AN HONEST debate is needed about what the NHS in Scotland "can and can't deliver" as the gap between funding and demand widens, one of Scotland's top doctors has warned.

Dr Peter Bennie, chairman of the British Medical Association (BMA) in Scotland chided the Scottish Government over the "tired mantra" that it was investing record amount on the health service, stressing that a lower proportion of GDP is spent on healthcare in the UK compared to most comparable EU nations.

He added that the Scottish Government "completely misses the point" by repeatedly emphasising the record number of doctors and nurses employed by the NHS in Scotland amid a surge in long-term medical vacancies, and urged ministers not to allow the NHS to "slip down the list of priorities" amid the distraction of Brexit negotiations in 2017.

In his annual Christmas address, Dr Bennie, a Glasgow-based consultant psychiatrist, said the public and politicians had to choose between increasing investment in order to maintain existing services in the face of an ageing population or rethink the scope of the NHS.

He said: “As Scotland's population profile gets older and has increasing health needs, the speed with which increasing demand is outstripping available resources is rapidly growing. Without sufficient resources, providing healthcare in the same way as we do now is becoming unsustainable.

“Funding is not keeping pace with the demands on the health service. It has been virtually stagnant across the UK since the onset of austerity – which is hitting the health of the public, especially the poorest in society, resulting in even greater demands on the NHS.

“The UK spends a lower proportion of its GDP on healthcare than most comparable EU countries and the gap has been growing in recent years.

“If the NHS does not get the resources it needs to keep pace with demand, then the only alternative is to look at the range and models of services that can realistically be delivered within the budget provided.

“If the gap between demand and resources is going to continue, then there is no choice but to ask what the NHS in Scotland can and can’t deliver in the future.

“Any change, particularly at a local level, can often seem too hard to achieve especially when there can be political mileage to be made in supporting the status quo.

“At the BMA, we have been calling for an honest, public debate about whether or not Scotland is willing to invest the resources that the NHS needs to deliver the current range and level of services."

Dr Bennie has previously called for greater cooperation across the health service in Scotland, warning against the "competition and commercialisation" model being pursued in England.

He said the health and social care workforce plan, due to be published in early 2017, offered "a big opportunity" to tackle the "major problems with recruitment and retention" and staff shortages in remote and rural areas.

Scottish Conservative shadow health secretary Donald Cameron said: “This is yet another startling attack on the SNP’s handling of the NHS, and it’s time they started to listen.

“For too long the SNP has failed to prioritise our health service, and as a result standards have dropped with almost all national targets missed last year.”

Labour Health spokesman Anas Sarwar added: "It is painfully clear that the SNP's failure to properly workforce plan has left our NHS staff over-worked, under-valued and under-resourced. This has left our NHS struggling to cope with demand."

Health Secretary Shona Robison said: “We agree with the BMA on the need for a mature plan as a result of the changing nature of healthcare delivery because of the challenges of increasing demand and improving life expectancy.

That’s why the last few months has seen the publication of three crucial building blocks for the transformational change required. The National Clinical Strategy is a blueprint for what health and social care will look like in the decades to come.

"The Chief Medical Officer’s Annual Report focusing on Realistic Medicine calls for a new relationship between doctors and patients and families built on mutual trust and shared decision making. The report describes reducing unwarranted variation in practice and outcomes which will in turn reduce harm and waste.

"This has already led to working differently and has been welcomed across all parts of the system.

"Finally, just this week, we published a National Delivery Plan with concrete actions for the next year and beyond. This plan has actions for Boards, Government and other stakeholders and we look forward to the BMA being a full part of discussions about implementation.”