How NHS Agenda for Change pay works
The National Health Service (NHS) in the UK employs the vast majority of non-medical staff under the Agenda for Change (AfC) agreement. This includes nurses, midwives, healthcare assistants, allied health professionals, administrative staff, and scientific personnel. Roles are graded into pay bands from Band 2 to Band 9.
Each pay band contains entry and top-of-band pay points, while Bands 5, 6, and 7 also feature an intermediate step point. Staff progress between step points as they accumulate full years of continuous NHS experience, usually after two, four, or five years depending on the band.
Worked example: Band 6 specialist nurse in London
Consider an experienced Band 6 specialist nurse at the top of their pay band working full-time (37.5 hours per week) in an Inner London hospital for the 2026/27 financial year.
Their basic full-time salary is £48,117. Working in Inner London entitles them to a 20% High Cost Area Supplement (HCAS), subject to the statutory maximum cap of £8,746. This brings their total gross earnings to £56,863.
As an active NHS Pension Scheme member, their gross pensionable pay places them in Tier 5 with a 10.7% contribution rate, amounting to £6,084.34 annually. Because NHS pension contributions are deducted before income tax under net pay arrangements, their taxable pay is reduced to £50,778.66. After applying the £12,570 Personal Allowance, standard UK income tax equals £7,743.46 and employee Class 1 National Insurance equals £3,147.86. Their annual take-home pay is £39,887.34, providing a monthly net pay of £3,323.94.
High Cost Area Supplements and NHS pension tiers
Staff employed in London and adjoining areas receive an additional non-consolidated High Cost Area Supplement (HCAS) to offset higher living costs. Inner London pays a 20% allowance (minimum £5,794, maximum £8,746). Outer London pays a 15% allowance (minimum £4,870, maximum £6,137). Fringe areas pay a 5% allowance (minimum £1,346, maximum £2,270). For part-time employees, the minimum and maximum caps are pro-rated to contracted hours.
NHS Pension Scheme contributions are tiered based on actual pensionable earnings. Contribution rates range from 5.2% on earnings up to £13,259 up to 12.5% on earnings above £67,668. Contributions receive full tax relief through payroll, lowering your taxable income.
Inputs for the NHS pay calculator
NHS pay band
Select your Agenda for Change pay band from Band 2 through Band 9 based on your contracted role.
Experience step within band
Choose whether you are on the entry point, intermediate step (Bands 5 to 7), or top of your pay band.
Location / London weighting (HCAS)
Choose whether your post attracts High Cost Area Supplement for Inner London, Outer London, or Fringe areas.
Contracted weekly hours
Standard full-time NHS hours are 37.5 per week. Part-time contracted hours pro-rate basic pay and London weighting proportionately.
NHS Pension Scheme member
Indicate whether you are enrolled in the NHS Pension Scheme. Contributions are deducted from pay before income tax is calculated.
Student loan
Select your undergraduate student loan plan (Plan 1, Plan 2, Plan 4, or Plan 5) if you make repayments through PAYE.
Where you pay income tax
Select whether you pay UK income tax under standard UK rates or Scottish income tax bands.
Tax year
The UK tax year runs from 6 April to 5 April. Agenda for Change pay rates take effect from 1 April each year.
CALCULATOR QUESTIONS
NHS pay calculator questions
How do NHS pay increments work?
Under the reformed Agenda for Change agreement, staff progress between pay step points after completing a set number of years of continuous service in that band and meeting local appraisal standards. Bands 2, 3, 4, and 8a to 9 have two pay step points (entry and top of band). Bands 5, 6, and 7 feature entry, intermediate (two to four or five years), and top step points.
Are High Cost Area Supplements pensionable?
Yes. London weighting payments (Inner London, Outer London, and Fringe supplements) are fully pensionable earnings under the NHS Pension Scheme. They are included in your gross pensionable earnings when determining your contribution tier rate.
How is part-time NHS pay calculated?
Part-time pay is calculated pro-rata against the standard whole-time equivalent of 37.5 hours per week. For example, working 18.75 hours per week pays exactly 50% of the full-time annual salary and London weighting for that band and step point.
Does paying into the NHS pension reduce my tax and National Insurance?
NHS pension contributions are deducted under an occupational net pay arrangement. This reduces your taxable income, providing full tax relief at your marginal rate. However, pension contributions do not reduce National Insurance contributions or student loan repayments, which are assessed on total gross pay.