NHS organisations across the UK make extensive use of bank arrangements. Bank work is usually delivered through zero hours contracts, which differ from substantive NHS Agenda for Change contracts in their terms, conditions and pay arrangements. These approaches vary across the UK.

In 2025, Congress asked RCN Council to investigate the impact of bank arrangements on NHS pay, terms and conditions. Work undertaken identified variation in how additional hours are offered and paid. Common practice includes nursing staff being paid bank shifts at rates that differ from their substantive contract, and additional hours only available through a bank contract rather than through the individual’s main employment. Evidence from the RCN (2025) highlights the wider context, with many nursing staff regularly working extra hours, often unpaid. Limited access to flexible working or overtime also influences decisions about taking bank shifts.

Payment for bank shifts is set by the organisation offering the shift. Bank shifts are often offered at band 5, regardless of the substantive band of the individual or the responsibilities involved. In some cases, bank workers carry out duties beyond the level of the pay band offered. This raises questions across the UK about consistency, fairness and how skills are recognised when bank arrangements operate alongside substantive NHS employment.

References

Royal College of Nursing (2025) State of the Profession: RCN Employment Survey Report 2025. Available at: rcn.org.uk/Professional-Development/publications/rcn-employment-survey-2025-uk-pub-012-342 (Accessed 24 March 2026).