This report considers how to make pay more market-facing in local areas for NHS Agenda for Change (AfC) staff and recommends market-facing pay to support recruitment and staff retention. The AfC system is perceived as fair and objective by all parties, supports stable industrial relations, and is viewed as compliant with equal pay principles. Analysis does not provide firm evidence for further investment in additional market -facing pay in the NHS at this time and further development of AfC is needed to meet the challenges and cost pressures in the NHS. AfC is considered the appropriate vehicle through which to develop market-facing pay as it already has positive features for it. The Review Body therefore specifically recommends a fundamental review of high cost area supplements, appropriate use of local recruitment and retention premia, and regular review of AfC, including its flexibilities, with any necessary negotiations brought to a conclusion at a reasonable pace