19 The association of ethnicity and migration status with agenda for change pay band in NHS healthcare workers: results from the UK-REACH study

OP 3: Health Services 5, B304 (FCSH), September 3, 2025, 14:30 - 15:30 Aims This study aimed to examine the association between ethnicity, migration status, and Agenda for Change (AfC) pay bands among healthcare workers (HCWs) in the UK’s National Health Service (NHS). Ethnic minority and migrant HCWs make up 24% of the NHS workforce, yet migration status is often overlooked in Human Resources records, potentially contributing to pay and progression disparities. Methods We conducted a cross-sectional analysis using baseline questionnaire data from the UK-REACH cohort study (December 2020–March 2021), focusing on HCWs on the AfC pay scale, including nurses and allied health professionals. Multivariable generalised ordered logistic regression models were employed to examine associations, adjusting for sex, education level, job role, and years qualified. Results Of the 5,771 participants, 18.2% were Overseas-born, with 10.2% identifying as Asian, 3.2% as Black, and 3.3% as Mixed ethnicity. Overseas-born ethnic minority HCWs were less likely to be in higher AfC pay bands compared to their White UK-born counterparts. After adjusting for confounders, Asian and Black HCWs were still less likely to occupy higher pay bands when ethnicity was analysed alone. Similarly, Overseas-born HCWs, regardless of ethnicity, had lower odds of being in higher bands than UK-born HCWs. When combining ethnicity and migration status, Black Overseas-born HCWs had approximately half the odds of being in higher pay bands compared to White UK-born HCWs, with similar disparities observed for White and Asian Overseas-born HCWs. Conclusions This study is the first to highlight the intersectional impact of ethnicity and migration status on AfC pay bands within the NHS. The findings underscore the need for policymakers to integrate migration status into NHS-wide electronic records to identify and address inequities in pay and career progression, promoting a fair and inclusive workforce.