NHS sick pay entitlement
NHS staff on Agenda for Change contracts get occupational sick pay that increases with length of service, capped at six months full pay plus six months half pay after five years. The rules sit in Section 14 of the NHS Terms and Conditions of Service handbook.
Sick pay by length of service
| Reckonable service | Full pay | Half pay |
|---|---|---|
| During the first year | 1 month | 2 months |
| During the second year | 2 months | 2 months |
| During the third year | 4 months | 4 months |
| During the fourth and fifth years | 5 months | 5 months |
| After completing five years | 6 months | 6 months |
Entitlement is measured in calendar months and runs on a rolling 12-month basis.
What counts as full pay
Full pay is your basic salary plus any regularly received pay supplements. The handbook explicitly lists London weighting (HCAS) and unsocial hours premia as part of full pay for sick pay calculations. The figure used is your average earnings over the three months immediately before your absence began, so if your normal rota includes nights, weekends or a regular bank shift pattern, your sick pay reflects that.
On-call payments and overtime are not part of full pay for sick pay purposes. If you are normally paid extensive overtime, your sick pay will be lower than your normal take-home.
How service is calculated
Reckonable service is continuous NHS service across any of the four UK nations. A move between NHS Trusts does not break service as long as there is no gap longer than 12 months between contracts. Time on maternity leave, paternity leave, adoption leave, shared parental leave and authorised career breaks all counts. Time spent on a placement during pre-registration training does not count.
Agency work, locum work outside a substantive NHS contract, and work for organisations such as private hospitals or care homes do not count even if you were doing the same job. This is why nurses returning to the NHS after a stint in the private sector sometimes find their sick pay entitlement has dropped back to the first-year level.
When you exhaust sick pay
Sick pay does not run forever. When you reach the end of full pay you move to half pay. When you reach the end of half pay you move to nil pay, although you remain employed. Some Trusts have discretionary policies that extend pay in exceptional cases, particularly for work-related injury, but there is no automatic right.
Long-term sickness absence may eventually lead to ill-health retirement under the NHS Pension Scheme or to a managed return to work on adjusted duties. Both pathways involve Occupational Health and your line manager. Trade union representation (RCN, Unison, Unite or others) is important if the absence is heading towards a capability process.
Injury Benefit Scheme
Staff whose earning capacity is reduced by a work-related injury or disease can apply to the NHS Injury Benefit Scheme. The scheme tops up income to 85% of pre-injury earnings for the duration of the absence or permanently for those whose earning capacity is permanently affected. It is administered by NHS Business Services Authority and sits separately from basic sick pay.
The scheme covers physical and mental health conditions that arise out of and in the course of NHS employment. Common claims include musculoskeletal injuries (back injuries from manual handling), needle-stick injuries leading to bloodborne virus transmission, and psychological injuries from workplace incidents. The 2008 version of the scheme applies to current claims.
Common questions
- Do I get full sick pay from day one of my NHS job?
- Yes. NHS occupational sick pay starts from your first day of NHS employment. You do not need a qualifying period. During your first year of service you are entitled to one month at full pay followed by two months at half pay if you are off sick for that long.
- How is NHS sick pay calculated?
- Full pay is your basic salary plus regularly received supplements like London weighting (HCAS) and unsocial hours premia. Half pay is 50% of full pay. The sick pay entitlement runs in a rolling 12-month period, so absences from earlier in the year count towards the cap.
- What counts as reckonable service for NHS sick pay?
- Any continuous service with an NHS organisation in the UK counts, including service in England, Scotland, Wales and Northern Ireland. A short break of less than 12 months between NHS jobs does not reset your service. Time on maternity leave, adoption leave or paternity leave also counts. Agency work and locum work outside a substantive NHS contract does not count.
- Does Statutory Sick Pay still apply?
- Yes, technically, but NHS sick pay is paid in place of Statutory Sick Pay (SSP) and is always at least as generous, so you are not worse off. Your payslip might show SSP as a separate line item with the NHS top-up added; the total is your full or half pay entitlement.
- What happens when my sick pay runs out?
- When you reach the end of full pay you move to half pay. When you reach the end of half pay you move to nil pay. You remain employed and your continuous service continues, but you receive no salary. Some Trusts will discretionarily extend pay in exceptional cases, particularly for work-related injury, but there is no automatic right.
- Are NHS injuries on duty treated differently?
- Yes. The NHS Injury Benefit Scheme can top up income to 85% of pre-injury earnings for staff whose earning capacity has been reduced by a work-related injury or disease. This sits on top of (or replaces) basic sick pay. It is administered separately by NHS Business Services Authority and you have to apply for it. The 2008 scheme rules are the ones currently in force.
- Does mental health absence get the same sick pay as physical?
- Yes. Section 14 of the Agenda for Change handbook treats all certified sickness absence the same, whether the cause is physical or mental health. You need a fit note from your GP after seven calendar days of absence (or earlier if your line manager requests one). Self-certification covers the first seven days.