Agenda for Change

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Agenda for Change (AfC) is the current National Health Service (NHS) grading and pay system for NHS staff, with the exception of doctors, dentists, apprentices 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.

Agenda for Change came into operation on 1 December 2004, following agreement between the unions, employers and governments involved.

Job evaluation[edit]

The AfC system allocates posts to set pay bands by giving consideration to aspects of the job, such as the skills involved, under an NHS Job Evaluation Scheme.[1] There are nine 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.[2] 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 from similar jobs elsewhere, despite the supposedly tighter definitions. Around 5% of staff appealed their initial banding,[3] 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 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 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 full implementation of KSF has been slow.[4]

Staff have a contributory pension with tiered employee contribution rates starting at a 5% rate increasing in 7 steps to 14.5% on income above £111,337.[5]


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. Additionally there was concern that the existing pay scales were not easily adaptable to developing gender equal value pay laws.[4]

Negotiations on a new system began in February 1999 when the Agenda for Change White Paper was published.[6] 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.

Negotiations on the new pay system were concluded in November 2002, allowing full-scale testing of the new Agenda for Change pay system to begin at 12 early implementer sites in England in June 2003, with pilot sites in Scotland following.[7]

On 1 December 2004 it was implemented across the UK, with pay and conditions backdated to 1 October 2004.[8] Although most NHS employees in England and Wales were quick to transfer to the new system with staff receiving their back-pay, Scotland had been slower to implement the system because Scotland took a more robust approach to the implementation. All the signatory organisations agreed to implement it through a partnership approach.[9]

In 2013 some amendments to Agenda for Change were agreed:[10]

  • 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.

From September 2014 NHS Wales intends to pay NHS staff at least the living wage, resulting in about 2,400 employees receiving an increase in salary of up to £470 above UK wide Agenda for Change rates.[11]

In March 2017 the National Health Service Pay Review Body (NHSPRB), the independent body who advises the government on healthcare sector pay, advised that the 1% pay cap be extended for another year.[12]

Following its announcement in March 2018 [13], In June 2018 unions announced that NHS staff in England had accepted a deal to reform the current Agenda for Change system and provide a multi-year pay deal. [14] The reforms include the removal of overlapping pay points between bands and incremental pay progression no longer occurring on a yearly basis. [15]


Example job profiles within the nine bands are:[16]

  1. Catering Assistant, Cleaner
  2. Administrative Assistant, Health Care Support Worker, Portering
  3. Secretary, Health Care Support Worker (Emergency Medicine/ Theatres), Occupational Therapy Assistant/ Technician/ Support Worker, Physiotherapy Assistant, Speech Therapy Assistant
  4. Office Supervisor/ Team Leader, Medical Secretary, Personal Assistant, Finance Officer, Assistant Nurse Practitioner, Occupational Therapy Assistant/ Technician/ Support Worker, Nursery Nurse, Pharmacy Technician
  5. Office Manager/ Junior Manager, Staff Nurse, Midwife (Newly Qualified), Diagnostic/Therapeutic Radiographer, Dietician, Emergency Medical Technician, Senior Pharmacy Technician, Occupational Therapist, Physiotherapist, Clinical Physiologist, Operating Department Practitioner (Newly Qualified), Speech & Language Therapist (Newly Qualified), Biomedical Scientist (Entry Level)
  6. Management Accountant, Junior Sister, Specialist Staff Nurse, Paramedic, Senior Radiographer (Diagnostic/Therapeutic) Emergency Nurse Practitioner, Health Visitor, Senior Physiotherapist, Senior Occupational Therapist, Biomedical Scientists, Chaplains, Trainee Clinical Scientist (STP)
  7. Department Manager, Senior Sister, Advanced Nurse Practitioner, Senior Radiographer (Diagnostic/Therapeutic Team Leader), Sonographer, Chief Dental Technician, Qualified Psychologist, Senior Paramedic, Chief Clinical Physiologist, Senior Physiotherapist, Senior Occupational Therapist, Physician Associate, Biomedical Scientist (Senior Level), Clinical Scientist (after completion of STP)
  8. (sub divided into 4 bands - a, b, c, d) Assistant Director, Senior Nurse Manager/ Matron, Advanced Pharmacist, Superintendent Radiographer (Diagnostic/Therapeutic), Senior Chief Clinical Physiologist, Senior Physician Assistant, Chief Biomedical Scientist, Consultant Paramedic
  9. Chief Pharmacist, Very Senior Clinicians managing large/multiple services, Deputy Board Directors and Very Senior Managers just below Corporate/ Board level responsibility

Knowledge and Skills Framework[edit]

The Knowledge and Skills Framework (KSF) is a competence framework to support personal development and career progression within the NHS in the United Kingdom. It applies to all staff except board members, doctors and dentists, as they did not come under Agenda for Change.

The Agenda for Change national agreement includes a commitment to introduce a system of annual development reviews and to create lifelong learning development opportunities. Staff have their own Personal Development Plan, developed jointly in discussion with their manager or reviewer.[17]

Employers and staff have called for a simplified KSF that is easier to use. In response, the NHS Staff Council has developed a simplified KSF that gives employers more flexibility and can be tailored to meet local needs.[18]


  1. ^ "How Agenda for Change works". NHS Employers. 20 February 2014. Retrieved 3 August 2014.
  2. ^ "National job profiles". NHS Employers. 20 February 2014. Retrieved 3 August 2014.
  3. ^ Richard Staines (21 July 2009). "Fair pay to the NHS? - Agenda for Change five years on". Nusring Times. Retrieved 27 January 2017.
  4. ^ a b Stephen Bach, Ian Kessler (2011). The Modernisation of the Public Services and Employee Relations: Targeted Change. Palgrave Macmillan. pp. 67–69. ISBN 9780230356917. Retrieved 6 February 2017.
  5. ^ "NHS Pension Scheme - Member contribution rates". NHS Pensions. Retrieved 19 May 2016.
  6. ^ James Buchan, David Evans (2007). Realising the Benefits? Assessing the Implementation of Agenda for Change (PDF) (Report). King's Fund. Retrieved 27 January 2017.
  7. ^ "NHS pay modernisation gets go-ahead". Scottish Government. 11 June 2003. Retrieved 3 August 2014.
  8. ^ "Support for you: Pay and conditions: Agenda for change". Royal College of Nursing. Retrieved 3 August 2014.
  9. ^ "NHS unions endorse new pay package". Scottish Government. 23 November 2004. Retrieved 3 August 2014.
  10. ^ Richard Johnstone (27 February 2013). "Agenda for Change deal will preserve national pay system". Public Finance. Retrieved 15 March 2013.
  11. ^ Mark Smith (9 July 2014). "Lowest-paid NHS staff in Wales to receive living wage increase in pay". Wales Online. Retrieved 6 August 2014.
  12. ^ Ian Snug (28 March 2017). "NHS Pay Review Body Recommends 1% Pay Cap is Extended". NursingNotes.
  13. ^ "NHS Agenda for Change 2018/19 Pay Scales". NursingNotes. 2018-03-21. Retrieved 2018-06-09.
  14. ^ "Nurses have voted 'overwhelmingly' to accept the NHS pay deal". NursingNotes. 2018-06-08. Retrieved 2018-06-09.
  15. ^ "NHS Agenda for Change 2018/19 Pay Scales". NursingNotes. 2018-03-21. Retrieved 2018-06-09.
  16. ^ "Agenda for Change Payscales 2017-2017". NursingNotesUK. 29 March 2017.
  17. ^ "The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process". Department of Health. 11 October 2004. Archived from the original on 7 January 2013.
  18. ^ "Simplified Knowledge and Skills Framework (KSF)". NHS Employers. Retrieved 11 April 2017.

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