Pay: NHS and independent health and social care employers

Introduction

This guide provides an overview of pay rates in the NHS and independent health and social care. It also outlines steps to take if you are seeking a review of your pay or banding.

See the Further information section below for our range of guides covering pay in different scenarios.

Statutory rates of payment

Statutory rates of pay are those which your employer is legally obliged to pay you if you meet certain criteria. Statutory rates represent the bare minimum an employer should be paying staff.

Go to Gov.uk and www.nidirect.gov.uk for information on:

national minimum wage and national living wage for all staff
statutory sick pay (SSP)
statutory maternity pay (SMP)
statutory paternity pay (SPP)
statutory adoption pay (SAP)

You may be entitled to higher rates of pay than those set out above. Check your contract and/or employer's policies to be sure of your exact entitlements.

Pay in the NHS

Nursing and midwifery staff in the NHS are paid according to the Agenda for Change pay structure. More information can be found on the NHS Terms and Conditions of Service Handbook. Pay rates are determined nationally by recommendations of the NHS Pay Review Body or negotiations between trade unions and the governments of the UK.

The Agenda for Change pay structure also outlines ‘pay step dates’, where pay is incremented after a certain length of service, and conditional upon you demonstrating that you have the requisite knowledge and skills/competencies for the role and that you have met the required level of performance. See NHS Pay Progression and Annex 23 of the NHS Terms and Conditions of Service Handbook (England and Wales).

Pay on appointment

Your starting pay will depend upon your circumstances. Read section 1 of the NHS Terms and Conditions of Service Handbook, as applicable to the country in which you work, and your employer’s local pay policy. There is also a summary in Agenda for Change.

In all cases, we recommend that your starting salary (and your specific pay point) is agreed in writing before you accept and start your new role. Where there is a discretionary element, try to negotiate your pay point. It is often better to point to your specific skills, experience and what you can bring to the role, rather than just focusing on your previous pay point.

Banding

The pay band a role is paid at is determined using the NHS Job Evaluation Scheme (JES). This is an analytical methodology for measuring the demands of the job, not the performance of the person doing the job.

NHS re-banding applications

If you think your current pay band is incorrect, we are encouraging RCN members to seek a job evaluation review. To do this you would need to demonstrate that your role has changed significantly (such as your level of responsibility or the need to make clinical judgements). Your role should be banded on the basis of the requirements of that role rather than the personal attributes you bring to it, so bear this in mind before requesting a review.

This area is complex. If you are thinking of asking for a review of your banding, please see our job evaluation guidance before taking further action.

Pay in independent health and social care employers

Standard 4 of the RCN Nursing Workforce Standards sets out our belief that the nursing workforce should be recognised and valued through fair pay, terms and conditions. We recommend that pay structures should be fair and equitable and should reflect the Real Living Wage as a minimum, as well as support nursing advancement and role development.

If your employer does not pay you in accordance with these rates, you could try to negotiate.

Our guidance on pay in independent employers explains how to review your pay and terms and conditions. In summary, you should:

check if your employer has a pay structure and/or uses a job evaluation scheme
update your job description
identify and match your job to an appropriate national job profile, linking this to an appropriate pay band
use your employer's standard working week and your hours, to calculate your hourly rate
gather details of payment for overtime, unsocial hours, travel time, holiday entitlement, sick pay, maternity pay, paternity leave and compassionate leave
look at the level of employer pension contribution
consider any recruitment or retention difficulties
consider if you have an annual appraisal and support in the form of study time for training and development.

The guidance includes a pay claim template letter and additional information to help you prepare your case clearly and concisely.

Please also see our Employment Standards for Independent Health and Social Care Sectors. These set out what we expect employers in these settings to deliver as a minimum for the nursing workforce.

We recommend that you have the support of your local RCN representative to make a claim. If you are in this position, contact us for further advice.

Pay on appointment

In all cases, we recommend that your starting salary is agreed in writing before you accept and start your new role. You can try to negotiate your starting pay, pointing to your specific skills, experience and what you can bring to the role, in addition to what you have been paid previously.

Pay in general practice

GP nursing staff are usually employed directly by general practices (GPs), which are independent businesses funded by the government. This means that each practice as an individual employer can set their own pay terms and conditions for their employees, and are not subject to Agenda for Change terms and conditions. However, each practice remains bound by national minimum pay requirements and statutory rates of pay. GP nursing staff's annual pay uplift is negotiated and agreed as part of contract negotiations between the government and the BMA and should be passed on by GP employers.

Read more about our campaign for fair pay for general practice nursing staff, including what the current situation regarding GPN pay is in each country.

National Minimum Wage: sleep-ins, training time and travel time

We know that health care assistants’ pay rates are often set at the national minimum wage/national living wage (NMW/NLW) or a few pence above it.

In some cases, the combination of normally paid hours and the failure to pay sleep-ins at an appropriate rate has resulted in overall pay falling below the NMW/NLW.

The same is true for workers who have to travel between clients during their shift or undertake mandatory training outside rostered hours. Recent HMRC advice suggests that mandatory training time is also classified as working time and so could also lead to a technical breach of National Minimum Wage regulations if not paid.

This is unlikely to affect members who are paid significantly above NMW, as sleep-ins, training and travel time do not have to be paid at NMW, but overall, total pay for total hours worked must be at least at NMW.

For information on rates of pay for sleep-in shifts, see the Gov.uk website.

Salary sacrifice

Some employers offer some benefits through a salary sacrifice arrangement, where staff give up part of their salary to pay for things like car purchase/lease, nursery fees and buying bicycles. These payments are taken directly from your wages, thereby reducing tax, national insurance and pension payments, as they are only paid on the remaining amount after the salary sacrifice amount has been deducted.

However, it is important that the remaining amount does not fall below the minimum wage, as this would be a breach of National Minimum Wage regulations.

One-off payments affecting benefits

Employers sometimes need to make an additional one-off payment, for example, when paying back pay following the late implementation of a pay rise, when paying a bonus or non-consolidated payment, or when rectifying an underpayment. These one-off amounts can, however, affect your universal credit, or some other benefit entitlements, for the following month.

If you are expecting such a payment and are worried that it may cause you to lose your benefit entitlement, it may be possible to ask your employer to make the payment in a number of instalments; your benefits may still be affected, but the difference should be smaller and potentially more manageable. We have produced a template letter to help you to request this.

If you are not sure whether you'd be better off receiving the payment as a lump sum or in instalments, contact us to be put in touch with our Welfare service, who can discuss your options with you.

See more about how earnings affect Universal credit.

RCN support

If you have been underpaid, follow the steps in our Underpayment of wages guide, which includes template letters that you can use to request that the underpayment is rectified. If you follow these steps but remain in dispute, please contact us for further support.

If you have any other dispute about pay: