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The system of pay for nurses is unfair and divisive


The recent pay award excludes nurses working in primary care and also highlights the shortcomings of Agenda for Change. Is it now time to discuss a fairer system, asks Marilyn Eveleigh 

By the end of June, NHS nurses in England saw their pay packets boosted by a one-off Covid-recovery bonus of at least £1,890 [minimum for Band 5] and the 5% pay increase for 2023/4 backdated to April.  This comes as part of the government’s funding settlement – still being disputed by some unions – awarded to NHS staff on Agenda for Change (AfC) contracts, following the nurses’ strike action. 

The pay uplift was welcomed and deserved, yet I’ll wager few nurses in general practice or care homes will have received this boost. Meanwhile, concerns have also been raised that many nurses delivering NHS care through social enterprises and community interest companies will not receive the pay increase. The Royal College of Nursing has suggested that those working in NHS organisations as bank staff have also been left out.  

The funding for the one-off payment part of the award only applies to staff working in statutory NHS organisations under AfC terms and conditions, where the government is the employer. Funding has not been allocated to non-statutory NHS providers, even if their staff are on AfC contracts; any one-off pay increase for these nurses must come from existing service budgets. This includes GPNs, who are employed by GP independent contractors to provide NHS services. For those in favour of GPNs being on AfC contracts, this loophole would still have excluded them from the new funding.

This format is divisive – damaging to staff, providers and a public that expects a joined-up NHS. Media headlines on the strike settlement ignored the anomaly of funding one group and excluding another despite both delivering NHS services. Nurses did not strike and lose pay just for the NHS, but for the wider profession, regardless of employer or role.   

The RCN was clear members were striking for action over recruitment and retention, factors contributing to the depletion and exhaustion of the workforce. It has a strong voice, representing the largest, most trusted healthcare profession, but one that has 40,000 unfilled posts. The college had separate government talks over an additional AfC spine for nurses to reflect the change in responsibilities since AfC was introduced in 2004. This was an honourable pursuit but, perhaps unsurprisingly, was not backed by other healthcare unions.  

It’s one thing for the government to agree a pay settlement but quite another to fully fund it. Giving the public unrealistic expectations of a supported and sufficient nursing workforce – and safer services as a consequence – through this divisive pay settlement speaks of ministerial naivety at best and duplicity at worst. 

The award serves to highlight how fragmented the NHS has become and the risk of creating second-class service providers, especially in community settings, with AfC no longer reflecting nursing skills and responsibilities. Nursing was not made a special case in the dispute, when four in 10 healthcare vacancies are for nurses, it should be. 

This is a topic for more discussion. Is it time to replace Agenda for Change… or perhaps the current Secretary of State for Health and Social Care?  

Marilyn Eveleigh is a nurse adviser and independent trainer in East Sussex