Agenda for Change

English National Health Service grading and pay system

Agenda for Change (AfC) is the current National Health Service (NHS) grading and pay system for NHS staff, with the exception of doctors, dentists, apprentices and some senior managers. It covers more than 1 million people and harmonises their pay scales and career progression arrangements across traditionally separate pay groups, in the most radical change since the NHS was founded. Agenda for Change came into operation on 1 December 2004, following agreement between the unions, employers and governments involved.

The AfC system allocates posts to set pay bands by giving consideration to aspects of the job, such as the skills involved, under an NHS Job Evaluation Scheme. There are nine numbered pay bands subdivided into points, similar to the old alphabetic Whitley Council 'grades' pay scales. A set of national job profiles has been agreed to assist in the process of matching posts to pay bands. All staff will either be matched to a national job profile, or their job will be evaluated locally. In theory, AfC is designed to evaluate the job rather than the person in it, and to ensure equity between similar posts in different areas. In reality it has been implemented differently in different places, and some posts have been graded very differently from similar jobs elsewhere, despite the supposedly tighter definitions. Around 5% of staff appealed their initial banding, but again the appeals process varies from site to site. Current indications suggest that lower bandings are being used in London and Scotland than elsewhere in the country. Under AfC, all staff have annual development reviews against the NHS Knowledge and Skills Framework (KSF). Normal pay progression is one point a year, but pay progression at specified 'gateway' points in each pay band depend on how the individual matches the KSF outline for their post. Progression onto a different band has become very difficult, as the post would need to have changed substantially in order to be re graded (even if the person in the post has developed and become more experienced or taken on more responsibilities this would not be seen as a good enough reason to re band a post). The full implementation of KSF has been slow.

The Knowledge and Skills Framework (KSF) is a competence framework to support personal development and career progression within the NHS in the United Kingdom. It applies to all staff except board members, doctors and dentists, as they did not come under Agenda for Change. The Agenda for Change national agreement includes a commitment to introduce a system of annual development reviews and to create lifelong learning development opportunities. Staff have their own Personal Development Plan, developed jointly in discussion with their manager or reviewer. Employers and staff have called for a simplified KSF that is easier to use. In response, the NHS Staff Council has developed a simplified KSF that gives employers more flexibility and can be tailored to meet local needs.

Agenda for Change, like its predecessors since at least 1974, includes additional payments, called the high cost area supplement, intended to relate to the additional costs, particularly housing, of living in London. There are three separate bands: Inner London, Outer London and London Fringe. The Inner London rate in 2017 was 20% of salary, with a minimum payment of £4,200 and a maximum payment of £6,469). Outer London rate was 15% of salary and London Fringe 5%. In 2018 the Chief Executive of Kingston Hospital NHS Foundation Trust called for a flat rate “weighting system” across Greater London in September 2018, saying that living in Richmond was no cheaper than living in Islington and that cost of living was a leading contributor to their staff turnover.