New NHS pay structure ‘just for nurses’ being considered

A separate pay structure exclusively for nurses is being explored in what could be a major shake-up of the NHS Agenda for Change (AfC) system in England.

The announcement of a “separate pay spine” was made by the health and social care secretary, Steve Barclay, yesterday as part of the new pay deal offer for AfC staff in the country.

In a letter to the Royal College of Nursing, Mr Barclay said the government was taking action to address “the specific challenges faced by nursing staff in terms of recruitment, retention and professional development”.

He added: “Reflecting on the conversations we have had since I became health secretary, I wanted to confirm that this work will involve: how to take account of the changing responsibilities of nursing staff; and the design and implementation issues, including scope and legal aspects, of a separate pay spine for nursing staff exclusively.”

The government’s aim would be for any changes that resulted from this work to be introduced within the 2024-25 pay year, stated Mr Barclay in the letter.

At present, the AfC contract sets out pay scales for all NHS staff apart from doctors, dentists and the most senior managers.

Registered nurses working clinically will typically be on bands 5-7 which, under the current AfC scales, provides a pay range of £27,055 to £47,672.

Nursing Times understands that the RCN called on the government for a commitment to the separate pay scale but was not supported by the other unions taking part in the negotiations on the pay offer.

A spokesperson told Nursing Times that the finer details on what a separate pay spine for nursing staff could look like were still to be discussed.

However, in a statement released yesterday, the Health Foundation think tank said the proposal “signals a possible end to AfC which has provided a single pay structure for the majority of NHS staff”.

James Buchan

Speaking to Nursing Times today, Professor James Buchan, senior visiting fellow at the Health Foundation and leading national and international analysist on nursing workforce and pay issues, said it had been recognised in recent years that the pay structures for nurses needed to be reviewed.

He said there was an “identified problem for nurses, particularly at band 5 and also a bit further up the scale, in terms of relative constrained progression after a few years”.

A briefing paper published last year by Professor Buchan and others at the Health Foundation on nurse pay found that progression for nurses stalled after a few years in the profession.

“Nurses can reach the top of their pay bands within a few years, and the expectation of increased future earnings then tails off quickly,” stated the paper.

Meanwhile, in 2021, the NHS Pay Review Body recommended that AfC pay structures should be reviewed to assess whether they were still appropriate for nursing as a “modern graduate profession”.

There were still questions over what a new pay spine for nurses meant, and to what extent nurses would still be connected to the existing AfC system, if at all, noted Professor Buchan.

“At this stage, as we can’t answer that, so we are speculating,” he said, before going on to highlight some of the points that he felt needed to be considered by those working on this project.

These included the “knock-on effect” that any changes to AfC might have for other NHS professional groups.

“Nurses have been very much front and centre in the pandemic response, and will be front and centre in rebuild of the system,” said Professor Buchan. “But there are other groups that deserve consideration.

“It’s a challenge that we’ll need to be focused on in terms of ensuring that the technical elements of any separate spine are thought through but also that the knock-on effect and repercussions for others is given consideration.”

One of the principles for establishing AfC in the first place was to create a system that provided “fair pay in terms of equal pay for equal value”, he noted. The AfC contract was introduced in 2004.

“So, if we’re looking at a situation where there’s some sort of de-linking for nurses, obviously that will have to be given consideration as well,” he told Nursing Times.

Professor Buchan also flagged the potential for any changes to lead to “more divergence” in nurse pay approaches between the UK countries.

The pay spine project will be focused on England. However, at the same time, Scotland is also carrying out a piece of work to reform its AfC system.

There has also been less of a UK-wide approach to pay awards in recent years, with Scotland in particular offering different awards to those offered in England.

Professor Buchan said: “It does, at the moment, feel like there’s the likelihood of more divergence across the UK in terms of how nurses’ pay is determined and perhaps what nurses are paid.”

Anthony Johnson, a nurse in Essex and lead organiser for the Nurses United UK group, welcomed the idea of a pay scale for nurses but expressed pessimism about how it would be delivered in practice.

anthony johnson student affairs

Anthony Johnson

He told Nursing Times: “In principle I think it’d be great to have a pay scale that recognised our skills and knowledge as they expand.

“But this is the real world. A world where NHS trusts downband roles to save pennies and where we all know there are too few union reps able to support us to be banded appropriately.”

He also highlighted concerns about the impact any changes could have on relationships between nurses and other professional groups.

“We’re at risk of being pitted against other NHS workers in the future, instead of working together to achieve our shared goals,” said Mr Johnson.

The proposed pay deal still needs to win support from union members before it can be implemented. However, according to the body NHS Employers, the pay spine work is separate to the government’s ’offer in principle’.

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