Every NHS job outside of medicine, dentistry and very senior management sits on the Agenda for Change pay framework. That covers around 1.5 million staff across England, Scotland, Wales and Northern Ireland. Roles are grouped into bands 1 through 9 (with sub-bands at 8a, 8b, 8c and 8d), and each band has between one and three pay points. You move up a pay point after two or three years of satisfactory service.
The 2026/27 pay deal applied a 3.3% consolidated uplift to every pay point in England, Wales and Northern Ireland. Scotland got 3.75% through a separate negotiation. The rise took effect from 1 April 2026, with most staff seeing arrears in their June or July payslip.
| Band | Entry salary | Top of band | Hourly (top) | Example roles |
|---|---|---|---|---|
| Band 2 | £25,272 | £25,272 | £12.92 | HCA, porter, cleaner |
| Band 3 | £25,760 | £27,476 | £14.05 | Senior HCA, phlebotomist |
| Band 4 | £28,392 | £31,157 | £15.93 | Assistant practitioner, pharmacy tech |
| Band 5 | £32,073 | £39,043 | £19.97 | Staff nurse, midwife, paramedic |
| Band 6 | £39,959 | £48,117 | £24.61 | Specialist nurse, senior physio |
| Band 7 | £49,387 | £56,515 | £28.90 | Ward manager, advanced practitioner |
| Band 8a | £57,528 | £64,750 | £33.11 | Principal pharmacist, service manager |
| Band 8b | £66,582 | £77,368 | £39.57 | Head of service, associate director |
| Band 8c | £79,504 | £91,609 | £46.85 | Director of nursing, chief pharmacist |
| Band 8d | £94,356 | £108,814 | £55.65 | Director of therapies |
| Band 9 | £112,782 | £129,783 | £66.37 | Trust director of profession |
Source: NHS Employers pay scales 2026/27. Hourly rates based on a standard 37.5-hour NHS working week.
Unlike private sector auto-enrolment (where everyone pays 5%), the NHS pension uses tiered contribution rates based on your salary. The more you earn, the higher your percentage. For 2026/27 the tiers are:
| Salary range | Contribution rate | Monthly cost example |
|---|---|---|
| Up to £13,259 | 5.2% | £57 on £13,000 |
| £13,260 to £28,854 | 6.5% | £135 on £25,000 |
| £28,855 to £35,155 | 8.3% | £222 on £32,073 |
| £35,156 to £52,778 | 9.8% | £326 on £40,000 |
| £52,779 to £67,668 | 10.7% | £476 on £53,400 |
| £67,669 and above | 12.5% | £694 on £66,600 |
Source: NHSBSA: Cost of being in the scheme. The rate applies to your whole salary, not just the portion within that tier. So a Band 5 nurse on £32,073 pays 8.3% of £32,073 = £2,662 per year (£222/month).
It's a big deduction, but the NHS pension is one of the best defined-benefit schemes still operating. For every year of service, you build up a pension worth 1/54th of your average revalued earnings. And the employer contribution is 23.7%, which you won't find anywhere in the private sector. Opting out saves you cash now but costs you significantly in retirement income.
If you work for the NHS inside or around London, you get a High Cost Area Supplement on top of your basic salary. It's calculated as a percentage but capped at minimum and maximum amounts:
| Zone | Percentage | Minimum | Maximum |
|---|---|---|---|
| Inner London | 20% | £5,794 | £8,746 |
| Outer London | 15% | £4,398 | £6,808 |
| Fringe | 5% | £1,192 | £1,846 |
Source: NHS Employers HCAS rates 2026/27. The supplement is pensionable, which means both your pension contributions and your eventual pension are calculated on your salary plus HCAS.
For a Band 5 nurse on £32,073, Inner London weighting adds £6,415 (20% of £32,073, within the min/max range), bringing gross salary to £38,488. That's a meaningful difference, though London rents eat most of it. A one-bed flat in Zone 2 costs around £1,600 to £1,900 a month, compared to £750 to £950 in most cities outside the M25.
Take-home on £32,073 (Band 5 entry, England, no student loan)
Gross salary: £32,073
NHS Pension (8.3%): £2,662
Income Tax: £3,368 (20% on £16,841 after pension relief)
National Insurance: £1,560 (8% on £12,570 to £32,073)
Total deductions: £7,590
Annual take-home: £24,483
Monthly: £2,040. Weekly: £471.
Add a Plan 2 student loan and take-home drops by about £20/month (9% of earnings above £29,385 = £242/year). It's not as steep as people expect because Band 5 entry is only just above the Plan 2 threshold.
Take-home on £48,117 + Outer London HCAS (Band 6 top, Plan 2 loan)
Basic salary: £48,117
Outer London HCAS (15%): £6,808 (capped at max)
Gross salary: £54,925
NHS Pension (10.7%): £5,877
Income Tax: £7,296 (all at basic rate after pension relief)
National Insurance: £3,109
Student Loan Plan 2 (9% above £29,385): £2,299
Total deductions: £18,581
Annual take-home: £36,344
Monthly: £3,029.
Notice how the pension rate jumps from 9.8% to 10.7% once gross (including HCAS) crosses £52,779. The London weighting pushes you into a higher pension tier, which partially offsets the benefit. Still worth it overall, but the net gain from HCAS isn't as much as the headline £6,808 suggests once you account for higher tax, NI, and pension.
NHS staff working outside standard hours (Monday to Friday, 6am to 8pm) get enhancements on top of their basic hourly rate. Under Section 2 of the NHS Terms and Conditions Handbook:
For a Band 5 nurse on £32,073 (hourly rate £16.40), a Saturday shift pays £21.32 per hour and a Sunday shift pays £26.24 per hour. Over a typical rota with one in four weekends, unsocial hours can add £2,000 to £4,000 per year to your gross pay, depending on the mix of nights and weekends.
NHS England has asked all trusts to review Band 5 nursing roles by October 2028. The aim is to check whether experienced Band 5 nurses are doing work that should be banded at 6. If your role is re-banded upward, your pay jumps immediately from wherever you sit on Band 5 to the entry point of Band 6, which in 2026/27 means going from a maximum of £39,043 to at least £39,959. It's a smaller jump than you might expect at the top of Band 5, but the ceiling is much higher (Band 6 tops out at £48,117).
If you think you're working above your banding, talk to your union rep about requesting a re-banding review. The RCN's "Know your worth" campaign has resources for this.
We pull pay band data directly from the NHS Employers 2026/27 pay circular. Tax calculations use 2026/27 HMRC rates (same engine as our main salary calculator). Pension tiers come from the NHSBSA. HCAS rates from the same NHS Employers circular. Everything runs in your browser. No data is sent anywhere.
If something doesn't match your payslip, it's likely due to salary sacrifice, marriage allowance, court orders, or a non-standard tax code. For a general salary calculation (not NHS-specific), try our main UK salary calculator which allows custom tax codes and pension types.
How does NHS pay stack up? Using ONS 2024 data, the UK median full-time salary is around £35,000. A Band 5 entry nurse on £32,073 is just below the median. By top of Band 5 (£39,043), you're above it. Band 6 and above put you comfortably in the upper half of UK earners.
But gross pay doesn't tell the full story. The NHS pension is worth an additional 23.7% of your salary from your employer, which doesn't appear on any payslip. On a £32,073 Band 5 salary, that's an extra £7,601 per year going into your pension pot. No private sector employer matches that. When you factor in the pension, sick pay (six months full, six months half), and 27 days annual leave rising to 33 days after 10 years, the total package is considerably better than the headline salary suggests.
Use our salary comparison tool to see how two different salaries stack up after tax, or check the hourly wage calculator to convert your NHS pay into an effective hourly rate including unsocial hours. If you're weighing up a move, it's also worth seeing the salary you'd need to buy a home in each UK city, since a Band 6 wage buys far more in Newcastle or Hull than in London or Bath.
Planning a house move? Check what you could borrow on an NHS salary with our mortgage affordability calculator.