Medical Job Planning and Rostering: How to Build Clinical Buy-In and Navigate Difficult Conversations
Job planning should be the most important conversation a consultant has each year. In practice, these conversations can become difficult, delayed or focused primarily on activity and capacity. In this panel from the Connected Health & Care Summit 2026, Rahul Chodhari, Consultant Paediatrician and NHS England lead for medical workforce productivity and consultant job plans, and Jonathan West, Head of Shared Medical Workforce Services at Royal Free London, share what makes job planning work, what goes wrong, and how to reposition it as a collaborative process that benefits clinicians and organisations alike.
Watch Rahul Chodhari and Jonathan West discuss how to turn consultant job planning from an adversarial exercise into a collaborative conversation, with practical advice on sign-off rates, disagreement handling and team-based approaches.
What the panel covers and the key messages
This panel explores consultant job planning from both the clinical and administrative perspectives. The key messages were:
- Job planning is a bilateral, mutual conversation. Consultants want respect for their career stage, development aspirations and wellbeing. Organisations need to know their available capacity
- The commonest reason for conflict is not disagreement but silence: parties becoming entrenched and stopping talking
- Clinical directors should not need to “win” a job plan discussion. The goal is the best mutually agreed outcome
- Nationally, sign-off rates were sitting around 30-35%. The push to improve is not punitive but exists so NHS England can demonstrate to Treasury that clinical resource is well deployed
- One-third of the 3,500 clinical directors in the country have less than two years of job planning experience, and nobody teaches them
- Only 60% of newly appointed consultants last year took a full-time 10 PA job, reflecting a generational shift toward work-life balance
- NHS England is developing eight open-access training modules on consultant job planning, the first four aimed at non-specialists
Warning signs, disagreement and documentation
Rahul Chodhari identifies four warning signs. First, no team-level conversation about service priorities before individual job plan discussions begin. Second, discussions focused purely on fitting people into clinics and theatres with no conversation about development. Third, previous-year sign-off happening well after May and June. Fourth, disputes left to fester without mediation or senior accountability.
Jonathan West describes how to handle disagreement. Start with what has been agreed, which is usually the majority. Apply professional curiosity to the remaining points. Ask how important the disagreement actually is. Consider whether it can be deferred to next year. The alternative, a protracted standoff and breakdown of relationships, can be more damaging to the working relationship.
On documentation, Rahul Chodhari recommends team-based workload descriptions discussed collectively before individual job plans, standardised activity descriptions, and transparent documentation that helps newly appointed consultants understand how workload is distributed across the team.
What this means for organisations and who it is relevant to
Jonathan West describes his administrative team at Royal Free as quite slim and says the key is making processes as slick as possible, using the Allocate Job Planning system effectively and having a good LNC-agreed policy. He identifies operational management engagement as the most common resourcing gap and argues that COOs, CFOs and the whole senior leadership family should be involved because there is something in job planning for all of them.
Rahul Chodhari adds that he has observed challenges in job planning among organisations experiencing significant financial recovery pressures, and that well-defined medical leadership with teaching and training for clinical directors is linked, in his view, with better sign-off quality, timing and lower WLI costs. He advises non-medics not to shy away from asking curiosity-based questions about job plans but to be aware that what they see may not represent the full picture, citing examples like GMC restrictions that explain why a clinic appears shorter than expected.
The panel closes with a call for software to be facilitative rather than frustrating, arguing that if clinicians are struggling with technology while completing a job plan, it can undermine the trust and transparency that the conversation is designed to build.
This session is relevant to medical directors, clinical directors, medical workforce teams, operational managers, finance directors, HR leads and anyone responsible for consultant job planning, SAS doctor engagement or medical productivity.
Frequently asked questions
The panel features Rahul Chodhari, Consultant Paediatrician and NHS England lead for medical workforce productivity and consultant job plans, and Jonathan West, Head of Shared Medical Workforce Services at Royal Free London and North London Partners Shared Services. It is moderated by senior RLDatix colleague, Darren Kilroy. The views expressed during the discussion are those of the individual speakers and do not necessarily represent the views of their organisation.
Rahul Chodhari describes three career stages: the first focused on skills, the middle on doing new things, and the last third wanting less intensity with recognition of experience. A good conversation has mutual respect, acknowledges that consultants are not machines, and includes service-level activity planning as a team exercise before individual discussions. He also emphasises that consultant’s capacity and priorities can change over time and should be recognised without stigma.
Jonathon West advises starting with what has been agreed, which is usually most of the job plan. For the remaining points, apply professional curiosity: understand why the consultant does something a particular way and how important it is to them. The aim is not for the clinical manager to “win” the discussion. Consider whether unresolved points can be deferred to next year. The worst outcome is a protracted standoff that damages the relationship permanently.
Rahul Chodhari identifies four potential warning signs. No team-level conversation about service priorities before individual discussions. Job plan meetings focused only on filling clinics and theatres with no development discussion. Previous-year sign-off happening well after May and June. And disputes left to fester without mediation or senior accountability. He also notes that clinical directors who do not offer a job plan when a consultant has not submitted one create persistent mismatches.
Rahul Chodhari explains that nationally, sign-off rates were around 30-35%. The push to improve is not punitive against individual organisations. It exists so NHS England can demonstrate to Treasury that clinical resource is well deployed. Organisations should not feel they are doing something wrong if they are behind peers, as long as they are making progress. The journey is about building trust and relationships, not achieving a target.
NHS England is developing eight open-access training modules on consultant job planning. The first four explain what job planning is for people who know nothing about it, with the aim of making the fundamentals more accessible to those with limited experience. Rahul Chodhari notes that one-third of 3,500 clinical directors have less than two years of experience and receive no formal training. The modules are intended to close that gap.
Only 60% of newly appointed consultants last year took a full-time 10 PA job, a figure discussed during the session in the context of changing expectations around consultant working patterns and work-life balance. The panel considers how differences in working patterns and expectations between generations may affect job planning conversations. Recognising these expectations and allowing newly appointed consultants time to settle into consultant working can help organisations build trust.
