Nurses can specialise within hospitals, or move out into the community and work as a school nurse. Midwives can however, have specialist midwife training, and do not need to have trained as a nurse. At the top end of the nursing pay scale are ward managers, nurses who specialise in a particular field of nursing, ward managers who take on extra responsibilities and senior nurses who have a trust-wide remit. The government and nursing unions disagree about how best to reward senior nurses. Around half are already in post, but many do not earn the top rate for their grade.
Many more nurses are needed, say unions.
Nursing unions are also concerned senior nurses are not receiving pay boosts from the discretionary points system, which is aimed at adding to the pay of senior nurses who have reached the top level of their grade. The government says the extra cash is aimed at rewarding senior nurses for extra work, but unions say because the allocation of the discretionary pay is left up to individual trusts, many of whom do not have the funds, very few of the nurses who could receive the extra payments do so. Pay system Under the Conservatives, some health trusts introduced local contracts for health workers and a handful still enforce them. The government is considering proposals to change the way NHS pay is set which could include more of a local pay element. He called for a clear role for local employers, which some have interpreted as a suggestion that the government is considering promoting local pay contracts - a move which Labour MPs criticised in opposition.