Understanding the NHS Band 4 Salary for 2026/27

If you're considering a role in the NHS or comparing hourly jobs with salaried offers, the band 4 nhs salary is a useful benchmark. In 2026/27, NHS Band 4 pays between £28,392 and £31,157 a year, depending on how long you've been in the role. That works out at £14.52 to £15.93 an hour for a standard 37.5-hour week.

These figures come from the NHS Employers pay scales for 2026/27, effective from 1 April 2026, and represent a 3.3% increase on the previous year. The rates apply to Agenda for Change staff in England, covering roles such as assistant practitioners, dental nurses, and some administrative supervisors.

Hourly to Annual Conversion: How It Works

The NHS calculates hourly pay by dividing the annual salary by 1,955 hours – that's 37.5 hours a week multiplied by 52.143 weeks (the average number of weeks in a year). So for the entry point:

• Annual salary: £28,392
• Hourly rate: £28,392 ÷ 1,955 = £14.52

If you prefer a simpler rule of thumb, you can use 52 weeks instead of 52.143. That gives:

• Annual ≈ hourly × 37.5 × 52
• At £14.52 per hour: £14.52 × 37.5 × 52 = £28,314 (close to the official figure)

For more on converting hourly rates to annual salaries, see our Hourly to Salary guide.

How Band 4 Compares to Other Benchmarks

The National Living Wage for 2026/27 is £12.71 an hour for workers aged 21 and over. At £14.52, the Band 4 entry rate is nearly 14% higher. That gap widens at the top of the band, where £15.93 an hour is 25% above the NLW.

For context, the UK median full-time gross annual pay is around £39,039, which at 37.5 hours a week equates to about £20.02 an hour. Band 4 sits below the median, but it's a structured pay scale with automatic progression and additional allowances that can boost earnings.

London Weighting and High Cost Area Supplements

If you work in or near London, your band 4 nhs salary will be topped up by a High Cost Area Supplement (HCAS). The rates for 2026/27 are:

• Inner London: 20% of basic salary, with a minimum of £5,794 and a maximum of £8,746
• Outer London: 15%, minimum £4,870, maximum £6,137
• Fringe (areas just outside London): 5%, minimum £1,346, maximum £2,270

So an entry-level Band 4 in Inner London would receive at least £34,186 a year (£28,392 + £5,794). The supplement is pensionable and subject to tax and National Insurance, so your take-home pay won't increase by the full amount, but it's still a significant boost.

Unsocial Hours and Overtime

NHS staff who work evenings, nights, weekends, or bank holidays get extra pay on top of the basic hourly rate. For Band 4 (and Bands 5 to 9), the enhancements are:

• Weekday nights (8pm to 6am) and Saturdays: +30%
• Sundays and bank holidays: +60%

At the entry rate of £14.52, that means:

• Night or Saturday shift: £18.88 per hour
• Sunday or bank holiday: £23.23 per hour

Overtime is typically paid at time and a half (£21.78) or double time on bank holidays (£29.04). These enhancements can make a big difference to monthly earnings, especially if you regularly work unsocial hours.

Take-Home Pay: What You Actually Receive

Your take-home pay depends on deductions for income tax, National Insurance, and the NHS Pension Scheme. At entry level (£28,392), a typical monthly breakdown might be:

• Gross pay: £2,366.00
• NHS Pension (6.5%): £153.79
• Income tax (20% above £12,570): £232.94
• National Insurance (8% above £12,570): £105.48
• Take-home: £1,873.79

At the top of the band (£31,157), the pension contribution rises to 8.3%, and take-home is about £1,990.32 per month. These figures assume no student loan repayments or other deductions. For a more personalised estimate, try our hourly calculator.

Progression and Trainee Rates

Band 4 has two pay steps: entry and top. You move from entry to the top after three years, provided you meet appraisal and training requirements. That progression is worth an extra £2,765 a year before tax – about £116 a month after deductions.

If you're training for a Band 4 role under Annex 21, your pay is a percentage of the band maximum (not the entry point). The percentages are:

• More than 3 years left in training: 60% (£18,694)
• 2 to 3 years: 65% (£20,252)
• 1 to 2 years: 70% (£21,810)
• Final 12 months: 75% (£23,368)

All these rates fall below the National Living Wage of £12.71, so trainees aged 21 or over are paid at least the NLW instead. The Annex 21 rules ensure you still get a pay rise each year, even if the percentage is topped up.

Comparing Band 4 with Other Roles

When weighing up hourly jobs against salaried offers, the band 4 nhs salary stands out for its stability, automatic progression, and generous unsocial hours enhancements. The NHS also offers a defined benefit pension, sick pay, and annual leave that many private-sector roles don't match.

However, the basic hourly rate may look lower than some agency or private healthcare roles, especially once you factor in London weighting and unsocial hours. It's worth using our salary articles to compare across sectors.

For more detailed data on NHS pay bands, visit our salary data page. And if you're negotiating a job offer, remember that the band 4 nhs salary is just the starting point – your total compensation includes pension, leave, and potential enhancements.

Key Takeaways

• Band 4 pays £14.52–£15.93 per hour (basic) in 2026/27.
• London weighting adds up to £8,746 in Inner London.
• Unsocial hours can boost hourly rates to £23.23 on Sundays.
• Take-home pay is around £1,874–£1,990 per month after standard deductions.
• Trainees are protected by the National Living Wage.

Whether you're starting out in the NHS or considering a move, understanding the full picture of hourly rates, annual salary, and allowances helps you make an informed decision. For more tools and comparisons, explore our topics section.