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Agenda for Change: a personal experience

Donna Davenport
RGN BSc(Hons) Specialist Practitioner
Professional Development Nurse
Practice Nursing
Stockport PCT

Agenda for Change (AfC), as everyone working in the NHS will now be aware, is the new pay structure replacing the old and outdated clinical grading system and existing General Whitley Council and Nursing and Midwifery Council terms and conditions.(1)
The new pay system was devised to ensure fair pay and reward staff for the jobs they were doing with the application of the knowledge and skills required to undertake these jobs.
AfC can be broken into three parts, which include job evaluation, terms and conditions, and the Knowledge and Skills Framework (KSF). The new pay structure, which applies to all employees within the NHS except doctors, dentists and directors aims to provide:(2)

  • A system that is fair and transparent.
  • Recognition and reward for skills and competencies that staff acquire throughout their career development.
  • Employer flexibility.
  • Greater support for teamworking through harmonised, out-of-hours and overtime arrangements.
  • Flexibility to pay retention and recruitment premia.
  • A simpler system to administer.
  • A system that will improve recruitment and retention and contribute towards making the NHS a "model employer".

[[NIP27_fig1_59]]

Implementation
Following early implementation across 12 pilot sites, guidance was devised that better informed the process for other parts of the NHS. So in early 2004 the onerous task of implementing Agenda for Change for all NHS organisations began; needless to say the initial target of full implementation by October 2004 was unrealistic given the scale of the work to be done. In early spring of 2004 Stockport PCT appointed a part-time AfC Lead and identified support from our human resources team for the project. This proved crucial to the huge task of organising and planning panels to undertake the role of job matching and analysis and maintaining the momentum for staff involved. This was closely followed by rollout of a national five-day training programme for job evaluators.
Twenty staff and management representatives undertook this training within the PCT. This was extremely intensive and covered all aspects of the AfC process, documentation and interview techniques. At each step, job evaluators were assessed and given feedback to ensure consistency in their future decision-making process.
I undertook this training and began work with the panels, which consisted of a mix of staff and management representatives, and involved matching groups of jobs to national job profiles.(3)
Initially it was felt that evaluators would need to commit to one day per month, but the momentum soon gathered. This, combined with strict monitoring and targets set by the Strategic Health Authority, meant that this soon increased to one day per week.
One of the major challenges in the early stages was the process of compiling up-to-date, comprehensive job descriptions for all staff within the PCT. Many were out of date and did not reflect the way jobs had evolved in the NHS as staff had developed skills and taken on new roles and responsibilities.
The RCN has produced useful guidance on updating job descriptions, and where these were accurate and concise the process and outcomes were far more favourable in terms of making a decision about the banding and avoided unnecessary delays for staff.
For some staff in unique roles there were no national profiles that matched these jobs. They had to complete a job analysis questionnaire (JAQ), which meant they were able to reflect on and analyse the jobs they were doing in relation to the 16 factors and also update their job descriptions and person specifications (see Table 1). On completion of the JAQ, which had been agreed by the postholder and their manager, staff were then invited to attend an interview panel to evaluate their post and clarify any areas requiring further information. Amendments were recorded, and the JAQ was then sent for evaluation by a further panel and scored accordingly to fit the new pay bands. Initially, some staff said they felt anxious and expected to be "grilled" about their jobs. However, as panellists, the intensive training we had received ensured we had the skills to interview in an objective but empathetic way to gain the relevant information.

[[NIP27_table1_60]]

Another aspect of AfC was consistency checking and monitoring of outcomes to ensure that submitted job descriptions were consistent and fair. This was carried out locally, at SHA level and at national level. There was also the opportunity for panels to raise any concerns about any of the panel's decision-making process.
 
Job doesn't match - what happens next?
While undertaking this role I also had to prepare my own team and ensure our job descriptions were accurate. As line manager I was able to guide them through the process of updating their job descriptions and preparing them for attending an interview if required. I received support from my immediate line manager as my job did not fit a national profile and I therefore had to complete a JAQ and attend the interview.
This experience has contributed to my continuing professional development in several ways:

  • As a panel member I was able to work with a range of professionals, both staff and management, including physiotherapists, district nurse team leaders and managers, which was a great opportunity to learn more about their varied roles within the directorate.
  • The process required high-level communication and analytical skills, which I was able to utilise with clear rationale for the decisions made. Working across multiprofessional teams meant that there was a requirement for exploring assumptions and checking understanding of different perspectives.
  • I have gained indepth knowledge and experience of job descriptions and person specifications and the importance of these in the recruitment process.

By September 2005, 98% of staff had been allocated their new pay bands. However, inevitably there are staff who are dissatisfied with the result. To date, 3.78% of staff have lodged an appeal against their banding and will go through the review process.(4) It is essential that staff receive support from their managers throughout, and there will also be a ongoing process for new posts to be matched.

AfC and independent contractors
As a professional development nurse for practice nurses, I have also been engaging with practice nurses and other members of the practice team to raise awareness and understanding of AfC and its effect on GMS contractors.
While national profiles have been agreed for both practice nurse and specialist practice nurse, there has yet to be full agreement that practices will take AfC on board, although some practices have started to address this. The new GMS contract describes AfC as part of a best-practice framework, and is linked to a points system and financial rewards for those practices that implement it.(5) The benefits of AfC will impact on the future workforce within general practice in terms of recruitment and retention and skillmix to improve patient care. However, as small independent contractors they will require advice, resources and support from PCTs to undertake this task and to ensure a fair process. There are a number of useful resources available to support this.
The widely used National Toolkit for Practice Nurses(6) is currently being replaced by a new project financed by the Department of Health, termed the Working in Partnership Project.(7) This will involve the development of a clear strategy to look at skillmix and effective use of clinical time, while improving availability of services for patients in primary care. Practice managers and PCT lead nurses will find this invaluable.
The Knowledge and Skills Framework, together with AfC, is about career and pay progression, and is a huge investment in the ongoing development of all NHS staff in the future.(8)
 
Conclusion
Being on both sides of the table, I have influenced and challenged the process while gaining insight into a major change within the NHS, which has been a challenging and rewarding experience. The RCN and the British Medical Association are urging GPs to implement AfC for practice nurses. Delay in implementation could have a major impact on the future recruitment and retention of practice nurses, and it is possible that we are seeing the effects of this already.

References

  1. DH. Agenda for Change. Available from http://www.dh.gov.uk/assetRoot/04/09/59/50/04095950.pdf
  2. DH. NHS modernisation agency 2004. Available from http://www.wise.nhs.uk/cmswise/default.htm
  3. DH. NHS job evaluation handbook. 2nd ed. 2004. Available from http://www.dh.gov.uk/asset Root/04/09/37/39/04093739.pdf
  4. Stockport PCT. Agenda for Change Policy 2004.
  5. The NHS Confederation. The new GMS contract 2003. Available from http://www.opsi.gov.uk/si/si2004/ 20040291.htm
  6. Macdougald N, et al. A tool kit for practice nurses. London: Aeneas Press; 2001.
  7. DH. Working in partnership programme 2004. Available from http://www.workloadmanagement.nhs.uk
  8. DH. The NHS knowledge and skills framework and the development review process 2004. Available from http://www.dh.gov.uk/assetRoot/04/09/08/61/04090861.pdf

Resources
NHS Employers
W:www.nhs employers.org/agendaforchange

Working in Partnership Programme
W:www.workload management.nhs.uk

NHS Primary Care Contracting
W:www.primary carecontracting.nhs.uk

Royal College of Nursing
W:www.rcn.org.uk

Department of Health
W:www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/ModernisingPay...

NHS Modernisation Agency
W:www.wise.nhs.uk/agenda forchange

NHS Confederation
W:www.nhsconfed.org