Band 4 pay in England, 2026/27
Senior assistant practitioners and team leaders below registered professional level.
- Minimum
- £28,392
- Maximum
- £31,157
- Hourly at top
- £15.93
- Years to top
- 3
| Step | Years from entry | Annual | Hourly (37.5h) |
|---|---|---|---|
| Entry | From day one | £28,392 | £14.52 |
| Top | After 3 years | £31,157 | £15.93 |
| Full range | £28,392 to £31,157 | £14.52 to £15.93 | |
England, 2026/27, effective 2026-04-01. Source: Pay scales for 2026/27 — NHS Employers.
Band 4 in England, what the role involves
Band 4 is the bridge between unregistered support roles and registered professional practice. Nursing associates (registered with the Nursing and Midwifery Council), assistant practitioners, pharmacy technicians, senior medical secretaries and team leaders all sit at Band 4. Many staff use it as a stepping stone to a Band 5 registered nurse, midwife or allied health professional role, but plenty of others stay at Band 4 long term because the work suits them.
A nursing associate provides hands-on care across a much wider range of clinical tasks than a healthcare assistant, working alongside registered nurses and increasingly leading patient care for stable patients. They administer medications (including injections), take responsibility for a small group of patients on a shift, and contribute to care planning. A pharmacy technician dispenses and checks medicines, runs discharge clinics, and supports medicines reconciliation when patients are admitted or moved.
How NHS pay is set in England
England has the largest NHS workforce of the four UK nations and sets the reference pay scale for the Agenda for Change framework. Pay is negotiated by NHS Employers on behalf of the Department of Health and Social Care, following the recommendation of the independent NHS Pay Review Body. Wales and Northern Ireland usually adopt the same recommendation; Scotland negotiates separately and consistently pays more.
Each year, NHS Employers and the trade unions submit detailed evidence to the NHS Pay Review Body. The Review Body hears the evidence, decides on a recommended uplift, and submits its report to the UK Government in the spring. The government then accepts, modifies or rejects the recommendation. The agreed uplift is published as a Pay Advisory Notice on the NHS Employers website and applied to the AfC scale with effect from 1 April, normally backdated by a month or two so staff see arrears alongside their first new monthly payslip.
How Band 4 pay in England compares to other UK nations
At the top of Band 4 in England, staff earn £31,157 per year for 2026/27. Scotland pays Band 4 more at the top of band: £34,303, a difference of £3,146 per year (10.1% more than England).
Band 4 is paid at a similar level across all four UK nations. Scotland uses a two-step structure with progression after three years; the other three nations use the same approach with the same gap between steps. Welsh Band 4 entry has been slightly higher than the English figure in recent years, by a few hundred pounds.
Recent NHS pay history in England
Three recent settlements give the picture. 2024/25 saw a flat £1,400 uplift to every Band 2 to 8c pay point, plus a 5% rise for Band 8d and Band 9. 2025/26 applied a consolidated 3.6% uplift to every pay point, worth roughly £1,090 at Band 5 entry. The 2026/27 deal is a 3.3% consolidated uplift, recommended by the PRB and accepted by the government in early 2026.
Common questions about Band 4 pay in England
- What is the Band 4 salary in England for 2026/27?
- Band 4 in England pays from £28,392 at entry to £31,157 at the top of the scale for 2026/27. Staff progress through 3 years to reach top of band.
- Does England pay Band 4 the same as the other UK nations?
- No. Scotland pays Band 4 more at the top of band, with a top rate of £34,303 compared to £31,157 in England. The difference is £3,146 per year (10.1%).
- What is the hourly rate for Band 4 in England?
- Based on a standard 37.5-hour NHS week, Band 4 entry pay of £28,392 works out at £14.52 per hour, rising to £15.93 per hour at the top of band.
- How is Band 4 pay set in England?
- Each year, NHS Employers and the trade unions submit detailed evidence to the NHS Pay Review Body. The Review Body hears the evidence, decides on a recommended uplift, and submits its report to the UK Government in the spring. The government then accepts, modifies or rejects the recommendation. The agreed uplift is published as a Pay Advisory Notice on the NHS Employers website and applied to the AfC scale with effect from 1 April, normally backdated by a month or two so staff see arrears alongside their first new monthly payslip.