Agenda for Change (AfC) is the national pay structure used by the NHS to ensure fair, consistent, and transparent salaries for over 1.4 million staff across England, Wales, and Northern Ireland. It excludes doctors and very senior managers and applies to clinical and non-clinical roles alike.
Key points covered in this guide:
- NHS pay bands range from Band 2 to Band 9 based on role and responsibility
- Staff move through pay points via structured progression tied to performance
- Most frontline roles are placed in Bands 5 to 7
- High Cost Area Supplements apply to London-based roles
- 2026/27 NHS pay rise proposal and implications explained
- Job re-banding and evaluation process outlined
What Is Agenda For Change And Who Does It Apply To?
Agenda for Change is the standardised national pay system used by the NHS in England, Wales and Northern Ireland. It was introduced to ensure fairness, transparency and equal pay for work of equal value across the NHS.
Agenda for Change covers more than 1.4 million NHS employees, including a wide range of clinical and non-clinical roles such as:
- Nurses and midwives
- Allied Health Professionals including physiotherapists, radiographers and speech therapists
- Paramedics and ambulance staff
- Healthcare support workers and clinical assistants
- Administrative, clerical, and secretarial roles
- Estates, catering, portering, and facilities staff
The system does not cover doctors and dentists, who are governed by separate contracts under the Medical and Dental Terms and Conditions. Very senior managers are also excluded as they operate under a distinct pay and performance framework.
This universal pay framework was created to eliminate regional pay variations and outdated local agreements. Every role is evaluated using a national Job Evaluation Scheme that assesses responsibilities, skill levels, and working conditions to assign a role to the appropriate pay band.
How Do The NHS Agenda For Change Pay Bands Work?
Agenda for Change uses nine bands to group similar roles together. These range from Band 1, which is mostly phased out, up to Band 9, which includes the most senior non-clinical roles.
Each band reflects:
- The level of responsibility in the role
- Required qualifications, experience, and registration
- The autonomy and complexity of decisions expected
- Supervision received or given
- Budgetary and managerial oversight
Within each band, there are pay points (also called pay steps). These represent different levels of experience or time spent in that role. Typically, employees move up one point per year, assuming performance expectations are met.
The relationship between job level and pay scale is as follows:
| Pay Band | Role Level | Progression Type |
|---|---|---|
| Band 2 | Entry-level support | Routine progression |
| Band 5 | Newly qualified professionals | Requires competency progression |
| Band 7 | Senior clinical and team leaders | Performance and evaluation |
| Band 8d–9 | Executive and strategic roles | Variable by contract |
Each pay band has a defined number of points. For example, Band 5 may have three points while Band 8 may have more. These increments are designed to encourage development and reflect increased value to the organisation over time.
What Does Each NHS Pay Band Typically Include?
Each NHS role is matched to a band using detailed job evaluation criteria. Below is a practical overview of how different bands align with job responsibilities and qualifications.
| Band | Typical Roles | Required Qualifications |
|---|---|---|
| Band 2 | Healthcare assistants, porters, domestic staff | GCSEs or equivalent |
| Band 3 | Therapy assistants, admin support, clerical officers | Experience plus basic qualifications |
| Band 4 | Assistant practitioners, associate therapists | Foundation degrees, NVQ Level 4 or equivalent |
| Band 5 | Staff nurses, paramedics, newly qualified AHPs | Professional registration (e.g., NMC, HCPC) |
| Band 6 | Specialist nurses, senior radiographers, social workers | Advanced clinical knowledge and experience |
| Band 7 | Team leaders, advanced practitioners, ward managers | Significant leadership and autonomous practice |
| Band 8a–d | Clinical service leads, operational managers | Postgraduate qualifications, strategic oversight |
| Band 9 | Directors of operations, chief nursing officers | Executive leadership, national-level responsibility |
Most frontline healthcare professionals, including nurses and allied health staff, will fall between Band 5 and Band 7. These are the most densely populated bands and serve as the foundation of patient care delivery across the NHS.
How Does Progression Work Within The NHS Pay Bands?
Pay progression is designed to reward loyalty, performance, and professional development. It is not automatic but follows a structured approach across most NHS organisations.
The usual criteria for progression include:
- Completion of one year in the role (time-based step)
- Positive appraisal outcomes
- Meeting performance standards and agreed objectives
- No active disciplinary or capability procedures
Each role has defined competencies for each pay step. This ensures that progression is aligned with demonstrable growth in knowledge, responsibilities, and output.
| Band | Number of Pay Points | Typical Time To Progress |
|---|---|---|
| Band 2 | 2 | 1 year |
| Band 5 | 3 | 2–3 years |
| Band 7 | 4 | 4–5 years |
| Band 8b+ | Varies | Based on contractual terms |
“From my experience in leading a clinical team, it’s clear that this approach is fair. Staff have clarity on what’s expected, and the link between performance and reward is meaningful. It helps us have better conversations during appraisals because expectations are aligned.”
A professional workforce adviser added:
“Too often, people assume they’ll get a pay rise each April simply because they’ve stayed in role. In reality, NHS pay progression is more sophisticated. It aligns performance, development, and service delivery. If a team member isn’t progressing, it usually reflects a need for better support or clearer expectations.”
This structured pathway reinforces professionalism across the workforce and helps managers ensure that growth is rewarded.
What Are High-Cost Area Supplements And How Do They Affect Pay?
The NHS recognises that working in or near London comes with significantly higher living expenses. As a result, staff based in these areas receive High Cost Area Supplements (HCAS), commonly known as London Weighting.
These are not flat rates but percentage-based additions to basic salary. They differ by geographical zone and are capped depending on the pay band.
| HCAS Area | Supplement | Example Calculation (Band 5) |
|---|---|---|
| Inner London | 20% of basic salary (max £7,377) | Base: £30,000 + HCAS = £36,000 approx |
| Outer London | 15% (max £5,703) | Base: £30,000 + HCAS = £34,500 approx |
| Fringe | 5% (max £2,011) | Base: £30,000 + HCAS = £31,500 approx |
These supplements are pensionable and counted as part of your overall NHS remuneration. Eligibility is based on the location of your employing Trust, not necessarily where you live.
This policy ensures that NHS careers remain viable across all regions, especially where housing and transport costs are highest.
Why Does Agenda For Change Matter For NHS Pay And Workforce Planning?
Agenda for Change is central to the NHS not only because it defines pay but also because it aligns HR strategy, workforce planning and organisational design. It ensures consistency and clarity across a national system that includes hundreds of Trusts and specialist providers.
Its importance is reflected in the following:
- It enables equal pay for work of equal value
- It supports career development and internal promotions
- It simplifies national pay bargaining with trade unions
- It assists with succession planning and recruitment forecasting
- It sets a transparent framework that supports NHS values
By using job evaluation instead of negotiation to set pay, the NHS ensures that personal circumstances or local politics do not influence salary decisions. The framework is fair, auditable and scalable across different settings.
The alignment of career bands with defined capabilities also helps universities and training bodies prepare graduates who are ready to enter Band 5 roles or move directly into Band 6 after additional qualification.
What’s Happening With The NHS Pay Rise For 2026/27?
As of the current policy cycle, the Department of Health and Social Care has proposed a 2.5% pay increase across Agenda for Change roles. This proposal has not yet been finalised, and negotiations with NHS unions are ongoing.
| Aspect | Status (as of early 2026) |
|---|---|
| Proposed increase | 2.5% |
| Union position | Rejected (deemed insufficient) |
| Review body involved | NHS Pay Review Body (NHSPRB) |
| Timeline for decision | Expected late summer or early autumn 2026 |
| Implementation | Likely in late 2026 or early 2027 |
| Backdating | Expected to be applied from April 2026 |
Pay deals are typically made after the NHSPRB gathers evidence from unions, employers and government departments. Once a decision is announced, it is implemented across all NHS Trusts and applies to every band.
Some speculate that inflationary pressure and workforce shortages might push the eventual pay deal closer to 3% or more, especially for frontline clinical roles. However, this remains uncertain until final recommendations are submitted and adopted.
What Are The Most Common Questions People Ask About Agenda For Change Pay Scales?
People considering NHS careers or internal moves often want to understand how Agenda for Change works in practice. Below are the most commonly searched and discussed topics.
How Often Do NHS Pay Points Increase?
Pay point progression typically occurs annually.
However, it is dependent on:
- Meeting your objectives during the appraisal
- Satisfactory performance reviews
- Length of service in the current role
Missing any of these criteria could delay or prevent progression.
What Happens When Job Responsibilities Change?
If your role evolves significantly, it can be re-evaluated using the NHS Job Evaluation Scheme.
This may occur when:
- You take on new clinical duties
- You begin supervising or managing others
- Your scope expands across services or sites
An updated job description is submitted to HR for review and may result in your role being placed in a different pay band. However, not all changes qualify for re-banding.
Can Bands Be Re-Evaluated Across The Organisation?
Yes. NHS Trusts regularly review job profiles and staffing structures. For example, if Band 4 assistant roles begin to carry responsibilities aligned with Band 5 expectations, re-banding may be initiated either by management or the employee.
How Do NHS Pay Deals Impact Existing Salaries?
Annual pay deals like the proposed 2026/27 increase are applied across all Agenda for Change bands. These increases are separate from individual pay point progression and often backdated to the start of the financial year.
Conclusion
Agenda for Change provides a structured, fair, and transparent pay system that supports the NHS workforce across clinical and non-clinical roles.
By aligning pay with responsibilities, performance, and progression, it offers clarity for both staff and employers.
With annual reviews, national consistency, and defined career pathways, it remains central to recruitment, retention, and workforce planning.
Understanding how bands, pay points, and supplements work ensures professionals are informed and empowered throughout their NHS careers.
FAQs about NHS Agenda for Change Pay Scales
What is the difference between pay progression and annual pay rises in the NHS?
Pay progression is movement up the pay points within a band, usually once per year based on service and performance. Annual pay rises are negotiated nationally and apply to the whole NHS workforce.
Are NHS pay bands the same across England, Wales, and Northern Ireland?
Yes, but actual pay figures may differ slightly due to devolved government decisions. Scotland has a separate but similar system.
Can I negotiate my starting band when joining the NHS?
Generally, no, since bands are tied to job descriptions. However, relevant experience may allow you to start on a higher pay point within the correct band.
Do NHS staff in the private sector follow Agenda for Change?
Not usually. Private providers may mirror AfC pay scales, but they aren’t legally required to.
How does London weighting impact pensions?
HCAS is pensionable, meaning it counts towards your NHS pension contributions and benefits.
What happens if I move between roles in different bands?
You will start at an appropriate pay point in the new band, and your previous service may be considered if it’s relevant to the role.
Is it possible to skip a band during promotion?
It’s rare but possible. For example, someone might move from Band 5 to Band 7 if their experience, qualifications, and role scope match the criteria.
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