NHS Band 4 Salary 2026/27: Pay Scale, Hourly Rate & Take-Home
Agenda for Change Band 4 in England pays £28,392 rising to £31,157 in 2026/27, after a 3.3% rise — £14.52 an hour at entry. After income tax, National Insurance and NHS Pension that is about £1,873.79 a month take-home (£1,990.32 at the top of the band).
Updated 2026-10-03 · NHS Employers 2026/27 pay scales · HMRC 2026/27 tax
Band 4 pay points 2026/27
| Pay point | Annual | 2025/26 | Monthly gross | Hourly | Pension rate | Take-home / month |
|---|---|---|---|---|---|---|
| Entry | £28,392 | £27,485 | £2,366.00 | £14.52 | 6.5% | £1,873.79 |
| Top (after 3 years) | £31,157 | £30,162 | £2,596.42 | £15.93 | 8.3% | £1,990.32 |
- Gross / month
- Take-home / month
Progression is automatic once you meet the pay-step requirements (an appraisal and completed mandatory training). The step from entry to the top of Band 4 is worth £2,765 a year before tax, or £116.53 a month after tax and pension.
What comes out of a Band 4 payslip
| Monthly | Entry (£28,392) | Top (£31,157) |
|---|---|---|
| Gross pay | £2,366.00 | £2,596.42 |
| NHS Pension | -£153.79 | -£215.50 |
| Income tax | -£232.94 | -£266.68 |
| National Insurance | -£105.48 | -£123.91 |
| Take-home | £1,873.79 | £1,990.32 |
NHS Pension contributions are deducted before tax (net pay arrangement), so a 6.5% contribution costs you less than it looks. With a Plan 2 student loan, entry-level take-home falls to £1,873.79 a month (£0.00 repaid).
Band 4 in London (HCAS)
High cost area supplements are a percentage of basic pay, subject to a minimum and maximum.
| Area | Supplement | Entry with HCAS | Top with HCAS | Take-home / month (entry) |
|---|---|---|---|---|
| Inner London | 20% (min £5,794, max £8,746) | £34,186 | £37,388 | £2,155.30 |
| Outer London | 15% (min £4,870, max £6,137) | £33,262 | £36,027 | £2,104.97 |
| Fringe | 5% (min £1,346, max £2,270) | £29,812 | £32,715 | £1,917.04 |
Unsocial hours and overtime for Band 4
- Saturdays and weekday nights (8pm–6am): +30% — £18.88 an hour at entry.
- Sundays and bank holidays: +60% — £23.23 an hour at entry.
- Overtime: time and a half (£21.78 an hour), or double time on bank holidays (£29.04).
Example: one 12.5-hour Sunday shift a month adds £109 of enhancement on top of basic pay at entry level — about £37 a month after tax, NI and pension.
Band 4 in Scotland, 2026/27
NHS Scotland has its own pay scales and a 3.75% rise for 2026/27. Band 4 pays £31,537 to £34,303 — £3,145 more than in England at entry — but Scottish income tax rates apply.
| Pay point | Scotland | Take-home / month (Scotland) | England take-home / month |
|---|---|---|---|
| Entry | £31,537 | £2,041.65 | £1,873.79 |
| Top (after 3 years) | £34,303 | £2,154.33 | £1,990.32 |
Typical Band 4 jobs
- Nursing associate (trainee and newly registered)
- Assistant practitioner
- Medical secretary
- Pharmacy technician (trainee)
- Team administrator
Banding is set by job evaluation against national profiles, so the same job title can sit in a different band at another trust. Moving up to Band 5 starts at £32,073 (£916 above the top of Band 4). Band 3 tops out at £27,476.
Calculate your own Band 4 pay
| Basic pay | £31,157 |
| High cost area supplement | £0 |
| NHS Pension (8.3% tier) | £2,586 |
| Income tax | £3,200 |
| National Insurance | £1,487 |
| Student loan | £0 |
| Take-home pay | £23,884 |
- Take-home £23,884 76.7%
- Income tax £3,200 10.3%
- NI £1,487 4.8%
- NHS Pension £2,586 8.3%
Your result is ready
All bands: Band 1 · Band 2 · Band 3 · Band 5 · Band 6 · Band 7 · Band 8a · Band 8b · Band 8c · Band 8d · Band 9
Band 4 roles: the assistant practitioner band
Band 4 covers jobs scoring 271 to 325 points and is where many assistant practitioner and technician roles sit. NHS Employers' index has 41 national Band 4 profiles, including two nursing profiles (Nursing Band 4i and 4ii, scoring 274 to 323), Midwifery Band 4, Pharmacy Technician (276 to 299), Dental Nurse (271 to 308), ODP Band 4, Ambulance Practitioner (280 to 301), radiography and therapy assistant practitioners, Tradesperson, and senior administrative roles such as finance team leader and HR administrator.
Band 4 has a single pay step: £28,392 at entry, then £31,157 on your pay step date three years after starting in the band, once you meet the Annex 23 standards.
How the top step interacts with pension and student loan
Band 4 is where two thresholds collide. At entry, £28,392 is in the 6.5% NHS Pension tier and below the £29,385 Plan 2 student loan threshold. The top point of £31,157 crosses into the 8.3% pension tier (above £28,854) and above the Plan 2 threshold.
So the £2,765 pay step does not all reach your bank account. Without a student loan, monthly take-home rises by £116.53. With a Plan 2 loan it rises by £103.28, because £159 a year now goes to the Student Loans Company. The higher pension contribution is not lost: it buys a bigger 2015 Scheme pension (£577 a year of pension at the top point against £526 at entry).
Trainee pay for Band 4 roles
Trainees who join the NHS and do all their training as employees, over a period measured in years, are not job-evaluated. Under Annex 21 they are paid a percentage of the top of the qualified band, and never less than the adult rate of the National Minimum Wage. For a Band 4 qualified role the percentages give:
If a percentage falls below the minimum wage, Annex 21 does not simply pay the minimum. From year two, it adds a supplement on top of the minimum wage equal to the cash difference between that year's percentage and the previous year's, so a trainee still gets a pay rise as training progresses.
| Time before qualifying | % of Band 4 maximum | Annual | Hourly (37.5h) | Below the NLW? |
|---|---|---|---|---|
| More than 3 years | 60% | £18,694 | £9.56 | Yes – paid at least £12.71 |
| 2 to 3 years | 65% | £20,252 | £10.36 | Yes – paid at least £12.71 |
| 1 to 2 years | 70% | £21,810 | £11.15 | Yes – paid at least £12.71 |
| Final 12 months | 75% | £23,368 | £11.95 | Yes – paid at least £12.71 |
Frequently asked questions
How much is NHS Band 4 per hour?
£14.52 an hour at entry and £15.93 at the top in 2026/27, based on a 37.5-hour week (annual ÷ 52.143 ÷ 37.5).
What is Band 4 take-home pay per month?
About £1,873.79 at entry in England with no student loan, after income tax, NI and a 6.5% NHS Pension contribution. At the top of the band it is about £1,990.32.
How much did Band 4 go up in 2026/27?
Entry pay rose from £27,485 to £28,392 (+£907), the 3.3% pay award from 1 April.
How long does it take to reach the top of Band 4?
after 3 years, subject to meeting pay-step requirements.
How long does it take to reach the top of Band 4?
Three years. You move from £28,392 to £31,157 on your pay step date, provided you meet the appraisal, training and conduct standards in Annex 23.
How are Band 4 trainees paid?
Annex 21 sets trainee pay at 60% to 75% of the Band 4 maximum depending on time left in training, and never below the National Minimum Wage. In 2026/27, all four rates fall below the £12.71 National Living Wage, so trainees aged 21 or over on those rates are paid at least the NLW.
Why does my pension go up when I reach the top of Band 4?
The top point of £31,157 is above the £28,854 tier boundary, so your contribution rises from 6.5% to 8.3% of pensionable pay.
Sources
Figures are taken from official government publications and were last reviewed on 2026-10-03.
- NHS Employers – Pay scales for 2026/27
- NHS Pay Review Body Thirty-Ninth Report 2026
- NHSBSA – Cost of being in the Scheme (contribution tiers)
- Scottish Government circular PCS(AFC)2026/1 – AfC pay 2025-26 and 2026-27
- SPPA – NHS Scotland member contributions
- NHS Employers – NHS Terms and Conditions of Service (Agenda for Change) Handbook
- NHS Employers – National job profiles and profile index (January 2026)
- NHS Terms and Conditions Handbook – Section 1: Pay structure (job weight by band, pay on promotion)
- NHS Terms and Conditions Handbook – Annex 23: Pay progression (England)
- NHS Terms and Conditions Handbook – Annex 21: Pay and banding of trainees
- NHSBSA – 2015 Scheme members guide (1/54th build-up rate, Treasury Order plus 1.5% revaluation)
- GOV.UK – Repaying your student loan: what you pay
- GOV.UK – National Minimum Wage and National Living Wage rates