What’s happened 

Fourteen health unions representing more than 1.2 million NHS workers have called on Health Secretary Yvette Cooper to restart talks aimed at reforming the Agenda for Change (AfC) pay structure. 

The unions, which include the Royal College of Podiatry, say progress has stalled following recent changes at the Department of Health and Social Care. 

AfC determines pay for most NHS staff, including podiatrists, nurses, physiotherapists, paramedics, healthcare assistants and many other healthcare professionals. 

In April, the government announced a 3.3% pay increase for AfC staff following a recommendation from the NHS Pay Review Body. Ministers also committed to talks on wider problems with the pay structure, with any resulting improvements to pay backdated to April 2026. 

The unions say those discussions now need to resume urgently. 

They argue that pay for AfC staff has increasingly fallen behind that of doctors and dentists, who have separate pay arrangements. 

According to analysis provided by the unions, resident doctors in England have received cumulative pay increases of 35% between 2023 and 2026, compared with headline increases of 18.5% for AfC staff over the same period. 

The unions also want the negotiations to consider the 2027 pay award because of the delays to the talks. 

Why this matters to members 

Most podiatrists working in the NHS are employed under AfC, so changes to the structure could directly affect members' pay and career progression. 

The unions argue that the current structure is making it harder for the NHS to recruit and retain experienced staff, with degree-level pay bands falling behind salaries available in other graduate professions. 

They are also critical of the way NHS pay is determined. Thirteen of the 14 unions say they will boycott the NHS Pay Review Body process, arguing that it cannot address the wider structural changes they believe AfC needs. 

Scotland takes a different approach, with NHS pay negotiated directly between the Scottish government and unions rather than through the pay review body. The unions say this has contributed to growing differences between NHS salaries in Scotland and elsewhere in the UK. 

The Royal College of Podiatry is one of the 14 unions supporting the call for talks to resume.

What happens next 

The unions are asking the government to return to negotiations with NHS employers and reach an agreement on changes to the AfC pay structure. 

They also want ministers to address the 2027 pay award through those discussions rather than relying on the NHS Pay Review Body process. 

Links and references 

• NHS Agenda for Change pay scales and arrangements  

• 10 Year Health Plan for England