Scottish Government sets out Agenda for Change reforms

It is one of several reforms that has been proposed by the Scottish Government that aims to support workforce recruitment, sustainability and retention.

The AfC review will accompany the 6.5% pay rise for 2023-24 which has been put forward today for nurses working on AfC contracts.

The AfC pay, terms and conditions agreement was introduced in December 2004, designed to deliver more unified approach to terms and conditions for staff governed by the agreement.

However, in recent months, trade unions, employers and the Scottish Government have recognised the need to modernise the system to ensure that it remains fit for purpose.

As a result, in January this year, Scottish health secretary Humza Yousaf committed to reviewing AfC as part of the 2023-24 pay deal.

Today a document of proposals was published, agreed jointly with the Scottish Government and health unions, summarising the proposed changes.

If the deal is accepted by health unions in the country, the Scottish Terms and Conditions Committee (STAC) will be responsible for taking the proposals forward with oversight from Mr Yousaf.

The final AfC review document is set to be prepared no later than September 2023.

It has been agreed that any final proposals put forward as part of this AfC overhaul may require trade unions to consult its members on the changes.

Additionally, the document published today said that should STAC fail to make progress on any of the changes, or reach agreement on the identified issues, this “may result in trade disputes” from health unions.

Unions, including the Royal College of Nursing and Unison, confirmed they will consider these AfC reforms, alongside the 6.5% pay rise, and make a decision about whether to accept the offer for 2023-24.

The document published today sets out the themes for the AfC review and includes the views of both staff side representatives and employers.

Pay and reward

The staff side position was that the pay spine values within the bands needed to be urgently reviewed and revised, and that pay increases between bands needed to be “meaningful”.

The paper noted that gaps between pay bands need “to be large enough” to incentivise AfC staff to seek promotion, which in turn would encourage career progression, particularly for those working at the top of their band.

The staff side warned that the NHS workforce crisis and expectations of staff “to do more with less” has “driven a culture where NHS workers ‘sink or swim’”.

Therefore, “faster and fairer” progression from the bottom to the top of the bands may be needed.

The document added that employers thought that there was value in targeted creation of progression routes in places where staffing is an issue, like critical care and operating theatres, which could reduce reliance on bank or agency staff.

Fair recognition of skills and experience

The staff side also argued that some AfC staff, particularly those in band 5 and band 6, have not had their professional growth recognised or rewarded properly, which has “negatively impacted recruitment and retention”.

It said that one way of fixing this could be through an accelerated career progression model “which will recognise the rapid accumulation of additional skills”.

This ties into the commitments outlined in the 2022-23 pay offer from the Scottish Government, which promised to review band 5 nursing profiles to ensure they reflect the current level of responsibility being undertaken by nurses in the band.

However, in the AfC document, the staff side called for this to be applied more widely to other professions alongside nursing.

It said: “This work is urgent – especially across professions and roles that are currently experiencing recruitment and retention difficulties.”

Employers also saw the value in this approach, stated the document, noting that reviewing current job profiles was “key in ensuring roles are still fit for purpose”.

Supplementary staffing – rates of pay, allowances and overtime

There is an “urgent need” to properly reward any additional hours that are worked, in order to reduce reliance on high-cost agency staff, stated the staff side.

One of the proposals is to move to standard overtime rates for all additional hours worked by substantive NHS employees including during bank shifts.

Additionally, there have been calls for consistency in the grades paid to staff who do offer to undertake extra hours.

The staff side said in the document: “Rates of pay and the way which substantive staff are paid through the bank should be reviewed as the current system acts as a disincentive and encourages staff to seek agency work.”

The document also noted that the rate paid for on-call staff should be reviewed, in recognition of the higher demands on these workers due to service pressures.