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Pay and Conditions

Agenda for Change was a programme of NHS reform that was implemented between December 2004 and December 2006. The objective of the Agenda for Change programme was to reform and standardise the pay and conditions of around 1.1 million staff in the UK NHS (except doctors and dentists and some very senior managers).

Agenda for Change reformed three aspects of the NHS:

  • Job evaluation.
  • Terms and conditions.
  • Career and pay progression

Job Evaluation

The purpose of job evaluation was to compare all of the different jobs in the NHS fairly. Job evaluation is based on equal pay legislation – equal pay for work of equal value. It enabled NHS staff to move from the different pay systems and spines that were in existence in 2004 on to a new integrated pay system.

The Agenda for Change website has an extensive section of job profiles for all disciplines and all levels. These inform bandings for jobs and the subsequent development of job descriptions. There are several for public health/health and wellbeing roles.

Terms and Conditions

Agenda for Change also harmonised the terms and conditions that existed since the NHS was established. These included, standard hours of working, overtime rates and annual leave. The terms and conditions have helped to ensure comparability and fairness for all staff.

Further Information

The full text of the final Agenda for Change agreement between the UK Health Departments, the NHS Confederation, and the Unions and Professional Bodies can be found here.

For more information about Agenda for Change, see:

  • England
  • Northern Ireland 
  • Scotland 
  •  Wales  


Career and Pay Progression

As well as supporting learning, the KSF (Knowledge and Skills Framework) is linked to pay progression.

In most years pay progression takes the form of an annual increase in pay from one pay point in a pay band to the next unless there are serious concerns about how the individual is performing in the current role. At two defined points or gateways in each pay band, access to higher pay points depends on demonstrating the application of knowledge and skills at a specific level.

The following are the two gateway points:

Foundation Gateway – This takes place 12 months after you have joined a payband no matter at what point you start on it. It checks that you are on track in developing the required knowledge and skills and is therefore associated with the Foundation KSF Outline for that post.

Second Gateway – This checks that you are applying the knowledge and skills that are needed and should be applied by anyone fully developed in that post. It is therefore associated with the Full KSF Outline for the post. The second gateway takes place at a fixed point towards the top of the pay band. Having gone through the second gateway, you will progress to the top of the pay band provided you continue to apply the knowledge and skills contained within the Full KSF Outline for that post.

Staff are expected to progress up the pay increments and pay bands as they continue to learn and develop with the support of their manager. It is only at gateways, or if concerns have been raised about serious weaknesses in applying skills and knowledge in the current role, that the outcome of a PDPR might lead to deferment of pay progression.

There must always be formal notification of any concern from your manager about any weakness, and an action plan must be drawn up to try to remedy the problem. Deferment will last until any problems are resolved.

The Agenda for Change pay circulars are published on the NHS Employers' website.

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