Agenda for Change

Agenda for Change (AfC) is the current NHS grading and pay system for all NHS staff, with the exception of doctors, dentists and some senior managers. It covers more than 1 million people and harmonises their pay scales and career progression arrangements across traditionally separate pay groups, in the most radical change since the NHS was founded.

It was agreed 1 December 2004, by unions, employers and government, but it is not yet fully implemented nationwide. Although most NHS employees in England and Wales have been transferred to the new system and received their back-pay, Scotland has been slower to implement the system because Scotland has taken a more robust approach to the implementation. All the signatory organisations have agreed to implement it through a partnership approach.

AfC assimilates staff to a new salary according to an evaluation of their job weight under an NHS Job Evaluation Scheme. There are nine new numbered pay bands subdivided into points, similar to the old alphabetic Whitley Council 'grades' pay scales. A set of national job profiles has been agreed to assist in the process of matching posts to pay bands. All staff will either be matched to a national job profile, or their job will be evaluated locally. In theory, AfC is designed to evaluate the job rather than the person in it, and to ensure equity between similar posts in different areas. In reality it has been implemented differently in different places, and some posts have been graded very differently to similar jobs elsewhere, despite the supposedly tighter definitions. Around 5% of staff have appealed their gradings, but again the appeals process varies from site to site. Current indications suggest that lower bandings are being used in London and Scotland than elsewhere in the country.

Under AfC, all staff will have annual development reviews against the NHS Knowledge and Skills Framework (KSF). Normal pay progression is one point a year, but pay progression at specified 'gateway' points in each pay band will depend on how the individual matches the KSF outline for their post. Progression onto a different band has become very difficult, as the post would need to have changed substantially in order to be re-graded (even if the person in the post has developed and become more experienced or taken on more responsibilities this would not be seen as a good enough reason to re-band a post).

The history of Agenda for Change
After five years of negotiations Agenda for Change (AfC) is now a reality - but how did it all begin? When the NHS was established in 1948 it adopted the Whitley industrial relations system, which was used in the civil service and local government. The system stemmed from work done by J S Whitley in 1916 and provided a framework for pay, terms and conditions.

The NHS Whitley system has essentially been unaltered since its inception, although there have been some changes. Nevertheless, it has been heavily criticised for decades. These criticisms centred on its structure, complexity, over centralisation, lack of flexibility and equal value.

Negotiations on a new system began in February 1999 when the four health departments of England, Northern Ireland, Scotland and Wales published the Agenda for Change White Paper. It aimed to address the issues of the Whitley system and highlighted the need for a change of pay, career structures and terms and conditions of employment within the NHS. It stated that any new pay system must deliver equal pay for work of equal value.

A number of organisations were involved in the discussions and negotiations including:

Four UK Health Departments The NHS Confederation - which represents NHS employers 20 trade unions and representative bodies.

Bands

 * 1 - Administration, catering, domestic, portering staff
 * 2 - Administration, catering, clinical support worker, patient transport, pharmacy assistant
 * 3 - Microbiology assistant, secretary, security
 * 4 - Mortuary, radiography or occupational therapy assistant, operating department practitioner, assistant psychologists
 * 5 - Nurse & midwife (entry level), dental technician (entry level), diagnostic/therapeutic radiographers, dietician, occupational therapist,paramedic, senior pharmacy technician, physiotherapist, assistant psychologists (higher grade), Clinical Physiologists
 * 6 - Art therapist, specialist dental technician, health visitor, nurse specialist,trainee clinical psychologist, pharmacist, Senior Clinical Physiologists
 * 7 - Chief dental technician, management - clinical & administrative, qualified psychologist,specialist pharmacist, Chief Clinical Physiologists
 * 8 - Advanced pharmacists,nurse & midwife consultants, higher management, psychologists, senior therapists (divided into 4 bands - a, b, c, d), Senior Chief Clinical Physiologists
 * 9 - Consultant Psychologists who run large services

Pay varies, at 2006 rates, from £11,782 to £88,397 across all bands, with extra allowances for London, being on call and leading.