Re-evaluating nursing: new NHS role profiles
What the new role profiles must achieve for nursing
Your job description says one thing. Your daily role looks entirely different. The result? Your pay band doesn鈥檛 reflect the work you do.
If this sounds familiar, you鈥檙e not alone. Two thirds of our members tell us that their banding is wrong. For years, we鈥檝e called for revised national nursing role profiles, so that nursing staff are banded correctly from the outset.
The NHS Staff Council鈥檚 Job Evaluation Group reviewed and redrafted job profiles for bands 2 and 3 in 2021. Employers have been slow to review the work carried out by staff at these bands to make sure they鈥檙e working at the correct band.
The group has now consulted on new draft profiles for all other Agenda for Change bands. These are due to be published in June 2025.
Why has this happened?
Nursing has evolved considerably since Agenda for Change was introduced 20 years ago. It鈥檚 now a degree-educated, highly skilled, safety-critical role. Registered nurses have significantly developed their clinical practice. They are accountable professionals 鈥� working independently to assess, plan, provide, evaluate and lead care. They manage teams and improve the safety and quality of patient care, while promoting health and preventing ill health.
But the recognition and reward for nurses has not kept pace with the advancement of their roles.
Many nurses working in the NHS begin and end their careers on the same pay band. They grow in experience, autonomy, confidence and leadership, but are never valued for the benefits that brings. Meanwhile, midwives and paramedics automatically progress to the next pay band after preceptorship.
Job evaluation is one route to make sure nursing staff whose roles have changed over time are re-evaluated and, where appropriate, placed on a new band. But what happens when the job profiles used in job evaluation are themselves wrong? The job evaluation process falls down.
'I know your value. I'll fight for it to be fairly rewarded'
Our General Secretary and Chief Executive Nicola Ranger says nursing staff must be properly recognised and valued through fair pay.
The reappraisal of nursing has not gone far enough
As the world鈥檚 largest nursing trade union and professional body, it鈥檚 our responsibility to help fix fundamental problems like this. As the largest health care employer in the UK, NHS pay sets a standard for nursing staff in all settings. We must get this right.
We were last consulted on the role profiles in 2024 and we responded with the concerns set out below.
1. The proposals still don鈥檛 fully reflect what nursing staff at each band do
We believe that the proposed new role profiles are inaccurate and don't reflect the reality of modern nursing at each pay band.
The role profiles haven鈥檛 been tested in the real world and they鈥檙e premised on out-of-date job descriptions.
3. All registered nurses should automatically progress from band 5 to band 6 after preceptorship
Professional development of roles is possible under Agenda for Change terms and conditions. Midwives and paramedics rightly benefit from it. Nurses don鈥檛. It鈥檚 a shameful injustice.
Registered nurse roles should be positioned and paid at band 6 after a period of preceptorship (time-limited, structured support).
5. On the job learning can be the most valuable 鈥� especially at higher bands
The new profiles for band 7 and above must reflect the broad nature in which nurses attain their knowledge and skills.
The proposals have so far not recognised clinical expertise gained from on-the-job learning, while working within specialist teams or on wards.
2. Many band 4 nursing staff are being asked to work outside of their role
Staff shortages have left many band 4 nursing staff picking up clinical tasks that should be reserved for band 5 nurses.
This nurse substitution is increasingly common. The new profiles should clearly set out the distinction in roles and responsibilities.
4. The new band 6 profile doesn鈥檛 create the adequate step change in responsibility, skills and knowledge聽
It鈥檚 essential the new profiles accurately capture the nuanced progression in responsibilities, skills and knowledge that band 6 nurses have trained for.
These nurses are held to extremely high standards. Their pay should mirror that.
6. The role of reflective practice in nursing leadership must be valued
Ongoing reflective practice and evidence-based learning has not been sufficiently valued in the proposals for bands 7 and above.
Development in these areas is essential to the growing autonomy and responsibility of nursing leaders at this level.
7. Differentiation between each band must be clear
Before publishing the new role profiles in June 2025, it鈥檚 essential that the full suite of updated bands are reviewed in relation to one another.
Each new band must clearly show the increased autonomy and responsibility of nursing staff at each band.
Agenda for Change is now over 20 years old. It no longer reflects modern nursing and what’s expected of nursing staff in each pay band.
The profile review has been a unique opportunity to ensure that nursing staff are not only correctly rewarded, but that the profession attracts a new generation of nurses with the right skills to deliver the level of care required.
The Westminster government must ensure every nursing professional is in the right band, so that every staff member is paid fairly and can afford to keep working in the NHS.
We know campaigning works
So far, we鈥檝e seen nursing staff working at band 2 progress to band 3 with the application of the updated health care support worker job profiles, thanks to our campaigning. And the Scottish government has agreed to review all band 5 nursing roles.
After the current review of bands 4 to 6, the NHS Staff Council鈥檚 Job Evaluation Group will turn its attention to bands 7 and beyond.
But we鈥檙e demanding so much more.
Don't wait to demand fairer pay
We鈥檒l work hard on behalf of all our members to make sure you're valued through fair pay, but it will take time.
If you work in the NHS and feel that your pay band doesn鈥檛 reflect the work you do, you can ask for your role to be reviewed.
Where next?
A separate pay spine for nursing
The Westminster government has ruled out plans to explore the creation of a separate pay structure, known as a pay spine, for nursing staff working for the NHS in England, despite overwhelming support.
Defining nursing, defying misconception
Our definitions of nursing clarify and bring consistency to the levels of our profession. They highlight the complexity involved in nursing, so that nursing staff are better recognised for their expertise.
