Agenda for Change

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Agenda for Change (AfC) is the current National Health Service (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.[citation needed] Current indications suggest that lower bandings are being used in London and Scotland than elsewhere in the country.[citation needed]

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).

Staff have a contributory pension with tiered employee contribution rates starting at a 5% rate increasing in 7 steps to 13.3% on income above £110,000.


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. H. 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 Agenda for Change White Paper was published. 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:

  • The four health departments of England, Northern Ireland, Scotland and Wales
  • NHS Employers - which represents NHS employers
  • Twenty trade unions and representative bodies.

After five years of negotiations Agenda for Change was implemented.

In 2013 some amendments to Agenda for Change were agreed:[1]

  • incremental pay rises for staff will now be conditional on individuals meeting locally set performance requirements
  • for the top three bands, 8c, 8d and 9, increments will have to be earned annually, and might not be retained where the appropriate local level of performance is not reached
  • for the top three bands employers may introduce alternative local pay arrangements
  • better protection for staff moved to lower grade posts.


Example job profiles within the bands are:

  1. Administration, catering, domestic, portering
  2. Administration, catering, clinical support worker, patient transport, pharmacy assistant
  3. Microbiology assistant, secretary, security, emergency care support workers, occupational therapy assistants, physiotherapy assistants, speech therapy assistants
  4. Mortuary, radiography or occupational therapy assistant, office manager, medical secretary, operating department practitioner (during training or entry level), assistant psychologists, nursing auxiliaries and nursery nurses, ambulance practitioners, physiotherapy assistants, speech therapy assistants
  5. Nurse & midwife (old D and E grades), dental technician (entry level), Diagnostic/Therapeutic Radiographers, dietician, occupational therapist, paramedic, emergency medical technician, senior pharmacy technician, physiotherapist, assistant psychologists (higher grade), Clinical Physiologists, operating department practitioner (qualified), Speech & Language Therapists (newly qualified), Biomedical Scientists (entry level)
  6. Junior Sister/ specialist senior staff nurse, Senior II Radiographer (diagnostic/therapeutic) Art therapist, specialist dental technician, paramedic practitioner, emergency nurse/care practitioner, health visitor, nurse specialist, trainee clinical psychologist, pharmacist, Senior Clinical Physiologists, Senior Physiotherapist, Senior Occupational Therapist, Biomedical Scientists (specialist level).
  7. Senior sister, Senior Radiographer (diagnostic/therapeutic team leader), Sonographer, Chief dental technician, management - clinical & administrative, qualified psychologist,specialist pharmacist,specialist paramedic, Chief Clinical Physiologists, Senior Physiotherapist, Senior Occupational Therapist, Physician Associate, Biomedical Scientists (Senior level)
  8. Advanced pharmacists, paramedic, modern matrons, nurse & midwife consultants, Superintendent Radiographers (diagnostic/therapeutic), higher management, psychologists, senior therapists (divided into 4 bands - a, b, c, d), Senior Chief Clinical Physiologists, Senior Physician Assistant, Chief Biomedical Scientists.
  9. Consultant Psychologists who run large services, Chief Pharmacists managing large/multiple departments


  1. ^ Richard Johnstone (27 February 2013). "Agenda for Change deal .will preserve national pay system". Public Finance. Retrieved 15 March 2013.