Imagine you are the CEO of a business that runs on a billion pounds of annual revenue. Your most expensive asset, the one that generates the value, is the senior professional workforce. Ask the CEO how many of those professionals are employed, and you might get a rough estimate. Ask how many are employed in each specialty, and surprise may follow. Ask if the number is right, and the silence is telling.
This is the state of NHS consultant workforce planning.
The numbers
The NHS came to life in 1948 and converted about 4,000 consultants from private practice into the new national enterprise. Over the subsequent 50 years, medicine transformed. New drugs, devices, procedures. The number of consultants grew from 4,000 to 24,000. The population grew from 50 million to 59 million.
Then acceleration. Over the next 25 years, the NHS added another 36,000. A 150% increase. Population growth from 2000 to 2025: 18%. So it was not that.
Medical invention and innovation have added to what doctors can do. Fair enough. The benchmarking argument says Austria has more consultants per capita, so we must need more. The problem is that benchmarking only tells you the benchmarked system may be wrong too.
The British Association for Paediatric Nephrology recommends one consultant per 0.5 million population. The GMC recognises 65 specialties and 31 subspecialties. Multiply every specialty body's growth logic across all of them, and the NHS would consume the treasury several times over. This is how Gainsbury's Law operates in practice: the means of modern medicine will always outpace what any economy can afford to provide.
The fiction of job planning
Post-Covid, everyone has been exercised by the fall in productivity. NHS England is activated on consultant job planning. Trusts are holding workshops, networking events, and improvement journeys.
A regional medical leader posted on LinkedIn this week, celebrating a job planning event with words that captured the state of play: proud, improvement journey, inspiring, commitment, curiosity, courage, energy, thoughtful, honest reflection, healthy challenge, transformative journeys, challenges they are navigating.
The actual questions that need answering are simpler. How is the current consultant capacity being used? What is the unanchored capacity? What is the right number of consultants per specialty?
Those questions were not on the agenda.
At STRASYS, the Decision Intelligence engine for healthcare, the Consultant Workforce Optimisation System exists to answer precisely those questions. CWOS treats the consultant workforce as the most expensive asset in the building and subjects it to the analytical rigour that any billion-pound business would apply to its primary value-generating resource.
Job planning is a technical capacity planning instrument. It should reveal: how many direct clinical care sessions per consultant, how much throughput per session, how much is spent on administrating the clinical work, and what is left after the four to six hours afforded weekly for maintaining skills and knowledge.
Medical leaders need help to do the least pleasant of all medical leadership jobs. CWOS provides the data, the framework, and the evidence base that makes the conversation possible.
The lifetime cost nobody calculates
Lifetime salary and pension costs for one NHS consultant come to approximately £7.5 million. Each sits on top of a pyramid of other workers, estates, equipment, and consumables.
60,000 consultants at £7.5 million each: £450 billion in lifetime cost to the treasury. A conservative estimate.
At that price, you would expect careful thought before making each appointment. You would expect a CEO to know whether 39 ophthalmologists is the right number, or whether 26 cardiologists could be redeployed to generate more value. You would expect a system-level workforce plan that connects consultant investment to population need.
None of these expectations are met. The Strasys Value Index reveals the consequence: trusts generating a fraction of the value their consultant workforce should produce, with no mechanism to identify the gap or act on it.
Naeem Younis, STRASYS CEO, argues that the right number of consultants per specialty is knowable. It requires population need analysis, activity data triangulation, and value generation benchmarking. CWOS provides all three. Without it, the NHS will keep adding to the headcount, keep running workshops about improvement journeys, and keep being unable to answer the most basic question a billion-pound business should answer: do we have the right people in the right places doing the right work?
Consultant Workforce Optimisation
Forensic data triangulation to identify trapped clinical capacity and release it.
Key Definitions
- Consultant Workforce Optimisation System (CWOS)
- A STRASYS product using forensic data triangulation to answer the question: what is the right number of consultants per specialty? Analyses programmed activity, clinical throughput, and financial performance to reveal unanchored capacity and misallocation.
- Gainsbury's Law
- A concept articulated through STRASYS analysis describing why NHS costs will always outpace economic growth. The means of modern medicine expand faster than any economy can fund. In workforce terms, every specialty body's growth argument, applied across 65 specialties, produces a mathematically impossible funding requirement.
- Strasys Value Index (SVI)
- A STRASYS product measuring trust-level value generation relative to population need. Reveals how much value the consultant workforce should be producing compared to what it actually delivers.
- Decision Intelligence
- The discipline of converting complex healthcare data into structured, actionable decisions for NHS leaders. STRASYS coined and owns this category in UK healthcare.
Frequently Asked Questions
Approximately 60,000, up from 4,000 in 1948 and 24,000 in 2000. The 150% increase since 2000 far exceeds the 18% population growth over the same period. No national framework connects this expansion to population need assessment.
Approximately £7.5 million in salary and pension costs per consultant career, from appointment to retirement. At 60,000 consultants, the total lifetime commitment to the treasury is approximately £450 billion. This excludes the supporting workforce, estates, and equipment each consultant requires.
Currently, no. Most CEOs and Medical Directors cannot state with confidence how many consultants they need in each specialty. Recruitment is driven by professional body recommendations, specialty association lobbying, and clinical director advocacy. CWOS provides the population-need-based analytical framework to answer this question for the first time.
Individual job planning treats each consultant as an isolated contract rather than as part of a team delivering value to a population. After two decades, job planning remains a work of fiction for most trusts: the process either delivers marginal improvement or delivers the consultant agreeing to be in the "process of negotiation." STRASYS advocates team-level optimisation connected to population need and value generation.
Answer three questions first: How is existing consultant capacity being used? What is the unanchored capacity in each specialty? Does the population need analysis support this appointment, or is it driven by professional demand? CWOS provides the data to answer all three. Without these answers, every new appointment is a £7.5 million gamble.
This article is adapted from the Friday Fish and Chip Paper, Dr Nadeem Moghal's weekly newsletter on LinkedIn.
Dr Nadeem Moghal
Chief Medical and Innovation Officer