A paper published in Journal of Advanced Nursing (Kahya 2006) described an application of the United Kingdom’s (UK) National Health Service (NHS) Agenda for Change Job Evaluation Scheme (AfC JES) to nursing jobs in Turkey. The AfC JES was designed, developed and tested in relation to health service jobs in the four countries of the UK. Although the system may turn out to be applicable to, for example, jobs in private sector hospitals in the UK, this was not within the remit of those commissioned to develop the AfC JES. Whether it is appropriate to healthcare jobs outside the UK is likely to depend on the nature of those jobs, their organizational context, the training systems in force and the legislative framework in which they operate.

The objective of developing a new single NHS grading and pay structure was to underpin the Government’s modernization programme for the health service, set out in ‘Agenda for Change: Modernising the NHS Pay System’ [Department of Health (DoH) 1999], from which the job evaluation system takes its name. The aim of the proposals was to facilitate a more flexible health service workforce and remove barriers to change, in a manner consistent with UK and European Union (EU) equality legislation, principles and practices. The AfC JES was designed to cover all NHS jobs except for doctors, dentists and the most senior managers and executives. Note that Kahya focuses on nursing jobs only.

The scheme was not developed from 2003–2004, as suggested, but was developed and extensively tested over a 5 year period from 1999 to 2004. It was the last stage of testing, by 12 ‘Early Implementer’ pilot sites, that took place in 2003–2004, with full implementation across the health service from October 2004.

Because of the scale of the exercise, with the NHS employing more than 1 million staff whose jobs were to be covered by the new grading and pay structure, it was never going to be feasible to evaluate individually every job in every organization. Instead, commonly occurring jobs were evaluated at national level and profiles developed for each, to which jobs at local level could be ‘matched’, following an agreed procedure based on an analytical process. Information is obtained from job descriptions which have been agreed between the manager and job holder. Only those jobs which cannot be matched in this manner are locally evaluated, on the basis of completed job analysis questionnaires (JAQs). Matching and evaluation are thus two distinct procedures. They appear to have been confused in Kahya’s paper.

The final important point by way of background is that the AfC JES was developed and implemented in partnership between health service managers, DoH representatives and trade unions. The joint technical group commissioned to develop the scheme was the Job Evaluation Working Party (JEWP). Now reconstituted as the Job Evaluation Group (JEG), it group monitors the operation of the JE system and makes recommendations for national guidance. This is possibly the largest comprehensive JE exercise in the world, so it would be surprising if everything had been perfect at the first attempt. JEG continues to monitor and make recommendations where change is appropriate.

The Job Evaluation Scheme’s factors

  1. Top of page
  2. The Job Evaluation Scheme’s factors
  3. The study of clinical nursing jobs
  4. References

Much effort went into identifying the AfC JES factors because the scheme had to be capable of measuring fairly the demands of a very wide range of jobs, from nursing and other direct healthcare provider jobs to those in finance, maintenance and estates, IT and information systems, as well as many different types of support role. The first-draft factors were tested on 100 jobs, as Kahya described, but the revised factor plan was subjected to two further rounds of re-testing and refinement on increasingly large samples of jobs. Some final adjustments to the factor level definitions were made following the Early Implementer pilot stage.

The AfC JES has 5 factors in the Knowledge and Skills group – Communication and Relationship Skills; Knowledge, Training and Experience; Analytical and Judgemental Skills; Planning and Organizational Skills; and Physical Skills. The choice of a single factor (Knowledge, Training and Experience) to measure the knowledge (procedural, technical, specialist) required for the job was quite deliberate on the part of JEWP, and not controversial. It was strongly influenced by the knowledge that some earlier schemes in the UK had used more than one factor and had been criticised on equality grounds for double counting the same job demand under more than one heading.

For example, an earlier scheme in the local government sector had two factors measuring Education and Experience. This had been withdrawn following criticism that these are alternative or complementary means of acquiring knowledge, and not distinct job features (Paddison 1987). Use of formal qualifications alone as a measure of knowledge can result in an under-valuation of jobs where most knowledge is not acquired by formal means; and not all experience results in additional knowledge. Therefore, these factors are not in AfC JES for reasons of equality and equal value.

Kahya seeks to measure Responsibility for Human Resources on the basis of the numbers of staff supervised. This was rejected by JEWP for two reasons. The first was that it is the nature of the supervisory demands which are more important than the numbers supervised or managed; and use of numbers gives odd effects when team size changes. The second reason was that many jobs in the UK NHS involve professional supervisory and training responsibilities not necessarily associated with formal managerial responsibilities; and, again, the nature of the demand is more important than the numbers supervised.

In relation to the Working Conditions factor, while conditions and hazards might be distinct job features in some organizational circumstances, in the UK health service the aim is to minimise unavoidable hazards, therefore introducing a separate factor could be counter-productive. In any event, working conditions and unavoidable hazards are often inextricably intertwined, so to have two factors could result in double counting of job demands. For instance, ambulance paramedics and technicians attend road traffic accidents, which involve both unpleasant conditions and some unavoidable hazards, but it is not possible to separate these out and they are not distinct job demands.

The study of clinical nursing jobs

  1. Top of page
  2. The Job Evaluation Scheme’s factors
  3. The study of clinical nursing jobs
  4. References

The evaluation of a sample of nursing jobs in Turkey using a ‘revised’ version of the Agenda for Change job evaluation system is based on false premises, as described above, and is unacceptable on equality grounds from our perspective. It is also flawed in a number of other ways:

  • 1
    The great majority of nursing jobs in the UK, because they are commonly occurring, should be and have been matched to the national profiles. However, no attempt appears to have been made in Kahya’s revision to follow the matching procedure before moving on to evaluations. It seems from the evaluation outcomes that at least some of the nursing jobs in the four Turkish hospitals would have matched relevant profiles.
  • 2
    The nature of the questionnaire completed by the jobholders is not explained. It is not clear that the AfC JAQ was used. This was developed to collect the information needed and its completion is an integral part of the evaluation procedure. Not using the AfC JAQ carries risks of inaccurate evaluation.
  • 3
    It seems that the 240 points available for the AfC Knowledge, Training and Experience factor have been apportioned between the separate Knowledge, Education and Experience factors, but it is not explained how or in what proportions.
  • 4
    The evaluations reported in the article cross grade boundaries. As the AfC grades are directly related to separate pay scales, jobs must come in one grade or the other.
  • 5
    The implication of Kahya’s study is that the AfC JES undervalues some nurse manager jobs. JEG does not agree that this is the case. Nurse team manager jobs with level 6 for the KTE factor commonly match the band 7 profile; and those with level 7 for KTE may well match a Professional Manager of Consultant profile in band 8a–c.

The above points illustrate the inaccuracies contained in Kahya’s articles.

Note: This article has been written by the Job Evaluation Group, a technical sub-group of the NHS Staff Council, which is the negotiating body for pay, terms and conditions in the UK National Health Service. It comprises managers from the NHS in England, Scotland, Wales and Northern Ireland and trade union officials with a secretariat provided by NHS Employers. The Job Evaluation Group has been responsible under the NHS Staff Council for devising, testing, monitoring, and overseeing implementation of the NHS Job Evaluation Scheme.


  1. Top of page
  2. The Job Evaluation Scheme’s factors
  3. The study of clinical nursing jobs
  4. References
  • Department of Health (DoH) (1999) Agenda for Change: Modernising the NHS Pay System. Department of Health: London.
  • Kahya E. (2006) A revision of a job evaluation scheme. Journal of Advanced Nursing 56 (3), 314324.
  • Paddison L. (1987) Job Evaluation and Equal Value – a Study of White Collar Job Evaluation in London Local Authorities: LEVEL, September 1987