Dean Royles, director of the NHS Employers organisation urged unions to show flexibility, particularly on pay progression and sickness pay.

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Teachers' pay rises have previously reflected length of service, but there will now be a stronger link between achievement and pay progression.

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He acknowledged a 1% cap was "tough" but said many public sector workers would be helped by "pay progression" - annual increases in salary grades - even when pay was frozen.

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But staff have remained worried about some of the changes, which are being looked at which include increasing working hours, cutting holiday entitlement and sick pay, and performance related pay progression.

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This is why discussions have been about making a much stronger link between providing high quality patient care and annual pay progression - with a much stronger emphasis on behaviours referenced in the NHS Constitution around compassion, dignity and respect.

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Progression pay is the effect on pay packets of public sector workers moving up a pay band.

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Progression pay will also be limited.

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Perhaps it is not surprising then that career progression and training opportunities rank with pay as the top three factors motivating Indian employees to stay.

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"Teachers' pay should reflect their performance, and should correlate with their career progression, " she said.

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