What Is NHS London Weighting (HCAS)?

HCAS stands for High Cost Area Supplement. It is an additional payment made to NHS staff whose place of work falls within one of three designated cost zones in and around London. The supplement exists because housing costs, transport, and general living expenses in London are substantially higher than the national average, and without additional pay, the NHS would struggle to recruit and retain staff in the region.

HCAS is:

• Added to your basic Agenda for Change salary
• Pensionable (it counts towards your NHS pension contributions)
• Taxable (income tax and NI apply to the full amount)
• Reviewed annually and uplifted in line with the AfC pay award

HCAS is not a separate allowance that is optional or discretionary. If your workplace is in a designated HCAS zone, you are entitled to receive it. It should appear on your payslip as a clearly identified line item.

The Three HCAS Zones — 2026/27 Rates

There are three tiers of HCAS, reflecting the cost gradient between central London and the wider surrounding area.

Inner London Zone

Rate: 20% of basic salary Minimum payment: £5,794 per year Maximum payment: £8,746 per year

The Inner London zone covers central London boroughs and NHS trusts located in the heart of the capital. For staff on lower bands where 20% of their salary would fall below the minimum, the minimum floor applies. For staff on higher bands where 20% would exceed the maximum, the payment is capped.

Outer London Zone

Rate: 15% of basic salary Minimum payment: £4,551 per year (approx) Maximum payment: £5,794 per year (approx)

Outer London covers the Greater London suburbs. The supplement is lower than Inner London but still represents a meaningful addition to take-home pay.

Fringe Zone

Rate: 5% of basic salary Minimum payment: £1,346 per year Maximum payment: £2,270 per year

The Fringe zone covers areas just outside the M25 that were historically part of Primary Care Trust regions with elevated living costs. It includes parts of Surrey, Hertfordshire, Essex, and Kent.

Which Areas Fall in Each Zone?

HCAS zones are based on historical Primary Care Trust boundaries established in 2005. Because PCTs were abolished in 2013, the geographic lines do not always align neatly with current local authority boundaries. This can create confusion — a road in one borough might qualify for HCAS while the street across the boundary does not.

Inner London Boroughs and Key NHS Trusts

Inner London includes: Camden, City of London, Hackney, Hammersmith and Fulham, Haringey, Islington, Kensington and Chelsea, Lambeth, Lewisham, Newham, Southwark, Tower Hamlets, Wandsworth, Westminster, and Greenwich.

Key NHS trusts in the Inner London zone include:

• Guy’s and St Thomas’ NHS Foundation Trust
• King’s College Hospital NHS Foundation Trust
• University College London Hospitals NHS Foundation Trust
• Barts Health NHS Trust
• South London and Maudsley NHS Foundation Trust
• Great Ormond Street Hospital NHS Foundation Trust
• Royal Free London NHS Foundation Trust
• Imperial College Healthcare NHS Trust

Outer London Boroughs and Key NHS Trusts

Outer London includes: Barking and Dagenham, Barnet, Bexley, Brent, Bromley, Croydon, Ealing, Enfield, Havering, Hillingdon, Hounslow, Kingston upon Thames, Merton, Redbridge, Richmond upon Thames, Sutton, and Waltham Forest.

Key NHS trusts in the Outer London zone include:

• Barnet Hospital (Royal Free London Group)
• Croydon Health Services NHS Trust
• Kingston Hospital NHS Foundation Trust
• North Middlesex University Hospital NHS Trust
• Whipps Cross Hospital (Barts Health)

Fringe Areas

Fringe areas include parts of: Basildon (Essex), Broxbourne (Hertfordshire), Dartford and Gravesham (Kent), Epping Forest, Epsom and Ewell, Hertsmere, Mole Valley, Reigate and Banstead, Sevenoaks, Thurrock, and Welwyn Hatfield.

Key NHS trusts in fringe areas include:

• Dartford and Gravesham NHS Trust
• Epsom and St Helier University Hospitals NHS Trust
• Frimley Health NHS Foundation Trust
• Basildon and Thurrock University Hospitals NHS Foundation Trust

Important: If you are unsure which zone your workplace falls into, check your employment contract, speak to your HR department, or check the Appendix 9 zone maps in the NHS Terms and Conditions Handbook. Your job advertisement should also specify the HCAS level applicable to the role.

HCAS Amounts by Band — April 2026/27

Inner London — 20% (minimum £5,794, maximum £8,746)

Note: The maximum cap of £8,746 applies from approximately Band 6 top onwards (where 20% of salary exceeds the cap).

Fringe — 5% (minimum £1,346, maximum £2,270)

How HCAS Affects Your Take-Home Pay

HCAS increases your gross pay, which means it increases all three main deductions: income tax, National Insurance, and pension contributions. The net benefit is therefore less than the headline HCAS amount.

Example: Band 5 Entry in Inner London

Without HCAS:

• Gross: £32,073
• Pension (8.3%): £2,662
• Taxable income: £32,073 − £2,662 = £29,411
• Tax-free allowance: £12,570
• Taxable: £16,841 at 20% = £3,368 tax
• NI: (£32,073 − £12,570) × 8% = £1,560
• Take-home monthly: ~£2,196

With Inner London HCAS (£6,415 added):

• Gross: £38,488
• Pension (8.3% on £38,488 pensionable): £3,194
• Taxable: £38,488 − £3,194 = £35,294
• Tax: (£35,294 − £12,570) × 20% = £4,545
• NI: (£38,488 − £12,570) × 8% = £2,073
• Take-home monthly: ~£2,634

Monthly take-home difference: approximately £438 more in Inner London vs non-London

HCAS and Your NHS Pension

HCAS is included in your pensionable pay. This means:

• Your pension contributions are calculated on your total pay including HCAS
• Your final pension benefit (if you are in the 2015 scheme) is based on your pensionable pay including HCAS for the years you received it
• Moving from a London role to a non-London role reduces your pensionable pay for future years but does not affect benefits already earned

This is important when considering a career move. NHS staff in London who move to equivalent roles outside London should factor in both the loss of HCAS from their gross pay and the lower pensionable earnings going forward.

HCAS and Home-Based Contracts

If you work under a home-based contract and your home address falls within an HCAS zone, you are entitled to HCAS at the appropriate level for your postcode. This is increasingly relevant as hybrid and community-based NHS roles expand.

If you later move home outside an HCAS zone, your employer should review your supplement entitlement. Similarly, if you move into an HCAS zone, you may become eligible to receive the supplement.

Why HCAS Is Facing Reform Pressure

For years, NHS staff and unions have argued that HCAS is outdated and unfair. The supplement is based on PCT boundaries from 2005 — over 20 years ago — and does not reflect current housing costs or commute patterns across England.

Critics point out that cities including Birmingham, Manchester, Bristol, and Leeds now have housing costs that rival Outer London fringe areas, yet NHS staff there receive no supplement. The 2026/27 NHS Pay Review Body report acknowledged growing interest in expanding HCAS, but stopped short of recommending changes. Any reform is expected to be part of the wider Agenda for Change structural discussions happening throughout 2026.

If HCAS is expanded or reformed, changes would likely be backdated to 1 April 2026.

Does HCAS Affect Visa Salary Requirements?

This is a common question for internationally recruited NHS staff. HCAS is treated differently depending on the context:

• For NHS payroll: HCAS is included in your total gross pay
• For Skilled Worker Visa eligibility: HCAS is generally not counted as part of your basic salary for visa threshold purposes, as it is an allowance rather than consolidated pay
• For mortgage applications: Most lenders treat HCAS as part of your total income, though policies vary

If you are on a Skilled Worker Visa and concerned about salary thresholds, confirm the position with your employer’s HR team and check the Home Office’s current guidance, as the treatment of allowances for visa purposes can change.

Frequently Asked Questions

My job offer says Inner London HCAS applies. How much will I receive?

At Band 5 entry from April 2026, you receive the Inner London HCAS of 20% of your £32,073 basic salary, which is £6,415. Your total gross is £38,488. However, check whether the minimum floor or maximum cap applies to your specific band.

I work at two NHS sites — one in an HCAS zone and one outside. Which rate applies?

HCAS is tied to your contractual base. If your contracted base is within an HCAS zone, you receive the supplement even if you sometimes work elsewhere. If your base is outside the zone, you generally do not receive HCAS even if you sometimes work in London.

The HCAS on my payslip seems wrong. What should I do?

Raise this with your payroll department in writing. Your contract should specify the HCAS level. You can also check the NHS Employers pay circular for 2026/27 or use the calculator on this site to verify your expected figure.

Will HCAS increase again next April?

Yes. HCAS is uplifted each year as part of the Agenda for Change pay award process. If the 2027/28 award is, for example, 3%, HCAS rates will increase by the same percentage — subject to the minimum and maxNHS London Weighting 2026/27 — HCAS Rates for Inner, Outer & Fringe Zonesimum thresholds also being adjusted.

Summary

NHS London Weighting (HCAS) for 2026/27 increased by 3.3% in line with the pay award. Inner London staff receive 20% of basic salary (minimum £5,794, maximum £8,746). Outer London staff receive 15% (minimum ~£4,551, maximum ~£5,794). Fringe staff receive 5% (minimum £1,346, maximum £2,270).

The supplement is pensionable and taxable, so the net take-home benefit is around 65–72% of the headline HCAS figure depending on your tax position. If you work in London and are not receiving HCAS, check your contract immediately — you may have an entitlement you are not claiming.

All figures sourced from confirmed NHS Employers 2026/27 pay circular. Inner London hourly rates inclusive of HCAS are published at nhsemployers.org.