Managers are still not reaping the benefits promised by Agenda for Change four years after it was introduced, according to the National Audit Office.
The watchdog said in a report last week that the Department of Health has not sufficiently encouraged trusts to develop new ways of working to secure the full benefits of the system.
This means the programme has not improved value for money, says the report, NHS Pay Modernisation in England: Agenda for Change.
The report highlights advantages, including simplified administration and pay negotiation systems and more accurate estimates of staffing costs.
But it claims there is little evidence of increased efficiency and says the£28m NHS pay bill in 2007-08 was broadly similar to what it might have been had the programme never been implemented.
Agenda for Change was rolled out between December 2004 and December 2006 for all staff except doctors, dentists and senior managers.
NAO researchers found "a recognition among trust managers that… after the transfer of staff to their new pay bands had been completed, many trusts had moved on to other initiatives or became absorbed in the reorganisations within the NHS which took place in 2006".
The report also calls for more detailed evaluations of productivity levels before and after the system was brought in, to see whether savings have been made.
It says the DH should "motivate" trusts to get more out of Agenda for Change by recommending that business cases for changes to services include a section on how the pay system will augment any hoped-for improvements.
This could include new roles or a change in the grade mix of staff around a given patient pathway.
The DH should in turn collate information from trusts showing how working differently under Agenda for Change has contributed to changes in productivity and patient care, it says.
NHS Employers director of pay, pensions and employment relations Gill Bellord said: "Agenda for Change was designed as a tool for managers to use to help make the changes they need to improve services for patients. But it cannot, by itself, improve their care - transition to the new system was the first step toward this."