Explaining the total reward offer across the employment journey
Key points
This guide will support employers to communicate in a clear and simple way all the national terms and conditions and benefits that make up the NHS total reward package, as well as some information on the Agenda for Change (AfC) pay system.
Providing this information to staff will help them to make informed choices and have better knowledge and understanding of NHS terms and conditions and benefits on offer to them when thinking about their future career choices.
Use the checklist for line managers which can be downloaded and used as part of the induction process to ensure all the important components that make up the total reward package in the NHS are covered during these conversations.
Existing staff may want to familiarise themselves with their current employment offer. Line managers can use this guide to support conversations with this group of staff, to help them understand more about the NHS pay and terms and conditions.
The value of working for the NHS
The NHS has a strong set of national terms and conditions which are attractive and comprehensive when considered as an overall reward package.
There are a wide range of national benefits (for example, the NHS Pension Scheme and generous annual leave entitlements) that make up a large proportion of the total package for employees.
It’s important to communicate your total reward package to staff, so that they understand the benefits they can access and the value of working for the NHS.
There is a focus in the NHS Long Term Workforce Plan on NHS organisations working with system partners to develop a clear employee value proposition (EVP) and promote this across the workforce. An EVP goes further than simply describing the terms and conditions and benefits on offer, but rather is a core and fundamental part of the package that an employee receives in return for the skills and experience they bring to their organisations. Employers need to communicate this as part of their wider EVP, and our new EVP resource can be used to help employers explain this.
National terms and conditions of service (TCS)
NHS organisations offer a comprehensive set of benefits, which are in addition to the local benefits offered by each specific organisation. These benefits are detailed below:
Annual leave
The NHS offers 27 days annual leave per year for a full-time employee, which increases to 29 days when an employee reaches five years of service, and then 33 days when they reach ten years of service.
All NHS Agenda for Change (AfC) staff are entitled to eight days of bank holiday leave each year. Part time staffs' entitlement is pro rata.
As the NHS provides services 24-hours per day, 365 days per year, there may be occasions where some staff are required to work bank holidays, however, they will be entitled to take those days at another time during the year.
For more information, read Section 13 - Annual leave and general public holidays of the NHS TCS Handbook.
Sick pay
The NHS has a number of provisions in place designed to support employees under AfC terms and conditions during periods of illness. How much sick pay an employee receives is based on their length of service.
New starters with less than a year's service are entitled to one month full pay plus two months half pay. This goes up to six months full pay, plus six months half pay for people with five years of service or more.
The aim is to ensure that if an employee was off work sick, they would initially receive exactly what they would while they were at work. Employees who are entitled to additional payments such as unsocial hours would still receive these during their period of sick leave.
Arrangements for this will vary slightly based on which UK devolved administration you are in, and on the individual employer, so it’s best to refer back to the local organisation’s policies for exact details of how unsociable hours sick pay is calculated.
The employees annual leave also continues to accrue while they are on sick leave.
For more information, read the sick pay terms and conditions section in the NHS TCS Handbook.
Returning to work after sick leave
Staff are fully supported when they return to work from a period of absence. A return-to-work interview would be conducted by the line manager with the employee. There would be a conversation at the return-to-work interview to discuss what reasonable adjustments might be necessary to help the employee return back to work.
Our Sickness Absence Toolkit provides guidance that allows NHS managers to have supportive conversations around sickness absence. The guide also includes information on reasonable adjustments and ways they can return to work, for example, a phased return.
NHS Pension Scheme
The NHS also has its own unique pension scheme that staff will be automatically enrolled into as part of the joining process. However, staff can choose to opt out of this if they wish.
Each month, an employee will pay between 5.2 per cent and 12.5 per cent into their pension, depending on their salary. Their contribution will be taken from their wage before tax, helping to make their money go further.
The employer will also pay 23.7 per cent of their salary towards their pension. This is much higher than the average employer contribution of around 3 per cent making the NHS Pension Scheme one of the most generous schemes in the UK.
How much pension an individual receives when they retire depends on their earnings and how long they have been a member of the scheme, so it’s best to sign up as early as possible. It’s secure, guaranteed by the government and the pension an employee will receive in retirement will go up every year with inflation. Their pension isn’t invested so there’s no risk of the value of their pension going down either.
Total Reward Statements
An employee will receive a Total Reward Statement each year. This provides personalised information about the overall value of their employment package working in the NHS and for their organisation.
The statement highlights the value of the local benefits and NHS pension benefits in one place.
Leave and pay for new parents
All employees have the right to take 52 weeks of maternity and/or adoption leave, or up to 52 weeks of shared parental leave (minus any maternity or adoption leave taken).
When an employee is pregnant they are entitled up to 52 weeks of maternity leave. An employee working full-time or part-time will be entitled to paid and unpaid maternity leave under the NHS occupational maternity pay scheme if they have 12 months’ continuous service. For the first eight weeks an individual will receive full pay, less Statutory Maternity Pay (SMP). For the next 18 weeks they will receive half of full pay including SMP. The following 13 weeks are paid at just SMP and the final 13 weeks is unpaid.
Shared parental leave and pay can be taken at any time within one year from the birth or placement for adoption, providing two weeks' compulsory maternity or adoption leave has been taken first. The way in which shared parental leave and pay is calculated is complex and will be different depending upon the individuals circumstances. More information can be found within the NHS Terms and Conditions of Service Handbook (Part 3, Section 15).
Flexible working
The NHS is committed to providing employees with the opportunity to balance their work and personal lives wherever possible, and to give people greater choice over their working patterns, helping them to achieve a better work-life balance.
In the NHS all employees have the right to request flexible working from day one of employment and there is no limit on the number of requests you can make. More information can be found within part 5, section 33 of the NHS TCS handbook and on the flexible working guidance web page.
The Agenda for Change pay structure
Agenda for Change is the pay system used within the NHS and it covers all staff excluding doctors, dentists and very senior managers, who all have their own separate pay structure. It consists of pay bands ranging from band 2 to band 9, that correspond to different roles and responsibilities.
Pay progression
Progression through the pay band doesn’t take place annually, however there are fewer pay points now within each band than there used to be so staff will get to the top of their bands more quickly.
What does this mean for each band?
Depending upon what band an employee is on will depend on how many years it will take to progress to the next pay point. Our web page contains the information on the AfC 2024/25 pay scales including the years it takes to be eligible for pay progression.
Pay progression and annual appraisal
Pay progression is also linked to the annual appraisal cycle. To progress to the next pay step point, an individual must have had an appraisal within the previous 12 months. Through the annual appraisal process time will be dedicated to talking about an individual’s progress and development.
Staff should have regular conversations with their line manager which can be used to support them carry out their role, as well a place to discuss their progress on work objectives.
Staff will also receive an increase to their salary when the national pay award is agreed by the government each year.
Annex 23 of the NHS TCS handbook contains further information on the national pay progression standards.
Additional payments
There are many roles within the NHS, given the nature of 24-hour working, that require individuals to work beyond non-standard hours and unsocial hours payments recognise the additional effort of staff working these. These are classed as variable elements of pay and are paid over and above base salary.
High Cost Area Supplement (HCAS) is an additional payment for NHS staff on Agenda for Change contracts who work in London and the surrounding areas. The value of HCAS depends on the location in which an employee works.
- Inner London = 20 per cent of basic salary, with a minimum payment of £5,132 and a maximum payment of £7,745
- Outer London = 15 per cent of basic salary, with a minimum payment of £4,313 and a maximum payment of £5,436
- Fringe = 5 per cent of basic salary, with a minimum payment of £1,192 and a maximum payment of £2,011
Details on the pay scales inclusive of HCAS can be found on the 2024/25 pay scales web page.
Career progression and training opportunities
The NHS offers a wide range of career pathways, allowing staff to develop and advance in their chosen field. There are many ways to do this including:
- advancing clinical skills
- taking up a management position
- experience in specialised areas
- training courses
- workshops
- e-learning modules tailored to specific roles
- professional development for example obtaining additional certificates or post graduate studies.
Local benefits
Each NHS organisation offers a variety of local benefits, in addition to the national terms and conditions, which are unique to it. Staff are encouraged to find out about their local rewards and benefits to understand what they have access to in return for being an employee. There are some great benefits that supplement the national terms and conditions.
Some examples of local trust benefits can include:
- salary sacrifice schemes – for example, cycle to work, car lease, home electronics
- subsidised car parking
- training schemes
- additional annual leave
- recognition schemes.
For more information please visit the reward section of the NHS Employers website.
Induction checklist
Line managers can use this checklist as part of induction conversations with new members of staff in their organisation to make sure all key parts of the total reward package have been explained to them.
We hope you find this information useful. If you want to understand the history, changes and developments of pay in the NHS, view our pay education hub: the journey of pay in the NHS.
