Re-evaluating nursing: responding to proposed NHS national role profiles
We won’t stop until nursing staff are paid fairly for the work they do
Your job description says one thing. Your daily to-do list says something entirely different. The result? Your pay band doesn’t reflect the work you do.
If this sounds familiar, you’re not alone. Two thirds of our members tell us that their banding is wrong. For years, we’ve called for revised national nursing role profiles, so that nursing staff are banded correctly from the outset. This should be a given.
The NHS Staff Council’s Job Evaluation Group has already reviewed and redrafted job profiles for bands 2 and 3. Employers must review the work carried out by staff at these bands to make sure they’re working at the correct band. But employers have been slow to act.
In April 2024, the NHS Staff Council’s Job Evaluation Group began consulting on new draft profiles for bands 4, 5 and 6.
Why has this happened?
Nursing has evolved considerably since Agenda for Change was introduced 20 years ago. It’s now a degree-educated, highly skilled, safety-critical role. Registered nurses have significantly developed their clinical practice. They are accountable professionals – working independently to assess, plan, provide, evaluate and lead care. They manage teams and improve the safety and quality of patient care, while promoting health and preventing ill health.
But the recognition and reward for nurses has not kept pace with the advancement of their roles.
Many nurses working in the NHS begin and end their careers on the same pay band. They grow in experience, autonomy, confidence and leadership, but are never valued for the benefits that brings. Meanwhile, midwives and paramedics automatically progress to the next pay band after preceptorship.
Job evaluation is one route to making sure nursing staff whose roles have changed over time are re-evaluated and, where appropriate, placed on a new band. But what happens when the job profiles used in job evaluation are themselves wrong? The job evaluation process falls down.
'I know your value. I'll fight for it to be fairly rewarded'
Our General Secretary and Chief Executive Nicola Ranger says nursing staff must be properly recognised and valued through fair pay.
Our verdict: this reappraisal of our profession doesn’t go far enough
We welcome the opportunity to share our views on the draft profiles. Progress is being made but we still don’t think the profiles accurately reflect the duties of modern nursing at each band.
As the world’s largest nursing trade union and professional body, it’s our responsibility to help fix fundamental problems like this. As the largest health care employer in the UK, NHS pay sets a standard for nursing staff in all settings. We must get this right.
We’ve told the NHS Staff Council’s Job Evaluation Group:
1. The new profiles still don’t fully reflect what nursing staff at each band should be doing
We believe that the new role profiles are inaccurate. They haven’t been tested in the real world and they’re premised on out-of-date job descriptions.
3. All registered nurses should automatically progress from band 5 to band 6 after preceptorship
Professional development of roles is possible under Agenda for Change terms and conditions. Midwives and paramedics rightly benefit from it. Nurses don’t. It’s a shameful injustice.
Registered nurse roles should be developed in line with their equivalent colleagues in midwifery. That means they should be positioned and paid at band 6 after a period of preceptorship (time-limited, structured support to transition them from newly registered nurses to autonomous nursing professionals).
2. Many band 4 nursing staff are being asked to work outside of their role
Staff shortages exacerbated by the pandemic have left many band 4 nursing staff picking up clinical tasks that should be reserved for band 5 nurses.
This is known as nurse substitution and it’s becoming increasingly prevalent. The new profiles should clearly set out the distinction in roles and responsibilities between these bands.
4. The new band 6 profile doesn’t create the adequate step change in responsibility, skills and knowledge
It’s essential the new profiles accurately capture the nuanced progression in responsibilities, skills and knowledge that band 6 nurses have trained for.
These nurses are held to extremely high standards. Their pay should mirror that.
We're committed to designing a pay structure that more appropriately recognises the knowledge and responsibilities of the nursing profession.
We know that NHS pay sets a standard for nursing staff in all settings. So, getting this right for the NHS is important for the independent health and social care sectors too.
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We know campaigning works
So far, we’ve seen nursing staff working at band 2 progress to band 3 with the application of the updated health care support worker job profiles, thanks to our campaigning. And the Scottish government has agreed to review all band 5 nursing roles.
After the current review of bands 4 to 6, the NHS Staff Council’s Job Evaluation Group will turn its attention to bands 7 and beyond.
But we’re demanding so much more.
The time to value and invest in nursing is now
With a new government in Westminster, we’re optimistic that we can fundamentally review job profiles and place every nursing professional in the right band, not just by changing words on a page but by engaging properly with what modern nursing truly is today.
We’ll make clear to the UK Minister for Health and Social Care that this change has the potential to uplift tens of thousands of nursing staff, making a significant difference to their financial wellbeing and job satisfaction. We believe this will ultimately help stem the flow of nursing staff leaving the profession because they’re underpaid and undervalued.
This is what nursing staff deserve, and this is what we demand. We’ll no longer accept this perpetual inequity.
Don't wait to demand fairer pay
We’ll work hard on behalf of all our members to make this happen, but it will take time.
If you work in the NHS in England and feel that your pay band doesn’t reflect the work you do, join our webinar to learn more about kickstarting the job evaluation process.
Where next?
Campaigning for accurate job profiles is just one way we’re working towards fair pay for nursing. See what else we’re doing.
A separate pay spine for nursing
In January, the UK government launched a consultation to explore the creation of a separate pay structure, also known as a pay spine, for nursing staff working for the NHS in England.
Defining nursing, defying misconception
Our definitions of nursing clarify and bring consistency to the levels of our profession. They highlight the complexity involved in nursing, so that nursing staff are better recognised for their expertise.
