A stronger link between delivering quality care and pay progression is among the new adjustments to the Agenda for Change (AfC).
Yesterday NHS Employers said there the way sick pay is calculated will be changed so unsocial hours enhancements are not paid to most staff when absent due to sickness.
The changes will come into effect from 31 March 2013, and NHS Employers said it will ensure NHS terms and conditions remain fair.
Dean Royles, chief executive of the NHS Employers organisation said the changes represent a "significant development."
"The revisions ensure the national pay framework is being responsive to the needs of the service, supporting compassionate patient care and improving job security," he said.
Royles noted that the negotiations have been "understandably challenging" because of current NHS reorganisation.
RCN chief executive Dr Peter Carter believes the decision is an "effective way" to protect Agenda for Change as a national system of pay.
He said: "Considering the present political and economic climate, we have acted pragmatically for the benefit of NHS staff, our members and ultimately, patients.
"This echoes what we were told by our members up and down the country; that the proposals were the best way to ensure all NHS staff receives equal and fair pay, no matter where they choose to live or work."
Progression through all incremental pay points in all pay bands will be conditional on individuals demonstrating that they meet locally agreed performance requirements in line with a proposed new Annex addition to the handbook, according to NHS Employers.
Other changes include:
For staff in bands 8C, 8D and 9, pay progression into the last two points in a band will become annually earned, and only retained where the appropriate local level of performance is reached in a given year.
Accelerated pay progression will be associated with preceptorship for staff joining pay band 5 as new entrants.
Pay during sickness absence will be paid at basic salary level - not including any allowance or payments linked to working patterns or additional work commitments.
However, this change will not apply to staff who are paid on spine points 1 - 8 of Agenda for Change, or to those whose absence is due to work-related injury or disease.
However trade union GMB does not agree with the changes.
Rehana Azam GMB National Officer for the NHS said the changes will only secure long term commitment from NHS Employers to maintain a national agreement on the surface.
"In practice the NHS is constantly being exposed to the market by this Government and Section 75 of the Health & Social Care Act and cuts to terms and conditions of NHS Staff are just two examples of many that pose real threats to destroying a National Health Service," she said.