NHS Employers' evidence to the pay review bodies 2025/26

NHS PRB key messages

Access the NHS PRB evidence. 

• Employers welcome the ambition and vision the government has set out in its response to Lord Darzi’s diagnosis. They share the commitment to build a health and social care system fit for the future around three clear priorities on the future delivery of care and services. 
• The government’s planned agenda to ‘make work pay’ places a new emphasis on enhancing workers’ rights, with the aims to create a fairer and more equitable working environment for everyone. While many of the changes proposed by the government to take effect in 2026 are already part of NHS employment in whole or large part, there are several areas where employers across the NHS will need to think through the implications due to the minimum standards changes being proposed for all workers across the UK. 
• Employers want to see that the ten-year plan and any refresh of the LTWP is matched with and supported by sustainable funding that builds on the investment to stabilise NHS finances. 

• Employers share their concerns around the levels of workforce-related cost savings they are having to make to contribute to overall financial saving plans. Employers do not see this as being a sustainable set of measures to be operating in, in light of their obligation to provide safe and effective care. 

• Industrial action has seen significant disruption to services, with waiting lists growing for access to services and care, and additional cost pressures for employers across the NHS. Relationships across the system and with trade unions have been put under enormous strain and pressure. Resuming normal partnership working relationships will require significant and continued efforts from all parties. 

• There has been recognition of efforts made to return the pay setting process back to an April implementation date. As this will not be completed in time for April 2025, we strongly recommend that this progress continues to be prioritised and the timetable in relation to the pay-setting process is adjusted by the government as early as possible, thereby enabling a return to prompt implementation and more timely payment of awards. 

• Challenges continue to be felt by employers across the NHS because of the interaction with the National Living Wage (NLW), salary sacrifice and net deduction schemes. This has resulted in organisations having no option but to prevent those staff, usually the lowest-earning staff, from accessing such an important part of the NHS total reward package which is having a huge impact on morale and motivation. 

• Employers express continued concerned about the lack of ability to monitor job evaluation compliance with operational requirements or banding outcomes at either an integrated care system (ICS), regional or national level.  

• Apprenticeships across the NHS continue to grow, with low dropout rates and high retention rates post-training, Employers believe a lack of post-training substantive posts counters the grow your own approach, and the appetite to offer apprenticeships. The current recruitment freezes faced by trusts have halted apprenticeship onboarding for 2024/25. 

DDRB key messages

Access the DDRB evidence. 

• Employers welcome the pay deals ending industrial action but are concerned that ongoing dissatisfaction and differing pay settlements could lead to further industrial action, hindering progress in rebuilding relationships, financial stability, and reducing waiting lists.
• We will support employers by implementing the doctors and dentists in training agreed pay deal with the British Medical Association (BMA), which includes pay increases for 2023/24 and 2024/25, collaborate with Department of Health and Social Care (DHSC) on training reforms, renegotiate exception reporting for fair compensation, and explore issues with flexible pay premia (FPPs) in certain specialties.
• We will support employers in implementing the SAS agreed pay deal with the BMA, addressing SAS contract imbalances, supporting career progression, and promoting the SAS advocate role to improve recruitment, retention, and wellbeing.
• We continue to support employers with the consultant pay deal agreed with the BMA and Hospital Consultants and Specialists Association (HCSA), including consultant pay scale reforms, pay progression, and shared parental leave. We will work to resolve Local Clinical Excellence Awards (LCEA) issues, focus on future contract reform, and re-establish joint negotiating committees.
• Employers face challenges recruiting entry-level primary care dentists, leading to prolonged vacancies. The LTWP is exploring measures to ensure new dentists deliver NHS care, which may require pay and employment terms changes. Addressing abuse towards salaried dentists is crucial for their wellbeing and retention.
• The rise in locally employed doctors (LEDs) due to less-than-full-time (LTFT) posts, training gaps, and workload pressures highlights the need for better education and career development support to improve retention, patient safety, and training programmes.
• Employers welcome the government's commitment to introduce changes to the operation of the DDRB process and their ambition to return to a timelier annual pay process. Making prompt payment of pay award changes at the beginning of the financial year would significantly help employers' budgetary and financial management processes.