NHS England Pay Bands 2026/27

How Pay Works in England

England is the home of Agenda for Change — the national pay and conditions system for most non-medical NHS staff. The AfC handbook defines bands, spine points, working hours (37.5 per week) and core terms. When other nations describe their pay as “different from England”, this is the baseline they mean.

Where England itself differs from the rest of the UK is the High Cost Area Supplement (HCAS) — a percentage-based top-up for staff working in and around London. No other nation has an equivalent.

HCAS Zones

HCAS is paid as a percentage of basic salary, subject to minimum and maximum annual caps. Eligibility is based on the former PCT area where your employer is located, not where you live. There are three tiers:

Rates and caps are from the 2026/27 AfC pay scales. If the percentage of basic salary falls below the minimum, the minimum is paid. If it exceeds the maximum, the maximum is paid.

How Pay Is Negotiated

In England, AfC pay is set following recommendations from the NHS Pay Review Body (NHSPRB), an independent body that takes evidence from the government, NHS employers, and unions. The Secretary of State for Health decides whether to accept, modify, or reject the recommendation.

For 2026/27, the government accepted a 3.3% uplift across all bands. Scotland negotiates separately through STAC and agreed 3.75%.

Tax

England uses the standard UK income tax rates (20% basic, 40% higher, 45% additional) and the 1257L tax code giving a £12,570 personal allowance. These rates also apply in Wales and Northern Ireland. Only Scotland has different income tax bands.

Unsocial Hours and Overtime

AfC staff in England work a standard 37.5-hour week. Hours above that threshold are treated as overtime. Unsocial hours payments for evenings, nights, weekends and public holidays are calculated on basic salary at rates set in the AfC handbook.

Pension

English NHS staff belong to the NHS Pension Scheme, administered by the NHS Business Services Authority (NHSBSA). It is a defined benefit scheme using a NET pay arrangement, so contributions come out before tax is calculated. HCAS counts as pensionable pay.