Trusts are making radical changes to pay and allowances to try to reduce costs and increase productivity without deviating from Agenda for Change.

Salford Royal Foundation Trust is deferring incremental pay rises by six months for staff who take more than 28 days of sickness absence a year. More than 56 days’ sickness will mean increments deferred by a year.

Employers can’t sit by and administer a pay system without questioning how they use [it] to reinforce the contributions they want from staff

Increments will also be held back from staff subject to disciplinaries or who fail to attend mandatory training sessions.

Chief executive David Dalton told HSJ: “Employers can’t sit by and administer a pay system without questioning how they use [it] to reinforce the contributions they want from staff.”

The changes apply to new starters or those who change their contracts voluntarily, for example by internal job moves.

The trust has also standardised expenses and stopped lump mileage payments.

Increments, worth around 3.2 per cent of salaries, are paid on top of the “headline” pay rise for Agenda for Change staff, which amounted to 2.4 per cent in 2009-10.

Sheffield Health and Social Care Foundation Trust has received an extra £686,000 from NHS Sheffield as a result of “staffing rota requirements and in particular the impact of Agenda for Change increments”. It may need to save a further £200,000, board documents reveal.

Kettering General Hospital Foundation Trust is “reviewing a number of pay options that will reduce the overall pay bill”, according to board papers.

These include cost of living supplements, on-call arrangements, overtime premium payments and local out of hours arrangements.

The report adds: “There is also the expectation that national pay agreements will be reviewed”.

Chief executive Mark Newbold said: “On annual increments we are not deviating from Agenda for Change terms and conditions of service, and the HR strategy will reflect this.”