Agenda for Change - Practice nurse job profiles

The Agenda for Change job profiles for practice nurses have been published. They are based on 16 factors, ranging from communication and relationship skills, knowledge, training and experience to mental and physical effort and working conditions.

The profiles are summarised below:  

Nurse working in a practice


Specialist Practice Nurse


Nurse Practitioner


Specialist Nursing and NMC


Nurse working in a practice
Band 5: 17,000-22,000

This practice nurse delivers nursing care, runs clinics, provides health promotion advice, carries out immunisations and smear tests and inducts new staff. She has knowledge of chronic disease management, general health care, family planning and well woman care. Qualification required RGN.

Her skills include being able communicate information on patients and reassure patients, plan home visits, run clinics and organise her own work. She gives injections and other surgical interventions; assesses and manages the care needs for patients; implements clinical policies and readjusts protocols to meet need. She makes judgment on changes to drug treatments and may refer patients to hospital.

This level of nurse works largely independently and her work is managed rather than supervised, she is able to demonstrate her duties to less experienced employees and supervise students, she undertakes surveys or audits which are necessary to her work and may occasionally participate in research and development, clinical trials or equipment testing.

Specialist practice nurse
Band 6: 20,300-27,500

A nurse working at this level delivers nursing care, runs specialist clinics, educates patients, carries out immunisations and smear tests and inducts new staff.

She will have specialist clinical knowledge. Qualification required: degree plus post registration (ENB) or equivalent.

She requires skills for assessing and interpreting specialist clinical conditions, has the ability to plan home visits, run clinics, organise her own work, give injections and other surgical interventions, assess and manage care needs for patients; implement clinical policies and readjust protocols when necessary.

This nurse is accountable for her own professional actions and is capable of initiating action within broad clinical policies; she will be able to demonstrate her own duties and supervise students; undertake research in her own specialism; carry out complex audits and become involved in clinical trials.

Highly specialist nurse (nurse practitioner)
Band 7: 24,500-32,300

This nurse assesses patients, plans and implements care, provides specialist advice and maintains records. She is a lead specialist in a defined area of nursing care, provides specialist education and training to other staff and students and undertakes research and lead clinical audits in her own specialist area.

She has professional knowledge acquired through a degree plus state registration supplemented by diploma level specialist training, experience, short courses and CPD.

She is able to communicate very sensitive condition related information to patients, relatives and provide empathy and reassurance, is capable of assessing and interpreting specialist acute and other patient conditions and taking the appropriate action, and has the ability to plan specialist nursing service provision including education and training and cover. She needs dexterity and co-ordination for intravenous injections is able to develop specialist protocols, to assess develop and implement specialist nursing care programmes and give advice to patients and relatives

This nurse is accountable for her own professional actions, is not directly supervised and is lead specialist for a defined area. She provides specialist training and education, undertakes research and leads clinical audit in her own area of work.

The pay bands quoted above are set at 2002-03 rates. If he profession votes to accept Agenda for Change, many nurses will receive further pay rises of more than 15 per cent over three years. Further information:

NMC to regulate specialist nursing
The Nursing and Midwifery Council has decided to regulate specialist nursing which means that it will become illegal for a nurse to call themselves nurse practitioner unless they are properly qualified.

A new tier of registration will be set up for clinical nurse specialists and other higher-level practitioners under the nursing section of the new three-part NMC register, which is to be introduced later this year.

The NMC will prescribe competencies for specialist and advanced practice nursing and this will protect the titles for these roles. Currently nurses can refer to themselves as nurse practitioners without having completed any extra training. From 2005 when the new rules are likely to be in force, nurses will only be able to use the title nurse practitioner after having completed recognised courses.