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Agenda for Change: will it really pay?

Sylvia Thomas
Project Lead Impact Team

The Agenda for Change (AfC) proposals have been negotiated and will be implemented in partnership with the trade unions and managers, fully funded by the government. AfC will improve pay conditions and careers, and - it is hoped - recruitment and retention. Foundation hospitals will be implementing AfC, but whether these trusts will be able to offer over and above AfC is not yet known. There remains a role for the pay review body for nurses, midwives, health visitors and the professions allied to medicine, and this will be expanded to include a wider number of qualified health professionals and their support staff.

Why do we need pay modernisation?
The present pay system is complex, consisting of a multitude of pay spines, grades and allowances, many of which are now dated. In 1995, some UK trusts implemented local pay bargaining, which meant that NHS employees transferred to local contracts that were not Whitley pay or terms and conditions - a number of employees in these trusts still have these contracts. This leaves a mix of local and national systems. Employees on local contracts will have the choice to transfer to the new pay system. Equal pay is a fundamental value within AfC and is achieved through the job evaluation scheme.
It is not easy to understand the present system of clinical grading. As nurses' roles have become far more diverse and have expanded well beyond their job descriptions, clinical grading no longer applies. Job evaluation will address this.
It is worth noting that national implementation will depend on the outcome of a further ballot from some NHS unions who have voted for implementation only in the early-implementer sites (expected to declare in the first weeks of November). From December 2004, NHS?staff will be assimilated into the new pay system, although the effective pay date remains 1 October 2004. The exception will be doctors, dentists and some senior management posts. There are at present 12 early-implementer sites in England that are currently fully implementing AfC, and four trusts in Scotland that are participating in a paper exercise only.
Although it is not mandatory, it is hoped that GP practices will also choose to implement AfC. Many primary care trusts are involving GP practice staff in their planning and working groups for AfC to enable them to fully understand the process. There is also work taking place nationally to test the impact of introducing AfC within GP practices.
In reality, nursing shortages could mean that GPs will have to give serious consideration to implementing AfC.

What is job evaluation?
Job evaluation is a systematic and consistent approach to defining the relative worth of jobs in an organisation. Within AfC, job evaluation will be transparent and will be used to determine which pay band a job falls into. This is to avoid the problems encountered when clinical grading was implemented in 1988 and staff and management both had separate guidelines that were open to interpretation by both parties, resulting in clinical grading appeals that went on for many years.
Job evaluation is not an assessment of individual skills or a workload measurement and will not be used to assess performance. The focus is on the job that is being carried out, not the person.
With AfC, jobs are classified under 16 factor headings, such as knowledge and skills, responsibilities, freedom to act, effort and environment. This scheme was developed by a national working party, which consisted of equal numbers of human resource managers and trade union representatives. They carried out job testing exercises on real NHS jobs and from this created national benchmarking. Some human resource managers and trade union representatives were also trained as analysts who could sit down with employees from different disciplines and help them fill out a comprehensive questionnaire about their job. This information was passed to the national working party to test the system.

National profiles have been developed for a wide range of jobs and are available on the Department of Health's Agenda for Change website (see Resources). The majority of jobs will be matched to the national benchmark profiles produced by the job evaluation process, by using job descriptions. The early-implementer sites stress the importance of updating job descriptions, which should be signed by both postholder and manager. A matching panel should consist of equal numbers of managers and staff representatives - most early-implementer sites had two staff representatives and two managers on a panel.
Jobs without profiles will be job evaluated. The postholder and analyst will complete a questionnaire. This will be signed off by their manager before going to a job evaluation panel, which will also consist of equal numbers of managers and staff members. This panel will analyse the job against the factor plan, and the result will determine which pay band will be used for that job.
There will be a nationally agreed procedure for processing appeals for members of staff who disagree with the result from either a matching or job evaluation panel. Computers will be used to store the job evaluations locally, and this will enable local evaluations to be checked for consistency. The national job profiles and evaluation database will be open to all.

Knowledge and skills framework
The knowledge and skills framework (KSF) is a common description of the knowledge and skills required for NHS jobs. It will be applicable and transferable across the NHS. It is feasible to implement and will be available electronically (for further information access the Agenda for Change website "Introduction to the Knowledge and Skills Framework" [see Resources]).
The KSF will outline what is expected for a specific job and will provide opportunities to show what a person can do best. Knowledge and skills will be linked to pay - it is how staff will increase their pay within a band. There will be the normal expectation of progression through the pay bands, with two gateways where pay progression is linked to knowledge and skills. To pass through a gateway the postholder will have to demonstrate that they have the knowledge and skills required for the job. If there is no evidence of development to the required level, the postholder will not pass through the gateway. However, if the postholder can demonstrate that the trust has not had systems in place for them to develop, they will be able to pass through the gateway. This means that trusts will be required to have a more robust continuing development structure in place.
The development can be linked to a postholder's own development, but the gaps and maintenance of their knowledge and skills required by their post will be considered first.

The KSF will help the postholder to understand what is expected of them in their job and give them an opportunity to develop the necessary skills and ­knowledge so that they can progress through the ­incremental points in the pay band.
It is the first time in the NHS that pay has been linked to knowledge and skills, which will give encouragement to the postholder to develop. An essential element of KSF is the requirement to have an annual development review between each postholder and their line manager to discuss achievement. A personal development plan will be agreed so that the individual can achieve the required levels of knowledge and skills.
Individuals will need to apply knowledge and skills in a number of dimensions to achieve the expectations of their job. The dimensions identify broad functions that are required by the NHS to enable it to provide a high-quality service to the public. There are 30 dimensions and 6 core dimensions which must be applied to all NHS jobs.
The core dimensions are communication; person and people development; service development; equality and diversity; quality; and health and safety. The specific dimensions include: health assessment; management of resources; production of information; management of people; leadership; partnership; health protection; application of technology; health promotion; biomedical investigation; and research and development.
It was anticipated that there would be between three and six dimensions for most jobs, but in the early implementer sites the majority have been two to three dimensions. Feedback from these sites will support further development before the national roll out.
Each dimension has a level descriptor that describes the level of knowledge and skill. The indicator describes at what level the knowledge and skills should be applied.
There are clear examples of application that illustrate how the level and indicators could be applied to a job.

Annual leave hours and overtime payments
There will be an improved holiday entitlement. On-call and unsocial hours will be calculated differently in AfC. New harmonised terms and conditions are being applied at the early-implementer sites, and final terms and conditions will emerge from them.

AfC should be viewed as a whole package, but the biggest benefit for primary care nurses will be the KSF, which will encourage the development of new roles required within the GMS contract.
Primary care nurses who are not employed by the NHS should be speaking to their practice managers about implementing AfC when recruiting and updating all staff pay. For advice contact a trade union - most are willing to give advice to nonmembers. The NHS website is the best resource, providing regular updates.

Department of Health
Agenda for Change webpages Guidance/HumanResourcesAndTraining/ModernisingPay/AgendaForChange/fs/en

Further reading
Department of Health. Job ­evaluation ­handbook. 1st ed. London: Department of Health; 2003. p. 3-6.
Department of Health. The knowledge and skills framework and development review. Guidance 31395. London: Department of Health; 2003. p. 3-5.
Department of Health. The new NHS pay system. An overview. London: Department of Health; 2003. p. 1-17.