RCN puts forward its case for separate nurse pay spine

The nursing career pathway needs to be “smashed wide open”, the Royal College of Nursing (RCN) has urged as it puts forward its evidence for a separate pay structure for the profession.

The RCN argued that advancements in nursing practice over the last 20 years meant it had “outgrown” Agenda for Change (AfC).

“We are weighted to the bottom of the pay and grading structure, without a clear route through”

Pat Cullen

Nursing therefore needed its own pay framework akin to what the medical profession has, the union said in its submission to the government’s ‘separate pay spine for nursing’ consultation.

The RCN said any new pay structure for nursing should be based on a nursing career framework that progresses through six levels of practice, described as:

  • Supportive (nursing support workers)
  • Assistive (registered nursing associate)
  • Registered nurses
  • Enhanced
  • Advanced
  • Consultant

The college wants to see starting salaries for nursing support workers improve to £27,500 and for newly registered nurses, £35,000.

At present, a nursing support worker on band 2 starts on £22,383 and newly registered nurses start on £28,407, as per the 2023-24 AfC contract in England.

In its evidence to the government, published today, the RCN said: “Our advancements in clinical, leadership and academic terms are not supported by the current AfC structure.

“Far worse, nursing staff find the status quo acts as a structural impediment to their further career progression and development.

“Consequently, it is a barrier to safer levels of staffing and higher standards of patient care.”

It noted how three-quarters of registered nurses were currently on band 5 and 6 – the lowest possible for their role.

One reason for this is because nurses’ progression is limited unless they choose to enter management roles and move away from patient care, added the RCN.

It argued that the problems around career progression, recruitment and retention in nursing were “unique” to the profession and therefore needed a “bespoke solution for nursing”.

It comes as the proposal for a separate nursing pay spine has been widely rejected by other healthcare unions who say that other professions are facing similar issues and that introducing something dedicated for nursing would create divisions.

However, in its submission to the government, the RCN pushed back against the idea that separating nursing out from AfC would cause “unrest” in the workforce, noting how doctors have their own structure but are still able to work well alongside their colleagues from other professions.

“Multi-disciplinary teamworking depends on effective communication, collaboration, and valuing the expertise of each member based on their respective professional roles, regardless of difference in pay or grading mechanisms,” stated the RCN.

“By taking the steps we have identified to ensure a more realistic recognition of nursing skills, knowledge, qualifications and contribution as well as clear career development opportunities, this would provide the positive consequence of facilitating the nursing workforce to work at their full potential meaning they can make an even more effective contribution to multi-disciplinary teamworking notwithstanding the introduction of a separate nursing pay spine.”

The RCN said its proposals would also benefit internationally educated nurses as it would ensure their previous experience was recognised rather than automatically placing them at band 5.

Professor Pat Cullen, RCN general secretary and chief executive, said: “Agenda for Change has lost sight of our value.

“After 20 years, three quarters of our members are on the two lowest pay bands possible for registered nurse professionals.

“We are weighted to the bottom of the pay and grading structure, without a clear route through.”

She added: “I want the career pathway for nursing to be smashed wide open.”

The RCN said the proposal for a separate nurse pay spine was backed by its members.

It said “independently carried out research” found that 59% of RCN members in the NHS in England were supportive of the change, while only 7% disagreed with the concept.

The RCN then carried out a further engagement exercise with its membership on the proposal.

Findings included:

  • 40% reported they had been employed in their band longer than they should have and 27% stated they had been unable to obtain a role at a higher band;
  • 87% disagreed that their current pay band recognised their knowledge, skills, education and current level of responsibility;
  • 77% did not think that the difference between bands was significant enough to recognise the increased experience and requirements between roles on different pay bands.

The government’s consultation on the pay spine proposal closed on 4 April.

The submissions will now be reviewed and the government said it would use the findings “to consider its position in relation to supporting nursing recruitment, retention and professional development in the NHS”.


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