This article reflects the conversations in the breakout group on this topic at the Recently Appointed Consultants symposium on Thursday 5 June 2014. Reviewed July 2021.


Creating a successful job plan involves accurate allocation of time between direct clinical care (DCC), supporting professional activities (SPA) and programmed activities (PA), amongst others. Starting the discussion of how to achieve this within a team helps to ensure activities such as clinical rotation commitments can be covered. When a group of consultants are in agreement this also lends strength to arguments when discussing job planning with managers.

Unfortunately coming to a group consensus about job plans can be difficult. Breaking the authority gradient can be tricky, especially for recently appointed consultants. Creating equitable job plans should be the aim, and transparency should be a focus in order to achieve this successfully. Unhappiness after negotiations could result in long-term misery for individuals and be detrimental to a service overall. Newer consultants should act with self-confidence in negotiations. Objective, adult to adult conversation can help communicate personal boundaries in an assertive way. Respecting each other’s boundaries can ensure that a team has a truly representational idea of group identity. Each individual should be clear about what their own expectations are to facilitate clear communication and avoid feelings of personal guilt. The long-term goals of each individual should be included in group job plans. Job plans naturally evolve over time, which can lead them to differ from the original job plan, and this should be acknowledged.

Difficulties can arise through individuals either being dominant or from those who don’t pull their weight. In either situation taking the gradual approach with small initial steps of compromise is advised and initial discussions in smaller groups can help ease the transition towards the ideals of the group as a whole. Each individual should feel engaged in the process.

It is advised that if recently appointed consultants feel time pressure, they should keep their own pace. Diarising work can help in disagreements between colleagues. It also helps to strengthen requests to managers. Finding support is useful. Networking with others, both within and outside the department, in order to discuss job planning strategies, can provide allies. Formal and informal networks, such as mentoring programmes, are also good sources of support.

Presenting proposed job plan changes to clinical directors and senior managers in terms of patient safety and group equality can strengthen a case. Perseverance and realistic expectations are important. Creating a timeline, of around two years, containing well-paced change will help to alleviate some of the resistance to change within a team and from managers. 

Breakout group leader: Professor Charles Swainson, Former Medical Director of NHS Lothian & Treasurer, Royal College of Physicians of Edinburgh