What is NHS On-Call Pay?
NHS on-call pay compensates you for being available to work outside of your normal hours and for any work you do if you’re called in. Under Agenda for Change (AfC), this is made up of two distinct parts: an ‘availability allowance’ for being on standby, and an enhanced payment for any hours you actually work.
Understanding how these components work is key to making sure you’re paid correctly for the disruption and commitment that on-call duties involve.
How On-Call Pay Works Under Agenda for Change
The rules for on-call arrangements are set out in the NHS Terms and Conditions of Service Handbook, specifically in Section 2 and Annex 29. While these national terms provide the framework, the exact details can vary between Trusts due to local agreements. However, the core structure is consistent across the NHS.
Your on-call payment is always split into two parts:
- The Availability Allowance: This is the payment you receive simply for making yourself available. It recognises the significant restriction on your personal time—you must remain contactable, sober, and able to return to your workplace within a specified time. You receive this allowance whether you are called in to work or not.
- Payment for Work Done: If your phone rings and you are asked to come in or perform work remotely, you are paid separately for this time. This work is paid at an enhanced rate to reflect its unsocial and disruptive nature.
It’s important to distinguish this from simply working overtime. An on-call shift is a formal standby arrangement, whereas overtime is typically a more straightforward extension of your contracted hours, paid at different rates.
Calculating Your On-Call Availability Allowance
The availability allowance is calculated as a percentage of your basic pay for the period you are on-call. For most on-call arrangements, this is set at 9% of your basic hourly rate.
Let's look at a realistic scenario. The figures below are based on the proposed 2025/26 pay scales for NHS staff in England.
Example: A Band 6 Physiotherapist
Saanvi is a Band 6 Physiotherapist with three years of experience, placing her on the middle of her band with a basic salary of £39,405 per year for a full-time 37.5-hour week.
- Annual Salary: £39,405
- Weekly Pay: £39,405 / 52.14 weeks = £755.75
- Basic Hourly Rate: £755.75 / 37.5 hours = £20.15
Saanvi is rostered to be on-call from 8 pm on a Friday to 8 am on Saturday—a 12-hour period.
To calculate her availability allowance, we first find out what her basic pay would be for those 12 hours:
- Basic pay for the period: 12 hours x £20.15 = £241.80
Now, we calculate the 9% allowance on that amount:
- Availability Allowance: 9% of £241.80 = £21.76
Saanvi will earn £21.76 for that 12-hour on-call shift, even if she receives no calls and enjoys an uninterrupted night at home. This payment is purely for her availability.
What Happens When You're Called In?
If you are contacted and asked to work during your on-call period, this triggers the second part of your payment. Under Agenda for Change, any work done while on-call is paid at time-and-a-half (1.5x your basic hourly rate).
Continuing our example, let's say Saanvi gets a call at 2 am for an urgent respiratory patient. She travels to the hospital, works for two hours, and then returns home.
- Saanvi's basic hourly rate: £20.15
- Her on-call work rate (time-and-a-half): £20.15 x 1.5 = £30.23 per hour
- Payment for work done: 2 hours x £30.23 = £60.46
For her on-call shift, Saanvi's total earnings would be:
- Total Pay: £21.76 (Availability Allowance) + £60.46 (Payment for Work) = £82.22
Time Off In Lieu (TOIL)
Your Trust's policy might offer you the choice of taking Time Off In Lieu (TOIL) instead of payment for work done. It's crucial that this is also offered at an enhanced rate. In Saanvi's case, she should be entitled to 3 hours of TOIL for the 2 hours she worked (2 hours x 1.5).
Whether you take the pay or the TOIL is often a personal choice, but it may also be influenced by departmental policy and staffing levels. Always clarify the arrangement with your manager.
On-Call Frequencies and Local Agreements
The 9% availability allowance is the standard for what are considered 'frequently and/or predictably onerous' on-call duties. However, the AfC handbook allows for local variation. Your Trust, in agreement with staff-side unions, may have different arrangements in place.
These agreements often define different allowance percentages based on the frequency of the rota:
- High Frequency (e.g., 1 in 6 or more frequent): Typically qualifies for the full 9% allowance.
- Medium Frequency (e.g., between 1 in 7 and 1 in 12): May attract a lower percentage.
- Low Frequency (e.g., 1 in 13 or less frequent): May have a significantly lower allowance or a different payment structure altogether.
Because these details are set locally, it is vital to know your own Trust's policy. If you are unsure, you can find this information in several places:
- Your employment contract or offer letter
- The staff intranet (search for 'on-call policy')
- Your line manager
- Your department's rota coordinator
- A representative from your union (e.g., RCN, UNISON, BMA)
- Your Trust's HR or payroll department
If you're applying for a role with an on-call component, make sure you ask about the frequency and remuneration at your interview. When crafting your application, you can use tools like the Staff Portal Application Copilot to help you articulate your experience and flexibility in handling such responsibilities.
On-Call vs. Unsocial Hours Enhancements
It's easy to confuse on-call payments with standard enhancements for working unsocial hours, but they are fundamentally different. On-call is about being paid to be available, while unsocial hours payments are for actively working during a rostered shift.
Here’s a simple comparison:
| Type of Work | What it is | How it's paid |
|---|---|---|
| On-Call Availability | Being on standby outside of your normal working hours, ready to be called in. | An allowance, typically 9% of your basic pay for the duration of the standby period. |
| Work Done On-Call | The hours you actually work after being called in from standby. | Paid at an enhanced rate, typically time-and-a-half (1.5x basic pay) or equivalent TOIL. |
| Unsocial Hours | Working a pre-rostered shift during evenings, nights, weekends, or bank holidays. | An enhanced percentage added to your basic pay for every hour of the shift that falls in an unsocial period. |
You can see how all these different enhancements add up and affect your final monthly pay. To get a clearer picture of your earnings after tax, National Insurance, and pension contributions, it can be helpful to use an NHS take-home pay calculator.
Key takeaways
- NHS on-call pay under Agenda for Change is made up of two parts: an availability allowance and a separate payment for any work performed.
- The availability allowance is a payment for being on standby and is usually calculated as 9% of your basic pay for the on-call period.
- If you are called in to work, you must be paid at an enhanced rate—typically time-and-a-half—or offered enhanced time off in lieu.
- The exact percentage of the availability allowance can vary based on the frequency of your rota and local agreements negotiated between your Trust and unions.
- On-call pay is different from unsocial hours payments, which apply to pre-rostered shifts worked at nights or weekends.
- Always check your contract, your Trust’s on-call policy, and your payslips to ensure you are being compensated correctly for your commitment.