The NHSE productivity recovery plan includes reactivating and making meaningful the consultant job plan. The aim is 95% compliance nationally. The assumption: if consultants do what it says on the tin, we will get better value from the most expensive asset in any hospital.
This is one of those hitting-the-target-and-missing-the-point moments.
The 2004 consultant contract was a time-and-motion instrument. It translated goodwill into programmed activities, each PA linked to pay. What was once just the job became a link between time, motion, and money. Consultants became clock watchers. Hundreds of millions in unexpected salary costs landed on the NHS wage bill. And the annual job plan review largely fell away.
Twenty years later, we have a static instrument that has failed the consultant, the team, the organisation, the patient, and the taxpayer.
Why individual job planning does not work
As a CEO once said: the toughest thing on the menu of things to get done by a clinical leader is the consultant job plan.
I can attest to that from direct experience. The consultant who asked if he could pour his bowl of vomit over my head when invited to review his job plan. The professor who wanted to know if I knew who he was. The colleague who broke into tears at the prospect of a timetable that could be reviewed. Fear. Power. Control.
"It's my job plan" reveals it all. The possessive says everything about why a 20-year-old individual instrument cannot drive system-level change.
The non-compliance also hides something. When you discover a consultant busy in a private clinic during their NHS time, the only mechanism to tackle it is the job plan. Job plan not agreed. Pass Go. Collect NHS salary and private practice income.
The case for team job planning
Medicine is a team sport. No consultant works in isolation. A team job plan reflects who does what, where, when, and with whom. It makes the investment in the most expensive and valuable NHS asset transparent and optimal.
There is a case study that proves this. A stroke service lead in east London wanted a better service for his patients. He needed a way to get the expert in front of the patient to make the decision to admit or redirect. Through team job planning, facilitated by STRASYS, a consultant was rostered every day on the floor until 9pm.
The results were immediate:
Time to see a senior decision-maker dropped from 16.1 hours to 105 minutes. HASU admissions reduced by 26%. Length of stay reduced by 3.6 days. Outliers went from 14 a day to zero, every day. Consultants enjoyed the work. Everyone had time for lunch. Recruitment got easy. The annualised prediction: 425 fewer admissions, 4,675 fewer bed days, and £645,000 in recoverable best practice tariff. Clinical outcomes were never better.
The bad news. After a cost-cutting manager removed the expert facilitation, the whole thing slowly fell back to how it used to be.
What we built from this evidence
At STRASYS, the Decision Intelligence engine for healthcare, we built the Consultant Workforce Optimisation System from the evidence that team job planning, not individual compliance, is the key to unlocking consultant productivity.
CWOS uses Workforce Physics: forensic data triangulation across clinical activity, job plans, programmed activities, and financial performance. It reveals where the trapped value sits. Lost programmed activities. Clinical capacity on paper that never reaches patients. Senior decision-making absorbed by work that others could do.
Since 2018/19, consultant headcount has grown by 28.5%, yet productivity has declined by 12.1%. More consultants did not produce more output. Because the operating model, the individual job plan, was never designed to optimise how teams deliver care. It was designed to pay individuals for time.
Workforce Decision Intelligence works alongside CWOS, providing the broader organisational view of how workforce resources should be allocated based on patient need, not historical rota patterns or loudest-voice demand.
Team job planning as a measure of Well-Led
Compliance with team job plans should become a measure of how well-led an organisation is. CQC's Well-Led domain asks whether leadership, management, and governance ensure high-quality care. Team job planning is the team hygiene factor that answers that question at the clinical level.
In a trust with 6,000 staff, it is the 200 or so consultants who control and direct the means of production. CQC can get close to how consultants actually work by influencing a long overdue move from individual to team job planning.
The consultant is the most expensive, most valuable, most capable asset. Team job planning should be the instrument to modernise how consultants work. And team job planning, not individual compliance, should be the 95% target.