by Simon Wright
Monster Healthcare Expert

Agenda for Change, the biggest shake-up in pay and conditions in the history of the NHS, should get off the ground at the end of the year. But how will it work? And what does it mean for nurses?

Agenda for Change is the culmination of five years of tough negotiations between the government and health unions. It is aimed at rationalising a hugely complex pay system with hundreds of separate arrangements. 

The final proposals offer clear advantages to both sides – a simplified, modernised system for the government; a fairer structure and potentially big pay increases for staff.

New structure

The new system, covering the whole of the UK and affecting nearly 1.3m staff, attempts to offer clarity, uniformity and fairness for all health jobs. All jobs will be evaluated under one of the biggest job evaluation schemes ever conducted and then given a ‘weighting’ which will determine precisely where they are positioned on the new pay spine. Jobs will be weighted according to:

• knowledge and skills required;
• responsibilities;
• physical, emotional and mental effort involved in the job;
• and, any extra demands imposed by the working environment.

There will be three new pay spines. The first will be for doctors and dentists; the second for nurses, other health professionals and most health care support workers, and the third for all other groups, including administrative, clerical and ancillary workers. The new arrangements will apply to all staff apart from very senior managers.

The nurses’ pay spine will be divided into nine bands with scope for progression within each. Some of this progress will be based on years in the job but at two key stages it will depend on demonstrating the necessary knowledge and skills to progress.

A new body, the NHS Staff Council, will oversee the new system. The Nurses’ Pay Review Body will be extended to cover all staff within the second pay spine. There will be a single pay negotiating forum for all NHS workers not covered by pay review bodies.

Pay

The new system offers a 3.225 per cent pay rise this year and next, plus at least 5.8 per cent to take into account the restructuring process. This year’s pay rise should, therefore, eventually be worth at least 5.925 per cent and next year’s 6.325 per cent.

The system has been designed to ensure that as many staff as possible move to bands that provide higher maximum pay. Most nurses should earn significantly more than the minimum 15.8 per cent promised between 2003 and 2005. E-grade nurses, for example, could pick up 6.5 per cent on top of the basic 10 per cent, and F-grade midwives could receive an extra 11.9 per cent.

Nevertheless, in any system with winners there are bound to be losers. It is anticipated that around 7.5 per cent of staff could be worse off – however, all will have their current salary protected for up to six years. There will also be a new minimum wage in the NHS of £11,135.

Terms and conditions

In the future all health staff will benefit from common terms and conditions, including overtime and annual leave. Everyone will work a 37.5-hour week, and overtime will be paid at time-and-a-half or double time for bank holidays. Annual leave will be 27 days for all new staff rising eventually to 33 days.

A new set of allowances will replace the current London weighting, fringe allowances and cost of living supplements. These will amount to £3,197–£5,328 in inner London, £2,664–£3,729 in outer London and £799–£1,385 in outlying areas.

At the same time, there will be some local flexibility to tackle recruitment ‘hot spots’. So those working in hard-to-recruit areas will receive extra cost of living allowances, as will staff in specialties with severe shortages.

Foundation trusts will be subject to Agenda for Change – although they will have additional pay freedoms, such as team bonus schemes or awarding recruitment and retention premia over 30 per cent.

Nurses in the private sector are not subject to the arrangements, but it is expected that similar arrangements will be adopted there once the scheme is running in the NHS.

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