NHS pay structure to be overhauled

Pay systems for staff in the NHS across the United Kingdom are to change radically under reforms initiated by the government last week, though it anticipates a long and difficult process of negotiation.

According to a proposal document, Agenda for Change, hundreds of pay scales and grades coveringone million NHS employees will be merged into three national pay spines: one for doctors and dentists; one for nursing staff; and one for the rest.

A pay spine is a ladder of pay points. Staff would move up the pay spines as their skills and competence grow, rather than by automatic increments. Employers would decide locally where to put each post on the pay spine, subject to national ceilings.

National pay thresholds would be set for key career stages, such as a newly qualified professional or an expert practitioner, ensuring guaranteed minimum pay levels. But the document states that the NHS has too rigid a structure of increments based only on the calendar.

For doctors, a new consultants' contract will be designed to ensure that rewards go to those who contribute most to the NHS. In place of a contract based on sessions it is proposed to base it on agreed responsibilities and clinical outcomes.

Not only would doctors be eligible for performance related pay above basic earnings, but also bonuses as rewards for “effective teams”.

Discretionary points and distinction awards will reward consultants who make the biggest contribution to the NHS. The pay review bodies for doctors, dentists, nurses, and allied groups will remain.

For 300000 other staff a single pay forum will replace 11 separate Whitley negotiating councils.

The health secretary, Frank Dobson, argues that the current pay system is out of date. It holdsback the staff and restricts their careers. There is not enough incentive to take on extra responsibility or develop extra skills, he states.

At present staff are more defined by their titles than by what they do for patients.