NHS Agenda for Change review: scope

Agreement with health trade unions setting out the scope for review of NHS Agenda for Change staff pay, terms and conditions.

Background and principles

The Agenda for Change (AfC) pay, terms and conditions agreement was introduced in December 2004 as part of widescale reform and modernisation to NHS pay, terms and conditions.

The system has successfully delivered a unified approach to terms and conditions for staff who are governed by the agreement (broadly described as AfC staff). All stakeholders (Trade Unions, Employers and The Scottish Government) recognise the need to modernise the system and ensure that it remains fit for purpose to recognise the work of the current and future NHS workforce.

In January 2023, the Cabinet Secretary for Health and Social Care committed to review Agenda for Change as part of the 2023-24 AfC pay deal. This Heads of Agreement has been agreed jointly with Scottish Government and Health Trade Unions. NHS Scotland Employers are fully committed to working through the detail.


The Cabinet Secretary has set out the following principles for the review of Agenda for Change:

  • make NHS Scotland an employer of choice for health and other staff
  • recognise the value of staff and professional roles
  • improve outcomes for the public
  • develop a modern and responsive pay, progression and reward system that meets the needs of NHS Scotland and its staff
  • ensure no financial detriment to staff, and
  • the remit and timescales will be fully agreed to ensure the work is undertaken and completed by an agreed date

The review must deliver in the context of NHS Scotland principles around sustainability and value and be evidence-based.

Whilst there should be a focus on addressing staff shortages across the AfC workforce, the review must deliver a positive change which will be:

  • fit for purpose
  • exemplar
  • equality proofed, and
  • available to all

NHS Scotland employers are of the view that the principles set out in the Heads of Agreement are adhered to when reviewing the detail as outlined within the review of AfC.

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