Last updated 19 June 2026
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NHS VSM Pay Framework
In short: NHS Very Senior Managers are board-level executives in trusts and integrated care boards. Their pay is set by a national framework of five bands, keyed to the size of the organisation, with ranges from about £100k to over £309k. A 3.0% award applies from 1 April 2026. This page explains how the framework works and what each role pays.
Who Is a VSM?
You are a Very Senior Manager (VSM) if you hold an executive position on the board of an NHS trust, NHS foundation trust or integrated care board (ICB) — or a senior post reporting directly to the chief executive without a board seat.
According to the SSRB 48th Annual Report, there were around 2,844 VSMs in trusts and foundation trusts in June 2025, plus about 766 in ICBs. Average VSM basic pay was £145k, and variable pay added 8.6% on average (£12k), giving typical total pay of around £157k.
Model a VSM salary
Open the calculator on a “VSM Custom” scenario, pre-filled with the average VSM salary. Adjust it to your own figure to see take-home pay and pension, including the personal allowance taper and additional-rate tax. For illustration only — not financial advice.
The VSM Pay Framework
The VSM pay framework, most recently published by NHS England in May 2025, sets pay ranges for VSM roles. It has five bands (A to E), keyed to the organisation’s turnover. It is not a spine like Agenda for Change: each individual is paid locally within a range, by the remuneration committee.
The framework groups roles into three levels:
- chief executives;
- board-level executive directors;
- executive directors who report to a board director.
Each range has three points: a minimum, an operational maximum, and an exception zone for unusual cases. Remuneration committees can offer a premium of up to 15% to attract leaders to challenged trusts, and a bonus of up to 10% of salary for strong performers. Annual uplifts can be withheld where an organisation sits in the lowest segment of the NHS performance league tables. Any VSM salary at or above £170k needs central approval.
The 2026 Pay Award
3.0%
Consolidated pay award for VSMs and ESMs from 1 April 2026
The Government accepted the Review Body on Senior Salaries recommendation of a 3.0% consolidated award for all VSMs and ESMs from 1 April 2026, and confirmed it in May 2026.
| Organisation turnover | Group | Minimum | Operational maximum | Exception zone |
|---|---|---|---|---|
| Up to £250m | A | £145k | £201k | £217k |
| £250m–£499m | B | £156k | £223k | £244k |
| £500m–£749m | C | £179k | £246k | £260k |
| £750m–£1bn | D | £223k | £257k | £287k |
| Over £1bn | E | £246k | £279k | £309k |
Gross annual ranges, effective 1 April 2025, rounded to the nearest £1,000. Source: SSRB 48th Annual Report, Table 5.1 (NHS England VSM pay framework, May 2025).
| Organisation turnover | Group | Minimum | Operational maximum | Exception zone |
|---|---|---|---|---|
| Up to £250m | A | £100k | £156k | £184k |
| £250m–£499m | B | £112k | £167k | £195k |
| £500m–£749m | C | £123k | £179k | £206k |
| £750m–£1bn | D | £134k | £190k | £217k |
| Over £1bn | E | £156k | £207k | £228k |
Gross annual ranges, effective 1 April 2025, rounded to the nearest £1,000. Source: SSRB 48th Annual Report, Table 5.2 (NHS England VSM pay framework, May 2025).
| Organisation turnover | Group | Minimum | Operational maximum | Exception zone |
|---|---|---|---|---|
| Up to £250m | A | Agenda for Change or equivalent | ||
| £250m–£499m | B | Agenda for Change or equivalent | ||
| £500m–£749m | C | £112k | £134k | £136k |
| £750m–£1bn | D | £117k | £140k | £146k |
| Over £1bn | E | £123k | £151k | £157k |
| AfC Band 9 (entry–top) | — | £113k | £130k | — |
The bottom row shows the Agenda for Change Band 9 range for comparison: in the two smallest turnover groups these roles sit at the AfC rate, and the bottom of the VSM ranges can sit at or below the top of Band 9. Gross annual ranges, effective 1 April 2025, rounded to the nearest £1,000. Source: SSRB 48th Annual Report, Table 5.3 (NHS England VSM pay framework, May 2025).
| Weighted population | Group | Minimum | Operational maximum | Exception zone |
|---|---|---|---|---|
| Under 1m | A | £190k | £214k | £239k |
| 1m–1.5m | B | £206k | £230k | £255k |
| 1.5m–2m | C | £239k | £260k | £282k |
| Over 2m | D | £271k | £293k | £314k |
Gross annual ranges, effective 1 April 2025, rounded to the nearest £1,000. Source: SSRB 48th Annual Report, Table 5.4 (NHS England VSM pay framework, May 2025).
| Role | Smaller ICBs (min–max) | Larger ICBs (min–max) |
|---|---|---|
| Chief finance officer | £144k – £173k | £167k – £197k |
| Chief nursing officer | £134k – £162k | £155k – £184k |
| Chief medical officer | £134k – £162k | £155k – £184k |
| Other board executives | £124k – £150k | £131k – £171k |
Smaller ICBs = groups A and B (under 1.5m weighted population); larger ICBs = groups C and D (over 1.5m). Source: SSRB 48th Annual Report, Table 5.5, effective 1 April 2025.
VSM Pay vs AfC Band 9
The current top of AfC Band 9 is £130k. In smaller trusts, the bottom of the VSM ranges sits at or below this level. The Review Body flagged this as a problem: there can be little financial reward for stepping up from a senior Band 9 role into a VSM executive post, which weakens the incentive to move.
The Review Body cited the Band 9 maximum as £126k in its 2026 report, rising to £134k in London with the High-Cost Area Supplement. It asked the Department of Health and Social Care to train remuneration committees on this overlap by July 2026.
Most VSMs stay in the NHS Pension Scheme, but membership falls as pay rises. At these salaries the annual allowance can make extra pension saving expensive, which is why some higher earners opt out. The decision is rarely simple — free guidance is available from Pension Wise, and a regulated financial adviser can model your own position. This page is information, not advice.
| Salary range | June 2024 | June 2025 |
|---|---|---|
| £110,000–£125,000 | 88% | 88% |
| £125,000–£150,000 | 88% | 90% |
| £150,000–£175,000 | 82% | 87% |
| £175,000–£200,000 | 72% | 82% |
| Over £200,000 | 65% | 71% |
| All VSMs | 84% | 87% |
Estimated share of VSMs in the NHS pension scheme. Source: SSRB 48th Annual Report, Table 5.7, effective 1 April 2025.
ESMs: A Brief Note
Executive and Senior Managers (ESMs) are the equivalent senior leaders in the Department of Health and Social Care’s arm’s-length bodies. There were around 502 ESM posts, on a separate framework set in 2016. The Review Body has recommended withdrawing the ESM framework; the Government accepted this, with withdrawal scheduled after April 2027 as NHS England is wound down. ESMs are a separate group from VSMs and are not covered further here.