Agenda for Change

Last updated

Agenda for Change (AfC) is the current National Health Service (NHS) grading and pay system for NHS staff, with the exception of doctors, dentists, apprentices and some senior managers. It covers more than 1 million people and harmonises their pay scales and career progression arrangements across traditionally separate pay groups, in the most radical change since the NHS was founded.

Contents

Agenda for Change came into operation on 1 December 2004, following agreement between the unions, employers and governments involved.

Job evaluation

The AfC system allocates posts to set pay bands by giving consideration to aspects of the job, such as the skills involved, under an NHS Job Evaluation Scheme. [1] There are nine numbered pay bands subdivided into points, similar to the old alphabetic Whitley Council 'grades' pay scales. A set of national job profiles has been agreed to assist in the process of matching posts to pay bands. [2] All staff will either be matched to a national job profile, or their job will be evaluated locally. In theory, AfC is designed to evaluate the job rather than the person in it, and to ensure equity between similar posts in different areas. In reality it has been implemented differently in different places, and some posts have been graded very differently from similar jobs elsewhere, despite the supposedly tighter definitions. Around 5% of staff appealed their initial banding, [3] but again the appeals process varies from site to site.[ citation needed ] Current indications suggest that lower bandings are being used in London and Scotland than elsewhere in the country.[ citation needed ]

Under AfC, all staff have annual development reviews against the NHS Knowledge and Skills Framework (KSF). Normal pay progression is one point a year, but pay progression at specified 'gateway' points in each pay band depend on how the individual matches the KSF outline for their post. Progression onto a different band has become very difficult, as the post would need to have changed substantially in order to be re-graded (even if the person in the post has developed and become more experienced or taken on more responsibilities this would not be seen as a good enough reason to re-band a post). The full implementation of KSF has been slow. [4]

Staff have a contributory pension with tiered employee contribution rates starting at a 5% rate increasing in 7 steps to 14.5% on income above £111,337. [5]

History

When the NHS was established in 1948, it adopted the Whitley industrial relations system, which was used in the civil service and local government. The system stemmed from work done by J. H. Whitley in 1916 and provided a framework for pay, terms and conditions.

The NHS Whitley system had essentially been unaltered since its inception, although there had been some changes. Nevertheless, it had been heavily criticised for decades. These criticisms centred on its structure, complexity and over-centralisation, and its lack of flexibility. There was also concern that the existing pay scales were not easily adaptable to developing equal pay for work of equal value. [4]

In 1997 an eleven-year-long landmark legal case for equal pay in the NHS, Enderby v Frenchay Health Authority , decided that the pay of speech therapists, mostly women, was of equal value to higher paid clinical psychologists, mostly men. The differences in pay were because the two groups bargained separately under the Whitley system. [6] This highlighted an important inadequacy of the NHS Whitley system.

Negotiations on a new system began in February 1999, when the White Paper Agenda for Change was published. [7] It aimed to address the issues of the Whitley system, and highlighted the need for a change of pay, career structures and terms and conditions of employment within the NHS. It stated that any new pay system must deliver equal pay for work of equal value.

A number of organisations were involved in the discussions and negotiations including:

Negotiations on the new pay system were concluded in November 2002, allowing full-scale testing of the new Agenda for Change pay system to begin at twelve "early implementer" sites in England in June 2003, with pilot sites in Scotland following. [8]

On 1 December 2004 it was implemented across the UK, with pay and conditions backdated to 1 October 2004. [9] Although most NHS employees in England and Wales were quick to transfer to the new system with staff receiving their back-pay, Scotland had been slower to implement the system because Scotland took a more robust approach to the implementation. All the signatory organisations agreed to implement it through a partnership approach. [10]

In 2013 some amendments to Agenda for Change were agreed: [11]

From September 2014 NHS Wales intends to pay NHS staff at least the living wage, resulting in about 2,400 employees receiving an increase in salary of up to £470 above UK wide Agenda for Change rates. [12]

Following the financial crisis which started in 2007, NHS pay was frozen in 2011 for two years, followed by increases capped at 1 per cent. [13] In March 2017 the National Health Service Pay Review Body (NHSPRB), the independent body who advises the government on healthcare sector pay, advised that the public sector 1% pay cap be extended for another year. [14]

In June 2018 employers and unions announced that NHS staff in England had accepted a deal to reform the current Agenda for Change system and provide a three-year pay deal. [15] [16] The reforms include the removal of overlapping pay points between bands and incremental pay progression no longer occurring on a yearly basis. [17] The final year of implementation is 2020/21. The objectives included: [16] [18] [19]

In 2020 the government agreed, due to the COVID-19 crisis, that NHS staff will not be fully subject to the public sector pay freeze when the three-year pay deal end in April 2021. [20]

Bands

Example job profiles within the nine bands are: [21]

  1. Catering Assistant, Cleaner
  2. Administrative Assistant, Health Care Support Worker, Portering
  3. Secretary, Health Care Support Worker (Emergency Medicine/ Theatres), Occupational Therapy Assistant/ Technician/ Support Worker, Physiotherapy Assistant, Speech Therapy Assistant, Social Care Assistant
  4. Office Supervisor/ Team Leader, Medical Secretary, Personal Assistant, Finance Officer, Assistant Nurse Practitioner, Occupational Therapy Assistant/ Technician/ Support Worker, Nursery Nurse, Pharmacy Technician, Social Work Assistant/ Social Case Officer,
  5. Office Manager/ Junior Manager, Staff Nurse, Midwife (Newly Qualified), Diagnostic/Therapeutic Radiographer, Dietitian, Emergency Medical Technician, Senior Pharmacy Technician, Occupational Therapist, Physiotherapist, Clinical Physiologist, Operating Department Practitioner (Newly Qualified), Speech & Language Therapist (Newly Qualified), Biomedical Scientist (Entry Level), Social Worker (Newly Qualified), Assistant Psychologist
  6. Management Accountant, Junior Sister, Specialist Staff Nurse, Specialist Dietitian, Paramedic, Senior Radiographer (Diagnostic/Therapeutic) Emergency Nurse Practitioner, Health Visitor, Specialist Speech and language therapist Senior Physiotherapist, Senior Occupational Therapist, Biomedical Scientists, Chaplains, Trainee Clinical Scientist (STP), Social Worker, Psychologist/ Trained Nurse/Social Work Therapist, Trainee Approved Mental Health Professional
  7. Department Manager, Senior Sister, Advanced Nurse Practitioner, Clinical Lead Dietitian, Senior Radiographer (Diagnostic/Therapeutic Team Leader), Sonographer, Chief Dental Technician, Specialist Clinical/Counselling/Forensic Psychologist, Senior Paramedic, Chief Clinical Physiologist, Highly specialist Speech and language therapist, Senior Physiotherapist, Senior Occupational Therapist, Physician Associate, Biomedical Scientist (Senior Level), Clinical Scientist (after completion of STP), Approved Mental Health Professional, Senior Social Worker
  8. (sub divided into 4 bands - a, b, c, d) Deputy Associate Director/ Associate Director, Senior Nurse Manager/ Matron, Advanced Pharmacist, Dietitian Manager, Superintendent Radiographer (Diagnostic/Therapeutic), Senior Chief Highly Specialist Clinical/Counselling/Forensic Physiologist, Senior Physician Associate, Chief Biomedical Scientist, Consultant Paramedic, Consultant Social Worker/ Team Manager, Approved Mental Health Professional Manager
  9. Chief Pharmacist, Very Senior Clinicians managing large/multiple services, Head/Director of Psychology, Head of Adult Services (Social Work), Deputy Board Directors and Very Senior Managers just below Corporate/ Board level responsibility, Directors of services which are not a Board level positions (e.g. Estates, Digital Services, Mental Health Services etc.)

Knowledge and Skills Framework

The Knowledge and Skills Framework (KSF) is a competence framework to support personal development and career progression within the NHS in the United Kingdom. It applies to all staff except board members, doctors and dentists, as they did not come under Agenda for Change.

The Agenda for Change national agreement includes a commitment to introduce a system of annual development reviews and to create lifelong learning development opportunities. Staff have their own Personal Development Plan, developed jointly in discussion with their manager or reviewer. [22]

Employers and staff have called for a simplified KSF that is easier to use. In response, the NHS Staff Council has developed a simplified KSF that gives employers more flexibility and can be tailored to meet local needs. [23]

London weighting

Agenda for Change, like its predecessors since at least 1974, includes additional payments, called the high cost area supplement, intended to relate to the additional costs, particularly housing, of living in London. There are three separate bands: Inner London, Outer London and London Fringe. The Inner London rate in 2017 was 20% of salary, with a minimum payment of £4,200 and a maximum payment of £6,469). Outer London rate was 15% of salary and London Fringe 5%. [24]

In 2018 the Chief Executive of Kingston Hospital NHS Foundation Trust called for a flat rate “weighting system” across Greater London in September 2018, saying that living in Richmond was no cheaper than living in Islington and that cost of living was a leading contributor to their staff turnover. [25]

Related Research Articles

<span class="mw-page-title-main">Pharmacy technician</span> Licensed health care provider well-versed in pharmacy

A pharmacy technician (PhT) performs pharmacy-related functions including but not limited to filling out prescription medications. Training, certification, licensing, and actual practice of pharmacy technicians varies not only worldwide but in some countries regionally as well as by employer.

Allied health professions (AHPs) are a category of health professionals that provide a range of diagnostic, preventive, therapeutic, and rehabilitative services in connection with health care. While there is no international standard for defining the diversity of allied health professions, they are typically considered those which are distinct from the fields of medicine, nursing and dentistry.

<span class="mw-page-title-main">Matron</span> Senior nurse in a hospital

Matron is the job title of a very senior or the chief nurse in a hospital in several countries, including the United Kingdom, and other Commonwealth countries and former colonies.

<span class="mw-page-title-main">Dental assistant</span> Medical profession

Dental assistants are members of the dental team. They support a dental operator in providing more efficient dental treatment. Dental assistants are distinguished from other groups of dental auxiliaries by differing training, roles and patient scopes.

A Review Body in the United Kingdom is a government mechanism to replace collective bargaining for certain groups of employees in the public sector, for example doctors and nurses in the National Health Service. A Review Body makes independent recommendations on pay after considering evidence from the relevant parties, with cherished expectations that the Government will honour those recommendations and the unions will not pursue national industrial action.

Nursing in the United Kingdom is the largest health care profession in the country. It has evolved from assisting doctors to encompass a variety of professional roles. Over 700,000 registered nurses practice, working in settings such as hospitals, health centres, nursing homes, hospices, communities, military, prisons, and academia. Most are employed by the National Health Service (NHS).

<span class="mw-page-title-main">History of the National Health Service</span>

The name National Health Service (NHS) is used to refer to the publicly funded health care services of England, Scotland and Wales, individually or collectively. Northern Ireland's services are known as 'Health and Social Care' to promote its dual integration of health and social services.

A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.

<span class="mw-page-title-main">Oregon Department of Consumer and Business Services</span>

The Oregon Department of Consumer and Business Services (DCBS) is the agency of the government of the U.S. state of Oregon, which has wide-ranging regulatory and consumer-protection authority in Oregon. It administers laws and rules governing workers' compensation benefits, workplace safety and health, building codes, and the operation of both insurance companies and financial institutions.

<span class="mw-page-title-main">Emergency medical personnel in the United Kingdom</span> People engaged in the provision of emergency medical services

Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.

A joint industrial council (JIC) or national joint industrial council (NJIC), known as a Whitley council in some fields, especially white-collar and government, is a statutory council of employers and trade unions established in the United Kingdom and elsewhere. It is a workplace partnership, an institution that serves for a forum of consultation between employees and employers. Councils were established from 1919. They typically worked to determine wage rates, terms and conditions in a specific industry. There were dozens of JICs, one for each industry. Most JICs were established between the 1920s and the 1940s. The larger JICs also had regional councils throughout the country and some industries had separate JICs for England and Wales, Scotland and Northern Ireland. The Isle of Man had its own councils.

<span class="mw-page-title-main">National Health Service</span> Publicly-funded healthcare systems in the United Kingdom

The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom, comprising the NHS in England, NHS Scotland and NHS Wales. Health and Social Care in Northern Ireland was created separately and is often locally referred to as "the NHS". The original three systems were established in 1948 as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery. Each service provides a comprehensive range of health services, provided without charge for residents of the United Kingdom apart from dental treatment and optical care. In England, NHS patients have to pay prescription charges; some, such as those aged over 60, or those on certain state benefits, are exempt.

<span class="mw-page-title-main">Health professional requisites</span> Regulations used by countries

Health professional requisites refer to the regulations used by countries to control the quality of health workers practicing in their jurisdictions and to control the size of the health labour market. They include licensure, certification and proof of minimum training for regulated health professions.

<span class="mw-page-title-main">Unlicensed assistive personnel</span> Paraprofessionals who assist with bedside care

Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.

<span class="mw-page-title-main">Paraveterinary worker</span> Professional in veterinary medicine

A paraveterinary worker is a professional of veterinary medicine who performs procedures autonomously or semi-autonomously, as part of a veterinary assistance system. The job role varies throughout the world, and common titles include veterinary nurse, veterinary technician, and veterinary assistant, and variants with the prefix of "animal health".

The Health Services functional constituency, formerly called the Health Care, was a functional constituency in the elections for the Legislative Council of Hong Kong first created for the 1988 Legislative Council election. The constituency is composed of health services related professionals with one of the larger number of electorates among the functional constituencies. It was a stronghold of the pro-democracy camp, holding the seat since its creation. It was merged with Medical into Medical and Health Services functional constituency in the major electoral overhaul in 2021.

An Assistant practitioner, also called an associate practitioner in nursing, is a university/college-trained and paid a level 4 of the UK NHS Career Framework An Assistant Practitioner is a worker who competently delivers health and social care to and for people. They have a required level of knowledge and skill beyond that of the traditional healthcare assistant or support worker.

The Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI), is a health care quality improvement incentive program initiated by the Centers for Medicare and Medicaid Services (CMS) in the United States in 2006. It is an example of a "pay for performance" program which rewards providers financially for reporting healthcare quality data to CMS. PQRS ended in 2016, beginning with the 2018 payment adjustment. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced this and other CMS quality programs with a new umbrella program called the Quality Payment Program (QPP), under which clinicians formerly reporting under PQRS would instead report quality data under one of two QPP program tracks: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APMs) track.

NHS Employers is an organisation which acts on behalf of NHS trusts in the National Health Service in England and Wales. It was formed in 2004, is part of the NHS Confederation, and negotiates contracts with healthcare staff on behalf of the government.

References

  1. ↑ "How Agenda for Change works". NHS Employers. 20 February 2014. Retrieved 3 August 2014.
  2. ↑ "National job profiles". NHS Employers. 20 February 2014. Retrieved 3 August 2014.
  3. ↑ Richard Staines (21 July 2009). "Fair pay to the NHS? - Agenda for Change five years on". Nusring Times. Retrieved 27 January 2017.
  4. 1 2 Stephen Bach, Ian Kessler (2011). The Modernisation of the Public Services and Employee Relations: Targeted Change. Palgrave Macmillan. pp. 67–69. ISBN   9780230356917 . Retrieved 6 February 2017.
  5. ↑ "NHS Pension Scheme - Member contribution rates". NHS Pensions. Retrieved 19 May 2016.
  6. ↑ Patricia Wynn Davies (4 April 1997). "Landmark victory for women in in[sic] fight for equal pay" . The Independent. Archived from the original on 23 February 2018. Retrieved 25 October 2020.
  7. ↑ James Buchan, David Evans (2007). Realising the Benefits? Assessing the Implementation of Agenda for Change (PDF) (Report). King's Fund. Retrieved 27 January 2017.
  8. ↑ "NHS pay modernisation gets go-ahead". Scottish Government. 11 June 2003. Retrieved 3 August 2014.
  9. ↑ "Support for you: Pay and conditions: Agenda for change". Royal College of Nursing . Retrieved 3 August 2014.
  10. ↑ "NHS unions endorse new pay package". Scottish Government. 23 November 2004. Archived from the original on 6 October 2008. Retrieved 3 August 2014.
  11. ↑ Richard Johnstone (27 February 2013). "Agenda for Change deal will preserve national pay system". Public Finance. Retrieved 15 March 2013.
  12. ↑ Mark Smith (9 July 2014). "Lowest-paid NHS staff in Wales to receive living wage increase in pay". Wales Online. Retrieved 6 August 2014.
  13. ↑ Dromey, Joe (22 March 2018). "Why the government's pay rise for NHS workers is barely a pay rise at all". New Statesman. Retrieved 19 January 2021.
  14. ↑ Ian Snug (28 March 2017). "NHS Pay Review Body Recommends 1% Pay Cap is Extended". NursingNotes.
  15. ↑ "Nurses have voted 'overwhelmingly' to accept the NHS pay deal". NursingNotes. 8 June 2018. Retrieved 9 June 2018.
  16. 1 2 "2018 contract refresh". NHS Employers. Retrieved 21 February 2020.
  17. ↑ "NHS Agenda for Change 2018/19 Pay Scales". NursingNotes. 21 March 2018. Retrieved 9 June 2018.
  18. ↑ "NHS Terms and Conditions of Service 2018 - at a glance factsheet" (PDF). NHS Employers. 2018. Retrieved 21 February 2020.
  19. ↑ Framework agreement on the reform of Agenda for Change (PDF) (Report). NHS Staff Council. 27 June 2018. Retrieved 21 February 2020.
  20. ↑ Mitchell, Gemma (25 November 2020). "Chancellor confirms NHS nurses will be spared from public sector pay freeze". Nursing Times. Retrieved 19 January 2021.
  21. ↑ "Agenda for Change Payscales 2017-2017". NursingNotesUK. 29 March 2017. Archived from the original on 9 March 2018. Retrieved 1 June 2017.
  22. ↑ "The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process". Department of Health. 11 October 2004. Archived from the original on 7 January 2013.
  23. ↑ "Simplified Knowledge and Skills Framework (KSF)". NHS Employers. Retrieved 11 April 2017.
  24. ↑ "London Allowances" (PDF). Unison. 1 April 2017. Retrieved 20 October 2018.
  25. ↑ "Hospital CEO calls for changes to London pay rates". Health Service Journal. 17 September 2018. Retrieved 20 October 2018.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.