How Agenda for Change works
Agenda for Change, usually shortened to AfC, is the national pay system for NHS staff in England, apart from doctors, dentists and some very senior managers. Every AfC job is matched to one of nine pay bands using a national job evaluation scheme. The band reflects the knowledge, responsibility and skills the role needs, not the person doing it.
Within each band there are up to three pay points, or steps. You start at the entry point and move up after a set number of years, as long as you meet the standards expected in your appraisal. Since the pay structure reforms of 2019, progression is no longer automatic every year. Instead there are fewer, larger steps.
Pay is reviewed every year by the NHS Pay Review Body, which makes a recommendation to the government. For 2026/27 the award was 3.3%, applied to every pay point from 1 April 2026.
2026/27 pay and take-home at each band
The table shows entry pay for each band in England, with estimated take-home pay after income tax, employee National Insurance and NHS pension contributions. It assumes a full-time post with no London weighting, unsocial hours or student loan, and a standard 1257L tax code. The figures come from the same tax engine as our NHS take-home pay calculator.
AfC entry pay and estimated take-home, England 2026/27
| Band (entry to top) | Take-home at entry, a year / month |
| Band 2: £25,272 | £20,401 / £1,700 |
| Band 3: £25,760 to £27,476 | £20,727 / £1,727 |
| Band 4: £28,392 to £31,157 | £22,485 / £1,874 |
| Band 5: £32,073 to £39,043 | £24,483 / £2,040 |
| Band 6: £39,959 to £48,117 | £29,157 / £2,430 |
| Band 7: £49,387 to £56,515 | £35,206 / £2,934 |
| Band 8a: £57,528 to £64,750 | £40,230 / £3,353 |
| Band 8b: £66,582 to £77,368 | £44,900 / £3,742 |
| Band 8c: £79,504 to £91,609 | £50,707 / £4,226 |
| Band 8d: £94,356 to £108,814 | £58,207 / £4,851 |
| Band 9: £112,782 to £129,783 | £67,512 / £5,626 |
Band 2 has a single pay point, which has been lifted in recent years to keep it above the National Living Wage. Bands 3 and 4 have two points. Bands 5 to 9 have three.
What each band typically covers
- Bands 2 to 4: support roles. Healthcare assistants, porters, domestic and clerical staff at Band 2. Senior healthcare assistants and therapy assistants at Band 3. Assistant practitioners and pharmacy technicians at Band 4.
- Band 5: newly registered professionals. The standard starting band for nurses, midwives, paramedics and allied health professionals after qualifying.
- Bands 6 and 7: experienced and senior clinicians. Senior and specialist practitioners at Band 6. Ward managers, advanced practitioners and clinical specialists at Band 7.
- Bands 8a to 8d: senior clinical and management roles. Matrons, consultant practitioners, heads of service and assistant directors.
- Band 9: very senior roles. Directors of large services and similar posts.
Exact banding depends on the job description, so two roles with similar titles can sit in different bands at different trusts.
Why take-home pay rises less than gross pay
Three deductions come out of NHS pay, and two of them rise faster than salary.
Income tax is charged at 20% above the £12,570 personal allowance, and at 40% above £50,270. Band 7's upper two pay points are the first on the AfC scale to cross into higher-rate tax. From Band 8b upwards, a significant share of every pay rise is taxed at 40%. At Band 9 the top point, £129,783, sits above £100,000, so the personal allowance taper applies too. Our £100k tax trap guide explains that effect.
National Insurance is 8% of earnings between £12,570 and £50,270, and 2% above that.
NHS pension contributions are set on a tiered scale. In 2026/27, the member rates are:
NHS Pension member contribution tiers, 2026/27
| Up to £13,259 | 5.2% |
| £13,260 to £28,854 | 6.5% |
| £28,855 to £35,155 | 8.3% |
| £35,156 to £52,778 | 9.8% |
| £52,779 to £67,668 | 10.7% |
| £67,669 and above | 12.5% |
The tiers are not marginal. The rate for your tier applies to all your pensionable pay. Contributions are taken before income tax, so they get full tax relief, but not before National Insurance. Your employer adds a further 23.7% of your pensionable pay, making the NHS pension one of the most generous in the UK.
Worked example: Band 5 to Band 6
A nurse moving from Band 5 entry (£32,073) to Band 6 entry (£39,959) gets a gross rise of £7,886. Take-home pay goes from £24,483 to £29,157, a rise of £4,675, or about 59% of the gross increase.
Part of the gap is tax and NI on the extra pay. The rest is the pension: the move takes pensionable pay from the 8.3% tier into the 9.8% tier, so the higher rate applies to the whole salary. That money isn't lost, though. It buys more pension, which is backed by a much larger employer contribution.
Worked example: Band 7 top to Band 8a entry
The top of Band 7 is £56,515 and the entry point of Band 8a is £57,528, a gross difference of just £1,013. Both are already in the 10.7% pension tier and both are above the higher-rate threshold, so take-home rises from £39,708 to £40,230, an extra £522 a year. The real financial gain from moving to 8a comes from the later pay steps, which take Band 8a to £64,750.
London weighting (HCAS)
Staff working in and around London get a High Cost Area Supplement, or HCAS, on top of basic pay. In 2026/27 it is:
- Inner London: 20% of basic pay, at least £5,794 and no more than £8,746.
- Outer London: 15%, between £4,870 and £6,137.
- London Fringe: 5%, between £1,346 and £2,270.
A Band 5 nurse at entry in Inner London gets £6,415 HCAS, for total pay of £38,488 and take-home of about £28,213. HCAS counts as pensionable pay, so it can move you into a higher pension tier. The London weighting calculator shows the effect for every band and zone.
Unsocial hours
Staff who work nights, weekends or bank holidays get unsocial hours enhancements on top of their hourly rate. For Bands 4 to 9, the rates are:
- Nights and Saturdays: time plus 30%.
- Sundays and bank holidays: time plus 60%.
Lower bands receive higher percentages, so check the Terms and Conditions of Service Handbook for Bands 1 to 3. For many ward-based staff, unsocial hours add several thousand pounds a year and make a noticeable difference to take-home pay. Our unsocial hours calculator works out the enhancement from your hours.
Other things that affect your pay
- Part-time work. Pay is pro rata to your contracted hours. Your pension tier is based on your actual pensionable pay, not the full-time equivalent.
- Student loans. Plan 2 and Plan 5 repayments come out of NHS pay through payroll. A Band 5 nurse on Plan 2 repays about £242 a year at entry pay. See our Plan 2 vs Plan 5 guide.
- Salary sacrifice schemes. Many trusts offer lease cars, cycle-to-work and other salary sacrifice benefits. These reduce your pensionable pay and can affect maternity pay. Our salary sacrifice guide explains the trade-offs.
- Bank and agency work. Extra shifts on the staff bank are paid at your band's rate and taxed through payroll. Agency work may pay more per hour, but usually without NHS pension or sick pay.
For your own figures, including your exact pay step, London weighting and any student loan, use the NHS take-home pay calculator.