The NHS terms and conditions of service handbook, often called Agenda for Change (AfC), is the national agreement that sets out pay and conditions for most NHS staff. This guide explains the key parts you need to know, including your pay band, annual leave, sick pay, and parental leave entitlements, in simple terms.
What is the NHS terms and conditions handbook?
Think of the handbook as the core employment contract for over a million people working in the NHS across the UK. It applies to the vast majority of staff, from healthcare assistants and nurses to porters and admin staff. It doesn't, however, cover doctors, dentists, or very senior managers, who have their own separate contracts.
Its official name is the ‘NHS terms and conditions of service handbook’, but you’ll almost always hear it called ‘Agenda for Change’ or simply ‘AfC’. The system was introduced in 2004 to standardise pay and career progression, ensuring that staff receive equal pay for work of equal value, no matter where in the UK they work.
While the AfC framework is UK-wide, the annual pay awards can be set differently by the governments in England, Scotland, Wales, and Northern Ireland. The figures and details in this guide are based on the terms for NHS England.
The full handbook is a massive document, running to hundreds of pages. This guide won't cover every clause, but instead will focus on the sections that affect your day-to-day working life the most. Understanding these terms is also incredibly helpful when you're applying for new roles, as it helps you appreciate the full value of an NHS job offer. When crafting your supporting statement, highlighting your experience within this framework shows hiring managers you understand the system.
Understanding your pay band
The cornerstone of Agenda for Change is its pay structure. Every non-medical job is evaluated and placed into one of nine pay bands. Band 1 was closed to new entrants in 2018, so new starters will begin at Band 2 or above. Each band has a number of pay points, and you progress up these points as you gain experience in the role.
Your pay band depends on the knowledge, responsibility, and skills required for your job. For example, a newly qualified nurse typically starts at the bottom of Band 5, while a highly specialist clinical lead might be at Band 8a.
Full-time hours in the NHS are 37.5 hours per week. On top of your basic salary, you are also paid enhancements for working ‘unsocial’ hours, such as nights, weekends, and bank holidays. These are set percentages of your basic pay and are detailed in Section 3 of the handbook.
Below are the pay scales for NHS England for 2025/26, effective from 1 April 2025.
| Band | Salary Range / Pay Points |
|---|---|
| Band 2 | £24,465 |
| Band 3 | £24,937 to £26,598 |
| Band 4 | £27,485 to £30,162 |
| Band 5 | £29,970 / £32,324 (2 yrs) / £36,483 (4 yrs) |
| Band 6 | £37,338 / £39,405 (2 yrs) / £44,962 (5 yrs) |
| Band 7 | £46,148 / £48,526 (2 yrs) / £52,809 (5 yrs) |
| Band 8a | £53,755 to £60,504 |
| Band 8b | £62,215 to £72,293 |
| Band 8c | £74,290 to £85,601 |
| Band 8d | £88,168 to £101,677 |
| Band 9 | £105,385 to £121,271 |
Progression through the points in your band is not automatic but is linked to you meeting the requirements of your role, which is usually confirmed at your annual appraisal.
Annual leave entitlement (Section 13)
One of the most valued benefits of the NHS contract is its generous annual leave policy, which is significantly better than the UK statutory minimum of 5.6 weeks.
Your entitlement is based on your length of service within the NHS. This service is cumulative, meaning periods of employment at different NHS trusts can be added together, even if you had a break in service. Your leave allowance is as follows:
- On joining: 27 days plus 8 bank holidays
- After 5 years of NHS service: 29 days plus 8 bank holidays
- After 10 years of NHS service: 33 days plus 8 bank holidays
For part-time staff, the entitlement is calculated on a pro-rata basis. The entire allowance, including bank holidays, is usually expressed in hours. A standard NHS working day is 7.5 hours, so a new full-time starter would have an annual leave entitlement of (27 + 8) x 7.5 = 262.5 hours.
Calculating this can be tricky, especially if you work irregular hours or joined part-way through the leave year. You can use our NHS annual leave calculator to work out your exact entitlement in hours.
Sick pay (Section 14)
The NHS occupational sick pay scheme provides a crucial safety net if you are unable to work due to illness or injury. The amount of sick pay you are entitled to depends on your length of service.
It's important to understand that the entitlement is based on a ‘rolling’ 12-month period. This means that when you go off sick, your employer will look back at the previous 12 months to see how much absence you have had and how much sick pay you have already received. This determines how much entitlement you have left.
| Length of NHS Service | Full Pay Entitlement | Half Pay Entitlement |
|---|---|---|
| During first year (after 4 months' service) | 1 month | 2 months |
| During second year | 2 months | 2 months |
| During third year | 4 months | 4 months |
| During fourth and fifth years | 5 months | 5 months |
| After five years | 6 months | 6 months |
A key point is that your sick pay is calculated based on what you would have earned if you had been at work. This means it includes any regularly paid enhancements for unsocial hours, not just your basic salary. This applies to staff on all bands.
For absences of up to seven calendar days, you can self-certify your sickness. For any absence longer than that, you will need to provide your manager with a fit note (previously called a sick note) from a healthcare professional.
Maternity and parental leave (Section 15)
The AfC handbook provides enhanced maternity and parental leave provisions that are a significant improvement on the statutory minimums.
Maternity Leave
To qualify for NHS occupational maternity pay, you need to have at least 12 months of continuous NHS service by the time you reach the 11th week before your estimated week of childbirth (EWC).
If you qualify, your pay will be structured as follows:
- 8 weeks of full pay (less any Statutory Maternity Pay or Maternity Allowance you receive).
- 18 weeks of half pay, plus your SMP or MA (the total amount cannot exceed your normal full pay).
- 13 weeks of SMP or MA only (the 2025/26 rate for SMP is expected to be around £187.18 per week, or 90% of your average earnings if that is lower).
- Up to 13 weeks of additional unpaid maternity leave.
It is a condition of the occupational scheme that you must return to work for an NHS employer for at least three months after your maternity leave ends. If you don't, you may be required to repay the occupational part of your maternity pay (but not the statutory part).
Let's take a realistic scenario. A Band 5 nurse working 30 hours per week has been in the NHS for four years. When she goes on maternity leave, she qualifies for the full occupational scheme. For the first 8 weeks, she'll get her normal full pay. For the next 18 weeks, she'll receive half her pay plus SMP. For the 13 weeks after that, she'll receive SMP only. She plans to take the full 52 weeks of leave, so the final 13 weeks will be unpaid.
Paternity and Shared Parental Leave
The handbook also covers other types of parental leave. Eligible partners with 12 months of continuous NHS service are entitled to two weeks of paternity leave on full pay.
Shared parental leave is also available, allowing eligible parents to share up to 50 weeks of leave and up to 37 weeks of pay between them. The rules can be complex, so it's best to speak with your HR department to understand your options.
Other important sections to know
While pay, leave, and sickness are the most frequently discussed topics, the handbook covers all aspects of your employment. Other key sections include:
- Redundancy Pay (Section 16): This details the calculation for redundancy payments, which are more generous than the statutory minimum. The calculation is based on your length of service and weekly pay. Always seek advice from your union if you are facing a redundancy situation.
- Flexible Working (Section 33): All employees have a legal right to request flexible working from day one of employment. This section outlines the specific process for making a request within the NHS and the grounds on which your employer can consider it.
- Grievance and Disputes (Part V): This part of the handbook sets out the formal procedures for raising and resolving workplace issues, concerns, or complaints. It's designed to ensure problems are dealt with fairly and consistently.
- Travel and Expenses (Section 17): This section explains the rules for claiming reimbursement for mileage and other expenses incurred while on NHS business, such as travel to other sites or for training courses.
Key takeaways
- The NHS terms and conditions handbook (Agenda for Change) is the employment contract for most NHS staff, governing your pay, leave, and rights at work.
- Your pay is determined by a national banding system, with progression through pay points in your band as you gain experience.
- Annual leave is generous, starting at 27 days plus bank holidays and rising to 33 days after 10 years of service.
- The occupational sick pay scheme provides substantial financial support during periods of illness, increasing with your length of service.
- If you meet the service requirements, you are entitled to enhanced maternity and paternity pay, which is significantly better than the statutory minimum.
- For any specific or complex queries, always refer to the latest version of the handbook on the NHS Employers website or speak with your line manager, HR department, or trade union representative.