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NHS should assess whether nurse pay system is ‘fit for purpose’, say researchers

Nurses walking in hospital


The nurse pay system in the UK should be reviewed and the way nurses pay is determined improved, health academics have said.

A report from the Health Foundation, published this week, called for a review of the UK system in which the NHS Pay Review Body (PRB) advises the Government on pay for NHS staff on Agenda for Change (AfC) contracts. It highlighted nurses’ wages are falling in real terms under the system.

The report said: ‘The pandemic has accelerated the need to review the current approach to NHS nurses’ pay determination… NHS recovery and rebuilding calls for an NHS nurse pay system that is built around supporting workforce sustainability and the achievement of service objectives.’

It also called for a ‘comprehensive NHS workforce strategy’, which ‘places the staff reward package front and centre’ and acknowledges pay ‘as a powerful drive or nurse motivation and retention’.  Staff need better career progression, pay and recognition, it found.

Although it said the PRB system has led to ‘pay stability’ for nurses and an ‘independent source of analysis’ taking evidence from stakeholders including employers and trade unions, it also pinpointed issues, including the inability to target additional incentives for hard-to-fill posts.

The Government can also go against PRB recommendations, it warned. For example, the public sector pay cap, imposed between 2010 and 2017, led to real-terms earnings decreases: although nurse wages grew by 13% between 2011 and 2021, they fell by 5% when including inflation.

Compared with nurses’ earnings in Australia, Canada, New Zealand and the United States, UK earnings were lower, the researchers highlighted.

The authors also explained they did not include practice nurses and nursing working for non-NHS employers ‘due to a lack of relevant data’. There is ongoing frustration among practice nurses over variable terms, conditions and pay because their contracts are not standardised nationally.

The research comes after the PRB suggested in July that the nursing profession may have outgrown the AfC system, and questioned whether it ‘accurately reflects the relative job weight of the realities, complexities and development trajectories of nursing as a modern graduate profession’.

Earlier this year, the Government accepted the PRB recommendation of a 3% pay rise for staff on Afc contracts for 2021/22 for England and Wales.