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NHS terms and conditions: Agenda for Change

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This guide includes information for staff employed by NHS employers about pay scales, sick pay, pay on appointment, pay progression, annual leave, overtime and annual leave, maternity entitlements and reckonable service.

NHS Employers have also produced a handy A-Z to help managers and staff navigate the NHS Terms and Conditions of Service Handbook ('the handbook').

Pay scales and job evaluation 

NHS pay scales in England are available in the NHS Employers handbook at annexes 2-3. These outline annual salary, hourly pay and adjustments for inner/outer London.

Information on NHS pay in Scotland is available here.

Information on NHS pay in Northern Ireland is here.

Information on NHS pay in Wales is in our Wales Pay FAQs.

Job evaluation

Job evaluation is the process by which jobs within the NHS are compared with each other, using agreed and consistent rules. Job roles are 'scored' against fixed criteria and matched with a specific pay band depending on how high that score is. 

Find out more about NHS job evaluation here. If you're thinking of asking for a review of your banding, please see our job evaluation resources

Your starting pay will depend upon your circumstances – these are described below. For further information read NHS terms and conditions (section 1, as applicable to the country in which you work) and your employer’s local pay policy.

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. 

Promotion within the NHS Basic pay on promotion will generally be set at the minimum pay-step point of the new pay band. See section 1 of the NHS terms and conditions, along with section 2.13 for Scotland, Northern Ireland and Wales. Your pay step date will reset to the date you start your new band.
Appointment to a post in a lower pay band through choice

The handbook does not state how your starting salary should be calculated if you start on a lower pay band through choice.

We believe that you should enter the new band at the point you would have reached if all your NHS service in equivalent, or higher, pay bands had been worked in the lower band.

Moving to another NHS employer

Annex 23 of the handbook (point 16) states that continuous previous service with any NHS employer counts in respect of reckonable service for pay step eligibility.

When this happens, it is common practice for staff to be paid on the minimum of the band until confirmation of previous salary (such as a copy of the last payslip or and contract) has been received from the former NHS employer. Once confirmed, any necessary adjustment should be backdated to your start date with the new employer.

Staff with a break in NHS employment

The handbook does not state how you should have your starting pay calculated if you have had a break in NHS employment.

Under local policy, management and human resources are likely to have the discretion to take into account previous NHS service. Generally, there would be no obligation to pay new starters with previous NHS service higher than the bottom of the pay band, unless the employer's policy explicitly states that this must be taken into account.

Staff without previous NHS employment Staff without previous NHS employment would normally be appointed to receive the minimum of the pay band. However, NHS employers do have the discretion to take into consideration previous experience that may be relevant to NHS employment.
Temporary movement into a higher band (acting-up)

Staff may be moved into a higher pay band on a temporary basis when a vacancy is unfilled (but being advertised), or the post is being held open for someone who is due to return, for example, from maternity leave or long-term sick leave.

Your pay should be set either at the minimum of the new pay band or, if this would result in no pay increase, at the first pay point in the band that would deliver an increase in pay. In circumstances where you are not required to carry out the full responsibilities of the post, pay will be determined by job evaluation. See section 6 of the handbook (as applicable to the country in which you work).

If you are being asked to work in a higher banded post for any period, you should only do so where your rate of pay is agreed in advance. If you are currently working in a higher banded post and are not being paid accordingly, you should discuss this with your manager, and contact us if you need further help.

Sections 1 and 6 of the handbook set out in more detail how pay and career progression within the NHS Knowledge and Skills Framework (KSF) performance system work. 1.15 of the handbook says that for 'newly appointed or promoted staff their pay step date will be the date they take up their post'.

Annex 23 sets out in detail the principles and guidance that underpin local pay progression policies in England and Wales. This also sets out pay step dates, what happens when you change job band, and pay progression standards. You should ask to see your employer's policy if you have any queries about the process being followed where you work.

Increments are conditional on meeting local standards 

Annex 23 states that incremental pay progression will be 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.                             

Frequency and timing of annual appraisals is important. KSF guidance states that employers should hold appraisals no later than three months prior to your incremental date. This would link performance and incremental pay progression and allow you time to prepare for the appraisal. You should also check your employer's written polices for specific detail of the process to be followed at your workplace.

If there are concerns 

You should be formally told the reasons for any deferral of your increment. Pay progression cannot be deferred unless there has been prior discussion, reasons have been clearly identified and documented, and the standards or levels yet to be achieved have been clarified. 

An action plan with clear objectives and review dates should be agreed by you and your line manager. You should then have the opportunity to achieve the necessary development before a final decision is made. Pay progression can be withheld if 'significant weaknesses in performance' have not been resolved despite opportunities for development. Employers can also (where appropriate) manage performance issues under local capability and/or disciplinary policies.

For more information on managing performance please see our advice on capability.   

Transparency and fairness 

While you need to demonstrate the application of knowledge, skills and competence in your role, your employer is also required to have an agreed and fair appraisal system in place. 

Employers’ appraisal, development and review systems should be transparent and applied consistently and objectively to avoid any unfair treatment of staff protected under the Equality Act 2010. Appraisals should be evidence-based and not based on bias, personalities or subjective views. Employers should also consider any 'reasonable adjustments' for those protected under the Equality Act 2010 and decisions should be made on a case-by-case basis.                              

In all cases, check your employer's local policy for more information about your workplace arrangements.

Below is a summary of the NHS sick pay entitlements. For full information, please see section 14 of the handbook. Please note that there are three sections; one covering England, one covering Wales, and the other covering Scotland and Northern Ireland.

You are entitled to the following sick pay:

During the first year of service One month’s full pay and two months' half pay
During the second year of service Two months' full pay and two months' half pay
During the third year of service Four months' full pay and four months' half pay
During the fourth and fifth years of service Five months' full pay and five months' half pay
After completing five years of service Six months' full pay and six months' half pay

Repeated periods of sickness absence

Your employer will take into account all periods of paid sickness absence during the 12 months immediately preceding the first day of a new episode of sickness. This will be deducted from your entitlement when calculating sick pay.

In aggregating periods of absence due to illness, no account will be taken of:

  • unpaid sickness absence
  • injuries, diseases or other health conditions sustained or contracted in the discharge of the employee's duties of employment, as defined in section 22 of the handbook
  • injury resulting from a crime of violence, not sustained on duty but connected with or arising from the employee’s employment, where the injury has been the subject of payment by the Criminal Injuries Compensation Authority (CICA) (England, Scotland and Wales) or the Compensation Agency (Northern Ireland)
  • as above, but an injury that has not been the subject of a compensation payment on the grounds that it has not given rise to more than three weeks' loss of earnings, or was not one for which compensation above the minimum would arise.

Staff who are on sickness absence due to a work-related injury, disease or other health condition may also be entitled to payment of an injury allowance as defined in section 22 of the handbook. To accompany section 22, the NHS Staff Council has published Injury Allowance – a guide for staff.

If sickness absence is because of an injury or disease wholly or mainly attributable to your employment, you may be entitled to claim additional benefits. For further information see accidents at work and personal injury.

Unsocial hours enhancements when on sick leave

Section 14 explains how sick pay for NHS staff is to be calculated. Please see the section that applies to the country in which you work.

The way in which your 'usual' sick pay is calculated will depend on what band you work in and whether the absence is due to work-related injury or disease.


Under section 13, table six of the handbook, you are entitled to the following annual leave:

On appointment 27 days annual leave + eight days general public holiday
After five years’ service 29 days annual leave + eight days general public holiday
After ten years’ service 33 days annual leave + eight days general public holiday

Irregular shifts

If you work non-standard shifts, that is, anything other than seven and a half hours excluding meal breaks, your annual leave and general public holiday entitlements should be calculated on an hourly basis, to prevent you from receiving more leave or less leave than colleagues on standard shifts (section 13.5).

Part-time workers

Part-time workers will be entitled to paid public holidays no less than pro-rata to the number of public holidays for a full-time worker, rounded up to the nearest half day (section 13.6). As a part-time worker, your public holiday entitlement will be added to your annual leave entitlement, and you should take the public holidays you would normally work as annual leave (section 13.7).

Annual leave pay

Pay during annual leave will include regularly paid supplements, including any recruitment and retention premia, payments for work outside normal hours and high-cost area supplements. Pay is calculated on the basis of what you would have received had you been at work. See section 13.9 of the handbook for more information on reference periods and how annual leave pay is calculated in the NHS.

If you work regular overtime, this should be included in the calculation of holiday pay. For more information, see our guidance on annual leave.

If you believe you have been underpaid, please see our underpayment of wages guide.


See section 15 of the handbook (note there are different provisions for England and Scotland, Wales and Northern Ireland) and your employer's policy for more detail. 

Contractual payments in the handbook are as follows:

  • for the first eight weeks of absence you will receive full pay, less any Statutory Maternity Pay or Maternity Allowance (including any dependents’ allowances) 
  • for the next 18 weeks you will receive half of full pay, plus any Statutory Maternity Pay or Maternity Allowance (including any dependents’ allowances), providing the total receivable does not exceed full pay
  • for the next 13 weeks, you will receive any Statutory Maternity Pay or Maternity Allowance that you are entitled to under the statutory scheme.

Eligibility for contractual maternity pay

Whether you work full-time or part-time, you will be entitled to paid and unpaid maternity leave under the NHS contractual maternity pay scheme, if you have 12 months’ continuous service with one or more NHS employers at the beginning of the 11th week before the expected week of childbirth.

Before the end of the 15th week before the expected date of childbirth (or if this is not possible, as soon as is reasonably practicable thereafter) you must provide your employer with a MATB1 form. 

You must also inform your employer in writing of:

  • your intention to take maternity leave
  • the date you wish to start your maternity leave; you can choose when to start this, usually any date from the beginning of the 11th week before the baby is born (but see paragraph 15.8)
  • your intention to return to work with the same or another NHS employer for a minimum period of three months after your maternity leave has ended.

Continuous employment and reckonable service

See sections 12 and 15 of the handbook for advice on continuous service.  

Returning to work after maternity leave

To claim NHS contractual maternity pay you must intend to return to work with the same or another NHS employer for a minimum period of three months after your maternity leave has ended.

You can return to work early if you give at least 28 days’ notice, although some local policies require eight weeks.

You have the right to return to your job under your original contract with no less favourable terms and conditions.

If you want to return to work on different hours in the same job your employer must facilitate this, unless they provide written, objectively justifiable reasons why this is not possible.

Failure to return to work

If you do not return to NHS employment within 15 months of the beginning of your maternity leave, then you will be liable to refund the whole of your maternity pay (except for the Statutory Maternity Pay element). In cases where your employer considers that to enforce this provision would cause undue hardship or distress, they will have the discretion to waive their rights to recovery.

If you satisfy the conditions in paragraph 15.7 but do not intend to work with the same or another NHS employer for a minimum period of three months after your maternity leave is ended, you will only be entitled to pay that is equivalent to Statutory Maternity Pay. This is paid at 90 per cent of your average weekly earnings for the first six weeks of your maternity leave, and at a flat rate sum for the following 33 weeks.

You can find out more about maternity, work and family here.

Section 12 of the handbook states:

"12.1 An employee’s continuous previous service with any NHS employer counts as reckonable service in respect of NHS agreements on redundancy, maternity, sick pay and annual leave. 

12.2 Employers have discretion to take into account any period or periods of employment with employers outside the NHS, where these are judged to be relevant to NHS employment. 

12.3 When employees who have been transferred out of NHS employment to a non-NHS provider return to NHS employment, their continuous service with a new non-NHS employer providing NHS funded services, will be counted as reckonable in respect of NHS agreements on sick pay, annual leave and incremental credit.”

Please also see Reckonable Service and Continuous Service Dates (NHSEI).

Bank workers are generally not regarded as employees and therefore do not build up 'continuity of service' in between specific bank shifts. This is important as continuity of service affects your entitlement to things such as annual leave and contractual sick pay, under the NHS terms and conditions of service. The RCN has tested this issue in the courts, on behalf of members, without success.

In the absence of continuous previous service with the NHS, employers have the discretion, under section 12 of the NHS terms and conditions of service handbook, to take into account 'any period or periods of employment with employers outside the NHS where these are judged to be relevant to NHS employment'.

Whilst this is discretionary and employers may argue that staff who work solely on a bank are not employees, staff might want to argue that this approach goes against the spirit of the clause and they should be entitled to some recognition of the years of service.

Please check any local policy and contract for more information on your position.

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Read the NHS terms and conditions of service handbook

Available from the NHS Employers website

Strike Hub

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.

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Fair Pay for Nursing

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

Pay in the NHS

Find out more about Agenda for Changepast pay scales and NHS mileage allowance.

Sick leave and sick pay

Learn about your sick pay entitlements, prepare for review meetings and find ways to deal with work-related stress.

Page last updated - 03/04/2024