The NHS’s most valuable asset is consultant time, so why are we not using it effectively?

By Dr Darren Kilroy

If consultant time is the NHS’s most valuable clinical asset, why do we still plan it based on past wisdom instead of new intelligence?

A landmark five-year analysis of thousands of consultant job plans, conducted in collaboration with NHS England, reveals a paradox that should concern every NHS leader: we have more doctors than ever, yet direct clinical care time has intentionally declined by an average of 0.16 Programmed Activities per job plan.

More doctors, fewer direct patient care hours.

As NHS England’s Deputy National Medical Director for Secondary Care at Stella Vig observes, job planning is not just a management exercise, it is a clinical leadership tool.

When we treat it as infrastructure in partnership with service leads, we unlock the real value of our people: their time, their innovation, and their ability to deliver better care.

The tools for job planning such as the contracts and the frameworks, haven’t changed in years, and they don’t need to.

What has changed, fundamentally and irrevocably, is the nature of clinical work itself.

Yet we’re still planning consultant capacity as if it were 2015, relying on historical patterns rather than intelligent analysis of what’s actually happening on the ground.

The invisible shift in clinical work

The data reveals what many clinicians have been experiencing for years; their work has been transformed.

Analysis by The Health Foundation shows that in 2021, 57 per cent of NHS staff reported working unpaid overtime, but this declined to 50 per cent in 2024.

EPR implementations, transformation projects, medical student teaching, nursing education – activities that once happened on discretionary effort during lunch hours or at the margins of the day, are now rightfully accounted for in job plans.

This isn’t consultants doing less, it’s organisations finally acknowledging the full scope of what we ask them to do.

NHS finance directors overwhelmingly feel they’re not extracting efficiency from contracted clinical hours.

The midnight panic of the finance director on call authorising thousands in agency bookings because staffing has collapsed is symptomatic of a deeper problem.

We’re measuring productivity, not value. We’re counting hours without understanding how those hours are actually being spent or what they’re achieving.

Meanwhile, hospital patients have become significantly more complex as simpler cases move to community settings.

Each patient now consumes more clinical time, yet we haven’t adjusted our planning frameworks to account for this fundamental shift in case mix.

The analysis also shows a concerning reduction in audit time, precisely when we need more, not less, clinical governance.

The result? We’ve created an illusion of staffing without the delivery of service.

The workforce assurance crisis

For the first time, NHS planning and compliance guidance explicitly mandates job plan sign-off targets over three years.

Yet current sign-off rates fluctuate wildly between 30 per cent and 90 per cent, averaging just 53-65 per cent.

This means nearly half of consultant job plans remain unsigned – a workforce assurance crisis that correlates with clinical leadership engagement, not NHS trust size.

Unsigned job plans aren’t just an administrative inconvenience.

They represent a fundamental breakdown in the conversation between organisations and their most valuable clinical workforce.

Without signed job plans, we have no shared understanding of what consultants are contracted to deliver, no baseline for capacity planning, and no foundation for service redesign.

From individual contracts to service-level intelligence

The analysis reveals that team-based job planning like aligning consultant capacity with actual service demand, is emerging as critical infrastructure for modern integrated care.

This represents a fundamental shift from managing individual contracts to service-level planning informed by real intelligence.

Consider an orthopaedic clinic.

On paper, the consultant has time allocated to see 15 patients in a morning session.

But if porters are delayed, admin staff are overwhelmed, transport doesn’t arrive on time, or theatre lists run late, that consultant might only see eight patients, despite being present and willing to work at full capacity.

The problem isn’t the consultant’s productivity; it’s the system’s coordination.

Job planning data, analysed at scale and in real time, can expose these systemic inefficiencies.

It can show where clinical capacity is being undermined by operational failures.

It can reveal patterns that individual trusts, looking at their own data in isolation, would never see.

Four non-negotiable actions for 2026

The good news is that these challenges are solvable, even within the constraints of today’s NHS.

The solutions don’t require additional funding or wholesale system redesign. They require smarter use of the intelligence we’re already generating.

First, we need to mandate sign-off as minimum workforce assurance. The new planning guidance provides the mandate; organisations must now deliver.

This isn’t bureaucracy, it’s the foundation for every other improvement. Without signed job plans, we’re flying blind.

Second, let’s standardise templates nationally. Consistency allows comparison, benchmarking, and learning.

It enables the kind of large-scale analysis that reveals trends invisible at NHS trust level.

Standardisation doesn’t mean rigidity, it means creating a common language for planning clinical capacity.

Third, we need to expand service-level planning tied to actual demand.

Move beyond individual contract management to understand how consultant capacity maps to service delivery.

This means bringing clinical leaders, operational teams, and finance directors into the same conversation, armed with the same data.

Fourth, we should use job planning data in real time for capacity modelling and pathway redesign.

This is where intelligence transforms planning. Real-time data can show where capacity is being eroded, where services are under pressure, and where interventions will have the greatest impact.

It creates what we might call a sentient health system – one that senses problems and self-corrects before they cascade into crises.

Job planning as the NHS’s nervous system

Clinicians aren’t the problem.

Outdated planning based on historical patterns rather than current intelligence creates illusions of staffing without service gains. It leaves finance directors signing off emergency agency requests at midnight because the system couldn’t see the crisis coming three days earlier.

Job planning is no longer about compliance. It’s about creating the nervous system the NHS desperately needs.

One that senses capacity pressures, identifies systemic inefficiencies and enables rapid response before problems become emergencies.

The tools haven’t changed because they don’t need to change. What needs to transform is how we use the intelligence those tools generate.

In an era of finite resources and infinite demand, we can’t afford to keep planning consultant time, our most valuable clinical asset, based on yesterday’s wisdom.

We need new intelligence. And we need it now.