NHS Pay Rise 2026/27: Updated Agenda for Change Pay Scales, Rates and 2027/28 Outlook

The NHS pay rise for 2026/27 has been confirmed at 3.3% for Agenda for Change staff in England and Wales, effective from 1 April 2026.

The consolidated increase covers nurses, midwives, paramedics, healthcare assistants, administrative workers and many other NHS employees.

The award was announced on 12 February 2026 and included in April salaries, avoiding the delays experienced in previous years.

Attention is now turning towards the 2027/28 NHS pay rise. New government evidence published on 19 October 2026 sets out a 2.4% financial planning assumption, although this is not a confirmed award.

With ongoing pay structure negotiations, separate arrangements across the four UK nations and continuing concerns about inflation, NHS workers need to understand both their current salary and what could change.

What Is the Confirmed NHS Pay Rise for 2026/27?

The NHS Pay Review Body recommended a 3.3% increase across Agenda for Change pay points, which the government accepted.

Unlike a one-off bonus, a consolidated award permanently increases contractual basic salary. It also influences pensionable earnings and calculations for certain additional payments.

Pay detail	Confirmed position
Pay award	3.3% consolidated
Announcement	12 February 2026
Effective date	1 April 2026
Payment	April 2026 payroll
Previous award	3.6% in 2025/26
Staff covered	Agenda for Change employees
Workforce in England	Over 1.40 million staff
Next review	2027/28 pay round underway

The government’s October evidence records more than 1.40 million Agenda for Change employees, equivalent to over 1.24 million full-time posts, as of March 2026. These figures should not be confused with the entire NHS workforce.

NHS Employers’ official 12 February 2026 announcement confirming the 3.3% consolidated pay award and April implementation.

What Will the NHS Pay Rise Be in 2027/28?

The government has begun preparing the next NHS pay settlement, but no final 2027/28 Agenda for Change percentage has been announced.

On 19 October 2026, the Department of Health and Social Care and NHS England published their written evidence to the NHS Pay Review Body.

The evidence confirms that:

• The 2027/28 review was commissioned in July 2026, earlier than previous years.
• Current financial plans accommodate a 2.4% uplift without reducing existing headline health commitments.
• Every additional 0.5 percentage points of NHS pay costs approximately £750 million.
• Awards exceeding available funding would require reprioritisation within departmental budgets.
• No additional Treasury reserve funding is available for pay settlements.
• The Pay Review Body is expected to report in 2027.

The 2.4% figure is therefore an affordability assumption, not a government offer or final recommendation.

An independent recommendation could differ, and ministers would subsequently decide whether to accept it.

This distinction matters because employees making mortgage, retirement or household budgeting decisions should not treat an unconfirmed percentage as guaranteed income.

Page 16 of the government’s 2027/28 NHS Pay Review Body evidence, showing the 2.4% planning assumption and estimated £750 million cost per additional 0.5% of pay.

When Was the NHS Pay Rise Announced and Paid?

The 2026/27 award followed an accelerated timetable designed to ensure NHS employees received their salary increase on time.

Date	Development
12 February 2026	Government announced the 3.3% award
March 2026	Funded pay structure negotiation mandate issued
1 April 2026	New Agenda for Change rates took effect
April 2026	Increased salaries paid through payroll
July 2026	Government commissioned the 2027/28 review
19 October 2026	Government published its 2027/28 written evidence
2027	Next Pay Review Body recommendations expected

The original 3.3% award did not generally require retrospective payments because it was implemented on schedule.

However, separately negotiated pay structure changes could still be backdated to April 2026.

What Are the NHS Pay Bands for 2026/27?

The following figures are the confirmed England Agenda for Change annual basic salaries. Welsh rates should be checked against NHS Wales’ separate pay circular.

Band	Entry salary	Intermediate	Top salary
2	£25,272	—	£25,272
3	£25,760	—	£27,476
4	£28,392	—	£31,157
5	£32,073	£34,592	£39,043
6	£39,959	£42,170	£48,117
7	£49,387	£51,932	£56,515
8a	£57,528	£60,417	£64,750
8b	£66,582	£70,896	£77,368
8c	£79,504	£84,346	£91,609
8d	£94,356	£100,140	£108,814
9	£112,782	£119,583	£129,783

Band 1 remains at £25,272 but is closed to new entrants.

These are gross salaries based on full-time contractual hours, excluding location supplements, overtime and deductions.

NHS Hourly Pay Rates 2026/27

Band	Entry	Intermediate	Top
2	£12.92	—	£12.92
3	£13.17	—	£14.05
4	£14.52	—	£15.93
5	£16.40	£17.69	£19.97
6	£20.44	£21.57	£24.61
7	£25.26	£26.56	£28.90
8a	£29.42	£30.90	£33.11
8b	£34.05	£36.26	£39.57
8c	£40.66	£43.14	£46.85
8d	£48.26	£51.21	£55.65
9	£57.68	£61.16	£66.37

How Much More Will NHS Staff Earn Compared With 2025/26?

The following comparison shows how basic entry-point salaries have changed.

Band	2025/26	2026/27	Annual increase
2	£24,465	£25,272	£807
3	£24,937	£25,760	£823
4	£27,485	£28,392	£907
5	£31,049	£32,073	£1,024
6	£38,682	£39,959	£1,277
7	£47,810	£49,387	£1,577
8a	£55,690	£57,528	£1,838
8b	£64,455	£66,582	£2,127
8c	£76,965	£79,504	£2,539
8d	£91,342	£94,356	£3,014
9	£109,179	£112,782	£3,603

These increases exclude pay progression. Employees moving to another step could experience a larger salary change.

How Does NHS Pay Step Progression Work?

Under the published structure:

• Bands 2 and 3 normally reach their final step after two years.
• Band 4 normally progresses after three years.
• Band 5 has two years between entry and intermediate, followed by another two years.
• Bands 6 to 9 generally have two years before the intermediate point and another three years before the final point.

Progression is subject to the applicable contractual criteria and employer procedures. A pay anniversary does not necessarily mean an automatic promotion to another band.

How Much Is NHS London Weighting in 2026/27?

Higher Cost Area Supplements (HCAS) increase pay for qualifying employees in London and certain surrounding areas.

Area	Supplement	Annual minimum	Annual maximum
Inner London	20%	£5,794	£8,746
Outer London	15%	£4,870	£6,137
Fringe	5%	£1,346	£2,270

Full NHS HCAS Pay Tables for 2026/27

These figures include basic pay and the applicable supplement. Each cell shows annual salary (hourly rate).

Band/step	Inner London	Outer London	Fringe
1 Entry	£31,066 (£15.89)	£30,142 (£15.42)	£26,618 (£13.61)
2 Entry/Top	£31,066 (£15.89)	£30,142 (£15.42)	£26,618 (£13.61)
3 Entry	£31,554 (£16.14)	£30,630 (£15.66)	£27,106 (£13.86)
3 Top	£33,270 (£17.01)	£32,346 (£16.54)	£28,850 (£14.75)
4 Entry	£34,186 (£17.48)	£33,262 (£17.01)	£29,812 (£15.25)
4 Top	£37,389 (£19.12)	£36,027 (£18.42)	£32,715 (£16.73)
5 Entry	£38,488 (£19.68)	£36,943 (£18.89)	£33,677 (£17.22)
5 Mid	£41,511 (£21.23)	£39,781 (£20.34)	£36,322 (£18.58)
5 Top	£46,852 (£23.96)	£44,900 (£22.96)	£40,996 (£20.97)
6 Entry	£47,951 (£24.52)	£45,953 (£23.50)	£41,957 (£21.46)
6 Mid	£50,604 (£25.88)	£48,307 (£24.70)	£44,279 (£22.64)
6 Top	£56,863 (£29.08)	£54,254 (£27.75)	£50,387 (£25.77)
7 Entry	£58,133 (£29.73)	£55,524 (£28.40)	£51,657 (£26.42)
7 Mid	£60,678 (£31.03)	£58,069 (£29.70)	£54,202 (£27.72)
7 Top	£65,261 (£33.38)	£62,652 (£32.04)	£58,785 (£30.06)
8a Entry	£66,274 (£33.89)	£63,665 (£32.56)	£59,798 (£30.58)
8a Mid	£69,163 (£35.37)	£66,554 (£34.04)	£62,687 (£32.06)
8a Top	£73,496 (£37.59)	£70,887 (£36.25)	£67,020 (£34.28)
8b Entry	£75,328 (£38.52)	£72,719 (£37.19)	£68,852 (£35.21)
8b Mid	£79,642 (£40.73)	£77,033 (£39.40)	£73,166 (£37.42)
8b Top	£86,114 (£44.04)	£83,505 (£42.71)	£79,638 (£40.73)
8c Entry	£88,250 (£45.13)	£85,641 (£43.80)	£81,774 (£41.82)
8c Mid	£93,092 (£47.61)	£90,483 (£46.27)	£86,616 (£44.30)
8c Top	£100,355 (£51.32)	£97,746 (£49.99)	£93,879 (£48.01)
8d Entry	£103,102 (£52.73)	£100,493 (£51.39)	£96,626 (£49.42)
8d Mid	£108,886 (£55.69)	£106,277 (£54.35)	£102,410 (£52.37)
8d Top	£117,560 (£60.12)	£114,951 (£58.79)	£111,084 (£56.81)
9 Entry	£121,528 (£62.15)	£118,919 (£60.82)	£115,052 (£58.84)
9 Mid	£128,329 (£65.63)	£125,720 (£64.30)	£121,853 (£62.32)
9 Top	£138,529 (£70.85)	£135,920 (£69.51)	£132,053 (£67.53)

How Much NHS Salary Will Staff Take Home After Deductions?

Gross increases do not translate directly into equivalent take-home increases.

Income Tax, National Insurance, pension contributions and student loan repayments affect the amount received.

The following examples use entry-point salaries, full-time employment in England, a standard personal allowance, NHS Pension Scheme membership and Plan 2 student loan deductions.

Band	2025/26 monthly net	2026/27 monthly net	Monthly gain
3	£1,681	£1,727	£46
5	£1,965	£2,020	£55
6	£2,285	£2,350	£66
7	£2,704	£2,784	£79

Illustrative calculations, rounded to the nearest pound. Assumes annualised earnings paid evenly, applicable pension thresholds for each year, no HCAS, overtime or additional reliefs, and standard employee National Insurance. Actual payroll calculations may vary.

For a Band 5 employee earning £32,073 in 2026/27, the approximate monthly deductions are:

Deduction	Monthly amount
Gross pay	£2,672.75
NHS pension at 8.3%	£221.84
Income Tax	£280.68
National Insurance	£130.02
Plan 2 student loan	£20.16
Estimated net pay	£2,020.05

NHS pension contributions are tiered, with 2026/27 employee rates ranging from 5.2% to 12.5%. A pay increase that crosses a pension tier can affect take-home calculations.

Caption: Official 2026/27 NHS Pension Scheme contribution thresholds and rates. Source: NHS Business Services Authority.

How Does the NHS Pay Rise Differ Across the Four UK Nations?

Although NHS organisations operate under broadly comparable pay frameworks, settlements and implementation schedules differ.

Nation	2026/27 Agenda for Change position
England	3.3% implemented in April
Wales	3.3% accepted, with separate Welsh pay scales and low-pay arrangements
Scotland	3.75% under an existing two-year agreement
Northern Ireland	3.3% award awaited implementation as of 14 October 2026

Scotland’s separate agreement followed a 2025/26 increase that was subsequently adjusted to 4.4%.

Northern Ireland’s position remained unresolved in mid-October amid budget difficulties. The Chartered Society of Physiotherapy opened an indicative ballot on 14 October over the delayed award.

Scottish Government’s official 2025–2027 Agenda for Change settlement showing the separate 3.75% increase for April 2026.

Are Doctors and Dentists Receiving the Same NHS Pay Rise?

Doctors and dentists generally operate under separate national pay arrangements.

The government accepted a 3.5% headline increase for doctors and most dentists for 2026/27, while certain community dental services received a 3.75% uplift.

For resident doctors in England, the subsequently agreed package incorporated additional pay-scale reform. The government’s October implementation update confirms that the combined measures produce an average 4.9% increase for 2026/27, backdated to April.

This is an average across affected resident doctors, not a uniform 4.9% headline award for every individual. Further nodal-point reforms are planned for April 2027.

What NHS Pay Structure Changes Could Be Backdated to April 2026?

In March 2026, the NHS Staff Council received a funded mandate from the governments of England, Wales and Northern Ireland.

Negotiations include improvements to lower pay bands, graduate pay and progression arrangements.

The mandate permits changes to be backdated to 1 April 2026 and allows potential agreements lasting up to three years, possibly incorporating headline pay for 2027/28 and 2028/29.

Negotiations remained ongoing when the government’s October evidence was submitted.

Separately, NHS England instructed employers to review Band 5 nursing roles to ensure job descriptions and pay bands reflect actual responsibilities. Trusts were required to submit delivery plans by July 2026, with reviews scheduled for completion by October 2028.

A Band 5 nurse is not automatically entitled to Band 6 pay: outcomes depend on formal job evaluation.

In a parliamentary answer dated 19 October 2026, Health Minister Karin Smyth reaffirmed employers’ responsibility for accurate job descriptions and confirmed that NHS Staff Council negotiations were continuing.

Is the 3.3% NHS Pay Rise Above Inflation?

The answer depends on the inflation period being compared.

UK CPI inflation increased from 2.6% in June 2026 to 3.1% in August.

Against August’s annual CPI rate, the 3.3% award was approximately 0.2 percentage points higher. However, this single-month comparison does not establish the real-terms outcome across the complete financial year.

UNISON criticised the award when it was announced.

Helga Pile, UNISON’s head of health, described it as an inadequate settlement for workers experiencing continued living-cost pressures.

The 2025 NHS Staff Survey also found that only 30.94% of Agenda for Change respondents were satisfied with their level of pay, demonstrating the significance of pay reform for workforce retention.

Why Are Lower NHS Pay Bands Under Pressure?

Pay compression is an important concern, particularly for Bands 2 and 3.

The National Living Wage increased to £12.71 per hour in April 2026, leaving England’s Band 2 basic hourly rate of £12.92 only 21 pence higher.

The government’s evidence also reports that approximately 74% of NHS estates and facilities management staff are concentrated in Bands 2 and 3.

For international recruitment, entry-level Band 3 salaries now exceed the £25,000 minimum referenced in the government’s evidence. However, meeting that salary figure alone does not guarantee visa eligibility; occupation rules, sponsorship and other immigration requirements still apply.

These pressures explain why restructuring lower pay bands remains a priority.

Conclusion

The confirmed NHS pay rise for 2026/27 delivered a 3.3% consolidated increase for Agenda for Change staff in England and Wales from April.

The next significant developments are the continuing pay structure negotiations and the independent 2027/28 pay review.

While the government has budgeted for a 2.4% increase without further spending trade-offs, this is not a settled award.

Staff should use official pay scales, pension contribution rules and individual payslips when assessing their current income, rather than relying on unconfirmed future percentages.

FAQs About the NHS Pay Rise 2026/27

Will NHS staff receive back pay in 2026?

The main 3.3% award was implemented in April. Further negotiated structural changes could generate backdated payments if an agreement is reached.

What is the Band 5 nurse salary in 2026/27?

Band 5 basic pay in England ranges from £32,073 to £39,043, excluding HCAS and additional earnings.

When will the 2027/28 NHS pay rise be confirmed?

The NHS Pay Review Body is expected to report in 2027. No final award has been confirmed as of 26 October 2026.

Will NHS pension contributions increase after the pay rise?

They can increase in cash terms, and a higher salary may move some members into another contribution tier.

Are NHS unions satisfied with the award?

UNISON criticised the 3.3% award and continues campaigning for improvements to NHS pay structures. The wider position of UNISON pay negotiations also reflects differences between public service sectors.

Will every Band 5 nurse move to Band 6?

No. Any rebanding depends on the duties of the particular role and the formal job evaluation process.

Does the 3.3% award cover every NHS employee?

No. Agenda for Change primarily covers non-medical NHS employees. Doctors, dentists and some other staff groups follow separate arrangements.