NHS Pay Bands Explained (2025/26): Complete Guide to Salaries, Roles & Progression
NHS Pay Bands sit at the heart of the Agenda for Change (AfC) framework, shaping how more than a million NHS staff are paid, developed and promoted. Whether you’re joining the NHS for the first time, planning your next career step and promotion or comparing pay across the UK nations, understanding how the banding system works is essential.
We provided a clear, comprehensive and UK-wide explanation of NHS Pay Bands for 2025/26, including who the system applies to, how roles are evaluated and banded, how pay progression works, and what each band means for your responsibilities, earnings and long-term career development.
Quick Answer
NHS Pay Bands are the national pay framework for most NHS staff, covering Bands 2 to 9 and reviewed annually under Agenda for Change (AfC). Band 1 is closed to new entrants, making Band 2 the lowest starting point in 2025/26. Staff progress through pay points within their band, while moving to a higher band requires applying for a promoted or re-evaluated role. The pay band system ensures fair salaries, consistent job evaluation, strong NHS Pension benefits and nationally agreed entitlements. Ongoing workforce reforms aim to modernise career pathways, support advanced practice, strengthen support-worker routes and integrate digital roles into future banding structures.
Why Understanding NHS Pay Bands Matters?
NHS Pay Bands determine starting pay, career progression, pension value, annual uplift eligibility, unsocial hours payments, and what training or qualifications are required for particular roles. Although the system is broadly standardised across the UK, actual pay rates differ between England, Wales, Scotland and Northern Ireland, making it essential for staff and applicants to understand how the structure operates nationally.
Whether you’re a student, a newly qualified professional, an experienced clinician, a manager, or part of the support workforce, the NHS pay structure influences:
- Your salary
- Your progression opportunities
- Your benefits and entitlements
- Your working patterns
- Your career pathway
Explanation of how the system works: the why, what, and how behind every band.
NHS Pay Bands at a Glance (Quick Overview)
NHS Pay Bands range from Band 2 (entry-level) to Band 9 (executive leadership). Each band links to job responsibilities, qualifications, and decision-making requirements.
| Band | Level | Typical Example Roles |
|---|---|---|
| Band 2 | Entry | Healthcare Assistant, Porter, Domestic Assistant |
| Band 3 | Senior Support | Senior HCA, Therapy Support Worker |
| Band 4 | Associate Level | Nursing Associate, Assistant Practitioner |
| Band 5 | Newly Registered | Staff Nurse, Midwife, Paramedic, AHP |
| Band 6 | Specialist | Specialist Nurse, Senior Radiographer |
| Band 7 | Advanced | Ward Manager, Advanced Practice Roles |
| Band 8a–8d | Senior Management/Specialist | Matrons, Clinical Leads, Senior Managers |
| Band 9 | Executive | Directors, Strategic Heads of Service |
What Are NHS Pay Bands?
NHS Pay Bands are a nationally agreed pay framework under Agenda for Change. They define:
- Job weight and responsibility
- Required qualifications and training
- Knowledge and skills
- Decision-making authority
- Autonomy and accountability
- Working conditions and effort required
NHS pay bands ensure fairness, consistency, and transparency across all NHS organisations.
NHS Pay Bands apply to around 90% of NHS staff, covering more than one million employees across the UK.
Who Uses NHS Pay Bands?
Staff Covered by Agenda for Change
The structure covers almost every non-medical staff group, including:
- Healthcare support staff
- Nursing support staff
- Registered Nurses & Midwives
- Paramedics & Ambulance staff
- Allied Health Professionals (AHPs)
- Admin & Clerical staff
- Estates & Facilities teams
- Scientific, Technical & Diagnostic staff
- Pharmacy & Laboratory teams
- Supervisors, clinical leads, service managers
Who Is NOT Covered?
These groups are paid under separate national frameworks:
- Doctors (junior doctors, SAS doctors, consultants)
- Dentists
- GP practice staff (unless employed directly by the NHS)
- Very Senior Managers (VSM)
- Contractors and locums not under AfC contracts
If you work in a GP practice, private provider, charity-run NHS service, or outsourced service, you may not be paid according to NHS Pay Bands.
How NHS Pay Bands Began
Before 2004, NHS pay was governed by the Whitley Council system, a fragmented structure with over 650 grades. This led to:
- Inconsistent pay between Trusts
- Significant pay variation for similar jobs
- Lack of national fairness
- Poor progression routes
To modernise and unify NHS pay, Agenda for Change was introduced in December 2004. It created:
- 9 clear pay bands
- A single national job evaluation system
- Standardised terms & conditions
- Equal pay for equal value
- Transparent progression pathways
AfC is now the foundation of pay for the majority of NHS staff across the UK.
What Is Agenda for Change (AfC)?
Agenda for Change (AfC) is the NHS’s national pay, terms and conditions framework covering the majority of non-medical staff. It was introduced in December 2004 to ensure fair, consistent and transparent pay across the entire NHS workforce.
AfC provides a UK-wide structure for:
- NHS Pay Bands (Band 2 to Band 9)
- Job evaluation, ensuring fair pay for work of equal value
- Pay progression rules and pay-step requirements
- Unsocial hours, overtime and High Cost Area Supplements (HCAS)
- Annual leave, sick pay and family leave entitlements
- The NHS Pension Scheme provisions
- Standardised employment terms across NHS organisations
AfC applies in England, Wales and Northern Ireland.
Scotland uses a similar AfC structure but negotiates pay and some conditions separately.
All Agenda for Change pay, terms and conditions are set out in the NHS Terms and Conditions of Service Handbook, with minor variations across the UK nations.
How the Job Evaluation (JE) System Works
Job Evaluation (JE) determines which band a role sits in. It ensures fairness by scoring roles based on nationally consistent factors.
Factors Used in Job Evaluation
The NHS JE Scheme scores roles across nine major factors, including:
- Knowledge, training & experience
- Analytical & judgmental skills
- Communication & relationship skills
- Physical skills
- Responsibility for patient care
- Responsibility for policy/service development
- Responsibility for financial & physical resources
- Responsibility for information resources
- Physical, emotional, and working conditions
Each factor contributes to a total score, placing the role in a band.
Why Job Evaluation Matters
- Ensures equal pay for equal work
- Prevents unfair pay variation between Trusts
- Provides a defensible, legally compliant system
- Allows roles to be reviewed as services evolve
Rebanding Tip
If your duties significantly change, the JE score can be reassessed, potentially increasing your band.
How NHS Pay Bands Work in Practice
NHS Pay Bands are not just salary tables, they are a complete pay system. This section explains how they operate day-to-day.
Pay Points Within Each Band
Each Band has several pay-step points (except Band 2 and some senior bands).
Staff progress based on:
- Satisfactory appraisal
- Mandatory training completion
- In-post competency
- Meeting local objectives
Pay Progression Differences Across Nations
- England uses a pay-step model introduced in 2018.
- Scotland uses a more traditional time-based progression.
- Wales and Northern Ireland broadly follow the English model but may introduce local variations.
Standard Hours: 37.5 Hours per Week
NHS full-time hours are 37.5 weekly, usually divided into:
- 3 × 12.5 shifts (common in inpatient services)
- Mon–Fri office hours
- Rotational shifts (days, nights, weekends)
Overtime
Paid at:
- Time-and-a-half (most situations)
- Double time on bank holidays
Part-time staff earn plain-time until they reach 37.5 hours.
Unsocial Hours
Paid when working:
- Evenings
- Nights
- Weekends
- Bank holidays
England/Wales/NI use Section 2; Scotland uses a different system under NHS Scotland terms.
Re-earnable Pay (Bands 8c & 9)
For senior NHS roles, part of the salary is re-earnable each year depending on:
- Achievement of objectives
- Leadership performance
- Service outcomes
HCAS (High Cost Area Supplements)
England-only payments for:
- Inner London
- Outer London
- Fringe areas
These supplements are pensionable.
NHS Pay Across the UK: England, Wales, Scotland & Northern Ireland
Although Agenda for Change (AfC) provides a UK-wide framework, actual pay values, uplift timings and certain rules differ between nations. This section explains the differences clearly.
England
- Pay rises are usually based on recommendations from the NHS Pay Review Body (NHSPRB).
- England uses the post-2018 pay-step progression model, linking progression to appraisal, capability and training compliance.
- High Cost Area Supplements (HCAS) apply in specific parts of London.
- Unsocial hours are paid under Section 2 of the AfC Handbook.
Wales
- Wales also uses AfC but negotiates directly with the Welsh Government and trade unions.
- Typically mirrors England but may apply additional pay agreements.
- Uses the same unsocial-hours arrangements as England (Section 2).
- HCAS does not apply.
Scotland
- Scotland does not use the NHSPRB.
- Pay is negotiated directly between the Scottish Government and trade unions.
- Base salaries for many bands are often slightly higher than England and Wales.
- Uses Annex E for unsocial-hours payments (calculated differently).
- Pay progression is more time-based and not as heavily linked to appraisal frameworks.
Northern Ireland
- Applies AfC in full.
- Typically adopts similar pay awards to England but may face delays due to budget and governance issues.
- Unsocial hours follow Section 2 (same as England/Wales).
- No HCAS.
Important Reminder
Detailed 2025/26 pay tables for each nation (England, Wales, Scotland & Northern Ireland) are published on each Band page (Band 2 to Band 9).
This overview focuses on the system rather than individual salaries.
Roles and Responsibilities by Band (High-Level Structure)
While each individual Band page contains full role examples, this page provides a system-level overview of how job responsibilities progress through the band structure.
Band 2 – Support Roles
Entry-level roles involving direct or indirect patient care.
Examples: Healthcare Support Worker, Porter, Domestic Assistant.
Band 3 – Senior Support Roles
Greater responsibility, more complex clinical support tasks.
Examples: Senior HCA, Therapy Support Worker, Phlebotomist.
Band 4 – Associate/Assistant Practitioners
Technical roles requiring additional training or qualifications.
Examples: Nursing Associate, Assistant Practitioner, Associate Pharmacy Technician.
Band 5 – Registered Professionals
NHS Band 5 has newly qualified clinicians with professional registration. Examples include Staff Nurses, Midwives, Paramedics, OTs/PTs and Radiographers.
View the full pay points, annual earnings and regional differences on Band 5 pay scale guide.
Band 6 – Specialist/Experienced Clinicians
Autonomous practitioners, specialist roles, or team leadership.
Examples: Specialist Nurse, Senior Physiotherapist, Theatre Practitioner.
Band 7 – Advanced Practice / Team Leadership
Complex clinical responsibility, advanced skills, leadership at ward/team level.
Examples: Advanced Nurse Practitioner, Ward Manager, Specialist AHP.
Band 8a, 8b, 8c & 8d – Senior Leaders & Specialist Experts
High-level management, service leadership, specialist clinical expertise.
Examples: Matrons, Service Managers, Consultant AHPs, Senior Operational Managers.
Band 9 – Executive Leadership
Strategic, Trust-wide leadership roles.
Examples: Directors, Heads of Service, Major Programme Leads.
Core Principle
Each increase in band corresponds to greater autonomy, higher complexity of decision-making, and increased accountability.
Pay Enhancements Under Agenda for Change
Your NHS salary includes more than your basic pay. Enhancements and allowances form an essential part of NHS earnings.
Unsocial Hours Payments
Unsocial hours are paid when staff work:
- Evenings
- Nights
- Weekends
- Bank holidays
England, Wales & Northern Ireland (Section 2)
- Structured percentage additions based on hourly rate
- Varies by band and time of shift
- Pensionable
Scotland (Annex E)
- Different rules
- Based on work categories and shift patterns
- Also pensionable
Common Misunderstanding
Unsocial hours do not automatically apply to all night shifts; eligibility depends on the local rota and the nationally defined time periods.creased accountability.
Overtime Pay
Overtime is normally paid at:
- Time-and-a-half
- Double time for bank holidays
Part-time staff receive standard (“plain-time”) pay until they exceed 37.5 hours.
On-Call Payments
Roles involving emergency response, specialist duties or 24/7 cover may attract:
- On-call availability payments
- Call-out payments
- Standby payments
Rules vary slightly between Trusts and UK nations.
High Cost Area Supplements (HCAS) – England Only
HCAS applies in:
- Inner London
- Outer London
- Fringe areas
Key points:
- Paid as a percentage of basic salary
- Has a minimum and maximum payment
- Pensionable
- Does not apply in Scotland, Wales or Northern Ireland
Recruitment & Retention Premia (RRP)
Used for hard-to-fill or high-turnover roles.
Amount and eligibility vary by Trust and region.
Additional Payments (Local Policies)
Some Trusts offer:
- Market supplements
- Enhanced clinical skills payments
- Clinical supervision allowances
These are local arrangements and not part of national AfC rules.
Career Progression Through NHS Pay Bands
Progression in the NHS is structured, transparent, and based on competencies.
There are two main types of progression:
Progression Within a Band — Pay Step Movement
Staff move through pay points by:
- Completing required time in post
- Meeting appraisal/ performance standards
- Completing mandatory training
- Maintaining attendance and conduct standards
Movement continues until reaching the top point of the Band.
Important for Staff in England
The 2018 pay deal created pay-step gateways, meaning pay progression is linked more strongly to performance and training, not just time served.
Scotland still primarily uses time-based progression.
Progression to a Higher Band – Applying for a New Role
To move up a band, staff must usually:
- Gain new qualifications or experience
- Demonstrate competency at a higher level
- Apply for and successfully be appointed to a higher-banded role
Examples of Typical Pathways:
- Support route: Band 2 → Band 3 → Band 4 (NVQ/Apprenticeship)
- Nursing route: HCA → Nursing Associate → Registered Nurse (Band 5) → Specialist/ANP (Bands 6–7)
- AHP route: Support worker → Assistant Practitioner → Degree route → Registered AHP (Band 5) → Specialist (Band 6)
- Admin route: Band 2/3 admin → Band 4 assistant manager → Band 5 service coordinator → Band 6/7 manager
Apprenticeships
NHS apprenticeships allow movement from support roles (Band 2/3) into registered professions without traditional university routes.
Rebanding: Can Banding Be Challenged?
Yes. If your duties change significantly, your band should reflect that.
Rebanding can be requested when:
- You take on substantial new responsibilities
- You supervise or manage staff
- Your role expands beyond your job description
- Service needs change and your job evolves
The Rebanding Process Typically Includes:
- Informal discussion with manager
- Comparing current duties with original job description
- Collecting evidence (rotas, responsibilities, training, emails, etc.)
- Submitting a request for Job Evaluation (JE) review
- Union support if desired
- JE panel scoring the role again
- New band confirmed or role remains unchanged
Protection
If rebanding leads to a lower band (rare), pay protection rules apply for a defined period.
NHS Pension by Pay Band
The NHS Pension Scheme is one of the strongest in the UK. It is a defined benefit scheme – meaning pension income is based on salary and service, not investment performance.
Key features across all UK nations:
- Pension grows annually based on your pensionable earnings
- Higher bands contribute more but receive higher pensions
- Early retirement possible from age 55 (with reductions)
- Employer contributions are significant
- Unsocial hours payments are typically pensionable
How Band Affects Pension
- Higher bands = higher annual pension
- More responsibility often means more pensionable supplements
- Long-term career progression significantly boosts retirement income
NHS Entitlements Across All Bands
All Agenda for Change staff receive nationally agreed entitlements, including:
Annual Leave
- 27 days initially
- 29 days after 5 years
- 33 days after 10 years
Plus 8 bank holidays.
Sick Pay
NHS staff sick pay is inked to length of service and its up to:
- 6 months full pay
- 6 months half pay
Family Leave
Enhanced maternity, paternity, adoption and shared parental leave apply.
Study Leave & CPD
- Mandatory training
- Professional revalidation
- Specialist courses
- Apprenticeships
Travel & Mileage
Mileage allowances apply if you use your own vehicle for work.
Flexible Working
You have the right to request flexible working from day one.
Disability Support & Reasonable Adjustments in the NHS
The NHS is one of the UK’s largest disability-supportive employers. Under the Equality Act 2010, all NHS organisations must make reasonable adjustments to support staff with disabilities or long-term conditions.
Types of Reasonable Adjustments
Common adjustments include:
- Modified duties or reallocation of tasks
- Adjusted shift times
- Reduced physical demands
- Changes to work patterns (e.g., fixed shifts instead of rotation)
- Additional rest breaks
- Assistive technology or specialist software
- Adjusted workstation or equipment
- Relocation of workspace
- Support workers or job coaches
- Hybrid or remote-working options (role dependent)
Access to Work Support
The Access to Work programme may fund:
- Specialist equipment
- Travel support
- Job coaching
- Communication support
- Adaptations to workspace
Applications can be made by employees or employers.
Trust-Level Disability Networks
Many NHS Trusts offer:
- Disability Champions
- Peer support networks
- Occupational Health assessments
- Workplace well-being services
Key Message
You do not need to disclose a disability to your whole team. Disclosure can be confidential and made only to the appropriate manager or OH team.
Future Changes to NHS Pay Bands (2026 & Beyond)
NHS pay structures evolve as workforce needs change. Several developments are being discussed or explored across the UK.
Potential Revisions to Band 5 Structure
Band 5 remains the largest and most pressured grade — especially in nursing and AHP roles. Discussions include:
- Splitting Band 5 into “junior” and “senior” steps
- Faster progression to Band 6 for certain professions
- Structured clinical development pathways
Growing Demand for Advanced Practice
The NHS is relying increasingly on:
- Advanced Clinical Practitioners (ACPs)
- Senior AHP roles
- Specialist nurses
These roles often sit in Bands 7-8, creating new upward pathways.
Workforce Transformation & Digital Expansion
As NHS services become more digital, new or evolving roles may impact banding:
- Digital midwives
- Clinical informatics specialists
- AI implementation leads
- Data analysts within clinical teams
- Virtual ward clinicians
These may require updated job evaluation scoring.
Apprenticeship Pathways
Across the UK, apprenticeships are expanding routes into:
- Nursing
- AHP roles
- Admin and managerial posts
- Associate practitioner roles
This may reshape Band 2–4 staffing and progression.
Retention & Recruitment Pressures
To address staffing gaps, future changes may include:
- Enhanced RRP schemes
- Local recruitment bonuses
- Retention payments for scarce skills
- Broader flexible working options
Devolution & Pay Divergence
Pay divergence may continue between:
- Scotland
- England
- Wales
- Northern Ireland
Creating region-specific priorities for future AfC structures.
Looking Ahead
While the core 9-band structure is stable, the content of roles within bands is likely to change significantly over the next decade.
Frequently Asked Questions
Summary
NHS Pay Bands form one of the most comprehensive public-sector pay systems in the world. They ensure:
- Equal pay for equal value
- National consistency
- Clear career progression
- Transparent job evaluation
- Fairness and accountability across all professions
We tried to explain the entire system: how pay bands work, how roles are evaluated, what differs across the UK, what enhances pay, how progression happens, and what benefits all AfC staff receive.
