How is NHS pay decided and what are we asking for?

What is the NHS Pay Review Body (PRB)?

Governments can use different routes to decide pay increases. Often UK governments ask review bodies to look at evidence and make recommendations on public sector pay before ministers set an award. The UK government determines pay for NHS staff employed on Agenda for Change (AfC) contracts through the NHS PRB.

There are 4 key stages to a review body process.

1. Governments must issue a remit letter to the PRB. This letter from a minister sets the parameters and is the first indication of when a pay award might be announced. 
2. The PRB gathers evidence. 
3. The PRB reports back to the government with recommendations on pay or contract changes.
4. The government decides on a pay award for staff. The PRB’s report is released.

Is the RCN taking part in the NHS PRB process this year?

The RCN didn’t participate in the NHS PRB process last year, as we were in active pay negotiations with the UK government. This year, although we’re participating, we’re also highlighting the flaws of the process and urging the PRB to take this opportunity to prove its independence. Our members rejected the 2022-23 and 2023-24 pay awards, so we’re still in dispute with the government and urge the PRB to support our claim to reopen those pay rounds.

The NHS PRB process is only fit for purpose if it is truly independent from the UK government and makes pay recommendations based on evidence, not on the will of politicians.  

What will the NHS PRB process look like this year?

Stage 1
The Secretary of State for Health and Social Care in England, Victoria Atkins, wrote to the PRB on 20 December asking it to advise on NHS pay. The formal remit letter described the “historic nature of the 2023 to 2024 awards” and the need for the PRB to consider the affordability of any pay award for NHS staff.

This letter should’ve been issued last autumn, so that you could receive your 2024-25 pay award announcement on 1 April. We expressed bitter disappointment with the government for starting the process so late, especially after it committed to improving the PRB process. This delay means your NHS pay award will be late – again.

The Welsh government Minister for Health and Social Services Eluned Morgan began the process in Wales on 30 January with a similar formal remit letter – which was sent late. In it, she asked to receive PRB recommendations “as soon as possible”. However, it is likely a decision on NHS pay will still be delayed beyond April, which we say is unacceptable.

• Read next: Pay justice now – government must enhance nursing salaries to combat NHS staffing crisis

In Northern Ireland, the RCN and other health trade unions are currently in negotiations with the Department of Health and employers over the 2023-24 pay award for nursing staff on AfC contracts in Northern Ireland. The Department of Health submitted a formal remit letter to the NHS PRB on 10 January, seeking recommendations on the 2024-25 pay round. We therefore expect a decision on NHS pay to be delayed beyond April here too.

The Scottish government has again indicated that it will engage in direct negotiations with the RCN and other health trade unions in relation to NHS pay in Scotland for the 2024-25 pay round.

Stage 2
Before making recommendations, the PRB can commission research on pay and related matters. It can also visit NHS workplaces to hear from employers and staff, and it takes evidence from NHS trade unions (including the RCN), NHS Employers and organisations, and the government.

The RCN wants to ensure that the voices and concerns of nursing staff are heard loud and clear. This year the RCN submitted written evidence, which was overseen and reviewed by your elected governing members. In it, we’ve stressed the fact that our members are disillusioned with the PRB – it needs to prove its independence by acting on the available evidence.

Our evidence shows that nursing staff are experiencing a cost-of-living crisis, caused by years of shocking real terms reductions in their salaries. It also shows that the NHS is in the midst of a staffing crisis, with 40,000 nursing vacancies in England alone and almost half of nursing staff thinking of leaving the profession.

The NHS is trapped in a cycle where poor pay and conditions are forcing staff to leave, which makes work even tougher for remaining staff, who then leave themselves. We have to break the cycle.

Based on this evidence, the PRB should recommend the following measures.

• A substantial, above-inflation pay rise for nursing staff. Only this will begin to restore nursing pay and deliver the pay justice the profession deserves.
• An additional recurring annual salary enhancement for NHS nursing staff in recognition of the chronic nursing workforce crisis. This would encourage more people to stay working in the NHS, helping to address the increasing nursing shortages across the UK.
• Better long-term career prospects. This could include a new career framework that enables nurses to reach the top of the profession quicker. This will deliver the recognition and career prospects that nursing staff deserve, keeping more people within the profession.
• Commitment to safe staffing. This will recognise the current lack of safe staffing levels, and the negative impact that this is having on both patient safety and staff wellbeing.

• Read more about these recommendations and our call for "decisive action" in our member news story.

Stage 3
After considering all of the evidence, the PRB will make recommendations on NHS pay to the governments. This year, the PRB has been asked to report its findings in May – this is much later than it should be, thanks to unnecessary government delays. We continue to pressure governments across the UK for timely action so members are not left waiting.

Stage 4
Governments consider the NHS PRB’s advice, but pay increases and how they're funded are political decisions — ministers always have the option to invest in nursing.

In our submission to the PRB this year, we urge the body to prove its independence to make wide-ranging and meaningful recommendations based on the evidence.

What happens after the announcement? 

Once governments announce pay awards after the PRB process, they’re not obliged to put it to a vote of NHS staff.

The RCN is committed to involving RCN members in decisions relating to their pay and conditions. In 2022, we asked RCN members whether they felt the award was adequate and what further action they wanted to take – this is what led you to vote for strike action.

Campaign with us for fair pay

The RCN’s Fair Pay For Nursing campaign continues to lobby governments for pay justice for nursing staff. This means a fully funded pay rise for NHS nursing staff on AfC contracts.

While the NHS PRB process applies to NHS staff, the RCN is clear that there must be parity of pay and other terms and conditions for nursing staff in all settings. Read about our work to secure fair pay for GP nursing staff.