Pay: You've got to admit, it's getting better

The recent pay deal left many feeling gloomy, but there are reasons to be cheerful, says Chris Green

Over the past five years, few issues in the NHS have been as contentious as that of how much the staff are paid. Just three weeks ago, it was revealed that GPs had received a pay rise of 10 per cent within 12 months, bringing the average salary of a family doctor up to a whopping £110,000. Yet in September, the Royal College of Nursing accepted the Government's 2 per cent pay rise for nurses in England with "great reluctance" and "a heavy heart", according to general secretary Peter Carter. It was the second year running that a salary deal below the rate of inflation had been offered, in line with Gordon Brown's commitment to similarly gradual pay increases across the public sector.

But the seemingly immovable cloud hanging over nursing salaries has a silver lining. Things are not as bad as they were five years ago. In 2004, the Government launched Agenda for Change, the most radical shake-up of the NHS pay system since the service was conceived in 1948.

Affecting more than a million staff – excluding doctors, dentists and senior managers – the agreement has created a much fairer system of payment that rewards nurses for the type of jobs they do, and the specialist knowledge they need to do them. Under the old system, many employees with a host of specialist skills found themselves unrewarded and underpaid.

"We're seeing more people coming back into nursing because the salaries are a bit better, the working hours are more flexible and the career progression is clearer," says Nick Goodwin, a fellow at the King's Fund, the London-based charitable health foundation. "There are also more chances of having your job upgraded, if you take on more skills besides the usual tasks you're asked to do. It's definitely a lot better than it was."

A nurses' starting salary is now £19,700, or £22,000 if you live in or around London. This might be slightly less than most university graduates earn when they begin their first job, but as nursing salaries in the NHS now rise incrementally, you're guaranteed a pay rise after a year. Those who are keen to start racing up the career ladder also don't have to sit in the same job for a minimum length of time: if you can prove you've learnt new skills, your salary will be reviewed. You could eventually be earning up to £40,000 as a consultant or advanced specialist.

Career progression within the NHS is also a lot less hazy than it used to be, thanks to the new "Knowledge and Skills Framework". This was a key part of the Agenda for Change, in which the NHS committed to train and develop its staff while they in turn pledged to the learn skills their employer needed.

While previously nurses could be stuck in the same job for years without any prospect of progression, they are now positively encouraged to broaden their knowledge: this in turn unlocks the door to higher wages.

"There are many opportunities for people to build their career in a way that suits them and direct it the way they want it to go," says Foluke Ajayi, head of careers and workforce supply at NHS Employers, which represents health trusts. "It's not about inflicting responsibility on people; it's about rewarding them for doing the work they'd like to do."

Flexible working hours are another perk of the job. Although the standard requirement for a full-time NHS nurse is 37.5 hours a week, these rules can be bent depending on an individual's situation. There may be core hours when you have to be at work, but allowances are made for those who have commitments as carers, or those who prefer to start late and finish late, or start early and finish early.

Like most public sector jobs, nursing has above-average pension provision. When the Agenda for Change was brought in, the NHS introduced a "final salary" pension scheme: this favours those who are approaching retirement and wish to reduce their hours and working commitments, without damaging their pension plan. The employee's highest salary is effectively frozen.

"An NHS pension is one of the better ones, along with teachers and academics," says Nick Goodwin, "and given the nature of the work, I think it'll remain so."