Nurses are calling for the government to overhaul NHS pay structures or face a “potentially irreversible” workforce crisis.
In its response to the government’s consultation on a separate pay structure for nursing staff, which closed last week, the Royal College of Nursing (RCN) said that nurses continually feel undervalued, with many unable to progress up the current pay spine despite gaining knowledge, experience and skills in their roles.
The union claimed that three-quarters of all registered NHS nurses in England are in bands 5 and 6, the lowest pay bands under the current Agenda for Change (AfC) structure. It said that many leave the profession without progressing into another pay band.
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The RCN believes a separate nursing pay spine would significantly improve career progression and professional development for nurses.
Its submission to the government highlighted the findings of its recent employment survey, which revealed that feeling undervalued was the most common reason why NHS nurses wanted to leave their jobs, cited by 70% of respondents.
Nearly a third told the RCN they were considering leaving their jobs. It said many were doing so in the first five years of their career.
Two-thirds said their current pay band was inappropriate or very inappropriate, while 87% disagreed that their pay band recognised their knowledge, skills, education and level of responsibility.
In 2023, just 22.1% of nurses told the union that they felt their pay band was appropriate. In 2015 this figure was 43.7%.
Forty per cent said they had been on that band for longer than they should have, and 27% said they had been unable to obtain a role at a higher band.
One nurse told the union: “I manage complexity and acuity in a high-stress environment, I am a highly skilled
nurse with 14 years’ experience, DipHE, BSc and now MSc. In any other profession my salary would track my extended skills – this simply hasn’t happened. I get paid the same grade as a one-year post midwife or other HCP. [healthcare professional]”
RCN chief executive Professor Pat Cullen said: “Nursing is not a calling. Or a vocation. Or ‘women’s work’. We are a profession. We are experts. We are leaders. There is an art and a science to what we do.”
She said that AfC, the pay structure for all NHS England staff except doctors, dentists and very senior managers, has lost sight of nurses’ value, and has led to nurses being “weighted to the bottom of the pay and grading structure, without a clear route through”.
“I want the career pathway for nursing to be smashed wide open. Whether you take on management roles or not, your knowledge and excellence as a nursing professional has to be recognised. Patients want the experienced nurse as well as the new joiner involved in their care and treatment,” Cullen added.
The RCN said that the AfC structure was “no longer reliable” in accordance with the Equality Act 2010, meaning that “AfC no longer provides equal pay for work of equal value”.
Its consultation response says: “Underinvestment in the nursing workforce has led to a situation whereby the practice of nursing has advanced since the introduction of AfC, yet neither the pay structure nor workforce development has changed to reflect this.
“Staff are also working at higher levels of responsibility and risk due to changes in roles and staffing shortages, yet within AfC neither are rewarded through higher pay or by delivering career progression to a higher grade. Furthermore, there is no skill mix analysis in respect of the nursing workforce. Agenda for Change is a ‘quantity, not quality’ structure, particularly in respect of nursing.”
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