The way the NHS works in Scotland needs to change dramatically if it is to survive the next 10 years, according a report.

The president of the Royal College of Surgeons warns that Scotland needs more doctors - both GPs and hospital consultants - to cope with rising demand.

Professor John Temple also said that the country needed better medical facilities and a broader planning system, possibly led by three "super health boards".

He said that developments like European directives on working time would pose enormous challenges for the NHS.

Professor John Temple: "Build teams"

"Most doctors work well beyond 56 hours and in the past they worked even more than that," he said.

"In the future it will not be appropriate or legal for a tired doctor to stay on duty and, therefore, that doctor will go off duty.

"We've now got to build teams with handovers of care so that patients continue to receive continuous care - that means more doctors, more training and more facilities."

His report was commissioned by the Scottish Executive, but the research was carried out independently and canvassed the opinions of many people in the medical workforce.

Working with a small advisory group the professor highlighted 10 key themes the executive should act upon, as well as making 37 more specific recommendations.

In response the executive has pledged to:

• Establish a system for proper medical workforce planning

• Create two new working groups to examine the career path for doctors

• Set-up a work working group to consider ways of getting more recruits through Scotland's medical schools

• Push harder for "reform, redesign and reconfiguration of NHS services".

Professor Temple's report was welcomed by the British Medical Association and Health Minister Malcolm Chisholm.

Dr Jim McCaul, chairman of the BMA's Scottish committee on junior doctors, said: "For the first time we are addressing a problem which threatens the whole future of the NHS in Scotland.

Junior doctors' hours will be limited

"Without adequate numbers of doctors our healthcare system will face considerable difficulties in future and so we must provide more doctors and, importantly, retain them."

Professor Temple's report on how Scotland's medical workforce should evolve over the next 10 years, calls for a nationally-led planning process.

It also floats the idea of three big regional health economies - or super-boards - for workforce planning and delivering all but the most specialised services.

'Radical report'

The report also warns too much care is delivered by staff in training and it suggests incentives are needed to recruit and keep doctors.

It calls for consideration to be given to maintaining acute services in small rural hospitals.

The health minister said the executive was committed to sustained investment across the NHS.

Malcolm Chisholm said: "This is a radical report - indeed the very first of its kind ever commissioned and carried out in this country.

Malcolm Chisholm: "Increasingly untenable"

"At its heart is a message that must continue to resonate across the NHS - both investment and reform, working in tandem, are needed to change and improve NHS services for patients."

A central theme of the report is that the system cannot continue as it has in the past.

It said: "We believe that change in the traditional models of service delivery is inevitable if public expectations and Scottish Executive policies for service delivery are to be met.

"A solution that relies on securing yet more doctors to work much as they have done in the past looks increasingly untenable.

"In essence the supply now and in the future will not meet the demand if we retain current patterns of service delivery. Redesign of the delivery of services is in our view inevitable."