NHS Pay Bands

NHS pay by nation

All four UK nations use the Agenda for Change framework, but each negotiates its own pay scales on its own timetable. Scotland normally pays more than England at every band.

Four nations, one framework

Agenda for Change is the single national pay framework for nearly every NHS employee in the UK outside medical and very senior management roles. It groups every job on bands 1 to 9, with sub-bands at 8a to 8d, and assigns a pay scale to each band. What it does not do is set the same cash figures across the four UK nations. Each nation publishes its own pay scale every year, drawn from its own negotiating process, with its own implementation timetable and its own circulars.

In practice, England, Wales and Northern Ireland operate close to each other because they all defer to the NHS Pay Review Body recommendation. Scotland negotiates independently between the Scottish Government and the NHS trade unions, frequently arriving at higher headline figures and richer structural elements such as multi-year deals with inflation guarantees.

How each nation negotiates

England is the largest workforce and acts as the reference point. NHS Employers negotiates on behalf of the Department of Health and Social Care, with the independent NHS Pay Review Body submitting an annual recommendation that the UK Government accepts, modifies or rejects.

Wales follows the same Pay Review Body recommendation in headline terms but publishes its own AfC(W) circulars. The Welsh Government has at times added top-ups at lower bands to keep entry pay above the Living Wage Foundation real Living Wage.

Scotland negotiates directly between the Scottish Government and the NHS Staff Council Scotland, sidestepping the UK Pay Review Body. Scottish settlements are typically agreed earlier in the year and have consistently been more generous than the English/Welsh/NI deal.

Northern Ireland implementation requires Northern Ireland Executive approval, which has historically caused delays of months or years compared with the rest of the UK. In some recent years NI staff have received their pay rise nearly two years after the rest of the UK.

How the cash differs at the bands people search for

The table below compares Band 2, Band 5, Band 6, Band 7 and Band 8a entry rates across all four nations for the latest published pay year. Band 5 (newly qualified nurses, AHPs, paramedics) is the most-searched comparison. Band 6 (specialist nurses, senior AHPs) is the next most common.

Band England Scotland Wales N. Ireland
Band 2 entry £25,272 £26,696 £26,300 £24,465
Band 5 entry £32,073 £34,544 £32,557 £31,049
Band 6 entry £39,959 £43,231 £40,559 £38,682
Band 7 entry £49,387 £52,845 £50,129 £47,810
Band 8a entry £57,528 £65,125 £58,379 £55,690

Figures are basic salary at entry to band, drawn from the latest published official circular for each nation. They exclude London weighting (England HCAS) and any enhancements.

London weighting in England

Staff working at NHS Trusts in and around London receive the High Cost Area Supplement (HCAS), a pay top-up on basic salary. The supplement has three zones: Inner London is 20% of basic salary (capped between £5,794 and £8,746 in 2026/27), Outer London is 15% (£4,870 to £6,137) and Fringe is 5% (£1,346 to £2,270). HCAS is pensionable and is subject to income tax and National Insurance in the usual way. None of the other UK nations operate an equivalent regional pay supplement.

Common questions

Do all four UK nations pay NHS staff the same?
No. England, Scotland, Wales and Northern Ireland all use the Agenda for Change framework but each negotiates its own pay scales. Scotland has consistently paid more than England at almost every band since 2018. Wales has caught up at lower bands but lags at senior bands. Northern Ireland tends to follow England with a delay because it needs Executive sign-off.
Why does Scotland pay NHS staff more than England?
Scotland negotiates pay separately through the Scottish Government and the NHS trade unions, rather than through the UK-wide Pay Review Body process. Successive Scottish Governments have chosen to use this flexibility to pay NHS staff more than rest-of-UK rates, partly as a recruitment and retention measure and partly as a political choice. The Scottish multi-year deals also include an inflation guarantee that triggers an automatic top-up if CPI exceeds the deal-implied figure.
Does the NHS pay rise apply across all four UK nations on the same day?
No. All four nations notionally apply pay rises from 1 April, but the implementation date is set by each nation's own circular. England, Wales and Northern Ireland often implement together (within a few weeks of each other), while Scotland frequently runs to a different timetable. Arrears for backdated periods are paid alongside the first new monthly rate.
Which UK nation has the highest NHS pay?
For most bands in the current pay year, Scotland pays the highest basic rates, followed by Wales, England and Northern Ireland in that order. The picture varies year by year because each nation negotiates separately. London-based NHS staff in England receive the High Cost Area Supplement (HCAS) on top of basic pay, which can push effective pay above Scottish levels for staff working at Inner London Trusts.
Can I transfer my NHS service between UK nations?
Yes. Service in any UK NHS counts as continuous NHS service for purposes of annual leave, sick pay and pension membership. You move onto the pay scale of the nation you are working in (so transferring from England to Scotland normally means a pay rise; the reverse normally means a pay cut). Your pay step is preserved by service length, not by the cash value you were previously paid.