NHS Agenda for Change

Post written to accompany January 2019 issue of Your Voice 

By Richard Fraser, Editor

The pay and conditions of some Voice members, including community nursery nurses, hospital teaching assistants, and school nurses employed by the National Health Service (NHS), rather than a local authority, are determined by Agenda for Change (AfC), which covers all NHS staff except doctors, dentists and the most senior managers.

NHS pay deal

The pay deals for England, Scotland and Wales were agreed at various stages during the summer, backdated to April 2018, but in Northern Ireland, a pay offer was not made until November 2018. [Sources: RCN and BBC.]  

An online calculator is available to help staff work out the exact amounts they’ll receive in each year of the three-year deal. 

Further information (Nursing Notes)


The introduction of Agenda for Change (AfC) in 2004 brought together several different pay arrangements into one overall structure underpinned by job evaluation.

NHS trade unions and employers agreed on the need for changes to be made to modernise AfC in a number of areas. The agreement reached in England in 2013 was recognised by all parties as the start of a wider conversation on a refresh of AfC.

At the November 2018 Budget, the Chancellor of the Exchequer reconfirmed the intention to end the 1 per cent basic pay policy, and announced that additional funding could be made available for a multi-year pay deal for AfC staff that would support productivity and recruitment and retention.

The Framework Agreement on the Reform of NHS Pay Structures for Agenda for Change Staff (June 2018) (pdf) set out a three-year agreement covering the years from 1 April 2018 to 31 March 2021. It sets out both the pay investment that will be made and the reforms that employers, NHS trade unions and the Department of Health and Social Care are agreeing to implement over the period of the agreement and going forward.

The key objectives in the discussions leading to the details set out in the framework agreement document were to:

  • support the attraction and recruitment of staff by increasing starting pay in every pay band;
  • support the retention of staff by increasing basic pay for the 50 per cent of staff who are at the top of pay bands and speeding up progression to the top of the pay band;
  • increase staff engagement by putting appraisal and personal development at the heart of pay progression, so that staff are supported to develop their skills and competences in each pay band and are rewarded for this. This will help ensure that all staff have the appropriate knowledge and skills they need to carry out their roles, so make the greatest possible contribution to patient care. It will be underpinned by a commitment from employers to enhance the relationship line managers have with their staff and to fully utilise an effective appraisal process;
  • ensure that the pay system can support the growing use of apprenticeships in the NHS;
  • ensure that the pay system is supportive of new training pathways and that the health service can deliver on the aspiration to focus on ‘careers, not jobs’;
  • map out future work that the NHS Staff Council will undertake to encourage consistency of approach to bank working (including how the service can better incentivise staff to offer their own time to the bank) and to the development of apprenticeship routes to healthcare careers; and
  • improve the health and wellbeing of NHS staff to improve levels of attendance in the NHS with the ambition of matching the best in the public sector.

The partners developed the agreement ‘in full awareness of the Public Sector Equality Duties and recognise that an equality impact assessment will need to be commissioned to support this agreement’.


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