Will NHS England’s medical consultant job planning improvement guide work?

Let me start with a story. Back in 2010, when I was head of learning and development in the NHS, I’d watch our director of workforce in a blind panic every month as they pulled together a board report. The report was simple: who works for the trust, including substantive, part-time, honorary contracts, and temporary staffing costs. So why the panic? Because nobody knew the answers.

Month after month, they scrambled to piece it together. This wasn’t a capability issue — our director of workforce was an excellent leader, and adept in their role. The problem was systemic; nobody had the data, and more concerningly, nobody knew where to look.

This problem existed long before I joined the NHS, and unfortunately, it still exists today. So, when I saw NHS England’s new improvement plan, my initial reaction was, hopefully, a step forward. Workforce planning has been a constant struggle. But the real question is: does this improvement guide truly help solve the underlying issues?

The positives: A step in the right direction

I’ve been around the workforce planning block for almost two decades. I’ve seen countless attempts to kick-start meaningful change. The most notable difference with this guide? It ties job planning directly to patient value, something often overlooked. Too often, job planning has been about capacity without understanding how that capacity impacts patient outcomes. Finally, a patient-centric focus — this is progress.

The plan also discusses some important areas that need addressing; consistency, engagement, utilisation of data-driven insights, leadership focus, capability, process structure, and demand and performance metrics. These are key areas for improvement, and I support these measures.

The familiar oversight

However, here’s the big ‘but’ — this guide, like many before it, focuses too much on procedure, and not enough on resistance, lack of perceived value and inconsistent linkages to demand. These are the familiar hurdles that those doing the job know all too well lead to poor engagement, and the real root causes of 20+ years of subpar workforce planning.

“The data isn’t being utilised effectively, and everyones knows it.”

It’s like telling someone, “just try harder.” No amount of process improvements will solve the underlying barriers unless we address the core issues. As it stands, it feels more like a numbers game. Those who truly understand workforce planning and its relationship with patient safety outcomes and workforce wellbeing know it’s far more complex.

Workforce planning is not as straightforward as finding a round peg for a round hole. It’s more akin to a 1,000-piece puzzle — having the right people, with the right skills, in the right place, at the right time. Without this, a team’s, a department’s, or on a bigger scale, an organisation’s ability to deliver safe services and ensure staff wellbeing can resemble a shaky house of cards ready to tumble.

The root cause of poor job planning

A barrier to improving the consistency of job planning is cultural resistance. This is understandable to a certain degree, as job planning feels incredibly personal, even though it shouldn’t be. There’s a strong resistance to anything perceived as a threat to individual autonomy.

There is also an ambivalence towards the process due to the lack of perceived value. Why should anyone engage in this process if the data isn’t used for anything? The improvement guide talks about triangulating data with HR and Finance, but without demand modelling, it feels empty. The data isn’t being utilised effectively, and everyone knows it.

“Workforce planning… it’s failing because trusts don’t have the time and capacity to make it work.”

The inconsistent link to demand makes it feel like an afterthought. Demand should be at the core of job planning — ‘this is the demand on my service, and here’s the capacity to meet it’, not the other way around.

As a result, people don’t engage in job planning as it is seen as a process that doesn’t improve wellbeing, workloads, service objectives, or patient outcomes. The same applies to safe staffing, reducing backlogs, or achieving service goals.

The biggest issues: Time and capacity

Here’s the crux: workforce planning isn’t failing because of systems, leadership, or metrics. It’s failing because trusts don’t have the time and capacity to make it work. The process is complicated and labour-intensive, requiring significant hours from multiple people to be truly effective.

Until we address this fundamental issue — the lack of time and capacity — job planning, and therefore workforce planning, will continue to fall short.

Familiar solutions, same old problems

I’m not saying the challenges are easy to fix, but they are solvable. We need to think outside the box, beyond risk aversion, regulations, and procurement rules, and focus on what will add real, tangible value. Solutions that flatten the landscape by dealing with all the root problems holistically, rather than manage the hill. Solutions that tackle data analysis, engagement, expertise, tools, and training and provide tangible outcomes like better quality management information, not simply enabling more input methods.

This improvement guide offers procedural fixes, but it doesn’t tackle the deeper, systemic issues that have prevented job planning from being effective for so long. Real change will only happen when we address the root causes that are holding workforce planning back.