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Pay: NHS and independent health and social care employers


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.

We also have a range of guides covering pay in different scenarios:

Annual leave and holiday pay

Cancellation of work

Having a family toolkit

Part-time workers


Time off work

Working time and breaks

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 and 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.

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 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.

If you think your current pay band is incorrect, it may be possible to seek a review. To do this you would need to demonstrate that the requirements of your role (such as responsibility and need to make clinical judgements) exceed the levels that would usually be expected of any other role in your current pay band.

This area is complex. If you feel your post has been allocated to the incorrect banding you should read the NHS Job Evaluation Handbook which explains the scoring system used to decide how the roles are allocated to certain bands. You should also read your employer’s own job evaluation policy (or 're-banding' policy) and our publication: NHS Job Evaluation Reviews: what to do if you think your pay band is wrong. You can find further information in our NHS job evaluation guidance.

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.

Discuss your concerns with your line manager in the first instance and read our NHS job evaluation guidance.

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 Agenda for Change handbook (AfC) pay rates for all nursing staff wherever they may work.

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 AfC 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 and sick pay
  • 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. 

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.

GP nursing staff are usually employed directly by general practices (GPs), which are independent businesses funded by the government. This means 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.

Read more about our campaign for fair pay for general practice nursing staff.

We know that health care assistants’ pay rates in the independent sector 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 website.


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Fair Pay for Nursing

Find out more about the Fair Pay for Nursing campaign and how you can get involved.

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For information on strike action, head over to our Strike Hub, where you can log in to stay up to date with new details about strike action as soon as they’re confirmed.

Your pay

Check your entitlements to pay - whether you work in the NHS or the independent sector.

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Get answers to your contract questions including notice queries and whether your employer can change your contract.

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Page last updated - 20/05/2024