Who Does Agenda for Change Cover?

Let’s clear this up straight away. Agenda for Change covers most NHS staff, but not everyone.

Staff Covered by Agenda for Change

If you work in any of these roles, you’re on Agenda for Change:

• Nurses and midwives — from newly qualified to senior sisters
• Healthcare assistants (HCAs) and support workers
• Allied health professionals — physiotherapists, occupational therapists, radiographers, dietitians, speech and language therapists
• Paramedics and ambulance staff
• Pharmacists and pharmacy technicians
• Administrative and clerical staff — receptionists, medical secretaries, managers
• Porters, cleaners and catering staff
• Healthcare scientists and biomedical scientists
• Dental nurses and technicians

Staff NOT Covered by Agenda for Change

Some NHS workers have separate pay arrangements:

• Doctors and dentists — they have their own pay frameworks
• Very senior managers (VSMs) — board-level executives
• Apprentices — separate pay arrangements apply
• General practice staff — GP surgeries can choose to adopt AfC, but it’s not compulsory

Quick check: If you work directly for an NHS Trust or NHS organisation and you’re not a doctor, dentist or very senior manager, you’re almost certainly on Agenda for Change.

When Did Agenda for Change Start? A Brief History

Understanding where the system came from helps you understand why it works the way it does.

The Problems with the Old System

Before 2004, NHS pay was a mess. The Whitley Council system had been running since the NHS was founded in 1948. Different staff groups had completely different pay scales. Nurses had one system. Admin staff had another. Scientists had yet another.

This created real problems:

• Pay was inconsistent and confusing
• It was hard to prove equal pay for equal work
• The system couldn’t adapt to modern healthcare needs
• Career progression rules varied wildly between professions

Development and Implementation

Change took years to happen:

• February 1999 — The Government published a White Paper called “Agenda for Change”
• November 2002 — Unions and employers finished negotiating the new system
• June 2003 — Testing began at 12 early implementer sites across England
• 1 October 2004 — Full rollout across the UK
• 1 December 2004 — Pay and conditions backdated to October

Major Reforms Since 2004

The system hasn’t stayed frozen since 2004. Here are the key changes:

The 10 Year Health Plan, published in July 2025, sets out the Government’s vision for NHS reform. A new 10-year workforce plan will be published in 2026, which will shape how AfC staff are trained and deployed in the future.

How the Agenda for Change Pay Band System Works

This is the heart of the system. Every job covered by Agenda for Change sits within one of nine pay bands.

The Nine Pay Bands Explained

Think of pay bands like a ladder. Band 1 is at the bottom. Band 9 is at the top. The higher the band, the more responsibility, skill and experience the job requires.

Band 8 is special — it’s split into four sub-levels: 8a, 8b, 8c and 8d. This gives more room for senior roles to be graded accurately.

Important: Band 1 is now closed to new entrants. If you’re starting a new NHS job, you’ll begin at Band 2 or above.

Here’s what each band typically covers:

These figures are for 2025/26 and apply to England, Wales and Northern Ireland. Scotland has slightly different rates because it negotiated a separate deal.

Pay Points and Progression Within Bands

Each band has several pay points (sometimes called pay steps). You don’t jump straight to the top of your band. Instead, you move up through the points over time.

Here’s how it works:

• Entry point — where you start
• Intermediate point(s) — middle steps
• Top of band — the maximum for that band

The time between pay points varies. For most bands, you wait 2 to 3 years between each step. This is called incremental progression.

For example, a Band 5 nurse starts at £31,049. After 2 years (and meeting performance requirements), they move to £33,487. After another 2 years, they reach the top of the band at £37,796.

How Jobs Are Assigned to Bands — NHS Job Evaluation

How does the NHS decide which band a job belongs to? They use something called the NHS Job Evaluation Scheme.

This system measures jobs against 16 different factors:

1. Communication and relationship skills
2. Knowledge, training and experience
3. Analytical and judgement skills
4. Planning and organisational skills
5. Physical skills
6. Responsibility for patient care
7. Responsibility for policy and service development
8. Responsibility for financial and physical resources
9. Responsibility for human resources
10. Responsibility for information resources
11. Responsibility for research and development
12. Freedom to act
13. Physical effort
14. Mental effort
15. Emotional effort
16. Working conditions

Each factor gets a score. Add them all up, and you get a total points score. That score determines which band the job sits in.

Jobs are usually matched against national job profiles — standard descriptions of common NHS roles. This helps keep things consistent across the country.

The whole system is built on one principle: equal pay for work of equal value. Two jobs with similar demands should be in the same band, even if they’re in completely different departments.

Pay Progression Under Agenda for Change

Moving up through pay points isn’t automatic. You need to show you’re doing your job well.

Annual Incremental Progression

Each year, you have the chance to move up one pay point within your band. But there are conditions:

• You must meet the required standards for your role
• You must demonstrate the knowledge and skills needed
• Your line manager must confirm you’ve met expectations
• You’ll usually have an annual development review

Think of it as a yearly check-in. If you’re doing your job properly and developing your skills, you move up. If there are concerns, your increment might be delayed.

The Knowledge and Skills Framework (KSF)

The NHS Knowledge and Skills Framework is the system that supports pay progression. It defines what knowledge and skills you need for your specific job.

When you start a role, you should receive a KSF post outline. This tells you exactly what’s expected. You and your manager then create a personal development plan to help you meet those expectations.

Each year, you’ll have a review to check your progress. This is sometimes called an annual development review or appraisal.

Gateway Points

Some bands have gateway points — specific stages where you must prove you’ve developed before moving further.

At these points, you need to show you’re not just doing the job, but actively applying the knowledge and skills required. It’s a quality check to make sure pay progression reflects real development.

What Happens If Progression Is Withheld?

If your manager has concerns about your performance, your increment can be delayed. But there are rules:

• You must be told formally, with clear reasons
• There must have been prior discussions about the issues
• You must be given an action plan with clear objectives
• You must have a fair chance to improve before any final decision

Your employer can’t just refuse your increment without proper process. If you think you’ve been treated unfairly, speak to your union representative or HR department.

Agenda for Change Terms and Conditions

Here’s something many people miss: Agenda for Change isn’t just about pay. It also sets out your terms and conditions of employment.

Before 2004, different NHS staff groups had different rules for things like annual leave and sick pay. AfC brought everyone together under one set of rules.

Annual Leave Entitlement

Your annual leave depends on how long you’ve worked in the NHS:

If you work part-time, you get a pro-rata amount based on your hours.

Previous NHS service counts. So if you worked for one NHS Trust, left, and then joined another, your earlier service usually counts towards your leave entitlement.

Sick Pay Entitlement

NHS sick pay is generous compared to many employers. Here’s what you’re entitled to:

If you’re off sick multiple times, your employer will look at the total sickness in the previous 12 months when calculating your remaining entitlement.

Maternity, Paternity and Family Leave

NHS maternity pay is also relatively generous:

• First 8 weeks — full pay (minus Statutory Maternity Pay)
• Next 18 weeks — half pay plus SMP
• Next 13 weeks — Statutory Maternity Pay only
• Final 13 weeks — unpaid

To qualify for the full NHS maternity package, you need 12 months’ continuous service by the 11th week before your baby is due. You must also intend to return to work for at least 3 months after your leave ends.

Paternity leave and shared parental leave are also covered under AfC terms.

Working Hours

Standard full-time hours under Agenda for Change are 37.5 hours per week.

However, Scotland is different. NHS Scotland is moving to a 36-hour working week from April 2026, following their separate pay deal.

If you work nights, weekends or bank holidays, you receive unsocial hours payments on top of your basic salary. The rates vary depending on when you work.

Other Key Provisions

Agenda for Change also covers:

• Redundancy pay — enhanced terms above the legal minimum
• Mileage allowances — for work-related travel
• Subsistence allowances — for meals when working away
• Employment break scheme — career breaks of up to 5 years
• Flexible working — the right to request flexible arrangements

All of these are set out in the NHS Terms and Conditions of Service Handbook, published by NHS Employers.

High Cost Area Supplements (HCAS)

If you work in or around London, you’ll receive extra pay on top of your basic salary. This is called the High Cost Area Supplement, or HCAS for short.

It replaced the old “London Weighting” allowance and recognises that living costs are higher in London and surrounding areas.

There are three zones:

The supplement is calculated as a percentage of your basic pay, but there are minimum and maximum limits. It’s pensionable, which means it counts towards your NHS pension.

Specific postcodes determine which zone you’re in. The NHS Terms and Conditions Handbook lists all the areas covered.

Agenda for Change Across the UK

Agenda for Change applies across the whole UK, but there are differences between the four nations.

England

England has the largest NHS workforce. Pay awards are usually based on recommendations from the NHS Pay Review Body (PRB), an independent group that considers evidence from unions, employers and the Government.

The Government then decides whether to accept those recommendations. In 2025/26, the Government accepted the PRB’s recommendation of a 3.6% pay rise for AfC staff.

Scotland

NHS Scotland often negotiates its own deals separately from England. Currently, Scottish NHS staff have a two-year deal:

• 2025/26: 4.25% pay increase
• 2026/27: 3.75% pay increase

Scotland is also moving to a 36-hour working week from April 2026 — a significant difference from the rest of the UK.

Wales

Wales follows the Agenda for Change framework, with pay awards determined by the Welsh Government. Generally, Wales aligns with England, but there can be occasional differences in how deals are structured.

Northern Ireland

Agenda for Change applies fully in Northern Ireland through Health and Social Care NI. Pay awards sometimes lag slightly behind England due to the separate political processes involved.

Key point: While the framework is UK-wide, always check the specific arrangements for the nation where you work. Pay rates and some conditions can differ.

How Pay Is Decided Each Year

You might wonder: who actually decides how much of a pay rise NHS staff get each year?

The Pay Review Body Process

The NHS Pay Review Body (PRB) is an independent group appointed by the Government. Their job is to make recommendations about pay for Agenda for Change staff.

Each year, they consider evidence from:

• Trade unions representing NHS staff
• NHS employers
• The Government (Department of Health and Social Care)

After reviewing all the evidence, they recommend a pay award. The Government then decides whether to accept it, reject it, or modify it.

Pay awards are usually implemented from 1 April each year.

Union Negotiations

The NHS Staff Council is the joint body where unions and employers negotiate changes to Agenda for Change. It includes representatives from 14 trade unions, including:

• UNISON (the largest)
• Royal College of Nursing (RCN)
• Royal College of Midwives (RCM)
• Unite
• GMB

Sometimes unions accept the pay offer. Sometimes they reject it and ballot members for industrial action. The 2023 pay deal came after significant strike action by nurses and other staff.

Recent Pay Awards

For 2026/27, the Government has asked the Pay Review Body to make recommendations. Evidence is being submitted now, and a decision is expected in summer 2026.

Moving Between Bands and Changing Jobs

At some point in your NHS career, you’ll probably change jobs. Here’s how Agenda for Change handles different scenarios.

Promotion to a Higher Band

When you’re promoted to a higher band, you’ll usually start at the minimum pay point of the new band. If that would mean no pay increase (because the bands overlap), you’ll be placed on the first point that actually gives you a rise.

Your increment date resets to the date of your promotion. So if you were promoted in June, your new increment date becomes June each year.

Moving to the Same Band at Another Trust

If you move to another NHS Trust but stay on the same band, you should enter at the same pay point you were on before. Your increment date stays the same, too.

The new Trust will usually ask for an Inter Authority Transfer (IAT) from your previous employer to confirm your salary and service. Until they receive it, you might be paid at the minimum of the band temporarily.

Moving to a Lower Band

If you choose to move to a lower band (perhaps for work-life balance reasons), you’ll usually enter at the equivalent point or the top of the lower band.

If you’re moved to a lower band because of organisational changes, pay protection policies may apply. Check your employer’s policy.

Acting Up (Temporary Higher Band)

Sometimes you might be asked to cover a higher-banded role temporarily — maybe someone is on maternity leave or a vacancy is being advertised.

This is called acting up. You should be paid at the minimum of the higher band (or the first point that gives you an increase). Acting up shouldn’t normally last more than 6 months.

Returning to the NHS After a Break

If you leave the NHS and come back:

• Within 1 month: You’ll usually return to the same pay point
• After 1 month: You’ll typically start at the minimum of the band, though relevant experience may be considered

Your previous service may still count for things like annual leave and sick pay entitlement, even if it doesn’t count for your pay point.

The NHS Terms and Conditions Handbook

The NHS Terms and Conditions of Service Handbook is the official document that sets out everything about Agenda for Change. It’s published by NHS Employers and updated whenever the NHS Staff Council agrees to changes.

What the Handbook Covers

The handbook is organised into several parts:

• Part 1: Principles and partnership working
• Part 2: Pay — bands, progression, HCAS, allowances
• Part 3: Terms and conditions — hours, leave, sickness, family leave
• Part 4: Employee relations
• Part 5: Equal opportunities
• Part 6: Operating the system

There are also detailed annexes covering specific topics like pay scales, annual leave and sick pay calculations.

Where to Find It

The handbook is available free online from the NHS Employers website. You can download the whole document or browse specific sections.

NHS Employers also publishes an A-Z guide to help you navigate the handbook more easily.

Important: For any questions about your employment rights under Agenda for Change, the handbook is the definitive source. If you’re in a dispute with your employer, this is the document that matters.

Benefits of the Agenda for Change System

Why does the NHS use this system? What’s in it for you and for employers?

Benefits for Staff

• Fair and transparent — you can see exactly what each band pays
• Equal pay — jobs of equal value get equal pay, regardless of profession
• Skills recognised — as you develop, your pay increases
• National portability — move between NHS employers without losing out
• Harmonised conditions — same leave, sick pay and other entitlements for everyone
• Protection from local cuts — national bargaining protects your terms

Benefits for Employers

• Consistent framework — easier to plan and budget
• Job evaluation — helps create new roles fairly
• Flexible teams — common terms make it easier to work across professional boundaries
• Simpler administration — one system instead of many

The Equal Pay Principle

This is fundamental to Agenda for Change. The NHS workforce is predominantly female. Without a robust job evaluation system, there would be a real risk of women being paid less for equivalent work.

The job evaluation scheme and national bargaining protect against this. Every job is assessed against the same 16 factors. Every band has the same pay points. There’s no room for unfair discrimination.

As the Royal College of Midwives puts it: “Agenda for Change is underpinned by a job evaluation system that is based on equal pay for work of equal value — fundamentally important when the NHS workforce is predominantly female.”

Frequently Asked Questions

What is Agenda for Change in simple terms?

Agenda for Change is the pay system used by the NHS for most staff except doctors and dentists. It determines your salary based on your job’s pay band (1-9), sets out your annual leave and sick pay entitlements, and ensures equal pay for work of equal value.

When was Agenda for Change introduced?

Agenda for Change was introduced on 1 October 2004, replacing the previous Whitley Council pay system that had been in place since 1948. It was implemented across England, Wales, Scotland and Northern Ireland simultaneously.

How many pay bands are there in Agenda for Change?

There are nine pay bands, numbered 1 to 9. Band 8 is subdivided into four levels (8a, 8b, 8c and 8d), making 12 distinct pay ranges in total. Band 1 is closed to new entrants.

Does Agenda for Change apply to doctors?

No. Doctors and dentists have separate pay frameworks and are not covered by Agenda for Change. Very senior managers and some apprentices are also excluded from the system.

Is Agenda for Change the same across the UK?

The framework is the same across England, Wales, Scotland and Northern Ireland, but pay rates can differ. Scotland often negotiates separate deals and currently has higher pay at some bands, plus different working hours arrangements.

How do I move up a pay band?

To move to a higher band, you need to apply for and be appointed to a post at that band. You cannot progress from one band to the next through time served alone — promotion requires taking on a higher-banded role.

What is the KSF in Agenda for Change?

The Knowledge and Skills Framework (KSF) defines the knowledge and skills required for each NHS job. It’s used for annual development reviews and determines whether you’ve met the requirements to progress through pay points within your band.

Where can I find the official Agenda for Change handbook?

The NHS Terms and Conditions of Service Handbook is available free on the NHS Employers website. It contains all the official rules and entitlements for Agenda for Change staff.

What’s Next for You?

Agenda for Change is the foundation of your NHS employment. Understanding how it works helps you:

• Know what you’re entitled to
• Plan your career progression
• Make informed decisions about job changes
• Negotiate fairly when starting new roles

Whether you’re a newly qualified nurse on Band 5, a healthcare assistant on Band 3, or a manager on Band 7, the same principles apply. The system is designed to be fair, transparent and consistent.

Useful next steps:

• Check your current pay against the 2025/26 pay scales
• Review your annual leave and sick pay entitlements
• Speak to your manager about your KSF development plan
• Contact your union if you have questions about your banding