Agenda For Change Update 9.10.02

Agenda For Change
Notes of a meeting of the Guild of Healthcare Pharmacists 9.10.02

The meeting was addressed by Mr Michael Fuller, Regional Officer, Amicus-MSF.

This change is a complete overhaul of the existing pay structures. Prime Minister Tony Blair has stated that the only way to modernise the NHS is to modernise the workforce and the only way to modernise the workforce is to modernise the pay structures. The timetable for this change was originally that the package would be published in July 2000. This slipped to July 2001 then July 2002, now October 2002 and possibly December 2002. This "simple process" has turned out to be one of the most tortuous processes ever. Why? There are 1.25 million workers in the NHS and all the different terms and conditions make harmonisation very difficult.

As of tonight, most of the discussions are still scheduled to be completed by the end of October, but it was fairly likely that there would be further slippage. There will then be a three month consultation period on the package and at the end of that period, all the unions will organise ballots to vote on it. Only union members in a union recognised for the discussions will be eligible to vote. If agreed, it should allow discussions on flexibility to be that much simpler. However, it is vital to ensure that everyone is well enough informed to make a proper decision on how to vote. The first of April 2004 is still the date for implementation.

The package consists of three main areas. Since the unions and management agreed at the start that nothing is agreed until it is all agreed, information on the contents is sparse. However, the papers circulated at the meeting, on the Job Evaluation Scheme and the Knowledge and Skills Framework, were two which had been produced. There is currently no documentation on the Harmonisation aspect of the discussions.

Job Evaluation
One circulated document was 23 pages long and the other can be downloaded from here. The central thrust of the whole AfC package is equal pay for equal value of work, and it is intended to remove all discrimination from within the NHS. There is one employer, the NHS, 11 Whitley Councils and around 830 different terms and conditions. There are about 15-16 individual employers in Scotland, but the courts have said that the NHS is one employer and so equal pay cases are easily possible. The only way to achieve equality is to evaluate jobs against a series of common factors; 16 in the circulated paper. Against each factor is a series of different levels. All existing job evaluation schemes were thrown out by the Department of Health, N.B. not the unions, as being unequal to the task. This is why the process has taken three and a half years. Every job in the NHS is to be assessed against these factors. The ranking order will list all 400 jobs evaluated and it should be possible to place most staff against on of these posts.

The proposal is that there will be 9 pay bands. Within each there will be 3-5 steps, so there will be in the region of 50 points on the scale. If there is no obvious match for someone's job, there may need to be a separate job evaluation exercise for it. Individuals must understand how this works. The job evaluation exercise only decides their position in the ranking order - it does not decide their pay. The pay attributed to each point is for negotiation and cannot be determined from the job evaluation. It is a separate process which still has to be worked out. Although it is only one of the three strands to the package, it is the one which has taken the most time.

Knowledge and Skills Framework (KSF)
How do you move up the pay spine? It is important to remember that the rate for the job is the top of the scale, not the bottom and this is to reflect experience (hopefully) gained whilst moving up the scale. The aim in AfC is to test that assumption. Do people need those 5-6 years to gain that experience? What happens when they hit the top of the scale? How is it assessed, if at all? This is where the KSF fits into the jigsaw. The actual document is 110 pages long and a synopsis was circulated at the meeting. There are 22 competencies. Around 6 of these will be core competencies and each profession will have some of the others. Automatic incrementation will continue, but at certain stages it will be necessary to show that the competencies have been attained. Continuous Professional Development (CPD), Personal Development Plans (PDPs) and annual appraisals will all be required and the skills achieved must be shown to help improve the pharmacy service. It will be a more structured process than exists at the moment and will allow movement between grades if competencies are fulfilled and mean an end to waiting for a higher graded post to become vacant before being able to progress higher. The quid pro quo for this is that management will want improved services. This is also why the Centre for Change and Innovation has been set up in Edinburgh. The KSF, though, has still to be honed. For example, there is no mention of partnership in the document and this must form part of it in Scotland.

The only difference between employees should be their salary, so out-of-hours working, holidays etc will all have to be harmonised.

The above is a fairly simple and crude overview of AfC. The BMA have walked away from the talks will have to be brought back in. Merit awards in the NHS are one of the most discriminatory things within the NHS. A lot of equal pay claims have been halted by the courts awaiting the outcome of the package.

Amicus still has to make a decision on whether to support the package and the other 17/18 unions involved have all to ballot their members. If the vote is to reject the package, there is no alternative and everything stays exactly as it is now. There are still some big issues to be sorted out. Management have proposed a working week of 37.5 hours. The Amicus position is for 35. Management want a working day of 8am to 10pm and hours outwith that being considered as on-call. Management want 5 weeks holiday a year, Amicus want 6 weeks. Will this force a change to shift patterns for everyone? As the job evaluation scheme has no right to appeal, job descriptions must be absolutely watertight. Both management and staff have to agree that the job description is accurate and that the post is wrongly graded before any appeal is possible. There are three pay spines in the package - Doctors and dentists / Professions / Ancillary and clerical etc. How is it possible to have three pay spines in an equal pay system? They must all be linked. Protection in Scotland is also an issue. AfC offers 18 months, organisational change in Scotland offers protection for life. Management are talking about implementing the changes to the winners over a period of three years. This implies that it is going to cost a lot of money. The Royal College of Nursing is demanding a large increase this year. The negotiations on the consultants' contract all indicate high cost.


Q. Rumours have surfaced about pharmacists not doing well out of AfC and there are concerns about how this will affect the current recruitment and retention problems.

A. Michael Fuller said he had been told about these rumours and had tried to investigate before attending the meeting. He was unable to find any substance or foundation to the rumours. Trends, though, are appearing. Duties are being deskilled and staff are moving to higher positions. Lower graded staff are gaining greater responsibilities so it should be effectively and upskilling exercise. There should be a debate about how the profession develops and he would not be surprised if it pushed pharmacists posts higher. The main previous rumour was that it would have a minimal cost. That s possibly false if the management are now talking about phasing it in. There is some concern as to where the professions match with nurses, since they are the biggest group. The ranking order should be available soon.

Q. What is important is how particular pharmacists were selected for evaluation.
A. No-one wants to have 135,000 appeals, and management and unions will want to short circuit this possibility. Marginal differences between posts will not be considered. Substantial differences must be evaluated. Pay rates south of the border are frequently inflated, but as the jobs should be broadly similar, there will be equal pay. It will be necessary to ensure that the correct identification is made. Neither unions nor management will be encouraging appeals, and evidence will need to be shown - the work done and an agreed job description. There may need to be a strategy for selective appeals.

Q. How does the workplace ballot work?
A. A protocol has yet to be drawn up. Ballot boxes will be available and all members will be notified in advance of when they can vote. There is the problem of proving membership and membership lists have been produced in the past. There is likely to be an exercise beforehand to ensure that the membership lists are as up to date as possible. The ballot needs to be as inclusive as possible.

Q. How will the KSF be implemented between the employee and manager? There are very few PDPs around although it should have been implemented under Learning Together some time ago. Who will carry this out, as managers have little time and HR are overworked?

A. The Education and Training Strategy has not gone away - it is the implementation that is at fault. If AfC is agreed, Scotland will shadow the early implementers in England who will start next April and see where the problems lie. The early implementers have 12-18 months to get up and running. NHS Scotland has said that it will do it in 12-15 months given the necessary resources in

Human resources
Trade union representatives and

However, that 12-15 months is dependent upon the early implementers starting on time. This period should sort out all the problems and the appeals. The Common Services Agency (CSA) will need to be benchmarked since there is no equivalent elsewhere. There is a group in Scotland feeding into the KSF such things as Learning Together, PDPs by 1/2001 and the PIN Guidelines on PDPs. The resource problem should be solved. In reality, there is now more money coming into the NHS than ever before, so managers cannot argue that there are no resources. There is a need to balance service development against staff development. The staff survey will be the cornerstone of staff development in the NHS. Next years survey will be carried out in October 2003 and there is an expectation that it will show significant improvements. How? The Staff Governance Standard was issued shortly after the last staff survey. It will incorporate everything into the Performance Assessment Framework against which Chief Executives are assessed. In June this year the Chief Executive of NHS Scotland met with staff sides in Trusts and asked about their employer for the first time ever. HE then asked the Trust Chief Executives about their implementation of PIN Guidelines. He expects all 8 PIN Guidelines to be implemented before his visit next year and is expecting this to be shown as great improvements in the staff survey. For the first time, Staff Governance will be treated equally with Financial Governance and Clinical Governance. The Trust Chief Executives' performance related pay is dependent upon the partnership forum agreeing that it should be paid, based upon performance against the Staff Governance Standard.

Q. Clinical pharmacy was mentioned as one of the developments for the profession. If a greater proportion of pharmacists were described as clinical pharmacists would they come out of AfC any better?

A. It helps if staff are grouped together. Healthcare Scientists (HCSs) are developing a group in Scotland and there is to be a conference around the KSF in the Autumn. Their first meeting took place a couple of weeks ago. It was agreed that I should discuss this with Michael as the Department of Health has made it clear that pharmacists are considered to fall within the HCS grouping.

Colin Rodden

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