Hospital Pharmacist
Vol 10 No 3 p90
March 2003

(An) agenda for change

By Robert McArtney, BPharm, MRPharmS, and Antony West, BPharm, MRPharmS

The title of this piece has two meanings to reflect two aspects of the proposals to modernise the NHS pay system. The first, 'Agenda for change' (AfC) is what the process has been called for almost four years of discussion and negotiation. More importantly, and this is from a Government perspective, this is "an agenda for change". An investment is being made to provide further impetus to the overall NHS modernisation agenda, not simply to provide those who work in the NHS with more pay.

So what will it mean for pharmacy staff working within the NHS? This question still has few, if any, clear answers available so far.

The first important point to make clear is that this "deal" now has the status of a "proposed agreement". There still has to be consultation with the members of all the trade unions involved, probably next month, and it is worth stressing that if you are not a member you will not get the opportunity to vote. The second point relates to the 'Job evaluation handbook' as this is intended to ensure that we are all in a position to answer that important question: "What does it mean for me?".

Job evaluation is an entirely new scheme that will "weight" a job. Details of the scheme can be found on the Guild of Healthcare Pharmacists' website (www.ghp.org.uk) as well as from the Department of Health. One word of warning, however: there is still a key document "missing" from the pack at the time of writing. This is the 'Knowledge and skills framework', the system that will underpin career progression within the NHS.

It will be the application of the job evaluation process to a range of benchmarked jobs that will determine where jobs "fit" on the new pay spine. The devil is then in the detail. Will the profiles of the benchmarked jobs make any sense? Does the score look right? It has been clear for some time that the number and range of jobs required to make the new structures comprehensible have been underestimated ... in fact the guild has raised this point many times within the union, and more recently, when the President met the junior Health Minister, David Lammy. We have also raised a number of other concerns and dissatisfaction with the outcome of the negotiations to date. This is where the early implementers come in as they are the pioneers who will help the NHS find a way through the process.

So, what are the main issues for pharmacists that can be teased out of the announcements and documents available so far?

• A reduction in working hours from 39 to 37.5 hours

• A clearer pay progression, based on knowledge and skills, and a contractual right to continuing professional development

• An end to automatic progression through a pay spine using so-called "gateways" at the start and end of each band

• More pay for those working in identified "high cost" geographical areas. While the initial focus is London, such allowances are not limited to the capital

• Recruitment and retention premia, especially where there are external labour market pressures. This will be a key area for the guild to negotiate on as there are differing applications of this

• New arrangements to deal with commitments outside normal working hours, such as overtime and emergency duties

• Harmonisation of annual leave entitlement

• New negotiating machinery to replace all the Whitley Councils

• No "big bang" as there will be so called early implementers, already announced, to help the NHS feel its way into the new system

• Pharmacists and their associated support staff join the pay review body

• Substantial protection clauses

• In addition to the implementation of AfC, a pay deal worth 10 per cent over the next three years, 3.225 per cent for the year 2003/04

There are some significant difficulties that arise mainly because the largest staff group in the NHS, the nurses, really have to be the pivotal point for any system that is intended to grasp the thorny problem of "equal pay". The negotiating team within the guild, currently the staff side of the Pharmaceutical Whitley Council, was optimistic that a deal could be done within AfC that offered a fair reward structure and a clearer career progression for pharmacists. This is, however, looking evermore problematic and is unlikely to be straightforward, especially given what we now know about the benchmarking and job profiling process to date, and some of the conditions that surround the use of the "recruitment and retention premium". The most important hurdles are:

• All newly qualified professional staff are intended to start in Band 5 (This will not be acceptable for junior grade pharmacists.)

• Most pharmacists receive the emergency duty commitment allowance (EDC) (This does not translate particularly well to AfC.)

• There are a significant number of "local agreements" for unsocial hours and overtime that are significantly better than the terms within AfC

• The profiles we have seen to date do not reflect the important role pharmacists, and pharmacy technicians, have in managing the risk associated with medicines

Of these, the last is perhaps the easiest to deal with as often pharmacists are not good at describing the responsibilities and accountabilities of their jobs. We should be able to draw on the experiences of pharmacists in those trusts that developed their own pay structures based on other job evaluation schemes and add this to the work being done by the early implementers. Issues around EDC and local agreements can be protected but significant changes to the final version of the proposed AfC agreement means that such protection is relatively short term, four years. The most intractable problem is that of salaries for pharmacists in the higher pay bands. The recruitment and retention premia must be right. For the moment, our belief is that there should be a nationally agreed rate that needs to be a percentage not a fixed sum. Incidentally, we have similar concerns in relation to our pharmacy technician colleagues as it is not yet clear where the evaluation of their jobs will leave them placed.

With the early implementers scheduled to start the process on 1 June, followed by everyone else in October 2004, there is a lot of work to do. The ballot is not, of course, a foregone conclusion, as the Government found out with the consultants! What is clear is that the NHS must remain competitive if it is going to recruit in the current labour market. It simply cannot afford to alienate even a relatively small group of staff for fear of destabilising services at a time when "targets" are everything. The key will be working with the early implementers.