NHS staff in Scotland: what’s the likely impact of the reduced working week?

In Scotland, the NHS recently reduced the standard working week for most of its workforce. The 170,000 staff covered by the Agenda for Change (AfC) pay system saw their full-time week fall from 37 hours to 36 hours in April this year.

The reduction was made without loss of annual earnings and is pro rata for part-time staff. It is equivalent to a 4.2% increase in hourly pay. Comparable NHS staff in the other three UK nations now work 1.5 hours more to be ‘full time’ than those in Scotland and receive a lower hourly rate of pay. But why and how did this change come about? And what are its likely implications as the NHS continues to face workforce challenges, including retention, across all four UK countries?

Direct control over pay and conditions in Scotland 

In 2018, the Scottish government withdrew from the UK-wide independent NHS Pay Review Body process, moving to direct national negotiation with Scottish NHS staff unions. This has enabled NHS Scotland to take direct control over staff pay and conditions.

The first obvious outcome is that NHS staff pay rates in Scotland now outstrip those in the other UK nations. In 2025/26, a nurse at the top of AfC Band 5 in England received an annual basic salary of £37,796; in Scotland, the same nurse would earn £41,483. 

The second outcome has been the reduced working week. In 2022/23, NHS nurses went on strike in England, Northern Ireland and Wales in support of a pay claim. Strikes were averted in Scotland when an agreement was reached between the Scottish government and unions in early 2023.

The agreement committed to reduce the full-time working week (RWW) from 37.5 hours in order to improve work-life balance and staff retention, and reduce barriers to work. RWW implementation was in two phases: a 0.5 hour reduction from 37.5 to 37 hours in April 2024 and a further 1 hour reduction to 36 hours from 1 April 2026. 

Local implementation 

The RWW was a nationally negotiated, top-down change. Local responsibility for delivery came only after national agreement, with the instruction that it be done safely, support service recovery and avoid creating additional pressures on staff.

Each area set out a local implementation plan reflecting its service models, working patterns and geography. Managers and staff were encouraged to ‘think innovatively’. Working examples included an early finish 1 day a week, a few minutes off each shift or minutes banked and then taken as a block. Reductions too small to improve work-life balance, or longer unpaid breaks, were not considered as in the spirit of the agreement. 

A range of local responses helped to maintain staffing during implementation: recruitment drives, backfill plans, ‘creative’ rostering and more time off in lieu. Reported implementation challenges included inadequate backfill funding to cover all staff changes during the transition, and staff cover issues in cases of relatively small staff ‘pools’, affecting some remote, rural and island localities, and specialist roles. There are also implications for workforce metrics when estimating staffing levels, with the change in the measure of hours for ‘whole time equivalent’ (WTE) meaning that staffing tools must be recalibrated.

Evaluating impact

Full implementation of RWW only began in April this year, making it too early to fully evaluate impact. But now would be a good time to set out plans for its evaluation. 

The Scottish government identified several key risks of RWW: reduced service delivery if mitigations failed; services not adapting, leaving staff overwhelmed; and increased agency and overtime spend. The government also noted that, ‘The projected costs for RWW are the most uncertain as not all lost hours would or could be replaced.’ And that like-for-like replacement for nursing and midwifery would cost £124m on the 2023/24 pay bill. 

The most obvious risk is that RWW requires additional staff or could exacerbate staffing shortages. A crude estimate for 170,000 headcount (roughly 147,000 WTE) is that a 4% cut in contracted hours removes about 220,000 hours a week, or around 6,100 FTE at 36 hours, before any offset from part-time workers increasing hours, overtime or bank cover. In addition, the extent to which the hours reduction is ‘real’ for individual staff, or has led them to work additional recognised or unrecognised hours, requires specific assessment.

A system-wide working-time reduction across a health workforce of this size is a rare event (although see, for example, Iceland’s experience). Given the costs, risks and potential benefits to staff retention of the RWW, the absence of independent evaluation would be a missed opportunity.

However, at the time of writing, there appears to be no planned national independent evaluation of the impact of RWW. There is scope to do so, ideally as part of a broader focus on the relative effect of different measures to improve NHS staff retention. There are regular NHS data in Scotland to support tracking pre- and post- trends in staff turnover and stability, absence rates or agency spend. This will not fully answer the question, because attribution is complicated by other changes in pay rises, staff mix and the external labour market. Organisational-level case studies would give greater insight into the realities of implementation and impact, and provide lessons for the other UK nations – notably the NHS in England, where the new workforce plan is awaited.