The Royal College of Nursing has conceded that nurse pay may in future need to be linked to individual performance as the NHS attempts to make huge efficiency savings over the next three years.

Royal College of Nursing senior employment relations advisor Gerry O’Dwyer told HSJ the union was involved in “very tentative” discussions about linking nurse productivity to pay.

This could involve developing a pay system similar to the Quality and Outcomes Framework for GPs.

Mr O’Dwyer said: “We have had some engagement with employers about how that might be achieved. We are not frightened to have that discussion; we want to explore how our members might benefit from that individually and collectively.”

But he stressed talks were only very early and far from the negotiation stage. A crucial issue to address was how nurse productivity would be defined and measured. The RCN is keen that any metrics would give considerable weight to patient satisfaction rather than simply “doing more for less”.

The RCN is keen to be on the front foot in discussions around nurse productivity in order to avoid efficiency savings translating into cuts to care quality. Mr O’Dwyer said: “We would be happy to explore the bigger issue of productivity as long as quality and patient experience is part of the picture.”

Geoff Winnard, Head of Agenda for Change at NHS Employers, said: “Employers will always be interested to hear contributions about how to improve the productivity of the workforce. We are working in partnership with staff organisations to review how the Knowledge and Skills Framework can be made more practical to use.”