The Pharmaceutical Journal
Vol 270 No 7247 p611-612
3 May 2003

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An agenda for change: ensuring NHS pharmacy staff are not undervalued

NHS workers will soon have a completely new pay system. Early implementation begins next month. Clare Bellingham (on the staff of the Journal) finds out what the changes mean for pharmacists and the pharmacy team

Related websites
DoH: Agenda for Change (more)

A complete reform of the way NHS workers are paid is under way. Pharmacists' current grading systems will cease to exist. This might strike fear in the hearts of some pharmacists but the message from experts is not to panic. There are some concerns but overall the new package is being positively received.

The main thrust of "Agenda for change" — as the new pay system is known — is fair pay. In other words, two pharmacists doing identical jobs in different hospitals will be paid exactly the same. But there is an underlying modernisation issue too: a new pay structure will be based on a modernised service.

National implementation of the new system will begin in October 2004. However, 12 early implementation sites, including both hospital and primary care trusts, have been identified to test the system, and they will start next month. It is unlikely that any results from these sites will be known before the end of this year.

The Department of Health says that the new pay system offers:

• Fairer pay

• Harmonised terms and conditions

• Career and pay progression

• A more transparent reward system for staff who work outside normal hours.

Ron Pate, chairman of the staff side of the Pharmaceutical Whitley Council, says: "This is the most significant development on pay for NHS staff since the creation of the Whitley Council. In effect it changes nearly all existing terms and conditions other than maternity/paternity leave and NHS pension arrangements. Its intention is to ensure equal pay for work of equal value. The other key issue is about modernisation of work to facilitate service improvements and delivery in the NHS."

The modernisation agenda should not be forgotten. Health Minister John Hutton recently described "Agenda for change" as a "commitment to reformed working practice in exchange for fairer pay". And Duncan McRobbie, principal clinical pharmacist at Guy's and St Thomas' Hospital, London, comments: "This is a modernisation agenda not just a pay issue. It's about increasing patient access to services."

The new pay system applies to all NHS staff except doctors, dentists and senior managers. This equates to an enormous number of people: over one million people work in the NHS.

Job evaluation

In order to determine basic salary, every NHS job has to be evaluated. This is what is causing the most concern. Mr Pate describes getting the job evaluations right as "critical". Jobs will be evaluated against nationally set and agreed criteria. These are grouped into knowledge and skills, responsibilities and effort. A score will then be calculated and used to determine the pay band the job is assigned. Eight new pay bands have been set, with four mini-grades within the highest band (see Panel). An additional ninth band is probable. Pay will be increased by 10 per cent over the next three years — in other words by 3.225 per cent per year.

The concern among pharmacists is that the job evaluation process will not reflect certain components of their jobs. Mr Pate comments: "I think the job evaluation factors do not take sufficient cognisance of pharmacists' legal responsibilities under the Medicines Act, their contribution and role in patient risk reduction in terms of interventions, and prescribing." One of the problems, he says, is that pharmacists are not always good at selling themselves. They need to reflect their role in the terminology that is required for "Agenda for change". "Too many pharmacists say 'we advise' when what they should be saying is 'we are responsible for' or 'held accountable for'. Clinical pharmacists should describe their roles in terms of delivering packages of care. It's all about using more robust language."

To help with this, the Guild of Healthcare Pharmacists is preparing a document about job evaluation banding indicators that will take account of "Agenda for Change" as far as is reasonably practicable and will propose a model for pharmacy career progression.

Few jobs have been evaluated to date. And the one published pharmacist evaluation was put in the wrong pay band because the job evaluation score was added up incorrectly. However, Mr Pate views this lack of evaluation as a good thing. "It allows us to be involved in the evaluations from an informed point of view," he says.

The guild strategy is to use Guy's and St Thomas' Hospital — which is an early implementation site — to profile a wide range of hospital jobs. The job evaluations obtained there will then be tested at other early implementation sites to identify any gaps. It is hoped that at least 80 per cent of hospital jobs will be covered by the work undertaken at Guy's and St Thomas'. Once the profiles have been drawn up, they will be subject to verification by the guild.

"We aim to get newly qualified pharmacists into band 6," says Mr Pate. And he hopes some chief pharmacists will be in band 9 rather than the current indication that they will be in 8c.

Meanwhile, Mr McRobbie says that he is hopeful that "Agenda for change" will deliver a remuneration package that will mean that salaries in hospital pharmacy can compete with those in community pharmacy.

Salary enhancements

The job evaluation banding gives the basic pay level. But that is not the end of the story. On top of the baseline salary are a number of enhancements, some of which will be agreed nationally and others locally.

Additional payments will be made for:

• Work done outside normal working hours

• Being on call

• Working in high cost areas (eg, London)

• Posts where recruitment and retention of staff is difficult

Mr Pate says that these are relatively complex arrangements around which the guild is preparing some explanatory papers covering what they mean in practical terms.

In terms of working hours, the eventual aim is for all NHS staff to be standardised to a working week of 37.5 hours. At the moment some staff work longer hours than this and some shorter. Pharmacists fall into the first category with a current standard week of 39 hours. Mr McRobbie comments: "If working hours for pharmacists are reduced to 37.5 hours a week it will have an impact on staffing levels. For every 25 pharmacists, you will need another one whole-time equivalent pharmacist."

This could be a particular problem because of the current pharmacist shortages. Some pharmacists will find themselves working overtime, particularly because a driver for "Agenda for change" is modernising services — and Mr McRobbie says that this means extending services according to public demand. However, he points out that although pharmacists work overtime now, under the new pay system, they will be paid for overtime. "At the moment people who work 45 rather than 39-hour weeks are not recompensed — it is just done on goodwill," he says. Mr McRobbie adds that there will be a need to balance this excess work with the working time directive.

On top of working the normal contracted hours each week, payments will be made for working overtime at a single harmonised rate of time-and-a-half for staff in pay bands 1–7. No provision for overtime payment has been made for more senior staff in pay band 8.

In addition, supplements will be paid to people who work "unsocial hours". Normal working hours for staff in pay bands 1–7 are considered to be 7am–7pm Monday to Friday. For staff in pay band 8, normal working hours are extended to 10pm on Monday to Friday and 9am–1pm on Saturdays and Sundays. Staff working outside these hours will receive unsocial hours supplements.

Some confusion exists over exactly how these payments will be made. Set payments have been agreed for staff who regularly work more than five hours of unsocial hours a week; fewer than five hours will be subject to local agreement. The fact that unsocial hours payments are pensionable, and will be paid during annual leave, offers pay stability.

Staff shortages will be recognised through additional recruitment and retention premiums. They will be paid to particular posts where recruitment and retention of staff is hard. For widespread problems the fee will be agreed nationally. Mr Pate says: "Pharmacists are one of the staff groups listed to receive a national recruitment and retention supplement. At the moment, we don't know how much it will be but we do know that it will be a national payment that everyone will receive."

So if "Agenda for change" is introduced, is there a danger people will be paid less? Initially the answer is no because people will have protected pay. But in the long term the answer is less clear. And pay protection only guarantees the current salary. "Agenda for change" aims to iron out any inequalities in pay so it is possible that if someone is currently graded too high that their salary will be frozen.

Future development

"Agenda for change" also aims to promote career development with the introduction of "personal development plans". To support career progression, a new "knowledge and skills framework" is being introduced. However, it will not be implemented until October 2006. This initiative is a good thing, according to Mr Pate. "Career progression will be a right and training must be given in order to allow this right to progress," he highlights. "It will be a key component of this that every postholder receives training: that training will be a contractual right, not a privilege."

In the meantime, Mr Pate's advice to pharmacists is to wait for Guy's and St Thomas' Hospital to go through the early implementation stage before acting themselves. "Pharmacists should be thinking about their job descriptions in the context of 'Agenda for change'. But they would be well advised to wait until we have issued more guidance following our experience at the early implementation sites before moving forward too quickly locally."

Nurses have recently voted to accept "Agenda for change". Ballots by the Royal College of Nursing and Royal College of Midwives in mid-April found that roughly nine out of 10 members supported the new pay deal.

Pharmacists will get their chance to vote soon. However, pharmacists only get a vote if they are members of Amicus (the trade union for skilled and professional people). Pharmacists gain membership of Amicus through joining the Guild of Healthcare Pharmacists so it is perhaps not surprising that the guild has experienced an increase in numbers since "Agenda for change" was published. Further details about the Guild and updates on "Agenda for change" will be published on the Guild's website (www.ghp.org.uk).

Amicus will hold two ballots. The first, later this month or June, will be about deciding whether or not to agree in principle to "Agenda for change" such that early implementation can proceed. If this ballot is accepted then the 10 per cent pay deal over the next three years will also be implemented.

The second stage will be about full implementation of "Agenda for change" based on experience at the early implementation sites and will not be held until next year. If members vote in favour of the pay deal this summer then the Pharmaceutical Whitley Council will have no further role. All Whitley Councils will be replaced by the NHS Staff Council. Its job will be to make national decisions on pay and terms and conditions.

The changes are enormous, not just for pharmacists and pharmacy staff but for everyone who works within the NHS. But those working at the heart of the changes are telling pharmacists not to panic. Mr McRobbie concludes: "This is a big opportunity for the health service and for pharmacy in particular. The last job grading was in the 1980s: pharmacy has come a long way since then and so have pharmacists' jobs."

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