Agenda for Change

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.