has now drawn a clear line between reform in principle and this particular set of reforms.

Health Secretary Angela Constance said she stood by the proposals and rejected the suggestion that they lacked justification. She argued the changes were focused on improving services for everyone in Scotland, regardless of where they live, and would remove barriers that currently cause variation and duplication across the 14 boards.

Constance said the reforms would build on planning work already under way involving every NHS board in Scotland. She also promised that detailed proposals would be underpinned by a full business case, with engagement involving NHS boards, staff representatives, trade unions, local government, integration authorities, social care partners and the public.

The political fight now centres on whether the government can convince frontline clinicians that structural change will translate into tangible improvements. The BMA's intervention carries particular weight because its members are the people responsible for delivering care within the system ministers want to reshape.

The union's stance also signals that opposition is unlikely to remain confined to doctors alone. BBC Scotland health and social care correspondent Lisa Summers noted that the BMA is the first medical organisation to publicly urge a rethink, suggesting other staff groups, unions and patient representatives could follow with their own concerns as details of the merger emerge.

For the Scottish government, the row presents a difficult balancing act. Ministers must sell the plan as a way of protecting frontline services while simultaneously reassuring a workforce that has repeatedly reported feeling exhausted, under-resourced and overwhelmed by constant change. Any perception that reorganisation is consuming time and money that could have gone directly to patient care would strengthen the case against the proposals.

The coming months are likely to prove decisive. The government has committed to developing detailed proposals supported by a full business case, but the BMA wants the process halted before it reaches that stage. How ministers respond to that demand – and whether other health organisations join the call – will shape one of the most consequential NHS debates of the devolution era.