Agenda for Change Explained: How NHS Pay and Terms Work

If you're a nurse, healthcare assistant, paramedic, therapist, scientist, porter, administrator or manager in the NHS, it's almost certainly your contract.

Your band comes from the job, not from you

Every job is placed in a band by job evaluation, which scores the post on 16 factors such as the knowledge it needs, its responsibility for patients and the physical and emotional demands of the work. Most posts are matched against national job profiles; jobs that don't fit a profile are evaluated locally. It's the job description that's banded, so two people doing the same job should be on the same band in any trust. If your job has changed, you can ask for it to be re-evaluated.

There are nine bands, with Band 8 split into 8a, 8b, 8c and 8d. Band 2 is the lowest band open to new staff in England.

Pay points and moving up

Each band has one, two or three pay points. You move up on your pay step date, not every year:

In England you move to the next point on your pay step date if you've had an appraisal in the last 12 months, aren't in a formal capability process, have no live disciplinary sanction and have done your statutory and mandatory training. Moving to a higher band is a promotion: you apply for the post, your pay starts at the bottom of the new band, and your pay step date resets.

Where you start

New starters normally start at the bottom of the band. If you're moving from another NHS employer, your previous NHS service counts towards your next step, so you should keep your pay point. Employers have discretion to start you higher for relevant experience outside the NHS, including abroad, so it's worth asking before you accept. Get the pay point agreed in writing.

Acting up is paid differently from promotion

If you're asked to cover a higher-band post temporarily, you go on the bottom of that band, or, if that wouldn't give you a rise, the first point in the band that would. Agree the pay before you start covering.

How the yearly pay award is set

AfC pay goes up once a year, but each country decides its own award:

• –England: the independent NHS Pay Review Body recommends a rise and the government decides whether to accept it. For 2026/27 it's 3.3%.
• –Wales: the Welsh Government responds to the same Pay Review Body report. For 2026/27 it's 3.3%.
• –Scotland: Scotland agrees its own deal. 2026/27 is the second year of a two-year deal for 2025 to 2027: 3.75%.
• –Northern Ireland: the Department of Health hasn't confirmed the 3.3% award yet, so pay is still on rates from 1 April 2025.

The NHS Staff Council, where employers and unions meet, maintains the handbook and negotiates changes to the terms themselves.

Your hours

A full-time week is 37.5 hours in England, Wales and Northern Ireland and 36 hours in Scotland. Scotland's shorter week, plus its own pay points, is why Scottish hourly rates are higher. The bottom of Band 5 is £32,073 in England and £34,544 in Scotland.

Annual leave

You get 27 days on appointment, 29 after 5 years' NHS service and 33 after 10 years, plus 8 public holidays (10 in Northern Ireland). Previous NHS service counts towards these, even after a break. Holiday pay includes regular extras such as unsocial hours payments. See the annual leave calculator.

Sick pay

Sick pay builds up with service, from 1 month's full pay and 2 months' half pay in your first year to 6 months' full pay and 6 months' half pay after 5 years. Paid sick leave in the previous 12 months comes off what you have left. Previous NHS service counts if the break was 12 months or less. See the sick pay calculator.

Maternity pay

With 12 months' NHS service by the 11th week before your baby is due, you get 8 weeks at full pay, 18 weeks at half pay plus Statutory Maternity Pay, then 13 weeks of Statutory Maternity Pay only, if you intend to return to the NHS for at least 3 months. See the maternity pay calculator.

Nights, weekends and overtime

Hours worked at night, on Saturdays, Sundays and public holidays get an unsocial hours payment on top of your hourly rate. In England, Wales and Northern Ireland it's 30% for nights and Saturdays and 60% for Sundays and public holidays from Band 4 up, with higher rates for Bands 2 and 3 (Band 2: 41% and 83%). Overtime, for hours over the full-time week, is time and a half for Bands 1 to 7 and double time on public holidays. Bands 8 and 9 don't get overtime pay. See the overtime calculator.

London

In England, staff in and around London get a High Cost Area Supplement on top of basic pay, at 20% in inner London, 15% in outer London and 5% on the fringe, each with a minimum and maximum. See the London weighting guide.

Bank work is usually not on AfC terms

Most NHS bank contracts are separate zero-hours contracts and aren't on the national terms, so bank workers usually don't get the yearly pay award, NHS sick pay or AfC annual leave automatically. If you have a permanent job and do bank shifts too, they're two separate contracts.