UK nursing pay bands explained

If “bands” have you confused, know that you’re not alone. The concept took me ages to understand. And the idea that nurses are “salaried” in the UK blew my mind – it took time for me to pick up the pieces.

So… bands. You see them listed in the salary section of every nursing job posting. Band 4, Band 5, Band 6, Band 7. What do they mean and which ones should you be considering for your next potential job?

Let’s start at the beginning

The NHS uses a pay system which they call Agenda for Change. This dictates the amount that people are paid for the job that they do. It isn’t a system exclusively for nurses, just about every job within the NHS has been allocated a band. Regardless of qualifications or any other professional merit you may have acquired along the way, the job you take determines the amount you are paid. A slightly unusual concept in America where we are used to requesting raises and presenting a cunning argument as to why we should be paid more. This doesn’t work in quite the same way in the UK (side note: you should still advocate for your experience to be considered when determining your salary).

Though the Agenda for Change is an NHS system, private nursing jobs will usually state the equivalent pay band even though you are free to negotiate.

The Agenda for Change

The Agenda for Change pay system is separated into 9 pay bands (remember, the job determines the band and this isn’t really negotiable in the NHS). Those bands are then broken down further into pay points which take experience into consideration (that’s your opportunity to negotiate). Newly graduated nurses start at “the bottom of Band 5” and work their way up as they gain more experience.

Examples of jobs in each band

Band	Jobs (not an exhaustive list, just some examples)
1	no longer used
2	domestic support worker, housekeeping assistant, driver, security officer, healthcare assistant
3	emergency care assistant, clinical coding officer, estates officer, mental health care assistant, trainee nursing associate
4	assistant practitioner, pharmacy technician, dental nurse, registered nursing associate, pre-registered nurse
5	nurse, operating department practitioner, podiatrist, therapeutic radiographer
6	school nurse, experienced paramedic, biomedical scientist, clinical educator, assistant nurse manager (deputy sister), specialist nurses
7	communications manager, estates manager, advanced speech and language therapist, nurse ward manager (ward sister), junior matron
8	This band is separated into 4 categories: a, b, c, and d. There are some jobs in this band which could be done by nurses, but they are mostly admin/corporate positions. Nurse consultant, head of education and training, strategic management, matron, head of departments, senior matron, lead nurse, speciality matron, lead nurse
9	podiatric consultant, chief finance officer, director of estates and facilities, chief nurse, deputy chief nurse
	(These job titles are just examples)

Which band should I be in?

Most nursing jobs will be in Bands 5-7. Band 5 is where the majority of newly qualified clinical practitioners will begin. If you are a new nurse in America and you have not yet had a job, you will almost certainly start in a Band 5 post at the bottom of the band.

If you have some experience as a nurse in America, you will likely be looking for a Band 5 post, but you can, and should, negotiate for your experience to be calculated into your starting salary. The next pay step will happen when you achieve 2 years of experience. If you have one year of US experience, you won’t immediately get any more money, but you will be one year closer to a pay rise. If you are going to work in an acute hospital, don’t be surprised if they will only consider your acute care experience. I’ve also heard of Trusts halving community nursing experience and using that to determine pay step. But whatever you do, don’t do a disservice to yourself and ignore your value.

Do I have to be in a Band 5 post?

Historically, all internationally recruited nurses were hired into Band 5 posts. However, over the last couple of years there has been a push to recognize the experience that international nurses have gained abroad and to factor that into their ability to fulfil job roles of a higher band. That is good news for us! Though do keep in mind that you will be working in a completely different system and this does take some time to get used to. You may have all the skills but you’ll be in a very foreign setting. You can always begin in a Band 5 post and watch the job listings within your Trust. It may make you more eligible for those positions because you have taken time to find your feet in the NHS.

If you have many years of experience, then you can look at Band 5 posts, but please, please negotiate to be at the top of the Band. You deserve it. You can also probably consider a Band 6 position. In my opinion, American nurses are trained to a high quality Band 6 level in any case. Don’t sell yourself short. If you read a job description that “fits” you and it’s a Band 6 post, go for it! There’s no harm.

What about higher bands?

I would guess the majority will fall into jobs within bands 5 and 6, but if you have management experience or more specialized healthcare administration experience, then there’s no reason you shouldn’t apply for those jobs in higher bands. But if you are on a tight schedule for moving over, then it may be more prudent to start with a lower band and work your way up once you’re in the system.

With the new Health and Care Visa (if that’s what you’re going to use to get right to remain), nurses are able to climb as high up the ladder as they can as long as the occupation code remains 2231: nurses

Disclaimer: I am not an immigration lawyer. Always do your own research and if you need consultation, contact a specialist for advice about your own personal circumstances.

Hold on a second… I’ve been offered a Band 4 post

If you are in the process of getting your NMC PIN and you have been applying for jobs, some Trusts will hire you into a Band 4 pre-registration nurse post until you have passed your OSCE and have received your license number (NMC PIN). This is the route I took because I was very keen to be trained to take the OSCE.

Some people may insist that you have less salary negotiating power if you do this because you will go from top of Band 4 to bottom of Band 5 once you pass your OSCE. However, if you negotiated your salary at the point of hiring, you should be able to go from top of Band 4 to whichever Band 5 pay point you agreed in advance. It will inevitably require some persistence and a number of emails to HR. My advice to you: be sure to have any agreement in writing and don’t give up.

I get bands now, but what will I be paid?

Every financial year the salaries in the Agenda for Change are updated. That means each April we all get a pay rise, even if it is just nominal and not always above the rate of inflation. There are also regular campaigns to increase the pay for nurses which is generally spearheaded by the Royal College of Nursing, one of the nursing unions in the UK. We are about to have a pay rise, but the salaries for 2021/22 can be found here.

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