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Pay: NHS and Independent health and social care employers

NHS pay

Nurses and Health care support workers 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

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.

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. If you are considering requesting a review we recommend that you have the support of your local RCN representative. Please contact us for more information.

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 AfC handbook 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.

Statutory rates of pay are those which your employer is legally obliged to pay you, provided you meet certain criteria. Go to and for information on:

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.

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.

Recent case law had established that sleep-ins were covered by the NMW regulations. If a worker is expected to sleep-in at their workplace then these hours were deemed as working hours. This was overturned at appeal (June 2018) meaning that employers do not have to pay NMW for such time (at the time of writing the claimant is considering a further appeal). However, the RCN Nursing Workforce Standards (standard 4) calls for the nursing workforce to be recognised and valued through fair pay, terms and conditions and therefore calls for the Real Living Wage to be given as a minimum.

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.

Fair pay for nursing #fairpayfornursing

Fair Pay for Nursing

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

Your pay

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

Your contract

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

Page last updated - 30/05/2022