What NHS employers have to do to get you through their doors

Organisations are being forced to compete with each other like never before to attract high-calibre staff in this seller’s market. Alistair Kleebauer reports.

Organisations are being forced to compete with each other like never before to attract high-calibre staff in this seller’s market. Alistair Kleebauer reports.

Picture credit: Daniel Mitchell

In a break from convention, the chief executive of a large NHS trust took to Twitter to pose a question that might have crossed the minds of fellow NHS leaders.

Central and North West London NHS Foundation Trust chief executive Claire Murdoch, who is a mental health nurse, tweeted: ‘Looking at paying additional incentives for band 5 nurses. Are we all just pumping up our costs in competition? Should we collaborate more?’

Incentives used by NHS employers to recruit nurses include ‘golden hello’ bonuses and ‘recommend a friend’ schemes that reward employees.

Organisations need to resort to these measures if they are to tackle staffing issues. The NHS’s own figures show 92% of hospitals in England missed their own nurse staffing targets in August last year – a deterioration from the previous January when the figure was 85%.

Short-term solutions

Attempts to boost the supply of nurses, such as the government’s decision to scrap the limit on nursing degrees commissioned, are unlikely to yield results quickly. This leaves employers casting around for short-term solutions.

Central and North West London trust has a vacancy rate of around 15% for some nursing areas, particularly in bands 5 and 6, according to Ms Murdoch.

She says the trust has significant vacancy levels in mental health, learning disability and older people’s nursing.

Recruitment problems can be exacerbated by geography. In 2014, an NHS Employers survey found an average nursing vacancy rate of 10%. In north, central and east London the figure stood at 14% and in south London it was 18%.

‘I would rather invest in fair pay than in incentives’

Claire Murdoch

Ms Murdoch says: ‘What we see are particular hot-spot recruitment areas. It is a seller’s market. Demand is outstripping supply.’

Ms Murdoch has become aware of trusts paying golden hellos of up to £3,000 and moving recruits up the Agenda for Change (AfC) scale.

But she says there is a risk trusts end up competing against each other with incentives – ‘overheating the market means we all rob each other’.

According to guidance in the NHS terms and conditions of service handbook (see box, below), trusts should consult neighbouring organisations before offering incentives to ensure the local labour market is not distorted.

Ms Murdoch questions the extent to which this happens: ‘I do question whether people are actually applying the guidance.’

The trust is considering offering band 5 nurses one or two additional AfC increments on appointment – a starting salary of up to £23,132 per year rather than £21,692. A golden hello of up to £2,000 is another option.

Workforce expert James Buchan of Queen Margaret University in Edinburgh says Central and North West London might be facing a ‘double whammy’ of problems.

He says: ‘London and the south east have more problems because of its high cost of living and there are certain specialisms including learning disability and mental health nursing that are more challenging to recruit for.

‘If you have to address both those issues, it is not surprising the trust is having to be competitive about increasing the starting pay to make posts attractive.’

Ms Murdoch’s trust is now calculating how much the possible incentives would cost, and expects to make a decision on whether to introduce them in the coming weeks.


Peterborough and Stamford Hospitals NHS Foundation Trust offers employees a bonus if they recommend a friend as a staff nurse.

The employee gets a £200 bonus if their friend is recruited and an extra £150 if the individual stays for at least 12 months. The new nurse gets a £100 bonus.

The trust’s director of workforce and organisational development Ian Crich says the scheme has recruited ten nurses in 18 months.

He adds: ‘Incentives are necessary because we need to do all we can to fill nurse vacancies locally, nationally and internationally.’


Maidstone and Tunbridge Wells NHS Trust considered a range of recruitment incentives including offers of bonuses, gym membership and iPads at the beginning of last year.

But in a report to the trust’s board, director of workforce Paul Bentley cautioned that recruitment incentives could cause a retention problem.

‘The inherent risk is that existing staff are aggrieved, leave and return, thereby incurring greater cost to the organisation.’

A trust spokesperson says the organisation decided not to introduce the incentives because it increased its nursing workforce through closer relationships with universities, open recruitment events and improved retention.

Unite professional officer for health Ros Godson says incentives can be welcome, but ‘they are only a short-term fix’.

She says: ‘Nurses are walking away from the profession they love because they have been deemed a soft target for the government’s brutal austerity agenda – they can no longer afford to work for the NHS.

‘The fact that golden hellos are being handed out shows the depth of the problem.

‘Health secretary Jeremy Hunt needs to undo the pay straitjacket and ensure decent salaries and conditions for a workforce that gives 101% on a daily basis in often very difficult conditions.’

Improving the employability of newly qualified nurses would also help, according to Ms Murdoch.

Guidance for employers

  • Recruitment and retention pay supplements can be awarded locally or, if the NHS pay review body recommends it, nationally.
  • There are currently no nationally agreed salary premiums.
  • Locally agreed premiums must be reviewed regularly to ensure their use is justified.
  • The NHS Terms and Conditions of Service Handbook ( sets out the steps employers should take before offering financial incentives.
  • If job adverts do not yield suitable applicants, employers should look at factors such as national vacancy data and local market conditions to find out why.
  • Non-pay incentives, such as training opportunities and help with childcare or relocation, should be considered.
  • If it is decided that the vacancy problem can only be addressed through pay supplements, employers should consider whether incentives will be required in the short or long term.
  • Organisations should consult neighbouring employers before introducing premiums.

Central and North West London trust assesses newly qualified nurses for their numeracy and literacy skills, as well as their values, and it rejects up to 80% of candidates.

Ms Murdoch says: ‘We still turn too many nurses away, which I think shows a systemic problem.

‘In truth, we need every nurse that qualifies. So let’s make every nurse that qualifies is suitable for a job offer.’

If Ms Murdoch’s trust does pursue the use of incentives, it will be a decision taken after considerable thought.

She says: ‘Nurses want fair pay for a fair day’s work. They want to work together, to have proper continued professional development, proper mentorship, and the opportunity to learn together.

‘I would rather invest in these things than recruitment and retention premiums’.

This article is for subscribers only