When you’re deciding how to work in the NHS, it’s easy to focus on the short-term perks, such as having the flexibility to pick and choose shifts, or being paid weekly. But the type of contract you’re on affects much more than your weekly schedule. From pay and pensions to sick leave and career progression, the gap between bank work and substantive employment is bigger than many realise. It’s worth noting the Employment Rights Bill will be looking at some of the working conditions that affect bank workers, such as increased rights for workers on zero-hours contracts.
Here’s what you need to know before you make the call.
Employment status and contracts
Substantive employment: You’re employed on permanent or fixed-term contracts with contractual (guaranteed) hours and contractual employment rights. Your employment status is most likely to be an employee.
Bank work: You’re on zero-hours contracts, with no guaranteed hours, no job security (and no obligation to be offered any work). You also have no obligation to take shifts offered and can choose what shifts to accept. Your employment status is most likely to be a worker, not an employee, although your specific contract and circumstances determine this.
If you sign or accept a substantive contract and a bank contract, they are separate contracts and each may have different terms, conditions and legal entitlements. You shouldn’t be forced to agree to a bank contract to work additional hours if you have a substantive contract in place; if asked to work additional hours, you can indicate your willingness to do this under your substantive contractual terms and pay rates.
Your pay
Substantive employment: You’re paid according to NHS terms and conditions with pay bands and incremental progression based on experience and service.
National NHS pay awards or agreements – for example, cost of living uplifts – are applied to pay including any agreed back-pay periods. Enhancements also apply for unsocial hours and overtime.
A substantive NHS contract says you should be paid at your normal pay rate for additional hours worked in a week up to 37.5 hours (37 hours in Scotland), which is contractual full-time hours. Hours worked beyond that should be paid at overtime rates.
As an alternative to overtime, you may request to take time off in lieu (TOIL) instead of receiving overtime payments. If you cannot take the TOIL within three months, you are entitled to overtime payment.
Bank work: Pay rates vary across employers and countries, and bank workers are not usually entitled to nationally agreed NHS cost-of-living uplifts. The majority of bank contracts are not the nationally agreed NHS terms and conditions.
Annual leave entitlements
Substantive employment: You’re entitled to paid annual leave, increasing with length of service.
Bank work: Your holiday pay is often included in the hourly rate or accrued separately, depending on the local policy. Unless the zero-hours (bank) contract matches NHS terms and conditions, the annual leave entitlement may only be the statutory minimum. That’s not the same as NHS contractual annual leave entitlement.
Sick pay
Substantive employment: You’re eligible for NHS occupational sick pay, entitlement increases with service length: up to six months on full pay and six months at half pay.
Bank work: Generally, you’re only entitled to Statutory Sick Pay (SSP), which is significantly lower than NHS occupational sick pay.
Parental leave
Substantive employment: You’re eligible for NHS maternity/paternity leave and pay, subject to length of service. You may also be able to use Shared Parental Leave (SPL), which allows you to share leave and pay with your partner during your child's first year. Again, you have to meet specific eligibility criteria. Find out more in the RCN's Having a family toolkit.
Bank work: Typically, you’re only entitled to statutory maternity/paternity pay.
Pension schemes
Substantive employment: You’re automatically enrolled in the NHS Pension Scheme.
Bank work: You may have access to the NHS Pension Scheme, but this depends on local policies and the nature of the bank contract. Substantive workers doing bank shifts in addition to their contractual hours will not receive pension contributions on bank shifts.
Flexible working
Substantive employment: You’re eligible for contractual NHS flexible working entitlements and you have the statutory right to request flexible working. If you’re having difficulty accessing flexible working arrangements, please read our advice guide on the topic.
Bank work: You have no right to request flexible working. That's because, as a bank worker, you have no obligation to accept any bank work offered.
Job security and career progression
Substantive employment: You’ll have a level of job security, career progression and opportunities for training and professional development.
Bank work: There’s a lack of job security and structured progression pathways. As a bank worker, rather than an employee, you might find that you’re not eligible for training and development programmes offered to employees.
More help and advice
- Agency worker or employee? This RCN advice guide gives you further information on your rights and how to check your employment status.
- Get help: take a look at our advice guides homepage for help with a range of topics including 10 things to check before you sign a contract, changes to your shifts and lots more.
- Can't find the answer to your question? Try our Get Help section, including how to contact the RCN Advice team.
