BMA Scotland Urges Ministers to Drop Plan Slashing Health Boards from 14 to Two

Doctors in Scotland have urged the Scottish government to abandon its proposal to dramatically restructure the country's NHS by reducing the number of health boards from 14 to just two, arguing the change would be expensive, slow-moving and unsupported by evidence that patients would benefit.

The call came from the British Medical Association's Scottish Council, which voted on Wednesday to oppose the plans put forward by First Minister John Swinney. The doctors' union is the first medical organisation to publicly demand that ministers reconsider the reform, which Swinney has described as the "most significant structural reform of our NHS in the devolution era."

Dr Nora Murray-Cavanagh, a GP based in Wester Hailes, Edinburgh, who took over as chairwoman of BMA Scotland only a few weeks ago, said the organisation wanted the government to "withdraw and rethink its whole approach" and to instead pursue a more immediate way of helping patients. She stressed that doctors are not resisting change for its own sake, acknowledging that services across Scotland are in a precarious state and that no one believes the current system can simply continue unchanged. Her objection, she said, is that this particular set of reforms risks putting Scotland on a path of "costly, time consuming, resource-sapping reorganisation" without serious engagement with the staff holding the service together, and with no clear evidence demonstrating how patients would gain.

Murray-Cavanagh said the BMA's Scottish Council members spoke passionately during their meeting about the impact the proposals would have on them and on the people they treat, adding that at the heart of the dispute is "the lack of any evidence on how these reforms will practically make care better."

The plan was unveiled by Swinney at the start of September as part of his Programme for Government. Under the proposal, the 14 existing health boards would be consolidated into two Strategic Health Boards, one covering the west of mainland Scotland and one covering the east, with separate arrangements being considered for the three island health boards. Ministers argue the shake-up would simplify administration, eliminate duplication between boards and free up resources that could be redirected toward frontline treatment, while also delivering more consistent care regardless of where a patient lives.

Health Secretary Angela Constance defended the plans in response to the BMA's intervention. She said the reforms are focused on improving services for people across the country, no matter their location, and would simplify how patients access the care they need. According to Constance, the changes would remove the geographic and bureaucratic barriers that currently exist between 14 separate health boards — barriers she said are known to cause unwanted variation and duplication in care. She also said the reforms would build on planning work already under way involving every NHS board in Scotland, and that detailed proposals would be supported by a full business case.

Constance promised that developing the finer points of the plan would involve engagement with a wide range of groups, including NHS boards, staff representatives, trade unions, local government, integration authorities, social care partners and the public. That commitment to consultation is likely to be tested in the coming months, given that the doctors' union has now formally lined up against the direction of travel rather than merely seeking changes to the detail.

The political context adds further weight to the dispute. When he announced the restructuring, Swinney framed it as the boldest organisational change to the NHS since devolution, and ministers have since sought to reassure the public that patients will not have to travel further for care under the new structure. The BMA's opposition therefore strikes at the central justification for the reform — that consolidation will produce better outcomes rather than simply redrawn boundaries on a map.

The BMA's position is notable because the organisation has long been a vocal advocate of fundamental NHS reform, repeatedly warning that without significant change the health service cannot survive. Its decision to oppose these specific proposals is therefore not a rejection of reform in principle but a judgment that the government has chosen the wrong mechanism and has failed to make the case for it. That distinction may make the intervention harder for ministers to dismiss as simple resistance to change.

More broadly, the standoff raises questions about the timetable and cost of any large-scale reorganisation at a time when health services are already under severe pressure. Restructuring 14 boards into two would touch on management structures, planning processes, staffing arrangements and local accountability, and critics argue that the energy and money required would divert attention from immediate problems facing patients and clinicians. Supporters counter that the current patchwork of boards entrenches variation and inefficiency, and that only structural change will resolve long-standing inconsistencies in care.

The Scottish government now faces a choice between pressing ahead with its preferred model and adjusting its approach in the face of opposition from the medical profession. Its stated willingness to engage with unions, boards and the public suggests ministers intend to keep the proposal alive while refining it, but the BMA has made clear it wants the plan withdrawn rather than amended. How that gap is bridged — or whether it can be — will shape the next phase of one of the most consequential NHS debates in Scotland's devolved history.