RepsDirect No 167 - 31 January 2003

Head of Health, Roger Spiller General Secretary, Roger Lyons

Agenda For Change

There are two formal letters circulated on Agenda for Change by the Joint Chairs and Secretaries of the Pay Modernisation Talks.

1. This letter tells you about plans for a new pay system in the NHS, known as Agenda for Change, and an associated three year pay deal.

This new pay system has been discussed over the last few years by the UK Health Departments, NHS Employers and NHS Staff Organisations. Negotiations on the new system were successfully completed at the end of November last year, and details of the proposals are now available at\agendaforchange. Further summary information including a booklet and answers to common questions will be available shortly.

If you are a member of an NHS staff organisation, you will be asked over the next few weeks whether you approve of the Agenda for Change pay system and the three year pay deal. Once all staff organisations have consulted their members, they will then meet with the UK health departments and NHS employers representatives to decide whether there is sufficient support to pay the proposed increase and start moving staff on to the new pay system. If there is sufficient support, the first pay increase under the three year pay deal will be made for everyone, and the first staff will move across to the new pay system in a number of volunteer "early implementer" sites across England.

2. Negotiators representing the four UK health departments, NHS employers and staff organisations have issued the full text of the proposed Agenda for Change pay modernisation agreement, on which negotiations were completed in November.

The full text includes a proposed partnership agreement under which the parties will work together over the next few years to implement the new pay system in a way which supports service modernisation and meets the reasonable aspirations of staff. It is available on line at\agendaforchange.

A first edition of the NHS Job Evaluation Handbook has also been released. This includes the first set of nationally agreed job evaluation results for common NHS jobs, on the basis of which staff in these jobs will transfer to the new pay bands.

The negotiators emphasise that only those staff whose jobs match the detailed description in the associated job profiles will necessarily move to the indicated pay band. Care should therefore be taken in using this table not to imply that everyone with a job title similar to those in the list will automatically move to the indicated pay band.

NHS Staff are being made aware that this information is available, and that members of NHS trades unions and professional organisations will be consulted on the new pay system and the 10% three year pay deal which also forms part of the reform package.

It is also planned to make available during the consultation period further summary and other general factual information to help staff during the consultation process. This will be prepared by the UK Health Departments, employers representatives and NHS staff organisations, working in partnership. Any recommendations to staff will however remain a matter for individual staff organisations.

In addition to this a full copy of the proposals and the Profiling arrangements are available at Later we hope to have the Knowledge and Skills Framework available as well. We shall let you know when.

In the meantime some examples of what improvements to salary the changes make to jobs representing over half our membership.

Audiology Technician presently on MTO2 maximum increased from £19,215 to £22,000 – 14.5%

Health Visitor grade H maximum increased £26,340 to £27,500 – 4.5%

Health Visitor Manager on grade H, maximum increased from £29,065 to £32,300 - 11%

Biomedical Scientist MLSO1 maximum increased from £19,215 - £22,000 – 14.5%

Biomedical Scientist Team Leader MLSO2, Maximum increased from £25,282 to £27,500 – 8.8%

The Profile document is incomplete. It only contains those profiles which have been completed and which have been accepted by the TU side of the Central Negotiating Committee. We are engaged in producing satisfactory profiles for the following jobs. We hope to have them resolved within the next four weeks.

This is for a variety of reasons:

Here is the latest state of play which each occupational group.


Large sections of our membership have been benchmarked and profiled. The profiles for Community Psychiatric Nurses and School Nurses are confused and contradictory and are being reworked. A specialist Health Visitor profile needs to be produced. The profile for a Theatre Nurse is inadequate unless it is only applied to those new to practice. A community nursery nurse still needs to be profiled.


The core membership in Pathology has been benchmarked. We are still finalising the profile for Medical Laboratory Assistants and Phlebotomist. We believe that further benchmarking needs to take place at the level of Manager and those who are a specialist.

Clinical Science:

The core clinical science membership has been benchmarked. However those working in departments with relatively small numbers of clinical scientists have yet to be benchmarked and profiled. This is now likely to take place in the Early Implementers.

Medical Technical Officer:

Because of the diverse nature of this group only a small number of professions have been benchmarked and profiled. These have come out at Band 5. These are suitable for application in our view at newly qualified levels of practice typically at level MTO 2 or 3. In addition we have some reservations about a couple of the profiles that have been produced and we are presently seeking for these to be reviewed. We are expecting shortly to receive for comment profiles for MTO jobs in medical physics.

There will be an attempt to produce generalised profiles at all levels for application in the MTO area. We will consult widely on their suitability for application and where there is general consensus they under value the contribution of specific groups we will be seeking local evaluations which will in turn create further additional profiles.

Speech and Language Therapy / Family of Psychology:

The whole family of profiles in each area are being reworked. Once we have received the revised profiles we will then determine their suitability for application and under what circumstance and through this process identify any need for further benchmarking.


Similarly work is ongoing in this area. One profile for specialist pharmacist has been agreed. A site has been identified amongst the Early Implementers where further benchmarking can take place.


Further benchmarking needs to take place at Assistant and Senior Manager level. Profiles for core section of staff are still being reworked.

We are aware that benchmarking has taken place for sexual health advisors, arts therapists and family therapists have taken place but we have seen no profiles for these groups to date. We are also aware that a commitment has been given to profile groups such as dental therapists, hearing therapists and genetic counsellors but to date no action has been taken and we are now chasing these up.

Please rest assured we are trying as far as possible to reduce any uncertainty on pay to a minimum in order that you can make an informed decision on Agenda for Change. The DOH have accepted that we are making a valid point in this respect.

There will however be gaps in the system for those who’s jobs do not fit one of the agreed profiles. This will often be because your work is different, usually more specialised, or the UK population of your job/profession is small. In which case we can make an informed estimate of the final position and submit the job for local profiling. This is one of the reasons for using Early Implementers.

Without question AfC is a mixed bag with benefits for most and some losses for others. However for Amicus MSF members we have secured very high levels of protection.


As far as salary is concerned the AfC recognises that in a number of areas market forces have had a major impact on existing pay levels. To address this the AfC is providing a Recruitment and Retention Premium. It will be a cash valued payment not time limited in any way which will be calculable for all purposes, pension, overtime, etc. The level will be set locally such that no one would receive in total a salary lower than the existing one inclusive of housing allowance. Indeed the definition of the payment says that the level must be such that no protection is needed.

One major reason for many Amicus jobs requiring this R&R payment is that we have been more successful than others over the years in improving salaries. After evaluation and the correction of previous anomolies we now have jobs compared on fair basis. because of long term underpayment of nurses, in spite of many of them receiving substantial increases, they are still underpaid by perhaps 15%. Because they are numerically the core of the NHS staff we are held down to those levels thus the need for the R&R Premium. Hopefully with time real pay will increase and the gap with the rest of the economy will narrow we shall be able to reduce the levels of RRP.

There is also a provision for further increasing the level if R&R needs require it and reduction of the level at any time in future would require the consent of those receiving it. The following categories of staff with which Amicus is involved are covered by RRP:

Chaplains (including housing Allowance)
Clinical Coding Officers
Cytology Screeners
Dental Nurses, technicians and Therapists
Estates officers/Works Officers
Medical laboratory Scientific Officers

Maintenance Craftpersons
Maintenance Technicians
Medical technical Officers

Midwives (new entrant)


The "ordinary" protections provided for pay and allowances operate till 30 Sept 2009 for Early implementers and 31st March 2011for the main roll out. Any one who requires protection should also have their job examined to identify how its value may be increased, by training, new activities, etc., so there should be no continuing need for protection.

In general then there should be no members who lose out on pay even in the long run and many who benefit. Below are some examples of the pay improvements between maximums on the grades.


Holidays are increased for the overwhelming majority of NHS staff up to 6 days for most nurses who comprise over one third of Amicus members. 33 days after 10 years service (41 days inclusive of bank holidays) and an even bigger increase in minimum levels for some.

Hours of work

Hours of work are the most difficult area for Amicus. Harmonisation on 37.5 is understandable given that the overwhelming majority of NHS staff are on 37.5 or longer. However it does mean a contractual increase of up to 2.5 hours for some of our members. The reality is that few members actually work contractual hours. Most professional staff in the NHS, largely because of poor staffing levels, actually work longer hours often up to 39 or 40. In future anything over 37.5 will be paid overtime or TOIL, your choice, and overtime will be paid at 1.5 (2X for bank holidays) for staff up to and including grade 7.

The protection arrangements are extensive providing up to 7 years full or part protection. In the meantime a number of unions including Amicus have policies to seek a reduction of the working week to 35 hours. Given the huge increase in staff this would require, 50,000 nurses alone, recruitment and training will have to expand further, we shall have to see this happens in order to provide a shorter week.

Out of Hours Work/On Call

We had been led to believe that existing arrangements would be able continue indefinitely. However that reverted to a 4 year period of protection. This need not concern us greatly as we have time to deliver improved arrangement over the next few years. Existing arrangements often include an effective supplement to salary instead of an R&R payment, we shall need to convert such elements from out of hours to RRP. We may then find in many cases that the proposed arrangements are not so much a problem in paying for the true out of hours element. Payments often include overtime payments as well, which of course will still be payable.


Equal Opportunities

Although by no means perfect in the application of Equal Opportunities, AfC goes a long way forward, especially when IWL is fully operational. The opportunities to break glass ceilings are enormous, with CPD a contractual right. Although the detail will be determined at local level, managers will have to work within the demands of the Skills and Knowledge Framework. Part time workers will have the same rights as full time staff including the right to progression through skills upgrading and CPD.

Equal value not only demands equal pay but other benefits to be equal as well. That is why harmonisation is so important. Harmonisation has produced benefits for the overwhelming majority of staff, not surprising as over 80% of NHS staff are women whose under-valuation in the past has been a scandal. We sought but failed to achieve all harmonisation at best practice levels. Within a budget constrained by the Treasury, the costs of doing so would have removed any ability to increase pay.

The projected costs of AfC are incalculable at present, in fact the NHS has never been able to accurately estimate costs. Given the improvements to scales, profiles, terms and especially protections since the first publication of the basic deal in October, the costs have escalated.

More information should be available on Profiles in time for the Health National Advisory committee at the end of February.

We shall also be publishing shortly a guide for all Amicus related NHS staff showing the gains and loses for each major job.

For your diaries the dates of the regional briefing conferences in March. Your regional Officer will be inviting elected representatives from all trusts to these meetings in the next few weeks. If you are unable to attend your local conference, please let the Regional Office know if there is another date and location which suits you better.

4th Norwich 5th London 6th South Wales

7th Reading 7th London 10th Saffron Walden

10th Leyland 11th High Wycombe 11th West Bromich

17th Newcastle 18th Castleford 18th Glasgow

19th Nottingham 19th London 20th Bristol

20th London 21st Belfast

The list is subject to modification as suitable venues become available.

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