Implementing local pay systems in nursing and midwifery.

Background: The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non-medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS.

Aim: The aim of this paper is to discuss a case study of the effects of changing nurses' pay progression.

Methods: Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents.

Findings: Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme.

Conclusions: The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging.