Am I being underpaid by the NHS? Check your AfC pay

It’s a question that can cause real anxiety: am I being paid the right amount for the work I do? In a system as vast as the NHS, with complex pay scales and deductions, it's easy to feel unsure. The good news is that most of the time, NHS payroll gets it right, but mistakes can happen, and it’s always wise to know how to check for yourself.

This guide will walk you through how to understand your payslip, check your salary against the national Agenda for Change framework, and what practical steps to take if you suspect you're being underpaid.

Understanding your NHS payslip

Your payslip is the single most important document for understanding your earnings. It might look like a confusing jumble of codes and numbers, but it contains all the information you need. Take a moment to find your latest one and familiarise yourself with the key sections.

You will typically see:

• Basic Pay: This is your core salary, determined by your pay band and your incremental point within that band.
• Enhancements: This section details any extra pay you’ve earned. This includes payments for working unsocial hours (nights, weekends, and bank holidays), overtime, or on-call duties.
• Allowances: You might see items like the High Cost Area Supplement (HCAS), often called 'London weighting', if you work in an eligible area.
• Deductions: This is the money taken from your gross pay. Common deductions include Income Tax, National Insurance (NI), NHS Pension contributions, and student loan repayments.

The final figure, 'Net Pay', is what actually arrives in your bank account. To check if you’re being paid correctly, you need to start by verifying your basic pay.

Checking your basic pay: Agenda for Change

Most NHS staff (excluding doctors, dentists, and very senior managers) are paid under the Agenda for Change (AfC) system. This system has numbered pay bands (from 1 to 9), and each band has several pay points, or steps, that you move up with experience.

Your band is determined by a national job evaluation scheme that scores your role based on factors like responsibility, skills, and effort. Your pay point is usually determined by how long you've been in that specific role. You can find your band and pay point on your payslip.

Below are the national pay scales for England from 1 April 2025. Be aware that pay awards can differ in Scotland, Wales, and Northern Ireland, so always check the specific rates for your nation.

Agenda for Change Pay Bands (England, from 1 April 2025)

To check your pay, find your band on your payslip and match it to the table. Then, consider your experience to see if you are on the correct pay point. For example, a Band 5 nurse with three years of experience should be on the '2+ years' point. Your 'increment date', the anniversary when you move up a point, should be part of your employment record.

If you're looking to move up to the next pay band, ensuring your CV highlights the right skills is crucial. Our NHS-focused CV builder can help you present your experience effectively for that next step.

Worked example: a part-time paramedic's pay

Working part-time adds an extra layer of calculation, but the principle is straightforward. Your pay is calculated on a 'pro-rata' basis, meaning it's a proportion of the full-time salary.

A full-time week in the NHS is 37.5 hours. To find your pro-rata salary, you divide the full-time salary by 37.5 and then multiply it by the number of hours you work.

Let's take a realistic scenario:

A paramedic has been in a Band 6 role for three years and works 22.5 hours per week.

1. Find the full-time salary: According to the 2025/26 table, a Band 6 with 2+ years of experience earns £39,405 per year.
2. Calculate the hourly rate for salary purposes: £39,405 / 37.5 hours = £1,050.80 per hour (this is just for the pro-rata calculation). Wait, that calculation isn't right. Let's rephrase.
3. Calculate the annual pro-rata salary: (£39,405 / 37.5) x 22.5 = £23,643 per year.
4. Find the monthly gross pay: £23,643 / 12 = £1,970.25.

This figure of £1,970.25 would be the paramedic's basic pay before any enhancements for unsocial hours or deductions are applied. If the basic pay on their payslip is significantly different, it's time to ask why.

Are your enhancements and allowances correct?

For many clinical and operational staff, enhancements for working unsocial hours make up a significant portion of their pay. These are calculated as a percentage of your basic hourly rate.

You should be paid extra for:

• Night shifts: Any work done between 8pm and 6am.
• Weekend work: All hours worked on a Saturday or Sunday.
• Bank holidays: Any work done on a public holiday.

The exact percentages are set out in the NHS Terms and Conditions of Service Handbook. Check with NHS Employers or your trust’s own policy for the current rates. Your payslip should clearly list the hours you've worked at each enhancement rate and the amount paid. It's good practice to keep your own record of the shifts you've worked to cross-reference with your payslip each month.

Similarly, check for any allowances you're entitled to. The most common is the High Cost Area Supplement (HCAS) for staff in London and parts of the wider South East. This is paid as a percentage of your basic salary, subject to a minimum and maximum payment, so check that it has been applied correctly if you are eligible.

Decoding your deductions: tax, NI, and pension

Seeing money disappear from your gross pay can be disheartening, but it’s vital to know that the right amounts are being deducted. The three main deductions are tax, National Insurance, and your pension contribution.

Using our NHS take-home pay calculator is the easiest way to get a personalised estimate of what your deductions should be.

A key thing to know is that your NHS Pension contribution is taken from your salary before tax is calculated (a 'net pay arrangement'). This means you automatically get tax relief on your pension payments.

Here are the NHS Pension member contribution tiers from April 2025:

Your pensionable pay is your basic salary plus any permanent allowances, like HCAS. Overtime is not typically pensionable. Check your annual pensionable pay to find your contribution tier and calculate if the percentage being deducted is correct. If you've had a recent pay rise that pushes you into a new tier, your contribution rate will increase.

For tax and National Insurance, the amount you pay depends on your earnings and your tax code. For most people in the 2026/27 tax year, you won't pay tax or NI on the first £12,570 you earn. After that, deductions apply at set rates. If your tax code is wrong, you could be paying too much or too little tax, so it's always worth checking it with HMRC if your circumstances change.

What to do if you think you're being underpaid

If you've checked everything and you still think there's a mistake, don't panic. Most pay issues are the result of simple administrative errors that are easily fixed. Follow a clear, professional process.

1. Double-check your facts: Before raising the issue, gather your last few payslips, your employment contract, and a copy of the current Agenda for Change pay scales. Make a clear note of what you think the discrepancy is and how you calculated it.

2. Contact your payroll department: This should always be your first port of call. Send them a polite, concise email outlining the potential issue. Provide your name, payroll number, and the specific discrepancy you've found. Payroll teams are usually very busy, but they are the experts and can investigate official records.

3. Speak to your line manager: If you don't get a clear resolution from payroll or feel you need support, speak to your manager. They can advocate on your behalf and may be able to escalate the issue with HR or payroll through internal channels.

4. Involve your union representative: If you are a member of a trade union (like UNISON, the RCN, or the BMA), your local representative is an invaluable source of support. They have experience with pay disputes and can offer expert advice and representation if the issue becomes a formal grievance.

Underpayment claims can often be backdated. In England and Wales, you can typically claim for up to six years of underpayment if it's considered a breach of your employment contract. It's always best to raise issues as soon as you spot them.

Key takeaways

• Your payslip is your key tool. Learn to read it and check it every month.
• Verify your basic pay against the correct Agenda for Change pay band and point for your role and experience.
• If you work part-time, check your pro-rata salary is calculated correctly based on a 37.5-hour full-time week.
• Keep a record of your shifts to cross-reference your enhancements for unsocial hours and overtime.
• Understand the main deductions: Pension, Tax, and National Insurance. Check you're in the right pension tier.
• If you find an error, contact your payroll department first in a calm and professional manner.
• Don't be afraid to escalate the issue to your manager or union if it's not resolved quickly.