NHS Agenda for Change review: scope

Pay and reward

Pay spine, band transition and incremental distribution

Staff side position

An urgency around review and revision of the pay spine values given the cumulative impact of how the pay spine has changed over time.

Any revision should look at achieving a more regulated incremental value and meaningful transition points for band to band on promotion.

The gaps between the pay bands need to be large enough to incentivise promotion and therefore encourage career progression, particularly for staff working at the top of their pay band. Small gaps between the bands are already an issue, and appropriate investment is needed at all levels of the pay structure to ensure that this issue is not exacerbated by further compression of the bands.  

Employer position

Employers acknowledge the need to redesign the pay system to better support staff going on promotion and are in favour of review.

Progression through pay increments

Staff side position

The NHS workforce crisis and increased expectations on staff to do more with less have driven a culture where NHS workers ‘sink or swim.’ The historic practice of taking time to learn the job is now a luxury that staff no longer enjoy and so progression should reflect this to facilitate faster and fairer progressions towards the agreed rate for the job, which is the top of the scale.

Consideration needs to be given to the length of time taken to move from the bottom to the top of the pay bands to support recruitment and retention at all levels.

Employers position

Employers see the value in targeted creation of progression routes where staffing is an issue (e.g. Critical Care and Operating Theatres) and are conscious of the opportunity that it could reduce supplementary staffing costs.

Pay on promotion

Staff side position

The potential loss of pay enhancements, such as unsocial hours and overtime, also needs to be factored into considerations when incentivising promotion between the pay bands.

Currently, when promotion may result in a loss of earnings when basic pay, unsocial hours and RRPs are considered and the working pattern is unchanged the staff member may be appointed to the first point of the new pay scale that produces a salary increase, this also includes circumstances where working patterns are not similar but, in these circumstances, only basic pay and long terms RRPs will be considered.

Consideration to be given to a change to provide that even in circumstances where the working pattern is changed, basic pay, unsocial hours, and any long term RRP should be taken into consideration as the loss of earnings on promotion at points such as band 6 to 7 have been shown to be a real disincentive to staff seeking promotion.

Furthermore, Staff Side believe that there is an urgent need to consider the operation of Annex 21 in respect of the salary paid to those in training posts. There are staff who are being paid less than they would in their substantive post to undertake training, this clearly acts as a disincentive to participate in further training and in turn impacts on the filling of essential specialist vacancies.

Employers position

Employers acknowledge the need to redesign the pay system to better support staff going on promotion and support the review of Annex 21.

Supplementary staffing – rates of pay, allowances, overtime and unsocial hours rates

Staff side position

Appropriate recognition and reward for additional work undertaken by NHS staff. There is a common view that whilst supplementary staffing will remain a feature of the delivery of services, there is an urgent need to do all possible to stabilise the workforce and properly reward additional hours worked. We have a shared concern that the escalating reliance on high-cost agency any further is not sustainable. We are aware of the work currently being led by the CNOs office and make the following observation on the need to revise terms and conditions.

We would propose a move to standard overtime rates for all additional hours worked by substantive NHS employees. This would include those hours worked through bank arrangements.

Dialogue is required on measures to further alleviate high-costs agency utilisation in areas such as ICU or other specialist services where current NHS staff might be willing to deploy to adjacent/more distant boards where travel is involved but, for example, costs inhibit. Additionally, we seek consistency in the grades paid to staff who do offer to undertake extra hours and seek payment on actual grade.

Rates of pay and the way in which substantive staff are paid through the bank should be reviewed as the current system acts as a disincentive and encourages staff to seek agency work. There were temporary changes in response to Covid which should be part of the considerations.

Employers position

Employers are content to work with Staff Side and The Scottish Government to address priorities through reviewing terms and conditions of service to provide a safe and effective service for staff and patients.

On call

Staff side position

With an increase in demand for services, shortages of staff and more regionalised working, the frequency where staff are on call and demands of the on-call period all point to the need for review. Additionally union members have reported concern that compensatory rest cannot be/is not being applied appropriately.

There is a shared view that both the rate paid for on call and the operation of on call should be reviewed. Consideration is also needed in respect of practices in use that are more reflective of the former “standby” arrangements i.e., staff staying within the hospital overnight.

Consideration to review the Scotland-wide policy to be universally applied across all NHS employers in Scotland in respect of the operation of on call arrangements including compensatory rest.

Employers position

Employers are content to work with Staff Side and The Scottish Government to address priorities through reviewing terms and conditions of service to provide a safe and effective service for staff and patients.