New research has uncovered a significant double disadvantage in pay for NHS staff who are both from ethnic minority backgrounds and born overseas
CREDIT: This is an edited version of an article that originally appeared in Open Access Government
The NHS is known for its diverse workforce, with 24% of staff coming from ethnic minority backgrounds – higher than the UK average of 18%. However, this diversity does not translate into equal pay or career progression, especially for those born outside the UK.
What the Study Found
The research team conducted a cross-sectional analysis of over 5,700 NHS healthcare workers. All were employed under the Agenda for Change (AfC) pay scale, which applies to most NHS non-medical staff, including nurses, midwives and AHPs. The study examined how ethnicity and place of birth impacted pay band placement.
The study revealed several key findings that highlight significant disparities within the NHS workforce. Black and Asian staff were found to earn less than their White counterparts, with Black staff earning on average 4.6% less. Additionally, overseas-born ethnic minority staff were significantly less likely to be placed in senior pay bands, even when they had similar qualifications and levels of experience as UK-born staff. The research also identified specific barriers faced by migrant healthcare workers, including challenges in gaining recognition for international qualifications, limited access to professional networks and fewer opportunities for training and career development – all of which contribute to stalled progression and persistent inequality.
Why This Matters in Primary Care
This research highlights real challenges in creating an inclusive and supportive environment. Staff from ethnic minority and migrant backgrounds are underrepresented in senior roles and may feel limited in their progression opportunities. This affects morale, retention and workplace equality.
What Can Practice Managers Do?
- Acknowledge potential disparities within your team and monitor pay band allocations.
- Support migrant staff by helping them access training, mentorship and leadership opportunities.
- Push for policy changes within your Integrated Care System (ICS) or Trust to recognise international qualifications and improve inclusion
- Encourage open conversations about workplace barriers and promote fairness in appraisals and career planning
Call for Better Data and Policy Change
The research also found that lack of data on migration status is a major issue. Without tracking this, the NHS cannot fully understand or tackle the root causes of inequality. Policymakers are urged to include migration status in workforce data collection to improve fairness and create targeted support systems.
This research underscores the urgent need for the NHS – and those managing its workforce at all levels – to recognise and address the structural inequalities faced by ethnic minority and migrant staff. For practice managers, this means taking an active role in promoting fairness, supporting staff development and advocating for systems that acknowledge the unique challenges migrant workers face. Ensuring equal access to training, mentorship and advancement opportunities is not only a matter of equity but also essential to building a stronger, more inclusive NHS workforce.
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