Agenda for Change
Agenda for Change is the pay and conditions framework used for nearly every NHS employee outside of medical and very senior management roles. It groups every job on bands 1 to 9, with sub-bands at 8a, 8b, 8c and 8d, and sets a national pay scale for each band.
How banding works
Every NHS post is matched to a band using the NHS Job Evaluation Scheme. The scheme scores 16 factors per role: knowledge, responsibility for patient care, responsibility for staff, responsibility for finance and resources, responsibility for policy implementation, freedom to act, communication and relationship skills, analytical skills, planning skills, physical effort, emotional effort, mental effort, environmental conditions, and a few others. The total points produced by the scoring determine the band.
Once a post is banded, the pay scale is fixed nationally. A local NHS organisation can't unilaterally pay above or below the national rate, and they can't move a job to a different band without a formal re-banding review with trade union sign-off. That's the whole point of the framework: a Band 5 staff nurse in Cornwall and a Band 5 staff nurse in Newcastle earn exactly the same basic pay.
Pay progression within a band
Most bands have at least two pay points: an entry step you join on and a top step you reach with experience. Larger bands (5, 6, 7 and 8a to 8d) have an intermediate step between the two. Progression from one step to the next happens after a fixed period of service (two or three years per step), provided your annual appraisal is satisfactory. Progression isn't automatic: you need to demonstrate that you've met the agreed objectives and competencies for your role.
Once you reach the top step of your band, the only way to earn more is to get promoted to a higher band or to take on additional responsibilities that justify a re-banding. Annual cost-of-living rises continue to apply (whatever the national pay deal delivers each year), but there's no further step progression within your current band.
What's outside Agenda for Change
Doctors and dentists are paid under their own framework, with separate scales for foundation doctors, specialty trainees, specialist and associate specialist doctors, and consultants. Consultant doctors also get Clinical Excellence Awards on top of basic pay, which can add £3,000 to £77,000 a year for the most senior posts.
Very Senior Managers (chief executives, chief operating officers, finance directors and other Board-level executives) are paid under a separate Very Senior Manager pay framework. VSM pay is set by the relevant Trust Board within national guidance, and the salaries are typically in the £140,000 to £250,000 range depending on Trust size.
Everyone else, around 1.5 million NHS staff in total, is on Agenda for Change. That includes every nurse, midwife, paramedic, physiotherapist, occupational therapist, radiographer, pharmacist, pharmacy technician, healthcare assistant, ward clerk, porter, domestic, catering assistant, and every administrative and managerial role up to and including Band 9.
The 12 bands in 2026/27
Tap any band for the full pay scale, role examples, progression rules and FAQs.
- Band 1. Closed to new entrants. Held by remaining staff who were not migrated to Band 2.
- Band 2. Entry-level support roles across NHS clinical and non-clinical services.
- Band 3. Senior support and entry administrative roles.
- Band 4. Senior assistant practitioners and team leaders below registered professional level.
- Band 5. Newly qualified registered professional roles — the entry point for nurses, midwives, AHPs and similar.
- Band 6. Specialist and senior practitioner roles, including most experienced nurses and AHPs.
- Band 7. Advanced practitioners, ward managers and clinical team leads.
- Band 8a. Clinical leads, matrons and senior managers in larger services.
- Band 8b. Senior service leads and consultant practitioners.
- Band 8c. Heads of profession and senior operational managers.
- Band 8d. Deputy directors and large-service heads.
- Band 9. Trust-level directors of profession. Senior medical staff and very senior managers are paid separately.
Common questions
- What is Agenda for Change?
- Agenda for Change is the national pay and conditions framework for the majority of NHS staff: nurses, midwives, paramedics, allied health professionals, technical staff, healthcare assistants, administrative staff and managers. Doctors, dentists and very senior managers (chief executives and other Board-level executives) are paid under separate frameworks. Agenda for Change covers roughly 1.5 million NHS staff across the four UK nations.
- When did Agenda for Change start?
- Agenda for Change was rolled out across the NHS from October 2004 after the 2003 framework agreement. It replaced a patchwork of older Whitley Council pay scales with a single banded structure built around the NHS Job Evaluation Scheme. The transition took several years to complete fully, with some staff retaining pay protection from their pre-AfC contracts.
- Do all four UK nations use Agenda for Change?
- Yes. England, Scotland, Wales and Northern Ireland all use the same Agenda for Change framework, but each nation negotiates its own pay scales and issues its own circular. Scotland negotiates separately through partnership with the trade unions and consistently pays more than the other three. England, Wales and Northern Ireland adopt the Pay Review Body recommendation in lockstep.
- How are NHS roles assigned to a band?
- Every NHS role is matched against the NHS Job Evaluation Scheme by a panel of trained job matchers and trade union representatives. The scheme scores the post against 16 factors covering knowledge, responsibility, communication, mental and physical effort, working conditions and a few others. The total points score maps to a band, and once a post is banded, the pay scale is fixed nationally. A Trust can't unilaterally move a job up or down without going through a formal re-banding process with joint sign-off.
- When do NHS pay rises happen?
- Most years, the NHS Pay Review Body publishes its recommendation in the spring and the government responds in early summer. The agreed uplift is applied to the Agenda for Change scale with effect from 1 April, backdated by a month or two. In practice, staff usually see the new pay rate plus arrears in their August or September payslip. Scotland negotiates on a different timetable and sometimes finalises its deal before the PRB has reported.
- Why are there sub-bands at Band 8 but not the others?
- Band 8 covers a wide range of senior roles with very different responsibility levels, from a service-area lead to a deputy director. Splitting Band 8 into 8a, 8b, 8c and 8d allows the framework to differentiate pay properly. The other bands cover narrower ranges of roles, so a single band works. Band 9 is the substantive director role (Director of Nursing, Chief AHP, Director of Pharmacy) and is also a single band because it covers a small number of clearly defined posts.
- What's the difference between a band and a pay step?
- The band is the slot your job sits in (Band 5, Band 6, and so on). Pay steps are the increments within a band. Bands 2 and below have a single step. Bands 3 and 4 have entry and top steps. Bands 5 through 9 have entry, intermediate and top steps. New starters join on the entry step and progress to the next step after a fixed period (two or three years per step) if their annual appraisal is satisfactory.
- Can my pay band go down?
- Only if your job is formally re-banded after a job evaluation review, and even then most Trusts apply pay protection so existing staff don't lose money in cash terms (their pay is frozen at the old rate until the new band's pay catches up). New post-holders would be appointed at the lower band from day one. Pay banding doesn't move down because of performance issues: those go through HR processes separately.