Clearer pay band progression and nursing responsibility recognised in handbook update

The accountability and responsibility for patient safety which nurses quickly acquire at the start of their careers has been recognised with a change to Annex 20 in the NHS Terms and Conditions of Service handbook. This section concerns the development of professional roles, enabling progression from band 5 to 6 for certain graduate-level roles. The updated section now specifically mentions nurses.

We’ve been campaigning and lobbying governments, NHS Employers and within NHS Staff Council for Annex 20 to apply to the nursing workforce given the profession’s demands, responsibility and the pivotal role nursing plays in the NHS. 

This annex can inform workplace planning and these changes remove a significant barrier to nursing progression.

Annex 20 forms part of our members’ contractual terms and conditions in the NHS and has been applied to other allied health professions. Although we’ve seen examples of its limited use in respect of nursing, it hasn’t been used universally for the nursing profession by employers across the UK.

An RCN report published in May 2025 made the case for band 5 to 6 career progression for nurses. This report set out our five reasons why Annex 20 should apply to the nursing workforce, in the same way as other Agenda for Change professions.

Nicola Ranger, RCN General Secretary and Chief Executive, said: “This update is a symbolic and important step towards recognition of nursing’s value. We’ve been calling for this for a long time – nursing staff have been left falling behind for too long.

“We firmly believe nursing deserves a career structure that supports clear progression with greater reward to recognise skills, competence, expertise and greater responsibilities assumed while keeping care close to the patient.

“The work doesn’t end here, though. We now need to ensure that employers use this update, and we need to see nurses progress from band 5 to 6, following a period of consolidated learning and experience.”

We’ve been calling for change and a focus on nursing career progression for years. In April 2025, the Westminster government ruled out our proposals for a separate pay spine for NHS nursing staff after a consultation in 2024. The RCN has continued to call for change and proposed the use of Annex 20 to uplift band 5 staff in submissions to government, including our 2025 Spending Review submission.

In December 2025, we published our evidence report which revealed the scale of the problem facing NHS nurses struggling to progress in their careers. The Left Behind report found too many nurses remain stuck at an entry-level pay band, despite often working at a higher level, with serious consequences for staff morale, patient care and nursing staff retention.

During the Health and Social Care Select Committee in Westminster on 17 December, Health Secretary Wes Streeting directly referenced Nicola Ranger and the RCN's asks, detailed in our report, on pay reform and career progression for nurses stuck at band 5.

He told MPs that Nicola had been "banging the drum really hard on this issue" on the professional status of nursing and recognising the contribution and value of nursing to the NHS. His remarks underline the weight of the RCN’s evidence, and he confirmed he is "looking at the band 5 to 6 issue".

Your job description should accurately reflect the work you do today. If you work in the NHS, it's an intrinsic part of your terms and conditions. If you work in independent health and social care settings, check whether your employer has its own job evaluation system in place.

If you think you’re not being paid fairly for the job you do, you can review and update your job description and ask for it to be evaluated. Here’s how to do that.