NHS sick pay provides financial support when you're too unwell to work, offering a safety net that's more generous than the statutory minimum. Your entitlement, which includes periods of both full and half pay, increases with your length of service and is calculated based on any absences within a rolling 12-month period. This guide explains how the Agenda for Change (AfC) occupational sick pay scheme works in practice.
What is NHS occupational sick pay?
When you're employed by the NHS under Agenda for Change (AfC) terms and conditions, you are entitled to occupational sick pay. This is a contractual benefit, separate from and more generous than Statutory Sick Pay (SSP), which is the minimum amount the law says employers must pay.
The NHS scheme is designed to ensure that you don't face immediate financial hardship if you need to take time off due to illness or injury. It recognises that recovery takes time and provides a tiered system of support that grows as your career in the NHS progresses.
To be eligible, you generally need to have completed a certain amount of service (currently four months) and follow your employer's sickness reporting procedures correctly.
Your sick pay entitlement based on length of service
Your entitlement to sick pay is directly linked to your length of service. This isn't just the time you've spent in your current role or trust; it's your continuous service across the NHS. If you have breaks in your NHS employment, it can get complicated, so it’s always wise to confirm your personal 'continuous service date' with your HR or payroll department.
The amount of full and half pay you are entitled to within any 12-month period is laid out in Section 14 of the NHS Terms and Conditions of Service Handbook. Here is a breakdown:
| Length of 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 |
What does 'half pay' mean?
When you move onto half pay, you receive 50% of your normal pay. However, you may also be eligible for Statutory Sick Pay (SSP) on top of this. The rules ensure that the combination of half pay and any SSP you receive does not exceed your normal full pay. The interaction between occupational sick pay and SSP can be complex, so if you have a period of long-term sickness, it's a good idea to talk to your payroll team to understand exactly what you'll receive.
Understanding the 'rolling 12-month period'
This is the most common point of confusion around NHS sick pay. Your entitlement doesn't reset on a fixed date each year (like 1st April or your work anniversary). Instead, it's calculated on a 'rolling' basis.
Here’s how it works: on the first day of any new period of sickness, your employer will look back at the preceding 12 months. They will count how many days of sick leave you've already taken in that timeframe and deduct this from your total annual entitlement. What's left is what you're eligible to receive for your current absence.
A worked example
Let's consider a Band 5 nurse with over five years of service, working full-time. Their full entitlement is six months of full pay and six months of half pay.
- In May, they were off sick for one month with an infection. They received full pay.
- They return to work and remain well for several months.
- In December of the same year, they unfortunately need surgery and are signed off for three months.
To calculate their pay for the December absence, payroll looks back 12 months from the start of this new sickness. They see the one-month absence in May. This is deducted from their six-month full-pay entitlement, leaving five months of full pay available. As their current absence is only for three months, it will be covered entirely by full pay. Once they recover and return, they will have two months of full pay and six months of half pay remaining for any future illness in the coming months.
What does my NHS sick pay include?
Your sick pay isn't just your basic salary. A significant and welcome feature of the NHS scheme is that it includes regularly paid supplements and enhancements. This means if you consistently work nights, weekends, or bank holidays, the extra payments you earn for those unsocial hours are included in your sick pay calculation.
This provides a much more realistic reflection of your normal earnings, which is particularly important for clinical staff and others who work around the clock. Payments that are not regular, such as occasional overtime, are not usually included.
If you want to get a clearer picture of your normal pay components, which helps in understanding your sick pay, you could use a tool like the NHS take-home pay calculator.
Reporting sickness and providing fit notes
To receive sick pay, you must follow your employer's sickness absence policy. While procedures vary slightly between trusts, the core requirements are standard.
- Initial reporting: You must notify your line manager (or a designated person/department) that you are unable to work as early as possible on your first day of absence, and explain the nature of your illness.
- Self-certification: For absences up to and including seven calendar days, you can 'self-certify'. This means you declare yourself unfit for work without needing to see a doctor. You will usually complete a form for this upon your return.
- Fit notes: If your absence lasts longer than seven calendar days, you must obtain a Statement of Fitness for Work, commonly known as a 'fit note', from a registered healthcare professional (such as your GP). You must send this to your manager or HR department promptly to ensure your pay is processed correctly.
A fit note will state either that you are 'not fit for work' or that you 'may be fit for work'. If it's the latter, the note will include recommendations for adjustments to help you get back, such as a phased return, altered hours, or amended duties.
Returning to work and other considerations
The goal of sick leave is to help you recover fully and return to work safely. In many cases, especially after a longer absence, this is a gradual process.
Your manager may refer you to your trust's Occupational Health department. They provide impartial advice to help support you, assess your fitness for your role, and recommend any adjustments that could facilitate a successful return to work.
One common adjustment is a 'phased return', where you gradually increase your hours and duties over a set period. You are typically paid your normal full salary during a phased return. It's an important tool for easing back into the demands of your job without risking a relapse.
It's also worth knowing that you continue to accrue annual leave entitlement as normal while you are on both full and half sick pay. If you fall ill during a period of pre-booked annual leave, you should report it as sickness immediately. You can then 'reclaim' those days of annual leave to take at a later time.
Key takeaways
- Your entitlement to NHS sick pay increases with your continuous length of service, up to a maximum of six months' full pay and six months' half pay.
- The system works on a rolling 12-month period, not a fixed year. Your remaining entitlement is calculated by looking at absences in the 12 months prior to your new sickness.
- Sick pay includes regularly paid enhancements for unsocial hours, reflecting your normal earning pattern.
- You must follow your local reporting procedures. You can self-certify for the first 7 calendar days, after which a fit note is required.
- Support is available for your return to work, including phased returns, which are paid at your full normal rate.
- If you are ever unsure, speak to your line manager, a trade union representative, or your trust's HR or payroll department for confidential advice.