Agenda for Change and equal pay

Introduction of Agenda for Change (AfC), the importance of equal pay and key changes to AfC terms and conditions since 2004.

14 March 2024

The introduction of Agenda for Change (AfC) in 2004 was the biggest reform of NHS pay since the NHS began and provided a single pay structure for all NHS staff except doctors, dentists and very senior managers (VSMs).  

The aim was to harmonise and modernise pay and conditions, terms of employment and HR policies across the NHS. The core principles of AfC were that jobs would be evaluated using a standard set of criteria and pay bands which would ensure consistent and equal working conditions and pay across a range of skills and jobs. AfC also recognised pay progression, with increments which linked to career progression and length of service. AfC introduced other important changes to wider terms and conditions of service for NHS staff, which included contractual arrangements for annual leave and sick pay. The introduction of these terms and conditions provided greater flexibility and support for staff.  

Conversations about a new pay system began in 1999, however a long period of talks and negotiations took place before a final agreement and proposal was published. Implementation began with a piloting process in 12 early implementer sites, followed by a national roll out. By 2006, more than 99 per cent of staff in England were on AfC pay arrangements. 

Additional allowances paid under the Whitley system were also harmonised as part of AfC. The previous London weighting and fringe allowances were replaced by high cost area supplement (HCAS), and recruitment and retention premium (RRP) was introduced to support organisations to recruit to hard to fill posts. For further information, read The King's Fund Realising the Benefits? report. 

Key AfC changes since 2004 

Since its introduction in 2004, Agenda for Change has seen a number of changes. 

The importance of equal pay

Equal pay has been a statutory entitlement since 1970, when the Equal Pay Act came into force. A primary aim of the introduction of AfC was to address the pay inequality which had become apparent over time, by ensuring that pay in the NHS was consistent with the requirements of equal pay law. To ensure that equal pay for work of equal value was delivered as part of the AfC reforms, the pay system was underpinned by a Job Evaluation Scheme (JES). 

In 2008, a legal challenge was brought which tested whether AfC was robust in terms of equal pay. Hartley and others vs Northumbria Healthcare NHS Foundation Trust and others claimed that AfC did not withhold a valid JES as thousands of predominantly male technical staff were placed in higher pay bands during its initial job evaluation process. The tribunal rejected these claims, finding that AfC and its national job evaluation scheme complies fully with anti-discrimination legislation. 

This was, and still remains important for a number of reasons:  

  • The implementation of the JES helped to reduce the risk of legal challenges relating to equal pay. The cost of settling equal pay claims is substantial, so a pay system that is fair and transparent provides a defence to these types of claims. Whilst the scheme was designed to be equal pay compliant, it is important for employers to understand that claims can still be brought against organisations locally if it is believed that the scheme has not been implemented correctly, leading to equal pay issues. 
  • AfC introduced clear pay bands based on job roles and responsibilities, reducing ambiguity and subjectivity in pay decisions. 
  • Standardising pay scales across different roles and professions meant that NHS staff employed on AfC terms and conditions received fair compensation for the work they undertook, irrespective of gender, ethnicity, or any protected factors. 
  • AfC addressed historical discrepancies in pay between traditionally male dominated and female dominated roles within the NHS, therefore closing the gender pay gap in the healthcare sector. 

The NHS Employers website has a dedicated job evaluation section which includes more information about its history and implementation. We have also developed an animation to explain more about the NHS Job Evaluation Scheme, which you can share in your organisations to help improve overall understanding of this national scheme.

Arrowing pointing upwards

Back to the pay education hub.

If you have any questions, please email the reward team.