The current state of play with NHS Pay and Terms and Conditions

In 2018 RCM members in England, Scotland and Wales voted to accept a three year (2018-2021) framework agreement which provided pay awards for those at the top of their band. For those not at the top of their band, there will be increases due to a combination of incremental progression and structural reform.

There are separate framework agreements in England, Scotland and Wales - you can view the RCM media releases for England, Scotland and Wales. The proposals in England were agreed formally at the NHS Staff Council (13 of the 14 NHS Trade Unions voted to accept) on 27 June 2018 with consultations following in Scotland and Wales.

The agreement is fully funded by the government in Westminster and does not come out of existing NHS funding. For members in Wales, Scotland and Northern Ireland, budgets go through the Barnett formula.

Trade unions have argued for a number of years that changes to Agenda for Change are necessary in order to modernise and make the pay system fairer. In negotiating the framework, unions have successfully opposed moves to diminish the value of unsocial hours. Therefore, current pay rates for unsocial hours are protected. There will be no performance-related pay. There are no changes to annual leave entitlement.

Key aspects of the frameworks mean:

  • the removal of overlaps between bands to increase starting and promotion pay
  • decreasing the number of incremental pay points in bands to make it quicker to reach the full rate for the role

The changes don’t make up for 8 years of pay restraint but they mark the beginning of trade unions once again being able to negotiate for fair pay on behalf of members.

Northern Ireland

The Department of Health’s position is that only a Minister can authorise pay realignment and/or set a new public sector pay policy that will allow for full funding of the Agenda for Change refresh as per the other countries. The RCM and other health and social care trade unions have advocated that the Agenda for Change refresh does not need ministerial approval. We remain committed to achieving pay parity with the other countries and negotiations are ongoing.

On 1 May 2019 the trade unions including the RCM published a statement committing to a series of meetings over the next two months with the Department of Health and employers to try and reach a positive outcome for our members. On 19 September 2019 the joint trade unions were unable to agree a business case put forward by the Department and employers. You can see the full statement here. The RCM will now follow our internal processes to plan a way forward and engage with members in Northern Ireland.

To find out exactly what the changes mean for you please see below resources:

We've also produced guidance to help members understand the pay charts in the framework agreement

April 1, 2019 marks the start of the second year of the Framework Agreement. The NHS Staff Council have produced some guidance to help you understand the second year.

The NHS Staff Council has now agreed Enhanced Shared Parental Leave and Child Bereavement Leave sections of the Agenda for Change handbook (England and Wales) effective 1 April 2019 as part of the framework agreement. Guidance documents to support staff to understand the handbook additions have now been published Occupational SPL Child bereavement leave.

If there are any issues or queries please contact Alice Sorby, Employment Relations Advisor on

Various sub-groups of the NHS Staff Council in England have been formed to take forward the non-pay elements of the framework in England. These are looking at apprenticeships, progression, bank and agency, leave and equality impact. We will update this page when we have more information on this ongoing work.

The NHS Staff Council has now agreed Enhanced Shared Parental Leave and Child Bereavement Leave sections of the Agenda for Change handbook (England and Wales) effective 1 April 2019 as part of the framework agreement. 

Pay progression for new starters and promoted staff from 01 April 2019 will be based on:

  1. the appraisal process having been completed within the last 12 months and outcomes being in line with the organisation’s standards
  2. there is no formal capability process in place
  3. there is no formal disciplinary action live on the staff member’s record
  4. statutory and/or mandatory training has been completed
  5. for line managers only – appraisals have been competed for all their staff as required

Please note that for newly qualified midwives, band 5-6 accelerated progression remains unchanged.

The NHS Staff Council will be monitoring pay progression and re-earnable pay to ensure there is no equality impact. Staff are expected to progress subject to meeting the above conditions. Funding calculations have been made on the basis that everyone who is able to progress, will.

You can access further information by downloading the publication New pay progression system for England
- A guide for staff side representatives or visit the NHS Employers website.

Agenda for Change

Agenda for Change is the nationally agreed UK-wide package of pay, terms and conditions for all NHS staff other than very senior managers and medical staff. You can access the Agenda for Change Handbook through the NHS Employers website and on the MSG website for those in Scotland

In 2004, pay, terms and conditions for NHS staff were harmonised into one package, ‘Agenda for Change’. The NHS Staff Council (and the sub-groups of the staff council) negotiate any amendments to Agenda for Change.

In 2013, some changes to terms and conditions were agreed in England, so there are some differences between staff in England and those in Scotland, Wales and Northern Ireland.

The RCM is committed to nationally agreed terms and conditions and believe that Agenda for Change is the most fair, transparent and equitable system. Agenda for Change is supported by a robust job evaluation scheme that is fundamentally based on equal pay for equal work.

The King’s Fund wrote a report in 2007, which concluded that: "Achieving equal pay for jobs of equal value was one of the key objectives of Agenda for Change. The trust managers were generally supportive of the more standardised working hours and job-evaluation-based pay as providing a more transparent and fairer pay system."

Please contact your workplace representative if you have any queries about your terms and conditions.

The RCM believes that national pay bargaining is the best system for the NHS and for midwives and maternity support workers. Nationally negotiated pay ensures a fair and transparent system and Agenda for Change is underpinned by a job evaluation system that is based on equal pay for work of equal value.

If we moved to locally or regionally negotiated pay, it would significantly reduce pay levels, it would weaken our bargaining position, and could lead to a fragmented system that is not transparent, fair or based on equal pay for work of equal value. This is fundamentally important when over 99% of midwives are female and nearly 60% of midwives work part time.

Therefore, local staff sides must not agree to any changes that move away from the national agreement. RCM Workplace Reps should try to attend your JNCC meeting so you are aware of any attacks on Agenda for Change.

If your trust attempts to move away from Agenda for Change please make sure you:

  • inform your Regional Officer immediately and send them any documents about the proposals;
  • do not agree to any change; and
  • inform members that they must not agree to any change

Once we are made aware of the threat, we will send communications to the employer on behalf of RCM members and send communications to the members. The sooner we know about a threat, the easier it is to fight it, so please make sure that you inform us immediately.

Evidence to the Pay Review Body