Why NHS pay increase needs to mark the start of better deals for all the UK's nurses

With pay rises agreed for England's NHS, nurses outside Agenda for Change and those in the rest of the UK will want to know when they'll get theirs

With pay rises agreed for England's NHS, nurses outside Agenda for Change and those in the rest of the UK will want to know when they'll get theirs

The pay gap for care home staff makes recruitment and retention difficult. Picture: Charles Milligan

The news that NHS nurses in England will soon get their most significant pay rise in a decade is good for many – but what’s next with the profession’s campaign for fair pay everywhere in the UK, outside as well as within the NHS?

The NHS deal will bring many of England’s NHS nurses a pay increase of at least 6.5% over the next three years. However, nurses working in the independent sector, for local authorities, GP practices or who are otherwise not on Agenda for Change (AfC) contracts, will not receive this uplift. 

Gap between independent sector pay and AfC 

Experts are concerned a gap in pay between nurses on AfC contracts and those who are not may intensify recruitment and retention pressures on social care, general practice and charitable providers. An average nurse working in general practice, for example, earns roughly the same as someone on AfC band 6.

The RCN is calling on government to provide ring-fenced funding to improve the pay, terms and conditions of all nursing staff employed by contractors delivering NHS services.


The average annual staff turnover of non-AfC nurses working in the social care sector

Source: RCN

The college wants a separate national staff council to be set up that would negotiate for nurses not directly employed by the NHS.

This body would facilitate pay discussions and provide a mechanism to improve workforce planning, recruitment, retention, staff engagement, employment skills, standards of care and productivity in independent health and social care.

‘Now we'll campaign for social care workers’

College general secretary Janet Davies says the college will turn its 'campaigning fire' on social care.

Janet Davies

‘The care sector already suffers from high staff turnover,’ she said after the college's NHS pay ballot. ‘So pay must be boosted there too if we are to prevent a nursing exodus for better-paid jobs in hospitals and the community.’

The National Care Association predicts a 5% real-terms widening of the pay gap between nurses on AfC terms and conditions and those working for independent employers – a spokesperson claimed more money is available to the NHS.

A recent survey by the Association of Directors of Adult Social Services (ADASS) offers up a picture of the care sector that will not surprise anyone hoping for better pay for care home staff. The research found slightly more than one in three authorities had seen residential and nursing homes shut.

Message for nurses who don't like the NHS deal

Overall, around a quarter of nurses who took part in the NHS pay ballot voted against the deal.

Ms Davies says she wants to reassure those who did not support the offer that their views are respected and their arguments have been heard at the RCN.

‘This is by no means the end of our campaigning for fair pay, and their contribution to that cause will remain invaluable.’

1 in 7

nurses work in the private or independent sector in the UK

Source: Labour Force Survey 2017

Lead pay negotiator and Unison head of health Sara Gorton emphasises the three-year pay deal must be the start of a trend.

Sara Gorton

‘Health workers will want to know ministers are committed to decent wage rises across the NHS for the long term, and that this isn’t just a quick fix.’

Unite national officer for health Sarah Carpenter agrees. ‘There are still a number of issues that have to be resolved at a local level, such as buying and selling annual leave, pay progression, and how trusts pay and support their apprentices,' she says.

The RCN says it will now monitor inflation, recruitment and retention and look to close the gap between living costs and nurses' pay. It promises to reopen talks if the economic situation changes.

Prospects for NHS staff in Scotland, Wales and Northern Ireland

Pay negotiations for NHS nurses in Scotland, Wales and Northern Ireland are at different stages, but England’s decision is likely to inform them.

Money to replicate the pay deal in England will now be available to the NHS in the rest of the UK.

Employees earning up to £80,000 would receive a minimum cumulative uplift of 9%, and those earning £80,000 and over will receive a flat rate increase of £1,600 a year. 

If agreed, staff in Scotland would receive a higher NHS pay uplift than England, with a band 5 nurse earning £1,030 more than their equivalent in England.

Negotiations on a pay offer for NHS staff in Wales continue. RCN Wales associate director employment relations Helen Whyley explains: ‘The Welsh Partnership Forum strategic pay sub-group has been meeting regularly to discuss the approach and potential implications for Wales.

‘Only by extending the pay rise to all nursing staff delivering publicly-funded services will problems with recruitment and retention be addressed’

Helen Whyley, RCN Wales

‘Now that the decision has been made by our English colleagues, the group will meet to consider its advice to the cabinet secretary on a pay offer for NHS Wales.

Helen Whyley

‘The RCN believes all health and social care employers, including the independent healthcare sector need to have a pay system that is comparative with the NHS.

‘Only by extending the pay rise to all nursing staff delivering publicly-funded services will problems with recruitment and retention be addressed.

‘We hope that any improvements in NHS pay will have a positive effect on pay in other sectors.'

How political deadlock is hurting nurses

In Northern Ireland, suspension of the devolved government since January last year means no decisions can be made about any NHS pay award.

RCN NI director Janice Smyth says it is still unclear exactly what authority civil servants have to deliver a legally sound pay deal.


of private sector nurses and midwives are foreign-born, pointing to a particular reliance on overseas staff

Source: Labour Force Survey 2017

‘The Department of Health has started discussions with trade unions to scope out what a pay deal might look like, but we are caught up in a political impasse and it is very difficult. Department representatives have told us they can’t commit to any undertaking on pay.’

Ms Smyth says the college is watching for the outcome of an ongoing judicial review about how much authority is vested in civil servants. 

She said: ‘We won’t know that until September, so we are not hopeful we are going to be able to negotiate anything before then.’

‘Nurses in Northern Ireland are saying we are already paid less than everybody else – what is going to happen to us?’

Janice Smyth, RCN Northern Ireland

Ms Smyth adds that the pay rise for England is likely to hamper recruitment in Northern Ireland.

Janice Smyth

‘Much as I, and nurses here, totally accept nurses in England are absolutely entitled to this increase in pay, it will be more difficult to recruit here. This affects services we can provide to patients and quality of care in our system and that is of concern.

‘Nurses here are saying we are already paid less than everybody else, what about us, what is going to happen to us?’

As Unite's Sarah Carpenter puts it, the NHS deal is not ‘the end of the story, but a first stage on the long march for pay justice’.

Pay deal at a glance 

  • Basic pay will rise straight away for everyone employed on Agenda for Change contracts in England and equates to 3% this year, 1.7% in 2019, and 1.7% in 2020.
  • Nurses at the top of their pay point will receive a lump sum worth 1.1% in April 2019, with the exception of those at the top of bands 8d and 9.
  • The salary increase will be paid in July and backdated to 1 April, so nurses can check pay slips from July onwards to see the difference.

Recruiting in general practice: ‘we can’t compete with Agenda for Change’

Reader and practice nurse Deborah_731226 posted her response to our story about the NHS pay deal:

‘I am pleased that NHS nurses will get a pay rise – I won’t as I am a practice nurse.

‘We are interviewing for a practice nurse to join our nursing team. Apart from one nurse who has practice nurse experience, the other nurses being interviewed are hospital-based. If they join our practice their terms and conditions will not be transferable. They won’t get the new pay rise.

‘The NHS plan is to have have more practice nurses. Student nurses have placements in GP surgeries. We need to be part of the NHS and be on Agenda for Change. What is the incentive for experienced practice nurses to stay, rather than return to the hospital or retire? 

‘I wonder if the nurses we interview next week will accept the position when they realise they are not on AfC. The previous appointees turned it down. I really hope the RCN will support practice nurses and other nurses who are not on AfC contracts in getting a pay rise too.’

And Kathryn_1128311 posted this: 

‘It should be mandatory that all nurses receive Agenda for Change pay and terms and conditions. The planned expansion in primary care will be more difficult to achieve if this is not sorted.’

Read more: NHS nurses in England to get biggest pay rise in a decade

Stephanie Jones-Berry is a freelance health journalist

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