The RCN is calling out NHS Trusts for undermining the terms and value of nursing work by: 

• Not paying overtime for full-time nurses working additional hours in their usual clinical setting, despite this being set out in Agenda for Change terms and conditions. 
• Only offering unfilled shifts via the staff bank or NHS Professionals (NHSP) on zero-hours arrangements with inferior pay, fewer protections, and no parity with substantive contracts.
• Reducing pay rates for these shifts, meaning many nurses are now being paid less than their standard rate, and sometimes on a lower grade than their qualification and clinical expertise. 

A staff nurse on a typical ward could be £40 worse off for a 12.5-hour shift, while intensive care nurses and those in other highly specialised settings stand to lose even more. In real terms, nurses are being paid less for taking on the most demanding and high-risk work, often while covering safety-critical staff shortages.

Simon Browes, Regional Director for the RCN North West, said: “It’s an erosion of pay, an insult to professionalism, and a betrayal of trust. 

“Nurses already give more unpaid overtime than any other profession, because we care deeply about our patients. But to be paid less for doing the same job, often under pressure and short notice, is completely unacceptable.” 

“Let’s be clear, nurses are highly skilled professionals. They carry enormous clinical responsibility. They deserve to be recognised and paid fairly for the work they do, regardless of whether it’s a rostered shift, a bank shift, or an emergency request.” 

A leaked NHS England North West paper, seen by the RCN, warned that this approach “raises substantial concerns regarding nursing workforce morale, patient safety, and operational resilience.” 

Yet despite that, plans to reduce bank shift rates in Cheshire and Merseyside have gone ahead, following similar changes already introduced in Greater Manchester. 

The paper draws on lessons from earlier cuts in the Midlands, highlighting rising agency costs, lack of consultation, and a breakdown in trust between staff and employers. In many cases, these “savings” turned out to be a false economy, with higher costs and greater disruption in the long run. 

In the face of a looming Resident Doctors’ strike action, Mr Browes added “This is not about pitting nurses against doctors, but nurses will not be quietly used to plug the gaps unless they are paid properly for the work. 

“If a nurse works extra hours in their usual setting, they should be paid overtime. If they work bank shifts or through NHSP, they should be paid at a rate that reflects their skill, experience, and responsibility.” 

Nurses across the region have reported feeling trapped, pressured to take on more shifts, to simply make ends meet, or out of a sense of duty, despite worsening terms and deteriorating morale. 

“Nurses do not stop being nurses when they walk through a different door. Their skills, judgement and care stay with them, and should be paid accordingly,” said Mr Browes. 

At a national level, even the Secretary of State for Health and Social Care has advised that Trusts must make bank work attractive and competitive, to reduce agency spend and improve workforce retention. These local cuts run counter to that national advice, and risk worsening a workforce crisis already affecting patient care. 

“Nurses are leaving the profession at an alarming rate, many within just a few years of qualifying,” Mr Browes continued. “This is a dangerous and growing crisis that will undermine any attempts to reduce waiting lists or improve patient care.” 

“We are all NHS users ourselves. We know, and the public knows, that when you take care of nurses, nurses take care of patients.” 

RCN members are currently being consulted on the 3.6% NHS pay award, the lowest public sector pay award this year, and will be consumed by inflation. Teachers, civil servants and police officers have all received more. With this backdrop, the recent changes to additional shift pay are seen by many as a tipping point. 

Mr Browes said: “Enough is enough. Nurses have held the system together. Now the system needs to respect and retain them, not drive them out.” 

RCN North West is demanding urgent action from NHS employers and system leaders to: 

• Reinstate overtime pay for full-time staff working in their usual setting. 
• Ensure all additional shifts are paid at or above Agenda for Change hourly rates. 
• Recognise bank and NHSP work as skilled labour, not casual or downgraded work. 
• End regional policies that artificially “harmonise” pay rates at a lower point of the scale. 
• Uphold national policy by making bank pay competitive, attractive, and fair.