NHS Pay Structure Overview (Agenda for Change)

Most NHS nursing, paramedic, and support roles are paid according to the Agenda for Change (AfC) banding system, which is used across England, Scotland, Wales, and Northern Ireland. Each band has set salary ranges with progression points. Key points include:

• AfC Bands and Roles: Bands 2–4 cover support roles (e.g. healthcare assistants, technicians), Bands 5–7 cover qualified clinical staff (e.g. staff nurses, paramedics at Band 5–6; ward sisters at Band 7), and Bands 8–9 cover senior management/consultant-level posts (nhsemployers.org). Doctors and dentists have separate pay scales and are not on AfC (nursingnotes.co.uk).
• Differences by UK Nation: All four nations use AfC, but pay scales differ slightly. For example, a Band 5 nurse’s starting salary is about £29,970 in England, £30,420 in Wales, £31,892 in Scotland, and £28,407 in Northern Ireland (gov.uk). Scotland’s NHS pay has been higher due to recent larger pay uplifts (5.5% in 2024/25) (rcn.org.uk), whereas Northern Ireland has lagged due to delayed pay awards (gov.uk).
• Annual Pay Uplifts: Recent deals have increased pay. In 2023/24, England, Wales, and NI implemented ~5% rises (plus one-off bonuses) (theguardian.com), and in 2024/25 Scotland gave a 5.5% rise (rcn.org.uk). In 2025, a further 3.5–3.6% increase was announced for England and Wales (nurses.co.uk), keeping nurse pay roughly in line with inflation.

Nurse Salaries (NHS)

Registered nurses in the NHS typically start at Band 5 (staff nurse level). Below are base salary ranges for Band 5 nurses, which cover newly qualified nurses up through experienced staff nurses:

• England & Wales (Band 5): ~£30,000 starting salary, progressing to about £36,500 at the top of the band (not including London weighting) (nhsemployers.org). For 2024/25 in England, Band 5 ranges from £29,970 at entry to £36,483 at the top (nhsemployers.org). Wales has virtually identical band figures (historically within a few hundred pounds of England’s) after matching recent pay awards.
• Scotland (Band 5): higher pay range of £31,892 starting, up to £39,735 at Band 5 top point (rcn.org.uk). Scotland’s nurses received above-inflation raises – e.g. a 5.5% uplift in 2024 – making Band 5 pay notably higher than in other UK nations (rcn.org.uk).
• Northern Ireland (Band 5): approximately £30,000 – £36,500, essentially aligned with England’s pay scale by 2025 (jobs.hscni.net.) (NI implemented the England/Wales 2023 pay award later due to governance delays (gov.uk).)

🔸 Note: Senior nursing roles fall in higher bands. For example, a Band 6 nurse (e.g. a senior or specialist nurse) in England earns ~£37,300–£44,900 (nhsemployers.org), while a Band 7 nurse (e.g. ward sister/charge nurse) earns ~£46,100–£52,800 at the top of the scale (nhsemployers.org). These ranges are a few percent higher in Scotland (e.g. Band 7 up to ~£59k) (gov.uk), and similar in Wales. Northern Ireland’s Band 6–7 figures now mostly mirror England’s (gov.uk).

Doctor Salaries (NHS)

NHS doctors’ pay is structured by role and experience rather than AfC bands. Key examples of base annual salaries (full-time) for medical staff across the UK include (gov.uk):

• Foundation Year 1 (FY1) Doctor: ~£36,600 in England (gov.uk). Scotland and Wales have slightly lower starting FY1 pay (about £34,500 (gov.uk) and £33,300 (gov.uk) respectively), while Northern Ireland’s FY1 lagged at roughly £29,500 (due to pending pay awards) (gov.uk).
• Foundation Year 2 (FY2): ~£42,000 in England (gov.uk), ~£42,800 in Scotland (gov.uk), ~£41,000 in Wales (gov.uk), and ~£36,300 in NI (gov.uk).
• Specialty Registrars (residents): In England, a registrar earns ~£50,000–£61,800 (range from junior registrar to senior registrar) (gov.uk). Scotland and Wales historically had slightly different junior doctor contracts, but by 2025 their mid-grade doctors earn on the order of £45–£55k base. NI has been lowest, with senior registrars around £44k base as of 2024 (gov.uk).
• Consultants: ~£105,000 base salary in Englandgov.uk. Scotland and Wales consultant pay is similar (~£107k Scotlandgov.uk; ~£106k Walesgov.uk). Northern Ireland consultants have been paid around £94k basegov.uk, pending uplift to close the gap. (Most consultants also earn additional pay for length of service and can increase earnings via clinical excellence awards or private work.)
• General Practitioners (GPs): A full-time salaried GP in England has an indicative pay of about £73,000gov.uk. In Scotland and Wales this is in the mid-£70k rangegov.ukgov.uk. (GP partners’ income varies widely and can be higher, but those figures are outside standard scales.)

🔸 Note: These figures are base pay only for contracted hours. Actual earnings can be higher with overtime, banding supplements (for junior doctors working nights/weekends), and allowances. For instance, junior doctors often have rota supplements for unsocial hours, and consultants may receive additional awards for excellence. The above numbers also do not include any one-off pay deal bonuses (covered below).

Paramedic and Ambulance Staff Pay (NHS)

Paramedics working in the NHS are usually on Band 6 of Agenda for Change, reflecting their registration as allied health professionals. Pay for paramedics and other ambulance staff is as follows:

• Qualified Paramedic (Band 6): Starting salary ~£37,300 in England, rising to about £45,000 at the top of Band 6 (nhsemployers.org). Scotland offers around £39,900 starting, up to upper-£40ks (Band 6 top ~£50.7k after recent uplifts) (nursingnotes.co.uk). Wales is roughly in line with England (starting ~£37.9k) (gov.uk), and NI has matched the ~£37.3k baseline as well (gov.uk).
• Emergency Medical Technician/Emergency Care Assistant: These support roles in ambulance services are often Band 4 or Band 3. For example, a Band 4 ambulance technician in England earns ~£26.5k–£29.1k (nhsemployers.org). In Scotland the same Band 4 would be ~£29k–£33k after recent increases (nursingnotes.co.uk). Band 3 (e.g. 999 call handler or emergency care assistant) ranges ~£24–£26k in England and Wales, and a few thousand higher in Scotland (gov.uk). (NI Band 3/4 pay is currently slightly behind England’s, pending updates (gov.uk).)

🔸 Note: Ambulance staff also receive unsocial hours pay enhancements for nights/weekends, which can significantly boost take-home pay given the 24/7 nature of the service. (For instance, night shifts add ~30–60% extra per hour as outlined below.)

Healthcare Assistant (HCA) Pay (NHS)

Healthcare Assistants, Nursing Auxiliaries, and other support workers typically occupy Band 2 or Band 3 roles:

• Band 2 (HCA) – The entry band for most HCAs. The basic salary is around £23,600–£24,500 per year in England (nhsemployers.org). (Band 2 has a single pay point in England: £23,615 in 2024/25 (nhsemployers.org), rising to £24,464 after the 3.6% 2025 increase (nursingnotes.co.uk.) Wales is similar (approx £24.8k in 2025) (nursingnotes.co.uk). Scotland pays more: about £25.7k for a Band 2 HCA (with a small uplift after 2 years) (nursingnotes.co.uk). Northern Ireland’s Band 2 is about £23.6k (matching England’s 2024 level) (jobs.hscni.net)
• Band 3 (Senior HCA/Support Worker) – A higher tier for more experienced support staff or those with additional training. Band 3 starts around £24,000–£25,000 in England (rising to ~£26,600 at the 2+ years point) (nursingnotes.co.uk). Scotland’s Band 3 ranges from £28,011 up to £30,230 (significantly higher due to pay deals) (nursingnotes.co.uk). Wales Band 3 is ~£25.3k–£27.0k (just slightly above England) (nursingnotes.co.uk). NI’s Band 3 roughly matches the older England rate (~£24,000–£25,700 top) (jobs.hscni.net).

These support roles also benefit from additional payments for unsocial hours (e.g. night shifts or weekends) which can add 30%–50% to hourly pay during those times (nurses.co.uk).

Overtime, Unsocial Hours, and Enhancements (NHS)

Overtime: NHS staff who work beyond full-time hours are compensated at premium rates. For Agenda for Change bands 1–7, overtime is paid at 1.5 times the standard hourly rate, and at 2.0 times the rate if the overtime falls on a public holiday (rcn.org.uk). (Senior staff on bands 8–9 generally are not eligible for overtime pay (rcn.org.uk.) Part-time staff receive their normal rate until they exceed full-time hours. For example, a Band 5 nurse in England with a base rate ~£15.88/hour would earn ~£23.82/hour for overtime, and ~£31.76/hour on bank holidays (rcn.org.uk).

Unsocial Hours: The NHS also pays unsocial hours enhancements for standard shifts that occur during evenings, nights, or weekends. These are additional percentages on top of basic pay, commonly in the range of +30% for nights/Saturdays and +60% for Sundays/holidays for many staff (nurses.co.uk_. (Exact rates vary slightly by role and nation, but the principle of premium pay for out-of-hours work is UK-wide.) These enhancements mean a nurse or paramedic working night shifts will earn significantly above their base salary for those hours, even before any overtime is counted.

Bonuses and One-Off Payments (NHS)

The NHS typically does not pay performance bonuses in the way the private sector might, but there have been one-off payments and recruitment/retention bonuses in recent years:

• One-off Pay Deal Bonuses: As part of resolving pay disputes, governments have issued one-time non-consolidated payments. For instance, in Scotland’s 2023/24 pay offer, staff received a one-off bonus between £387 and £939 (tiered by pay band) in addition to salary increases (bmj.com, sor.org). In England, the 2022/23 deal included a lump sum (approximately 2% of salary) for NHS staff (theguardian.com). These bonuses are “non-consolidated” – i.e. not added to base pay, but paid as a single separate amount, often called a “NHS backlog bonus” or “cost-of-living payment.”
• “Golden Hello” Recruitment Bonuses: To attract staff into hard-to-fill posts, some NHS Trusts offer welcome bonuses. For example, mental health nurses in parts of England have been offered “golden hello” payments up to £4,500 – typically paid in instalments over 1–2 years to ensure the nurse stays in post (theguardian.com). It’s not uncommon to see £1,000–£3,000 sign-on bonuses for nurses in specialties with acute shortages (theguardian.com). These are local incentives and vary by region and trust. (One trust offered £4.5k split into £1.5k on signing, £1.5k after 12 months, £1.5k after 24 months (theguardian.com). Another advert in London offered £3k upfront for mental health nursing roles (theguardian.com.)
• Retention and Hardship Payments: During the pandemic and beyond, some staff received small retention bonuses or cost-of-living support payments from devolved governments or employers. For instance, all NHS and social care staff in Wales got a £735 bonus in 2021 (post-tax ~£500) as a “thank you” payment (though this is slightly outside our timeframe). While not routine, these bonuses underscore efforts to improve retention.

Overall, while ongoing bonuses are not a standard part of NHS pay, these one-time or targeted incentives have become more common in response to staffing crises and the rising cost of living.

Private Sector Healthcare Pay

Pay in the private healthcare sector (e.g. private hospitals, clinics, care homes, agency work) is not governed by national scales, so it varies widely. Reliable data indicates:

• Nurse Pay – Private vs NHS: Some private employers match or slightly exceed NHS pay rates for nurses, while others may pay less. There is no single pay structure; salaries are often individually negotiated (nurses.co.uk). For example, a private hospital might advertise a staff nurse role at, say, £35,000/year for an experienced nurse, which could be higher than an NHS nurse of similar experience (especially outside London). However, another private employer might offer less but with other benefits. Bottom line: some private nurses earn more than in the NHS, and some earn less (nurses.co.uk) – the “NHS vs private pay” debate has no universal answer. Benefits also differ (NHS has a very generous pension and leave allowance, which private jobs may offset with higher base pay or other perks) (nurses.co.uk).
• Doctors: Many senior doctors supplement their NHS income with private practice. A full-time consultant in a private hospital might negotiate a higher salary than the NHS base (~£100k+), but these roles are few compared to NHS posts. GPs in private (e.g. in independent sector or telehealth firms) also negotiate pay individually. Generally, the NHS tends to provide stable, defined salaries, whereas private sector pay can vary based on demand and the doctor’s specialty/reputation.
• Agency Staff Rates: Working via staffing agencies or “bank” (overtime pool) can yield much higher hourly pay for nurses and others. Agency nurses often earn significantly above NHS hourly rates due to short-notice and high-demand shifts. For example, an average agency nurse through one major agency earns about £43.65 per hour (2024 data), compared to around £23–£25 per hour for a typical NHS nurse’s wage (a24group.com). Even factoring in lack of pension and benefits, this pay premium is substantial. Indeed.com data shows the overall UK average agency nurse rate is ~£26/hour (a24group.com), but many agencies pay £30–£50+ per hour for experienced nurses or last-minute shifts. In extreme cases of workforce shortages, media reports have found agency nurses paid over £1,000 for a single shift, with some instances up to £2,500 for one critical shift (politicsuk.com). (Such cases are exceptional but illustrate the cost pressure in the system.) Similarly, locum doctors can earn £50–£60/hour (double a junior doctor’s normal rate) by doing agency work (politicsuk.com).
• Private Ambulance and Care Staff: Outside the NHS, roles like paramedics or carers in private companies also negotiate pay per employer. Often, private ambulance services pay paramedics a salary roughly comparable to NHS bands or slightly higher to attract NHS-trained staff. Care home assistants might earn hourly wages in the range of £10–£15/hour depending on region and employer, sometimes below equivalent NHS band rates but occasionally with other incentives.

In summary, the NHS provides a clear pay framework with set rates and regular increments, whereas private sector pay is variable – it can reward experience or specialization with higher pay in some cases, but it lacks the uniformly generous pension, leave, and overtime structure of the NHS (nurses.co.uk). Many healthcare workers move between NHS and private or agency work to balance the stability vs. pay trade-offs in their careers.

Differences Across the Four UK Nations

All UK countries follow the broad patterns described above, but to recap notable differences:

• Scotland generally leads in NHS pay levels. Following higher pay awards, Scottish NHS staff at equivalent bands earn slightly more (e.g. a Scottish nurse’s base salary is roughly £1,900 higher than an English nurse’s in 2025) (nurses.co.uk). Scotland also has a 37-hour standard week (vs 37.5h in rest of UK) (rcn.org.uk) effectively boosting the hourly rate.
• England and Wales have very similar pay scales for NHS staff. Wales often mirrors England’s pay offers (5% in 2023/24, 3.6% in 2025) (nurses.co.uk), sometimes with minor tweaks. Any differences in figures (few hundred pounds) are usually due to timing of awards or slight policy variances. Both have the same 37.5h standard week and similar high-cost area supplements for e.g. London.
• Northern Ireland has faced delays in implementing pay rises due to political stalemate. NI staff went without a new deal for some periods, causing pay to lag behind. By early 2025, NI had matched the England 2023 deal (Band 5 at £29,970) (jobs.hscni.net), but future rises depend on budget decisions. NI health service staff numbers are smaller, and historically some NI pay awards have been implemented late or in a lump, leading to backpay situations.

Despite these differences, the rank order of pay by role is consistent UK-wide – e.g., a Band 6 paramedic will outearn a Band 3 HCA in any country, and a consultant doctor will earn several times a nurse’s salary everywhere. The variations are chiefly in magnitude (Scotland highest, NI often lowest) and timing, rather than the structure of pay itself. All nations are grappling with retaining healthcare staff through improved pay and conditions, within their budget constraints.

Every effort has been made to verify the data on this page but please do contact us if updates need to be made.