Mixed views on proposed new national nursing profiles

There has been a mixed reaction among the profession in response to a consultation on draft changes to the national NHS job profiles for nursing and midwifery.

The NHS Staff Council’s job evaluation group (JEG) is currently leading a consultation, which closes on 30 June, on revisions to the job evaluation matching profiles for bands 4,5 and 6.

“It is absolutely clear that we find our members far closer to a level of moral distress in doing their job than they’ve ever been”

Phillip Coghill

Some nurses have welcomed the proposed changes, arguing that they better reflect the level at which nurses in each band are working, while others think adding additional responsibilities to certain bands will make it harder for nurses to be remunerated for their work.

The NHS job evaluation scheme makes sure that all jobs advertised in the health service are matched to nationally evaluated profiles.

The profiles are supposed to reflect the knowledge, skills and responsibilities for common roles in the NHS.

Nearly all NHS jobs are matched with a national profile when they are created.

Where jobs cannot be matched to a profile, a full evaluation must be undertaken locally to determine pay banding.

If a nurse or midwife thinks they are not being paid fairly for the job that they do, such as taking on additional duties not in their job description or achieving additional specialist qualifications, they can request a job evaluation.

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In June 2021, the Royal College of Nursing (RCN) wrote to the NHS Staff Council to request a review of nursing profiles.

Shortly after, the Royal College of Midwives (RCM) requested the same for midwifery profiles.

The calls came because both unions were concerned that the current profiles do not reflect the modern nursing and midwifery landscape.

They argued that the profiles did not account for developments in clinical practice, education and training across both professions, nor did they factor in the complexity of some roles and emerging specialist posts.

As such, the NHS Staff Council agreed to undertake a review of the national profiles, which began in the summer of 2022 and is expected to be completed by the end of 2024.

Louise Chinnery, a national officer for Unison and staff-side chair for the JEG, told Nursing Times that if national profiles were not updated regularly, “there’s a real risk banding simply doesn’t reflect the reality of what staff are doing”.

National trade unions, employer bodies, local NHS organisations, chief nursing and midwifery officers, the Nursing and Midwifery Council, and academic and professional bodies all contributed to the review.

Unison’s submission highlighted that band 5 nurses had taken on more complex duties and responsibilities in recent years, noted Ms Chinnery.

“Although it’s too early to predict the final outcome, the union will be supporting all nursing staff who believe their jobs have changed significantly, but their banding hasn’t followed suit,” she added.

The review has so far analysed the current profiles for nursing and midwifery from bands 4 to 6, aiming to ensure they accurately reflect clinical practice and responsibility, to enable NHS jobs to be matched appropriately.

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The revised profiles, first published in April, include further detail about the remit of jobs, with more current examples of skills and responsibilities they might have, which reflect contemporary nursing and midwifery practice.

While the consultation is ongoing for the bands 4-6 profiles, the JEG is progressing on separate work around bands 7 and above, and those revisions will be consulted on later this year.

Phillip Coghill, the RCN lead for pay, terms and conditions, welcomed the revisions to the profiles, arguing that for some time nurses in the lower bands “were not being banded fairly”.

“The union will be supporting all nursing staff who believe their jobs have changed significantly, but their banding hasn’t followed suit”

Louise Chinnery

He said: “It is absolutely clear that we find our members far closer to a level of moral distress in doing their job than they’ve ever been, because of the circumstances they find themselves working in and providing care in.”

For example, Mr Coghill said band 5 nurses were routinely being asked to lead shifts in the absence of a more senior nurse, while those in the community were expected to carry larger caseloads.

He added: “The profiles pick up and recognise the fact that, for example, many band 5s are leading teams and in charge of clinical settings or caseloads.

“Many band 6s will be undertaking significantly advanced clinical interventions that have been developed not just through their undergraduate training, [or] through experience in a clinical setting, but through a level of postgraduate education.”

However, not all nurses have welcomed the fact that the profiles attribute additional responsibilities to band 5s and band 6s, arguing that it will make it harder for them to be remunerated for their skills.

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Nursing workforce academic, Professor Alison Leary, said it was “disappointing to see clinical specialist expertise banded so low” and warned that it was “unlikely to help retention”.

Alison Leary

Separately, the revised profiles have placed greater emphasis on the fact that band 4 nursing associates “work in support of a registered nurse” and will carry out specific duties for patients “as delegated by a registered nurse or other relevant professional”.

In addition, the profiles now specify that band 4 roles could have skills including non-complex wound management, blood glucose monitoring, urinary monitoring, ECG recording, as well as venepuncture, insertion or removal of urinary catheters or cannulas and restraint of patients.

Professor Leary said parts of the proposals were “contradictory”, especially around the roles and remits of band 4s.

“The band 4 role now puts the responsibility of the nursing process with a registered nurse yet then states later that this worker will ‘assess, plan, implement and evaluate interventions appropriate to babies, infants, children’,” she noted.

Nursing Times put these concerns Unison and to NHS Employers, which runs the NHS job evaluation group, but both declined to respond.

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