The association of ethnicity and migration status with agenda for change pay band in National Health Service healthcare workers: Results from the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH)

Objectives: Ethnic minority and migrant healthcare workers (HCWs) constitute 24% of the UK's National Health Service. Migration status, often overlooked in Human Resources records, is associated with their placement within the Agenda for Change (AfC) pay bands. Therefore, we analysed the association between ethnicity, migration status, and AfC pay bands using data from the UK-REACH cohort study. Design: Cross-sectional study. Setting: UK-REACH cohort using baseline data collected via online questionnaires across various healthcare settings. Participants: Healthcare workers from a broad range of professional roles across the UK, recruited between December 2020 and February 2021. Main outcome measures: We used multivariable generalised ordered logistic regression models to examine the associations between ethnicity, migration status and AfC pay bands, adjusting for sex, education level, job role, and years qualified. Results: We found that Overseas-born ethnic minority HCWs were less likely to be in higher AfC pay bands compared to their White UK-born counterparts. Specifically, Asian Overseas-born and Black Overseas-born HCWs reported significantly lower odds of being in higher pay bands compared to White UK-born workers. Conclusions: Overseas-born HCWs from ethnic minorities resided in lower paid roles than White UK HCWs. Our study is the first to highlight a link between migration status and the AfC pay band and to explore interactions between ethnicity and migration within this context. Our data highlights the need for policymakers to incorporate migration status into NHS-wide electronic records to address career progression and pay inequities.