In May 2023, the previous government agreed a deal for the Agenda for Change (AfC) workforce through negotiations with the NHS Staff Council. The Royal College of Nursing (RCN) raised concerns about how the AfC pay structure is affecting the career progression and professional development of nurses, and the impact of this on recruitment and retention. The RCN suggested that a separate pay spine for nursing staff could address these concerns. 

However, responses to the subsequent consultation highlighted that the career progression challenges faced by nurses were also being experienced by other NHS professionals, and the evidence was not considered to present sufficient justification for separating nurses' pay from the rest of the AfC workforce. 

RCN general secretary and chief executive, Professor Nicola Ranger, said: ‘The government had a chance to set nursing on a new path, where it's valued, understood and rewarded fairly. It is now clear that ministers and the government are not in fact "on the side of nurses".

‘In under a year in power, they have attached themselves to a status quo which is failing nursing, the NHS and patients.'

The Royal College of Midwives' director for employment relations, Joanne Kaye, said 'to separate out one profession from another would have been divisive'.

She added: 'Teamwork is the foundation on which the NHS is built, and years of experience shows us it is the best way to deliver safe high-quality care.'

In response, the College of Paramedics, said: ‘We shared our concerns of the impact of a separate pay spine on paramedics and other healthcare professionals facing the same workforce issues, over a thousand of our members shared their views via our survey last year, which we used to develop our responses to the UK Government.'