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Make pay progression easier to stop nurses quitting, NHS told

NHS must assess if Agenda for Change pay system is fit for purpose, Health Foundation says
Image of piggy bank with four piles of coins topped by letters spelling out 'wage'

NHS must assess if Agenda for Change pay system is fit for purpose, Health Foundation says

The NHS needs to assess if its nurse pay system is fit for purpose and make pay progression easier to prevent nurses leaving the profession, a report says.

An analysis of nursing pay by the charity the Health Foundation says the health service must put staff pay and rewards ‘front and centre’, adding that nurses have suffered a 5% real-terms pay cut over the past decade. It also calls for a potential reworking of the

NHS must assess if Agenda for Change pay system is fit for purpose, Health Foundation says

Image of piggy bank with four piles of coins topped by letters spelling out 'wage'
Picture: iStock

The NHS needs to assess if its nurse pay system is fit for purpose and make pay progression easier to prevent nurses leaving the profession, a report says.

An analysis of nursing pay by the charity the Health Foundation says the health service must put staff pay and rewards ‘front and centre’, adding that nurses have suffered a 5% real-terms pay cut over the past decade. It also calls for a potential reworking of the Agenda for Change (AfC) pay system, which has been in place since 2004.

NHS nurse pay fell 5% in real terms in decade to 2021

AfC was established in a bid to improve recruitment and retention, increase pay flexibility and ensure the NHS complied with equal pay legislation.

Health Foundation senior visiting fellow and Nursing Standard columnist James Buchan said pay is a powerful driver of nurse recruitment and retention, with new figures from the Nursing and Midwifery Council revealing the number of nurses leaving the profession is at its highest in four years.

‘With recent significant increases in inflation and further rises predicted, questions remain over whether the current pay award is adequate recompense for nurses’ efforts at the front line of combating the pandemic – often at great personal risk – and whether it can contribute effectively to motivating and retaining existing nurses, as well as attracting urgently needed new recruits,’ Professor Buchan said.

The report found that the basic earnings of NHS nurses grew by 13% between March 2011 and March 2021, but after accounting for consumer price inflation this amounts to a 5% earnings reduction in real terms. Seven years of government pay freezes and pay caps up to 2017 also led to a ‘significant drop’ in nurses' pay, it said.

Singling out pay scales for practice nurses, the report found the current structure was ‘too compressed, with insufficient overall progression’.

Report recommends more opportunities to progress to higher pay rates

Recommendations in the report include better pay progression so that skilled, experienced staff are given more opportunity to progress to higher pay rates.

Employers should use pay supplements to attract staff into hard-to-recruit roles or in areas with a high cost of living, it says, and there should be greater flexibility in NHS pension contributions to encourage more nurses to remain in or return to work.

The report comes after an indicative ballot found RCN members in Scotland are prepared to strike over their 4% pay rise offer. An RCN ballot on the government’s 3% offer in England and Wales closes on 30 November.


Find out more

The Health Foundation (2021) Nurses’ pay over the long term: what next?


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