Topic 7.2 — Workforce Planning

In one sentence: Workforce planning is the disciplined practice of matching the supply of people and skills to the demand your services will place on them — the right people, with the right capabilities, in the right place, at the right time, for a price you can afford.

Why this matters in health and care#

The scarcest resource in digital health and care is not money or technology; it is people with the right skills. Digital, data, and technology specialists are in acute national shortage, and health and care compete for them against better-paying private employers. A programme business case that assumes you can simply hire ten engineers next quarter is a fiction that will unravel at delivery time.

Workforce planning turns that risk into a managed variable. It is a statutory and strategic expectation in the NHS: the NHS Long Term Workforce Plan frames workforce as a first-order planning object, and integrated care systems are expected to plan their workforce across organizational boundaries, including social care. Poor planning shows up as safety gaps (rotas that cannot be filled), wasted public money (emergency agency and contractor spend), and stalled transformation (a shared care record with no one to run it).

Done well, workforce planning connects your service strategy to real people decisions — recruitment, training, skill mix, and retention — far enough ahead that you can actually act. This topic covers the analytical discipline; it feeds the longer-horizon Workforce Strategy (see Topic 7.3) and is delivered through People & Organizational Development (see Topic 7.5).

Core concepts#

Strategic vs operational workforce planning. Operational planning fills next quarter's rota and next month's vacancies. Strategic planning looks three to ten years out and asks what workforce a changed service model will need — for example, the roles required when AI-assisted triage or virtual wards become business-as-usual. Both are needed; the failure is doing only the operational and calling it planning.

Demand and supply. Demand is the workforce your future services will require, derived from service plans, activity forecasts, demographics, and new models of care. Supply is the workforce you will actually have — current headcount adjusted for turnover, retirement, absence, training pipelines, and the labour market. The gap between them is the object of planning.

Skills and capability frameworks. You cannot plan what you cannot name. Capability frameworks give a shared vocabulary of roles and skills. The Government Digital and Data (formerly DDaT) Profession Capability Framework defines the digital roles (product manager, delivery manager, user researcher, service designer, software engineer, data professionals, and more) and the skills and levels within each — a ready-made taxonomy for describing digital demand and supply.

Build, buy, borrow. Three ways to close a gap: build (grow your own through training and development), buy (recruit permanent staff), or borrow (contractors, secondments, partners, suppliers). Each has different cost, speed, and retention-of-knowledge profiles.

Workforce intelligence. The data foundation — establishment vs actual headcount, vacancy and turnover rates, skills inventories, age profiles, and pipeline data — without which planning is guesswork dressed up as analysis.

The six-step methodology#

The health and care sector's established approach is Skills for Health's Six Steps Methodology to Integrated Workforce Planning®, cited in the NHS Long Term Workforce Plan and used across NHS England, Wales, and Scotland. It gives a repeatable structure:

1. Defining the plan — set scope, timeframe, and the service strategy the workforce must deliver; engage stakeholders.
2. Mapping service change — translate future service models into their workforce implications.
3. Defining the required workforce — describe the future workforce in numbers, roles, and skills (the demand side).
4. Understanding workforce availability — assess current supply, turnover, pipelines, and the labour market.
5. Planning to close the gap (action planning) — decide build/buy/borrow interventions, skill-mix changes, and development.
6. Implementing, monitoring, and refreshing — enact the plan and revisit it as reality diverges from forecast.

The steps are not strictly linear; you iterate, especially between demand (step 3) and supply (step 4) as the gap becomes clear.

Best practices#

1. Start from service strategy, not from the current establishment. Base demand on where the service is going — new care models, digital channels, demographic pressure — not on last year's structure with a percentage added. Planning that extrapolates the status quo will faithfully reproduce today's gaps.

2. Do strategic and operational planning as one connected system. Let the long-horizon strategic view set the direction (which capabilities to build) and the operational view manage the near term (which posts to fill now). Reconcile them so they do not contradict each other.

3. Name skills, not just headcount. "We need five more people" is not a plan. Use a capability framework (Government Digital and Data / DDaT) to specify roles, skills, and levels, so recruitment, training, and job design have a precise target.

4. Model supply honestly, including attrition. Factor in turnover, retirement age profiles, maternity/parental leave, training completion rates, and competition from higher-paying employers. Optimistic supply assumptions are the most common cause of plans that fail on contact with the labour market.

5. Choose build/buy/borrow deliberately per gap. Borrowing (contractors) is fast but expensive and lets knowledge walk out of the door; buying takes time in a competitive market; building is slow but retains capability. Match the mechanism to the gap's urgency and how strategic the capability is — build the capabilities that are core to you, borrow the transient ones.

6. Manage the contractor/permanent balance explicitly. Contractors bridge urgent gaps and inject scarce skills, but an over-reliance on them raises cost, weakens retention of institutional knowledge, and creates fragility when they leave. Set a target ratio and a plan to convert critical contracted knowledge into permanent capability.

7. Use scenario planning under uncertainty. You cannot forecast a decade precisely, so plan for several plausible futures (e.g. rapid AI adoption vs slow; generous vs constrained funding) and identify the "no-regrets" moves — the investments, such as digital literacy, that pay off across all scenarios.

8. Build a workforce intelligence base and refresh the plan. Invest in the data — establishment, vacancies, turnover, skills inventory, pipeline — and treat the plan as a living document reviewed on a regular cycle, not a document produced once for a business case and shelved.

9. Plan across the system, not one organization. In an ICS, workforce moves between acute, community, primary, and social care. Plan for shared and rotational roles and a shared talent pool, or organizations will simply poach scarce staff from each other.

10. Plan for retention, not just recruitment. A plan that assumes you can hire your way out of a gap will fail in a tight labour market where digital, data and clinical-informatics skills are scarce and mobile. Model attrition honestly, invest in the conditions that keep people — development, flexibility, good leadership — and treat every avoidable leaver as a planning failure, not just bad luck (see Topic 7.5 — People & Organizational Development).

11. Build the plan on trustworthy workforce data. Supply-and-demand modelling is only as good as the establishment, vacancy, skills and attrition data beneath it, which in many organizations is fragmented and out of date. Invest in a single, current view of who you have and what they can do, and be explicit about the assumptions and uncertainty in any forecast rather than presenting a false precision.

Questions to discuss with your team#

1. Are our supply assumptions honest, or are we quietly betting on being able to hire scarce specialists quickly and cheaply? Optimistic supply modelling is the single most common reason workforce plans collapse on contact with the labour market, because digital, data, and technology specialists are in acute national shortage and health and care compete for them against far better-paying private employers. The temptation is understandable: a business case reads better if it assumes twelve engineers arrive next quarter, and the people writing the case are rarely the people who later have to fill the rota. The debate to have is whether your plan has genuinely factored in turnover, retirement age profiles, parental leave, training-completion rates, and — crucially — the reality that a neighbouring trust's recruitment drive can worsen your local supply overnight. Consider stress-testing your own numbers: what is your actual digital-staff turnover, how many key people are near retirement, and where does local salary benchmarking put you against the market? A good answer replaces wishful headcount arithmetic with modelled attrition and a named source for every assumption, and it is candid about which posts you probably cannot fill on the timeline the plan claims.

2. For each capability gap, have we made a deliberate build/buy/borrow choice — and are we drifting into contractor dependency by default? Closing a gap by building (growing your own), buying (permanent recruitment), or borrowing (contractors and suppliers) carries very different profiles of cost, speed, and knowledge retention, yet organizations under delivery pressure tend to reach reflexively for contractors because they are the fastest lever. That reflex is where the trouble starts: repeated borrowing with no strategy to convert critical knowledge into permanent capability lets institutional knowledge walk out of the door, raises cost structurally, and creates fragility when contractors leave mid-programme. The principle worth debating is matching the mechanism to the gap — build the capabilities that are core and strategic to you, borrow only the genuinely transient ones — and whether you have an explicit target contractor-to-permanent ratio rather than a number that simply accreted. Look at a real example from your own portfolio, such as standing up a platform team, and ask whether the borrowed capacity has a concrete knowledge-transfer and conversion plan or is silently becoming permanent. An honest answer records a deliberate decision per gap, sets a target balance with a plan to move toward it, and names the specific critical knowledge you are at risk of losing.

3. Are we planning our workforce for where the service is going, and across the whole system — or extrapolating today's establishment in our own organization? Two failure modes compound each other here: basing future demand on last year's structure with a percentage added (which faithfully reproduces today's gaps and under-resources any real transformation), and planning your organization's workforce in isolation within an ICS where staff actually move between acute, community, primary, and social care. The tension is that starting from service strategy demands you first agree what the service will become — AI-assisted triage, virtual wards, a shared care record as business-as-usual — which is uncertain and contested, and planning across organizational boundaries means ceding some control and confronting the fact that partners may simply poach one another's scarce staff. This is where scenario planning earns its keep: model several plausible futures and identify the no-regrets moves, such as whole-workforce digital literacy, that pay off whichever future arrives. Ask whether your current plan names the new roles a changed care model requires, and whether social care is in the plan at all or conveniently out of scope. A strong answer derives demand from future service models rather than the current establishment, plans for shared and rotational roles across the system, and is explicit about the scenarios it is hedging against.

4. Are we planning as hard for retention as we are for recruitment — and do we treat every avoidable leaver as a planning failure? Most workforce plans are written as recruitment plans, yet in a tight market for digital, data, and clinical-informatics skills you cannot hire your way out of a gap that a revolving door keeps reopening; every experienced leaver takes institutional knowledge with them and resets a training investment to zero. The uncomfortable truth is that the conditions that keep people — development pathways, flexibility, good line management, a sense of purpose — sit largely outside the recruitment team's control and rarely appear as line items in a business case, which is precisely why they get neglected. The trade-off worth debating is how much of your scarce funding and leadership attention goes into attraction versus the far less glamorous work of making people want to stay. Look honestly at your own attrition: where are people going, at what tenure, and are your regretted leavers clustered in exactly the scarce roles your transformation depends on? A candid answer models attrition explicitly, invests in the drivers of retention rather than treating turnover as background noise, and connects the plan to People & Organizational Development (Topic 7.5) instead of assuming the labour market will keep refilling the bucket.

5. How good is the workforce data underneath this plan, and are we honest about its uncertainty rather than dressing up guesswork as precision? Supply-and-demand modelling is only ever as trustworthy as the establishment, vacancy, skills, and attrition data beneath it, and in many organizations that data is fragmented across systems, out of date, or simply absent for the digital workforce — so a plan can look rigorous while resting on numbers no one has validated. There is a real tension here between the decisiveness a business case demands and the intellectual honesty of admitting how wide the error bars are; a forecast quoted to a single decimal place can imply a confidence the underlying data cannot support. The discussion to have is whether you have a single, current view of who you have and what they can do, and whether your plan states its assumptions and their uncertainty openly rather than burying them. Consider where your figures actually come from — is your skills inventory real or aspirational, and when was headcount last reconciled against the establishment? An honest answer invests in a trustworthy workforce-intelligence base, is explicit about which numbers are measured versus estimated, and presents ranges and scenarios rather than a false precision that will not survive contact with reality.

6. Are we planning the workforce for a digitally changed service, or bolting digital roles onto a workforce still shaped for the old model? New models of care — AI-assisted triage, virtual wards, a shared care record as business-as-usual — do not simply add a handful of technical posts; they change what existing clinical and operational staff do every day, and a plan that only recruits engineers while ignoring the digital literacy of the wider workforce will stall at adoption. The tension is that upskilling the whole workforce is slow, competes for the same time and money as frontline delivery, and produces benefits that are diffuse and hard to attribute, so it is easy to defer in favour of visible new hires. The angle worth debating is whether digital capability is treated as everyone's concern — a no-regrets investment that pays off across every future scenario — or quarantined inside a specialist team that the rest of the organization is not equipped to work with. Ask whether your plan names the reskilling and digital-literacy uplift existing roles will need, not just the new roles a changed model creates. A strong answer plans for the whole workforce's capability, sequences upskilling alongside the technology rollout rather than after it, and recognizes that the scarcest constraint may be adoption capacity, not just specialist supply.

In practice: a health & care example#

An ICS plans the workforce for a three-year digital and data transformation, including a shared care record and expanded virtual wards.

Using the six steps, the programme team first defines scope and engages clinical and operational leaders (step 1), then maps how virtual wards and the care record change roles (step 2) — new remote-monitoring nurse roles, data analysts, and a platform engineering team. Using the Government Digital and Data framework they specify the required workforce precisely (step 3): 4 product managers, 6 user researchers, 12 software engineers at defined levels, 5 data engineers, and clinical safety capacity. Supply analysis (step 4) reveals hard truths — current turnover of digital staff is 18%, two key engineers are near retirement, and local salary benchmarking shows the ICS pays below market.

The gap plan (step 5) blends build, buy, and borrow: a graduate and apprenticeship pipeline plus internal reskilling for the medium term (build), a targeted permanent recruitment campaign with a revised pay case (buy), and a time-limited contractor team to stand up the platform while permanent staff are recruited and trained alongside them for knowledge transfer (borrow). Two funding scenarios are modelled; digital-literacy uplift for existing clinical staff is identified as a no-regrets move in both. The plan is reviewed quarterly against actual vacancies and turnover (step 6), and revised when a neighbouring trust's recruitment drive worsens local supply.

Sector lenses#

Startup#

A digital-health startup's workforce plan is a cash-runway calculation as much as a capability one: every hire is weighed against months of runway, so build/buy/borrow tilts hard toward buying a few versatile senior people and borrowing specialists on contract. The realistic planning horizon is 12–18 months — tied to the next funding round — not the three-to-ten-year strategic view an ICS must take. Scenario planning still matters, but the scenarios are commercial (will the pilot convert to a paid contract?) rather than demographic. The existential risk is key-person dependency: losing one of three engineers can halt delivery, so even a tiny startup should name its single points of failure and cross-train against them.

Small business#

An established small provider — a GP practice, a community pharmacy, a care home or domiciliary-care agency, a single-site clinic, or a small health-tech supplier past the startup stage — must meet the same duties as a large trust but with no dedicated workforce-planning or IT function to do it. Planning here is pragmatic and personal: the practice manager or owner holds the whole establishment in their head, so build/buy/borrow usually means training an existing member of staff into a digital task or borrowing a shared resource from a federation, primary care network, or supplier. The binding constraints are tight cash and thin cover — a single leaver or long absence can remove a capability entirely — so key-person risk and cross-training matter as much as they do for a startup, but against a backdrop of ongoing patient-facing operations that cannot pause. Because dedicated digital capability is unaffordable, the realistic move is to buy it as a service or share it across the system, and to invest in the digital literacy of the generalist staff you already have rather than hoping to recruit scarce specialists you could not retain.

Enterprise#

A large NHS trust or ICS plans an establishment across thousands of posts, using the Six Steps methodology and a workforce-intelligence base of vacancy, turnover, and skills data. Its defining constraint is that it competes for the same scarce digital staff as its neighbours and against higher-paying private employers, so supply modelling with honest attrition assumptions is decisive. Build/buy/borrow becomes a portfolio decision at scale — apprenticeship pipelines and internal academies to build, revised pay cases to buy, framework contractors to borrow — and the contractor-to-permanent ratio is a board-level risk. Crucially, an ICS must plan across organizational boundaries, including social care, or partners will simply poach one another's staff.

Government#

A national body plans workforce at the level of the whole system: the NHS Long Term Workforce Plan sets training-place numbers and funding envelopes years ahead, shaping the supply every trust and startup later draws on. Its levers are policy and money — commissioning university and apprenticeship places, setting national pay frameworks, funding programmes such as NHS Digital Readiness — all under Treasury spending rules and public accountability. Because these decisions bind a decade out and cannot easily be reversed, rigorous scenario planning and no-regrets investment (whole-workforce digital literacy) are essential. Accountability runs to Parliament and the public, so the plan must be transparent, evidenced, and auditable — and the failure mode is a strategy that is published but never reconciled against the real supply it produces.

Common failure modes#

• Headcount without skills. Planning numbers of bodies while ignoring the specific capabilities needed, producing recruitment that fills posts but not gaps.
• Optimistic supply. Assuming you can hire scarce specialists quickly and cheaply, and ignoring attrition, so the plan collapses at delivery.
• Contractor dependency by drift. Reaching for contractors repeatedly with no strategy to convert critical knowledge to permanent staff, until cost and fragility become structural.
• Plan-and-shelve. A workforce plan produced once for a business case and never refreshed as reality diverges.
• Single-organization tunnel vision. Planning your organization's workforce in isolation within an ICS, competing for the same scarce staff as your partners.
• Extrapolating the status quo. Basing future demand on the current structure, so transformation is under-resourced from day one.

Maturity model#

Checklist#

• The plan starts from future service strategy, not the current establishment.
• Demand is expressed as roles, skills, and levels using a capability framework (Government Digital and Data / DDaT).
• Supply is modelled with turnover, retirement profiles, pipelines, and labour-market competition.
• Each gap has a deliberate build / buy / borrow decision recorded.
• The contractor-to-permanent balance has an explicit target and knowledge-transfer plan.
• At least two future scenarios are modelled and no-regrets investments identified.
• A workforce intelligence base (establishment, vacancy, turnover, skills) exists and is maintained.
• The plan is reviewed on a defined cycle, not produced once and shelved.
• Planning is done across the ICS/system, including social care, not one organization in isolation.
• The plan connects to Workforce Strategy (Topic 7.3) and is delivered through People & OD (Topic 7.5).

Key sources#

• Skills for Health — Six Steps Methodology to Integrated Workforce Planning®: skillsforhealth.org.uk
• NHS England — NHS Long Term Workforce Plan (2023)
• Government Digital and Data (formerly DDaT) Profession Capability Framework: ddat-capability-framework.service.gov.uk
• NHS England / e-Learning for Healthcare — Six Steps Approach to Workforce Planning
• The Topol Review (2019) — Preparing the healthcare workforce to deliver the digital future (digital workforce demand)
• CIPD — strategic workforce planning and scenario planning guidance

References#

1. Workforce planning — Wikipedia — https://en.wikipedia.org/wiki/Workforce_planning
2. Employee turnover — Wikipedia — https://en.wikipedia.org/wiki/Employee_turnover
3. Labour economics — Wikipedia — https://en.wikipedia.org/wiki/Labour_economics
4. Gap analysis — Wikipedia — https://en.wikipedia.org/wiki/Gap_analysis
5. Scenario planning — Wikipedia — https://en.wikipedia.org/wiki/Scenario_planning
6. Retraining (reskilling and upskilling) — Wikipedia — https://en.wikipedia.org/wiki/Retraining
7. Six Steps Methodology to Integrated Workforce Planning — Skills for Health — https://www.skillsforhealth.org.uk
8. NHS Long Term Workforce Plan (2023) — NHS England — https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/
9. Government Digital and Data Profession Capability Framework — GOV.UK — https://ddat-capability-framework.service.gov.uk
10. The Topol Review: Preparing the healthcare workforce to deliver the digital future (2019) — Health Education England — https://topol.hee.nhs.uk
11. Strategic workforce planning — CIPD — https://www.cipd.org

See also Topic 7.0 — Team Structures, Roles & Responsibilities, Topic 7.3 — Workforce Strategy, and Topic 7.5 — People & Organisational Development.