Agenda for Change (AfC) is the national pay system for NHS staff in the United Kingdom, introduced in 2004. It covers more than a million people — nurses, midwives, allied health professionals, healthcare scientists, paramedics, porters, administrative staff and managers. Doctors, dentists and very senior managers have separate pay arrangements.
Every AfC job is evaluated against a national job evaluation scheme and assigned to one of nine pay bands (with Band 8 split into 8a–8d). The band reflects the knowledge, responsibility and skills the job requires, not the person doing it.
Bands and pay steps
Each band contains a small number of pay steps. Bands 2 to 4 have an entry rate and a top rate; bands 5 to 9 have an entry rate, an intermediate rate and a top rate. Staff progress to the next step after a set number of years, subject to a pay step review — typically after two years to the intermediate step, and after a further two to three years to the top step.
Band 1 closed to new entrants in 2018; the small number of staff who remain on it are paid the same rate as Band 2.
How pay is set each year
Each year the independent NHS Pay Review Body (PRB) takes evidence from government, employers and trade unions, then recommends an award. The government decides whether to accept it. For 2026/27 the award in England is 3.3% on all points, effective 1 April 2026; for 2025/26 it was 3.6%.
On top of basic pay, AfC staff can receive unsocial hours enhancements (Section 2 of the handbook), overtime, on-call payments, and a High Cost Area Supplement of 5% to 20% for staff in and around London.