Date published: 26 September, 2024
Date last updated: 26 September, 2024
Improvement

Medical consultant job planning

Improvement guide: sharing learning from across organisations for impactful change.

Interim version published September 2024

Introduction: generating greater value for patients through improved planning

The NHS has set itself the ambition to become the fastest improving health system in the world. To achieve this bold ambition, we need to:

  • continuously identify and define best practice to underpin consistent care standards
  • create an infrastructure to spread and scale this best practice
  • develop and spread improvement and operational capability across the NHS to underpin sustainable improvement

This medical consultant job planning improvement guide is one way in which the NHS will work towards this ambition, supporting consultants to deliver more efficient and effective care.

Drawn from interviews with medical directors, this guide sets out how clinical and operational leads have improved medical consultant job planning.

At the heart of this guide is the ambition to deliver better, safer care for patients and support clinical colleagues by sharing learning. Job planning is a professional as well as contractual obligation for consultants and employers. Job planning cycles were challenging during COVID with the workforce adapting and responding flexibly to difficult circumstances. We need to improve the job planning process to respond to changes in service delivery, support the work life balance of colleagues, standardise processes across organisations, and understand medical capacity to inform service planning for 2025/26.

Good job planning helps you deliver services more effectively for patients. It can increase productivity and efficiency gains with an alignment of the demands of the service with the clinical capacity to deliver it. Job planning supports staff and service development, applies a standardised, consistent, transparent and fair approach, and enables consultants to consider how to innovate and drive change within services.

This guide does not change or override the contractual provisions for consultants. It is primarily designed for job planning medical consultants. However, a lot of the content is relevant to other professional NHS groups, including non-medical consultant grade staff. A further bespoke improvement guide will be developed recognising the contractual and other differences for our specialty and specialist (SAS) colleagues.

We want to understand how this guide works for you and your teams, and how we can further develop and improve it to make it as useful as possible to support local improvement programmes. Therefore, this is an interim guide – our intention is it will be refined, developed and updated as we learn what works through your teams. Please share your thoughts on the guide and your ideas to include in it – details on how to do this are at the end of this guide.

Thank you to the chief medical officers, medical directors and trusts who supported the development of this guide by sharing their learning and the approaches and processes they adopted to drive clinical and operational improvements.

“Regular, timely job planning should be done in a spirit of openness and collaboration, ensuring the sustainability of medical careers and for the services we work within. I see this as central to the recognition of our expertise and to the breadth of the work we do in the NHS”. Eddie Morris, Regional Medical Director, East of England

“A robust approach to individual and team job planning is one of the actions I have seen have significant impact in challenged services and services with challenged behaviour, but it is not always an easy task to undertake. Having clear support and expectations around this is a really positive step that I absolutely welcome”. Jessica Sokolov, Regional Medical Director, Midlands

“High quality job planning is the cornerstone of workforce design. It supports doctors to have a manageable work/life balance and provides the organisation with a workforce who can meet the challenges of demand. If we don’t understand our capacity, we can’t realise our potential”. Hamish McLure, Regional Medical Director, North East and Yorkshire

Using this guide and wider improvement activities

This guide provides some of the most impactful interventions that can support trust boards, medical directors, chief people officers and clinical and service managers and clinicians to improve care for patients and deliver more productive services. The high impact interventions and change ideas described should feed into your local improvement work, led by those closest to the point of care and supported by senior sponsorship, as you test, learn and adapt rapidly.

The guide will sit alongside regionally led, nationally supported consultant job planning interventions and improvement analytics currently under development.

The overall improvement programme has 2 principal aims:

  • to make care safer and improve patient experience by increasing the adoption of good practice
  • to maximise the value of patients’ and clinicians’ time and the productivity of services by tackling waste and addressing poor processes

Key resources to support good job planning

This is an improvement guide, not a comprehensive guide to job planning. Links are included throughout to key resources to implement good practice, including:

Track your ‘level of attainment’ for e-job planning to identify improvement opportunities

By documenting and digitising job plans using job planning software, hospitals can understand their workforce capacity better. If you also use e-rostering software, you can match your planned capacity to expected demand even better.

To support you to use this software to its fullest potential we have:

  • set out 5 ‘levels of attainment’ (LOA) for using e-job planning systems, underpinned by meaningful use standards which describe the processes and systems hospitals need to progress through the levels – these are grounded in best practice job planning policy and processes
  • developed a dashboard which helps hospitals, systems and regions track their annual progress in advancing their LOA across different workforce groups
  • identified high impact actions and change ideas drawn from the experiences of medical directors, aimed at advancing LOA for medical consultants

The levels of attainment and their associated meaningful use standards are:

  • chronological: reflecting your progress towards implementing the most effective e-job planning systems
  • all-encompassing: suited to all clinical workforce groups, while allowing nuances specific to each
  • meaningful: setting standards for matching workforce capacity to demand
  • measurable: enabling hospitals to self-assess their progress in implementing e-job planning and best practice job planning policy, and NHS England to identify lessons to share and target support

Level 0 – No e-job planning

e-job planning software may be being procured or in place, but fewer than 90% of employees are fully accounted for on the system. Job plans may be in place (for example, paper-based or Microsoft Excel) but are not recorded on dedicated e-job planning software.

Level 1 – Basic individual e-job planning

The trust has procured e-job planning software and trained its staff to use it. Trust-wide policies detail the e-job planning process and its governance. At least 90% of employees have an active e-job plan.

Level 2 – Advanced individual e-job planning

The trust allocates time and resources to e-job planning. The trust uses the full functionality of e-job planning software to include details of the agreed average output of planned activity. It maintains a fair and transparent culture around e-job planning.

Level 3 – Team e-job planning

Teams establish team e-job planning meetings that align team objectives to individual e-job plans and service needs, as defined through team capacity and demand analysis. Planned and delivered activity is reconciled at least quarterly using data from the trust’s e-rostering system, with objectives annualised if this meets service needs. The trust ensures e-job planning is consistent between teams.

Level 4 – Organisational e-job planning

There is board-level accountability for monitoring e-job planning across all workforce groups, ensuring audit and review. Individual and team objectives, departmental budgets and the trust’s objectives are aligned, so it can respond dynamically to services’ changing needs.

High impact interventions for trust boards, chief medical
officers, chief operating officers and chief people officers

Roles and responsibilities

In high performing organisations roles and responsibilities are clearly delineated. The trust’s board is responsible for ensuring the organisation is well-governed and the hospital’s job planning policy, systems and procedures:

  • provide a fair and transparent process for job planning all consultants employed under the National Terms and Conditions
  • consistently support consultants across the hospital to provide the most productive, efficient and effective clinical care pathways for patients in each specialty
  • are designed to meet educational, clinical and leadership objectives along with the organisation’s strategic and financial objectives
  • support meaningful conversations, and align service and individual objectives, which are mutually beneficial
  • follow good practice shared by NHS England, NHS Employers and the BMA
  • produce timely and accurate management reports to assure the board the above are in place and well managed

The chief medical officer is responsible for ensuring each consultant has an up to date and approved job plan designed to deliver the clinical demands of the services, via divisional directors.

The chief people officer is responsible for ensuring the policy is delivered fairly and transparently in accordance with employment law and the consultant’s individual employment contract, and the policy aligns with good practice guidance from NHS Employers, the BMA and individual royal colleges.

Lessons learned

  1. Set clear expectations for an annual job planning cycle, with targets and key milestones to be delivered on a quarterly basis.
  2. Establish a job planning committee, which has oversight of job planning approaches, and can ensure they are transparent and fair across the organisation.
  3. Develop medical leadership in job planning by providing training on key topics, such as HR approaches and finance / budget management, and ensure time is protected in job plans for training and job planning activities.
  4. Ensure operational teams understand the job planning approach, follow good practice and can access regular training.
  5. Set a clear expectation for job planning data to be reported to the organisation’s board, and for this data to be triangulated with other information, including activities delivered and financial plans.

High impact interventions for clinical and divisional directors, clinical leads, general managers and service managers

In high performing organisations clinical leads and colleagues in operational roles are jointly responsible for ensuring the totality of job plans meet the operational needs of their services and provide assurance that external duties and private practice do not impact unduly on service requirements. Job plans that meet these operational and service requirements are built on an understanding of:

  • baseline activity and performance of the current service
  • aspirations of the service and associated business plans
  • agreed standards to provide the ‘must dos’
  • activity required in the year ahead
  • capacity – for example theatre, procedure, ward round, outpatients and educational supervision
  • whether targets are being delivered
  • the clinical team’s development needs
  • how to reduce unwarranted delivery variation between clinicians
  • investment required for new service delivery
  • individual and team resources
  • the support required to deliver job plans
  • workforce issues and existing gaps

Lessons learned

  1. Implement an annual job planning cycle, with targets and key milestones to deliver on a quarterly basis.
  2. Set the tone for good job planning conversations by being clear and consistent on the purpose of good job planning.
  3. Build trust in the job planning process by following good practice.
  4. Develop a clear and consistent approach to job planning nomenclature and language and a clear delineation between Direct Clinical Care activities and Supporting Professional Activities.
  5. Establish a hospital wide job planning committee, which has oversight of job planning approaches, and can ensure they are transparent and fair across the organisation.
  6. Develop medical leadership in job planning by providing training on key topics, such as HR approaches and finance / budget management, and ensure time is protected in job plans for training and job planning activities.
  7. Ensure operational teams have regular training so they understand the job planning approach and how to apply good practice.
  8. Triangulate job planning data with related information, including activities delivered and financial plans. This can ensure there is visibility of planned versus delivered activities and can be supported by implementing good e-rostering systems.
  9. Align the job planning approach with leave allowances. This may require the consideration of annualisation where mutually agreed.
  10. Develop your service level planning, including with the consultant body and wider MDT to align service demand to capacity.

Change ideas: how to implement the high impact interventions

Establish an annual cycle for job planning

Objective

Establish an annual cycle for job planning – underpinned by a trust board approved job planning policy – to deliver clear, robust and cyclical processes.

Metrics

Resources

Consider the following when developing the job planning policy:

National employment contracts:

National job planning guidance:

Activities to consider

Good job planning processes and a successful annual cycle for job planning rely on the following systems and processes being in place and functioning effectively:

  • a trust board approved local job planning policy
  • e-job planning and e-rostering systems
  • business planning processes with budgetary approval for pay spend changes

The following activities will help establish a robust job planning cycle:

  1. review national employment contracts and job planning guidance, to ensure the job planning policy and processes are fit for purpose, comply with contractual provisions for consultants and are grounded in good practice
  2. engage the Joint Local Negotiating Committee in the development of the job planning policy and include clear mediation guidance in the policy
  3. create a governance structure to oversee how the consultant workforce can be optimised through the job planning process. This will include:
    • trust board reporting with metrics
    • roles and responsibilities and training for all the roles involved in job planning
    • underpinning job plans with sound business planning and budgetary approval for pay spend changes
    • Key Performance Indicators (KPIs)
    • an annual job planning evaluation process for continuous improvement
    • clear quarterly gateways that are expected to be completed as part of the job planning cycle

Set the tone for good job planning conversations

“The job planning conversation should be relational, not transactional.” Associate Medical Director

“You need to build trust in the job planning process by maintaining good practice and inviting staff to be part of the conversation.” Medical Director

Objective

Job planning conversations with consultants are productive and informed by service requirements. They build trust in the process and create the right climate for effective job planning by adopting a partnership approach and maintaining good practice.

Resources

Activities to consider

Meaningful conversations between colleagues are an important element of the job planning process, to align both service and individual objectives. Job planning is more valuable when it is grounded in informed conversations on service requirements, and the capacity required to meet expected clinical and non-clinical demand. Although job planning and medical appraisal inform each other, they should be separate processes.

When preparing for conversations with consultants about their job plans:

  1. be clear and consistent on the purpose and benefits of job planning and take a partnership approach
  2. be clear on the process that will be followed
  3. understand the total volume of programmed activities required to meet the clinical and non-clinical demands of the service (capacity and demand planning): the senior clinical leads with support from the operations, workforce (business partnering) and finance teams should meet to discuss budget setting and activity planning, and to understand what it costs to run the service and the volume of programmed activities required to meet clinical and non-clinical demand. This meeting should include a wider discussion about educational needs and any proposed changes in service, location, staff numbers or skill mix and potential impact of any hospital or national objectives or initiatives. The outputs of this process should be available ahead of individual job planning processes. Use consistent job planning language

Objective

Use clear and consistent language for job planning and establish agreed activities within the job planning categories to ensure there is transparency and fairness in job planning across the organisation.

Metrics

Local tracking metrics include:

  • number of job plans with clearly delineated job planning activities. These may be categorised as shown in the classification table below
  • use of standardised templates for activities, for example OPD and theatres
  • regular reporting on DCC: SPA: ANR: on call activities

Level 1 activity

Category

DCC

SPA

ANR

ED

Other

On-call

 

Level 2 activity

Activity

Standard lists (PAs / Hrs)

%

Level 3 activity

Specific detailed activity

Bespoke (for example, colorectal list at site)

Resources

Activities to consider

When establishing clear and consistent language for job planning:

  1. Identify direct clinical care (DCC)activities, such as clinics, procedure lists and theatre lists, under grouped headings. More detailed descriptions – such as location, modality and sub-specialty information – can be detailed within bespoke Level 3 descriptors. It is important to include activities such as Advice and Guidance, triage, multidisciplinary teams (MDTs) and other DCC admin requirements in this category. The time taken to deliver these activities should be regularly reviewed to ensure appropriate Programmed Activity (PA) allocation
  2. be clear on what constitutes as Supporting Professional Activities (SPAs) and ensure this is appropriately recognised within the job plan. This includes training, education, service development, non-clinical admin, and audit and research. Again, it is helpful to agree group headings and fair and transparent tariffs across relevant workforce groups, for example, continuing professional development (CPD) and core SPA allocation. The Academy of Medical Royal Colleges estimates that 1.5 SPAs per week are the minimum for a consultant’s CPD for revalidation purposes. Additional SPAs may be funded in line with the consultant contract. Educational supervision and clinical supervision should be fully recognised and provided for within job plans
  3. be clear on what constitutes External Duties (ED) and Additional NHS Responsibilities (ANR). EDs are for external roles delivered within working hours (for example, research, guest lecturers) while ANRs are delivered within working hours and paid by the substantive employer (for example, Clinical Advisory Groups, Integrated Care Board work and committees, mental health first aider, Freedom to Speak Up Guardian, union representatives and training programme directors). Where EDs are commissioned, it is important to ensure there are appropriate recharge mechanisms in place. Equally where core NHS business is commissioned, this is classified as ANR and is at the cost of the employer
  4. clarify your approach to Additional Programmed Activities (APA). These can be agreed over and above the standard contract, reviewed annually and can be ended with 3 months’ notice
  5. remember that Additional to Contract (ATC) is a non contractual term. While ATC PAs may be included in job plans to recognise discretionary work that is done ‘above and beyond’ and without remuneration, such as voluntary research, they should not be used to deliver NHS activities

Establish a job planning committee

Objective

Establish a job planning committee to provide assurance to the board on the outputs of job planning the clinical workforce. The committee will review all aspects of performance, including financial, risks affecting job planning delivery, mitigating actions, job plan sign off rates, and consistency and monitoring issues. The purpose of this committee is not to sign off or change individual job plans and does not override the contractual sign off process of job plans between the consultant and their clinical manager.

Metrics to be tracked by the committee

Process metrics:
  • number of e-job plans approved and signed off by the clinical line manager
  • number of appeals outstanding, with timescale and reasons
  • number of different roles who attended training and development sessions
  • an on-call supplement audit
  • a payroll reconciliation audit with ongoing monitoring (job planned versus paid)
Performance metrics by specialty:
  • DCC / SPA ratio
  • premium pay spend

Resources

Activities to consider

When establishing a job planning committee:

  1. Create terms of reference for the committee outlining specific duties including:
    • overseeing the development and delivery of the trust’s job planning commitment
    • regularly reviewing and monitoring job planning sign off rates, taking action to address where these are low 
    • regularly reviewing and monitoring bank, agency and waiting list initiative spend in relation to the clinical workforce and taking action where required 
    • reviewing and approving policies and procedures that fall within the remit of the committee
    • identifying fair and transparent processes and consistency within job planning. Each job plan and service may be different and therefore the role of the committee is not simply to identify inconsistencies between job plans but to identify where that inconsistency is unwarranted or unfair
  2. Carefully consider the committee’s membership. This should include all roles responsible for ensuring the trust’s job planning policy and procedures are implemented effectively to provide optimum patient experience and outcomes, and there are fair and transparent workforce terms and conditions. Suggested membership includes:
    • medical director (or associate) (chair)
    • chief operating officer (vice chair) 
    • chief people officer
    • divisional / clinical directors / senior medical clinical leads  
    • divisional general managers  
    • temporary staffing lead
    • professional leads (for example, AHP, nurse, healthcare scientist, pharmacist) 
    • member of the Local Negotiating Committee (LNC)
    • medical staffing lead
  3. Consider how the committee and job planning processes can support consultants wishing to work more flexibly, including Less Than Full Time consultants, those undertaking ‘retire and return’ and those in peri-retirement
  4. Oversight of job plans over 10 Programmed Activities. Employers should consider removing PA thresholds to allow consultants who wish to, to undertake job plans in excess of 10 PAs (and 12 PAs where relevant opt-outs are voluntarily entered into), provided working patterns remain safe. These job plans should be reviewed regularly

Develop good medical leadership in job planning

Objective

Medical leaders are developed so the job planning process is effective, collaborative, consistent, appropriate, professional and follows good practice.  

Metrics

  • Attendance rates at local job planning training sessions

Activities to consider

To develop medical leadership:

Protect time for job planning and associated training:
  • medical directors should consider how best to resource protected time for those responsible for job planning. This should be delineated, appropriately renumerated and reflected in the local job planning policy
  • ensure those responsible for job planning have protected time to undertake job planning and training activities. This should be reflected in the job planning and study leave policy
  • clinical service leads should have time allocated in their job plans to undertake individual job plan reviews on an annual basis
Provide access to training and track attendance:
  • clinical service leads should attend local training, which will cover the specifics of job planning within their organisation and how best to lead the department, taking into consideration the range of activities the consultant body undertakes. Specific training should be considered for clinical leads on the complexities of the consultant contract (annual leave over a compressed working week, out of hours activities, on-call). This may also include other topics, such as understanding the departmental budget and service plan

Support operational teams to understand the job planning cycles

“The job planning process is completed by the most competent person, who has completed the necessary training, not the most senior team lead just because it has historically been part of their job description”. Associate Medical Director for Workforce

Objective

Operational teams have the required support and training. They understand how to support good practice job planning in their organisation and, where appropriate, are included in job planning discussions. 

Metrics to be tracked by the committee

  • Attendance rates at local job planning training sessions

Activities to consider

Operational managers need to understand the core requirements of job planning and how to use the outputs to plan services.

To support upskilling, provide:

  1. regular job planning training for newly appointed leads
  2. formal and informal training, with peer support and 1:1 coaching on the more complex aspects of job planning, including how to link the job planning cycle to the hospital’s business planning timetable. This can help align consultant and organisational objectives

Understand job planning data in a wider context

“You need one dedicated person, sat on the same corridor, who can analyse your data, tell the story behind it and take on an objective role in discussions”. Deputy Medical Director

Objective

Job planning data is considered alongside other key data points such as delivered activities, and finances / budgets, to ensure services continue to meet patients’ needs.

Resources

Activities to consider

  1. Establish a regular review of performance data with finance, clinical, operational and human resources teams, who undertake a service-level review at least quarterly to enable capacity and demand matching.
  2. Gain the support of analytics and operational intelligence teams.
  3. Consider system as well as hospital level data. Collaboration at a system level can facilitate more efficient care delivery, improve the interface between primary and secondary care and, where mutually agreed, can support more flexible, efficient deployment of consultants so activities and job plans are not wedded to site.
  4. Ensure e-job plans, ledgers, roster templates and electronic staff records automatically reconcile, to improve efficiency and consistency across them. This should also be considered when procuring and implementing an e-job planning system.
  • job planning data, including sign off rates, DCC / SPA ratio
  • planned versus delivered sessions
  • expected versus actual demand
  • planned versus actual budget
  • premium pay spend, including locum spend and Waiting List Initiative spend

Annualisation in job planning

Objective

Job plans may be annualised where mutually agreed and where it supports consultants and employers to provide services in different patterns. This can address seasonal demand patterns or enable staff to work compressed or annualised hours.

Metrics

Locally held metrics:

  • all DCC activities delivered on a quarterly basis compared to planned activities
  • additional PAs and / or Waiting List Initiative payments
  • completed / signed off job plans

Resources

BMA and NHS Employers 2011 guide on consultant job planning, sets out the best way to calculate annualisation, study and annual leave allowances. It notes that:

‘Annualisation is an approach to job planning in which a consultant contracts with their employer to undertake a particular number of PAs or activities on an annual, rather than a weekly basis. Most consultants are used to carrying out at least part of their work on an annualised basis where the on-call commitment varies from week to week.

As with all aspects of job planning the decision on whether to annualise a job plan or not must be made by mutual agreement. At the outset, employers and consultants should agree that activity relates to measurable outputs and that arrangements reflect the professional nature of the consultant contract and consultants’ continuing responsibility for care as described in the GMC’s Good Medical Practice.

At the same time employers should clarify a consultant’s responsibilities when they are not scheduled to work, are not undertaking any other planned activity, on-call or when they are on leave, for example whether they are required to return to work in the event of an emergency.’

Service level job planning

Objective

Undertake consultant service level job planning to align capacity to service demand and ensure all colleagues understand the total demand on the services and how best to collectively meet this.

Metrics

At a local level, a team will monitor and track their collective performance to identify any variance from plan and agree mitigating actions to be implemented.

This will be led by the service leadership team and likely include team objectives, departmental budgets, performance indicators and other relevant metrics. For instance, success could mean a reduction in backlog, waiting lists and / or agency spend. Measures should also include specific job plan KPIs, such as planned versus delivered activity, as set out in the Meaningful Use Standards. It is good practice to monitor ongoing demand and capacity.

Resources

Activities to consider

The 4 domains to establish good service level job planning processes are below. These can help inform service level job plan discussions. Service level job planning does not mean that all colleagues have the same job plan. There may be variation in how the activities are delivered and shared among colleagues.

We recommend adopting the term ‘service level planning’ and shifting away from ‘team-based job planning’ to maintain the distinction between the contractual process of individual job planning between a consultant and their line manager, and the process of matching the team’s capacity to service demand.

  1. Demand and forecast activity
  • Review previous demand and activity data, including backlog data
  • Agree the service plan for the coming year, including commissioned services, planned delivery model and growth. This should also consider available resources and any resource constraints that have or may impact on activity, for example, bed capacity, clinic space, and wider MDT (for example nursing) capacity
  1. Capacity (Direct Clinical Care)
  • Review establishment, including temporary staffing pay
  • Match workforce availability to planned activities, including headroom and annualisation calculations
  1. Leadership and Educational Portfolio (SPA and ANR)
  • Set team objectives, linked to hospital objectives
  • Agree team development plan
  • Review performance, safety and patient outcome data
  1. Ongoing monitoring
  • Review agreed KPIs
  • Establish regular meetings to review ongoing metrics, and consider whole specialty-line or separate medical and non-medical meetings
  • Track Waiting List Initiative (WLI) spend. Where capacity and demand are aligned, the need for WLIs is lower

Please share your ideas and feedback with us

Thank you for engaging with this guide. While we have collected a wide range of improvement ideas, we want to gather your local improvement ideas for inclusion in an updated version of this guide early in 2025.

Please share your ideas and feedback with us. There are 2 ways you can do this:

Publishing reference: PRN01435_iii

Date published: 26 September, 2024
Date last updated: 26 September, 2024