The key achievement of the joint statement on the way forward in developing a new pay system for the NHS is that it has gained the commitment of management and staff organisations (news, page 2, 14 October). Those organisations that attempted to achieve changes to the NHS's antiquated pay structures through the backdoor of 'local pay' may welcome an approach which attempts to achieve NHS-wide reform. But it only adds a limited amount to our understanding of the pay document Agenda for Change, and there are areas of principle to be resolved.

The new arrangements will apply to all staff employed by NHS statutory bodies, including those employed by primary care trusts on trust terms and conditions, and to managers on localised arrangements. Transition to the new structures will therefore be complex and may wipe out good examples of local practice.

The extension of the scope of the review bodies is not as radical as first thought. It may be limited to professions requiring professional qualifications, state registration and, with a majority of members employed in healthcare.

This could leave some professional groups resenting exclusion.

There is a commitment to introduce NHS-wide job evaluation, and consideration is being given to evaluating some common jobs centrally. If this is for quality control it will be welcome. But one objective of Agenda for Change is to ensure that jobs are designed to meet service needs. The service must not be constrained by national job descriptions.

The linkage between the three new pay spines is crucial. We must have fair and internally consistent arrangements so that reward relates logically across them. The joint statement postulates that jobs with the same evaluation score as a newly qualified nurse should enjoy the same minimum starting salary.

This will bolt together the pay spines so that differential growth in salaries will not be possible.

It would mean that this year's recommendation for an exceptional increase to such nurses would be directly 'knocked on' to other staff without there necessarily being an equivalent justification. If so, why are we considering three pay spines? In the light of these proposals the only way to reflect the variations in the national labour market between jobs would be the use of local pay supplements.

Some issues, including pay progression, are not resolved by the joint statement. Other methods like competencies have significant potential and good work has been done locally with positive service outcomes. Such options must not be either be 'parked' or restricted by inappropriate NHS-wide arrangements.

Agenda for Change also looks to harmonise and simplify conditions of service and provide for local flexibility. Although this is an important objective, the area of local flexibility looks limited. This is likely to disappoint employers who were happy to accept NHS-wide pay structures but wanted freedoms to deal with key issues locally.

One of the issues that clouds the problem of local freedom on terms and conditions is whether the equal pay claims can be made across the NHS or just with individual employers. Until this is resolved the scope for local determination will not be clear.

The joint statement indicates that implementation will start in April 2001 with a group of 'early implementers'. The rest of the service will follow later.

This will be a protracted process requiring much communication, training and development.

Implementing local terms and conditions was a major exercise for trusts.

This time it will be carried out in social partnership mode. But NHS-wide cooperation will need to be replicated locally by staff, their representatives and managers under pressure to reach objectives. At present most NHS employees will know little and care less about this exercise. Pay is an emotive issue, but pay reform is not unless it threatens people's individual interests.

It worth reminding ourselves that the Royal Mail recently engaged in a painstaking national negotiation (reputedly lasting two years) to reform pay arrangements for delivery staff. Despite the national agreement and support of the union, their members voted it out. We have been warned.

Agenda for Change offers the only way forward towards reforms that are long overdue. I hope that the process of translating aspiration into reality does not limit its potential for supporting the wider objectives of the NHS.

John Langran Senior Consultant NHSP