AS we approach the end of another year, spare a thought for the doctors and nurses in the frontline of our hospitals.

While the rest of us might be putting our feet up, chomping on a Chocolate Orange and pouring another glass of Prosecco, they are battling one of the busiest times of the year - especially those in A&E.

The latest figures from ISD Scotland, published on Christmas Eve, paint a picture of a service buckling under increasing demand.

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So far this winter - taking into account October, November and the first half of December - there have been a total of 303,248 attendances at emergency departments across Scotland. That is up 5% from 287,520 during the same period in 2018.

However, most striking of all is the huge spike in the number of patients waiting more than 12 hours in A&E: that has surged nearly five-fold year-on-year, from 469 in 2018 to 2,177 so far this winter.

Given that the winter has been mild so far and that attendances tend to shoot up over the festive fortnight, these figures suggest that our emergency departments are under extreme strain with the worst yet to come.

So what is the problem?

One issue could be the increasing vacancy rate among A&E consultants. In the past year, emergency doctor numbers have stagnated at around 230 yet vacancies climbed by 62% - from 11.5 to 18.6.

If this seems odd it is because this increase was not due so much to A&E doctors leaving the NHS as more posts being created to meet growing demand - but the hospitals being unable to attract the extra specialist medics needed to fill them.

Most of the delay is simply down to a shortage of hospital beds, however, leaving patients in A&E limbo far too long.

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Another, more hidden problem though, lies in general practice.

Notably, between 2004 and 2019 the headcount of consultants in Scotland increased 64% from 3497 to 5737. But over the same period, the GP headcount grew by just 13%, from 4,456 in 2004 to 5,049.

Research has shown that where consultant provision is high, the threshold at which hard-pressed GPs will refer patients to hospital for clinical tests, scans and investigations is lower.

This is particularly the case among better-off, more demanding patients.

The effect is that while these affluent patients take up the bulk of GP appointments and hospital waiting times slots (sometimes needlessly), poorer patients with more real ailments on average give up trying to see a GP, their health deteriorates and in due course they end up in A&E.

It might seem counter-intuitive, but solving the A&E crisis is as much about correcting the GP-consultant imbalance as it is about funding hospitals.