NHS pay modernisation
NHS pay modernisation

Author: Great Britain: National Audit Office

Publisher: The Stationery Office

Published: 2008-02-28

Total Pages: 60

ISBN-13: 9780102953015

DOWNLOAD EBOOK

Each year general medical practices provide some 290 million consultations. The new contract (implemented in April 2004 but increased spending began in April 2003) changed the basis for commissioning primary care services. Instead of contracting with individual General Practitioners (GPs), Primary Care Trusts (PCTs) commission services from some 8,325 GP practices with around 33,000 GPs. This study examines the negotiation and implementation of the new contract and how well it is working in practice. In the first three years the PCTs spent £1.76 billion (9.4 per cent) more than the minimum committed by the Department of Health. Mostly this was due to an underestimation of the amount that GPs would earn from the pay for performance scheme, the Quality and Outcomes Framework (QOF), and the additional cost of providing out-of-hours care (most GPs have opted out of providing this service). GPs' salaries have increased by an average of 58 per cent. Practice nurses have not benefited to the same extent. While the number of consultations with patients has increased, these are not in proportion with the increase in costs, and productivity has fallen by 2.5 per cent per year. GPs are working less hours. Some progress has been made in extending the range of patient services, reduced administration, high quality care and linking pay and performance, and staff satisfaction and morale. Progress has not yet been demonstrated in productivity, and re-designing the services around patients. The contract has contributed to improved recruitment and retention of GPs. The NAO recommends that the Department develop a strategy for yearly negotiations on the QOF, which should be based more on health outcomes. PCTs should provide more services based on local need and review the number and skills of staff employed to commission and performance manage GP services with the aim of improving local commissioning.

NHS pay modernisation in England
NHS pay modernisation in England

Author: Great Britain: Parliament: House of Commons: Committee of Public Accounts

Publisher: The Stationery Office

Published: 2009-06-18

Total Pages: 44

ISBN-13: 9780215532268

DOWNLOAD EBOOK

Agenda for Change, the pay modernisation programme for 1.1 million NHS staff in England, representing a pay bill of £28 billion in 2007-08, was implemented between December 2004 and December 2006. It covered all NHS staff, except doctors, dentists and senior managers. Agenda for Change introduced a job evaluation scheme and harmonised employment terms and conditions for the multitude of jobs within the NHS. A key part of the programme is a process for encouraging staff development and improving staff performance known as the Knowledge and Skills Framework. Agenda for Change was expected to bring about new ways of working which would contribute to improved patient care and to more efficient delivery of services. Total savings of £1.3 billion over the first five years were predicted. These were to come from improvements in productivity of 1.1 to 1.5 per cent a year, reductions in equal pay claims, reduced use of agency staff and more controllable pay costs. The Department and NHS Trusts did not establish ways of measuring the effects of Agenda for Change and there is no active benefits realisation plan. The NHS pay bill for the staff covered by Agenda for Change has risen by 5.2 per cent a year on average since 2004-05 while productivity fell by 2.5 per cent a year on average between 2001 and 2005. By autumn 2008 (nearly two years after Trusts had completed transferring staff to Agenda for Change terms and conditions and pay rates) only 54 per cent of staff had had a knowledge and skills review.

NHS Pay Modernisation in England
NHS Pay Modernisation in England

Author: Great Britain. National Audit Office

Publisher: The Stationery Office

Published: 2009

Total Pages: 44

ISBN-13: 9780102954562

DOWNLOAD EBOOK

The NHS has successfully transferred 1.1 million NHS employees on to a new simplified pay system. This was a substantial task which the NHS, in partnership with the trade unions, achieved in a short timescale. There are some examples of NHS trusts using Agenda for Change to help introduce new roles. But the Department of Health did not put enough emphasis on getting trusts to develop these new ways of working to secure the full benefits from the new pay system, so the programme is not yet achieving the intended value for money. Agenda for Change has reduced pay administration in the NHS, simplified pay negotiations and made it easier to estimate staff costs and monitor budgets. The NAO estimates that for 2007-08 the £28 billion NHS paybill is broadly similar to what it might have been if the programme had not been implemented. The Department predicted that Agenda for Change would save at least £1.3 billion by 2008-09 and productivity would increase, but it did not put in place any central monitoring arrangements to show what impact the new contract has had on productivity. The only productivity measure available for the NHS as a whole shows that productivity continued to fall when Agenda for Change was introduced, though the rate has since slowed. A key element of Agenda for Change, the Knowledge and Skills Framework, which defines the skills needed for a certain role and provides a tool for reviewing their use in the workplace, has not yet been fully implemented by many trusts. Effective use of the Framework is fundamental to achieving the full benefits of Agenda for Change.

Pay modernisation
Pay modernisation

Author: Great Britain: Parliament: House of Commons: Committee of Public Accounts

Publisher: The Stationery Office

Published: 2007-11-22

Total Pages: 44

ISBN-13: 9780215037299

DOWNLOAD EBOOK

In October 2003, the Department of Health (the Department) agreed a new national contract for NHS medical consultants in England. This report examines the contract negotiation; the cost implications; the effectiveness of the implementation process; and the extent to which the expected benefits for patients and the NHS had been realised. It was intended that employers would get greater control and management of their consultants' workload, and patients would benefit from a more flexible and responsive service. The Department hoped to reward consultants who made the biggest contribution to NHS work and reduce the average number of hours worked, in exchange for increased productivity. These benefits were dependent on a mandatory and rigorous process of workload planning for individual consultants (job planning). The implementation of the contract was rushed and the NHS has yet to see many of the intended benefits. Over the first three years, the Department allocated an additional £715 million to NHS trusts which was £150 million more than originally estimated. Although consultants' pay has, on average, increased by 27 per cent (from £86,746 to £109,974) and their working hours have decreased, there are no measurable improvements in productivity. The Department has succeeded in increasing the number of consultants working in the NHS, from 28,750 in October 2003 to 31,990 by September 2005, but the number of hours consultants work in private practice has neither increased nor significantly decreased. Other intended benefits have not been realised: for example the proportion of time consultants spend on direct clinical care is less than intended, and the contract has not been used to extend and develop new services for patients.

The Modernisation of the Public Services and Employee Relations
The Modernisation of the Public Services and Employee Relations

Author: Stephen Bach

Publisher: Bloomsbury Publishing

Published: 2011-09-29

Total Pages: 200

ISBN-13: 1350304727

DOWNLOAD EBOOK

The Modernisation of the Public Services and Employee Relations provides an integrated and up-to-date account of changes in work and employment in the public services. The book examines a range of different sectors focusing on core public services, especially local government, the NHS and the civil service.

Pay modernisation
Pay modernisation

Author: Great Britain: National Audit Office

Publisher: Stationery Office Books (TSO)

Published: 2007-04-19

Total Pages: 60

ISBN-13:

DOWNLOAD EBOOK

The new contract for consultants was agreed in 2003 and widely implemented by April 2004. It was needed to increase the size and commitment of the consultant workforce if it was to deliver the NHS reform agenda and comply with the requirements of the European Working Time Directive to reduce consultants' hours. By the end of March 2006, the Department had spent £715 million on the new consultant contract (27 per cent more than the original estimate of £565 million), partly because the government had underestimated the amount of work consultants did. In September 2005, approximately 32,000 consultants worked for the NHS in England, primarily within NHS acute and mental health hospitals, accounting for £3.8 billion of expenditure in the NHS in England in 2005-06. The NAO conclude that the contract is not yet delivering the full value for money to the NHS and patients that was expected. The contract has helped to align consultants' pay levels with their contribution to the NHS, but some consultants are actually working the same if not fewer hours for more money. There is little evidence that ways of working have been changed, and few trusts have used job planning as a lever for improving participation or productivity. The contract has delivered some benefits in management of consultant time, prevention of an increase in private practice, securing extra work at plain-time and increasing participation. The contract has the capacity to provide some new levers for further enhancing management control. There is scope for the NHS trusts to make much more of the opportunity presented by the annual renegotiation of job plans to devise a set of agreed job plans that will deliver more efficient and effective services to patients.

24 Hours to Save the NHS
24 Hours to Save the NHS

Author: Nigel Crisp

Publisher: Oxford University Press

Published: 2011-09-15

Total Pages: 247

ISBN-13: 0199639957

DOWNLOAD EBOOK

'24 hours to save the NHS' is the inside story written by the man with unprecedented authority as both Chief Executive of the NHS and Permanent Secretary of the Department of Health. It describes the successes and failures as well as the pressures and the difficulties of making improvements in the 4th biggest organization in the world.

Market-facing Pay
Market-facing Pay

Author: NHS Pay Review Body

Publisher: The Stationery Office

Published: 2012-12-05

Total Pages: 182

ISBN-13: 9780101850124

DOWNLOAD EBOOK

This report considers how to make pay more market-facing in local areas for NHS Agenda for Change (AfC) staff and recommends market-facing pay to support recruitment and staff retention. The AfC system is perceived as fair and objective by all parties, supports stable industrial relations, and is viewed as compliant with equal pay principles. Analysis does not provide firm evidence for further investment in additional market -facing pay in the NHS at this time and further development of AfC is needed to meet the challenges and cost pressures in the NHS. AfC is considered the appropriate vehicle through which to develop market-facing pay as it already has positive features for it. The Review Body therefore specifically recommends a fundamental review of high cost area supplements, appropriate use of local recruitment and retention premia, and regular review of AfC, including its flexibilities, with any necessary negotiations brought to a conclusion at a reasonable pace

Management of NHS hospital productivity
Management of NHS hospital productivity

Author: Great Britain: National Audit Office

Publisher: The Stationery Office

Published: 2010-12-17

Total Pages: 44

ISBN-13: 9780102970029

DOWNLOAD EBOOK

Productivity in hospitals has been falling by around 1.4 per cent a year since 2000 whilst NHS expenditure has increased by over two thirds in ten years. The Department of Health has achieved significant improvements in such areas as waiting times, healthcare associated infection rates, patient outcomes, reduced cancer mortality and the patient experience. However, the NHS pay contracts introduced since 2003 have increased costs but are not always used effectively by hospitals to drive productivity improvements. The NHS needs to deliver between £15 billion and £20 billion of efficiency savings per year by 2013-14. Around 40 per cent of these savings are expected to come from increasing efficiency in hospitals, requiring productivity gains of approximately six per cent per annum. The 'Payment by Results' system of setting national tariffs has promoted some efficient practice, but there is still substantial variation between hospitals. If all hospitals performed at the level of the top 25 per cent in respect of staff costs, use of estate, control of emergency admissions and bed management, the NAO estimates that the NHS could save around £1.6 billion a year. The Department has launched a national initiative (QIPP) to help the NHS deliver annual savings of up to £20 billion. There are risks to the delivery of the initiative, which is the responsibility of Strategic Health Authorities and Primary Care Trusts, whose focus may be distracted by the proposals for their closure by 2013.