NHS Pay Progression: Appraisals, Increments & Step Points
Updated for 2026/27 | Agenda for Change | England, Scotland, Wales & Northern Ireland
If you work under Agenda for Change, you may be waiting for a salary increase and wondering exactly when — and whether — it will arrive. NHS pay progression is not automatic. Under the rules introduced in 2018, moving to the next pay step point depends on meeting a set of national standards, with your annual appraisal at the centre of the process. This guide explains how every part of the system works: what step points are, how many exist in your band, when your pay step date falls, what can block progression, and what to do if your step is deferred.
In short: NHS pay progression is the process by which AfC staff move from the entry point of their pay band to the top, via a fixed number of intermediate pay step points, provided they meet annual performance and conduct standards.
What is NHS pay progression?
Agenda for Change (AfC) is the pay system that covers the majority of NHS staff — nurses, allied health professionals, healthcare scientists, administrative staff and many others. It groups jobs into nine pay bands, each with a minimum and maximum salary. Within each band, there are a small number of fixed pay points. Staff move through those points via a process called pay progression.
Before April 2019, staff moved up one spine point every year almost automatically. The 2018 AfC pay deal changed that. The new system replaced the old spine points with a smaller number of pay step points, and linked movement between them to an annual appraisal process. The trade-off: fewer steps, but they are larger jumps — meaning staff reach the top of their band faster than under the old system.
It is important to separate two different types of pay increase that NHS staff receive:
- Annual cost-of-living award: a percentage rise applied to every pay point in every band, set by the government each April following the NHS Pay Review Body recommendation. For 2026/27 this is 3.3% in England.
- Pay step progression: movement to the next pay step point within your band, triggered on your pay step date when you meet the national criteria. This is separate from the cost-of-living award.
Both can happen in the same year, but they are governed by entirely different rules. This article covers pay step progression.
How do NHS pay step points work by band?
The number of pay step points in your band determines how long it takes to reach the top of your salary range. The 2018 deal created a simpler structure than the old spine point system.
Bands 2, 3 and 4
These bands have two pay points: an entry point and a top point. Staff therefore have one pay step date. Once they progress from entry to top, there are no further internal steps within that band.
Bands 5, 6 and 7
These bands have three pay points: entry, an intermediate point, and a top point. Staff have two pay step dates. For a Band 5 nurse, for example, the first step falls after approximately two years and the second after a further two years, bringing them to the top of the band around four years after joining.
Bands 8a, 8b, 8c, 8d and Band 9
These bands also have two pay step dates. The gap between steps is longer — typically five years — reflecting the seniority of these roles. Bands 8a to 9 also require meeting Knowledge and Skills Framework (KSF) gateways for progression.
The table below summarises the structure across all bands:
| Band | Pay step points | Years to top of band | Typical roles |
| Band 2 | 2 (entry + top) | 1–2 years | Healthcare assistant, receptionist, phlebotomist |
| Band 3 | 2 (entry + top) | 1–2 years | Clinical support worker, pharmacy assistant |
| Band 4 | 2 (entry + top) | 1–2 years | Nursing associate trainee, technician |
| Band 5 | 3 (entry, mid, top) | ~4 years (2+2) | Newly qualified nurse, physiotherapist, OT |
| Band 6 | 3 (entry, mid, top) | ~5 years (2+3) | Junior sister, specialist nurse, senior OT |
| Band 7 | 3 (entry, mid, top) | ~5 years (2+3) | Advanced nurse practitioner, team manager |
| Bands 8a–9 | 2 (entry + top) | ~5 years | Head of service, director, consultant AHP |
Use our NHS pay bands 2026/27 guide to see the exact salary figures at each pay point, or use the NHS take-home pay calculator for your band to see what a pay step means for your net monthly income after tax, National Insurance and pension.
What is a pay step date and how is it set?
Your pay step date (PSD) — formerly called the incremental date — is the anniversary date on which your pay step review takes place and, if criteria are met, your salary moves to the next point. Here is how it is determined in different circumstances:
- New to the NHS: your PSD is the anniversary of the date you started in your current role.
- Promoted to a higher band: your PSD resets to the anniversary of the date you commenced in the new band. If you are promoted in June, your PSD becomes June each year going forward.
- Lateral transfer (same band, different trust): your PSD does not change. You enter the new trust at your current pay step point and your existing anniversary date is preserved.
- Re-banded via job evaluation: your PSD becomes the anniversary of the agreed effective re-band date.
- Move to a lower band: your PSD remains the same as it was before the move.
- Return after a break in service of one month or more: you are normally treated as a new starter and your PSD is set from the date of return.
It is worth noting that your PSD does not change just because a pay step was deferred. If your step is delayed for any reason, the original PSD remains in place for future years.
What criteria must you meet to progress to the next pay step?
Progression to the next pay step is not a formality. Staff must actively meet five national standards before a pay step can be approved. If any one is not met, the step is deferred.
| Criterion | What it means |
| Appraisal completed | A satisfactory annual appraisal recorded in the last 12 months |
| No live capability process | No active formal performance management plan in place |
| No live disciplinary sanction | No formal disciplinary outcome currently on your record |
| Mandatory training up to date | All statutory and mandatory training modules completed |
| Manager criterion (line managers only) | All direct reports must also have had their appraisals completed |
Meeting these criteria is the responsibility of both the employee and the line manager. The manager must record the outcome of the pay progression meeting in the Electronic Staff Record (ESR) — specifically as a “Pay Progression Meeting” review type with a Yes or No outcome — before the payroll deadline for that month. If the manager fails to record a positive outcome in time, the step will not be paid on the correct date.
Employees typically receive an ESR reminder approximately four months before their PSD, and again around one month before. If you have not heard from your manager by three months before your PSD, raise it proactively.
How does the NHS appraisal link to pay progression?
A point of frequent confusion: the annual appraisal and the pay step meeting are two different events.
- Annual appraisal: happens every year for all staff. It covers objectives, performance, development, and values. The outcome must be satisfactory, and it must have been completed within the 12 months before your PSD.
- Pay step meeting: only happens on your PSD years — once for bands 2–4, twice for bands 5–9. The manager reviews whether all five national criteria are met and records a Yes or No in ESR.
The appraisal feeds into the pay step meeting: a satisfactory appraisal outcome is one of the five criteria that must be met. But having a good appraisal alone does not trigger a pay step — it only triggers at the correct PSD, and only if all other criteria are also met.
Practical tips for employees approaching a pay step date:
- Review the objectives agreed at your last appraisal and gather evidence that you have met them.
- Check your mandatory training compliance well before the PSD — outstanding modules are a common cause of deferral.
- Confirm with your manager that the pay progression meeting has been recorded in ESR before the payroll deadline, which is typically the first working day of the month in which your step is due.
The NHS payslip explained guide can help you verify that a step increase has been correctly applied once it is due.
What happens if your NHS pay step is deferred?
A deferred pay step means your salary does not move to the next point on your PSD. The step is put on hold until the reason for deferral is resolved. Here is what you need to know:
What triggers a deferral?
- An appraisal has not been completed in the last 12 months, or the outcome was unsatisfactory.
- A live formal capability process is in place.
- A live formal disciplinary sanction is recorded on your file.
- Mandatory or statutory training is incomplete.
- For managers: one or more direct reports have not had their appraisal.
What situations cannot block a pay step?
The following must not be used as grounds for deferral:
- Maternity, paternity or adoption leave: absences under family leave policies cannot affect your pay step. The step should be applied automatically.
- Long-term sickness: absence through illness should not prevent a pay step unless there is also a separate formal capability process running.
- Ill-health capability: this is treated differently from conduct-based capability. Sickness-related capability alone should not block progression.
- Manager sickness: if your manager is off sick and cannot conduct your appraisal before the PSD, you should still receive your increment unless you independently failed to meet one of the criteria.
How does deferral work in practice?
If a step is deferred, your manager must record a No outcome in ESR and state the reason. A review date is then set — typically linked to when the reason for deferral is expected to resolve (for example, the end of a training cycle, or the conclusion of a capability or disciplinary process).
When the review takes place and the criteria are met, your pay step is actioned from the date the criteria were satisfied — not from your original PSD. The original PSD itself remains unchanged for future years.
Can you appeal a deferred pay step?
Yes. If you believe your pay step has been unfairly withheld, you have the right to challenge the decision through your trust’s appeals or grievance procedure. During the appeal, the increment is withheld. If your appeal is successful, the increase is backdated to your original PSD. Contact your union representative — such as RCN Direct for nursing staff — to support an appeal.
How does pay progression work for promoted or newly joined NHS staff?
When you change role or join the NHS, the rules around your starting pay point and PSD depend on the type of move. See also our detailed guide on how to move up an NHS pay band for the full picture on promotion strategy.
New starters
Staff new to the NHS are appointed to the bottom pay point of their band. Their PSD is set as the anniversary of their start date. Previous experience outside the NHS may be considered for incremental credit, but this is at the recruiting manager’s discretion.
Promotion to a higher band
On promotion, you enter the new band at the minimum pay point — or, if the bands overlap, the first pay point that actually delivers a pay increase. Your PSD resets to the anniversary of the date you took up the new role.
Lateral transfer within the NHS
Moving to a different trust at the same band is not a promotion. You carry your current pay step point across to the new employer, and your PSD remains unchanged. The new trust is expected to honour your existing position on the pay scale.
Acting up (temporary promotion)
If you temporarily act up into a higher band, you are paid at the rate of the higher band for the duration of the acting-up period. Your PSD on your substantive band is generally unaffected by a temporary arrangement.
Returning after a break in service
A break in service of one month or more means you are typically treated as a new starter on your return: bottom of the band, new PSD. A break of less than one month usually allows you to re-enter at your previous pay step.
For a full comparison of what different career moves mean for your NHS take-home pay, use the relevant band calculator.
Does NHS pay progression differ across the four nations?
The Agenda for Change framework and its pay step structure apply across England, Wales and Northern Ireland. Scotland follows the same step-point architecture but negotiates its pay deal separately.
- England: 3.3% pay award for 2026/27. AfC bands and step structure as described in this article.
- Wales: AfC terms apply with separate annual award negotiations. Step structure is identical to England.
- Northern Ireland: AfC terms apply. Pay award mirrors England in most years.
- Scotland: a separate 2025–2027 pay deal includes a commitment to maintain pay rises at least one percentage point above CPI inflation. Step points and PSD rules follow the same AfC logic, but salaries differ. Staff in Scotland also pay higher income tax at the lower bands. See our NHS Scotland pay rise guide for detail.
In all four nations, the pay step progression criteria — appraisal, no live capability, no live sanction, mandatory training — are the same under the AfC handbook.
FAQ: NHS pay progression quick answers
Is NHS pay progression automatic?
No. Since 1 April 2019, pay step progression requires a positive outcome to be recorded in ESR. You must have a satisfactory appraisal within the last 12 months, no live formal capability or disciplinary process, and up-to-date mandatory training. Staff who joined before 1 April 2019 moved through transition arrangements and are now fully on the new system.
Can I lose a pay step I have already received?
A pay point already reached is not normally removed. However, in very limited trust-level policies, a formal disciplinary process can result in a pay reduction of 5% or 10%. This is rare and subject to a separate appeals process.
What if my manager is off sick before my pay step date?
If your manager’s sickness prevents the appraisal or pay step meeting being held before your PSD, you should still receive your pay step — provided you have independently met all the national criteria. The manager’s absence is not a valid reason to withhold your increment. If this happens, raise it with HR promptly.
Does unpaid leave affect my pay step date?
Certain types of leave — including maternity, paternity and adoption leave — do not affect the PSD. Long-term unpaid absence, such as a career break, may delay the PSD depending on trust policy. Check your local pay progression policy or speak to your HR team.
How much does a pay step actually increase my salary?
The increase depends on your band and which step you are moving to. For example, a Band 5 nurse moving from the entry point to the mid-point in 2026/27 would see their gross salary increase by several thousand pounds. Use the Band 5 take-home pay calculator, Band 6 calculator or Band 7 calculator to see the exact net difference after income tax, National Insurance and NHS pension contributions.
Where can I check my pay step date?
Your pay step date is visible in the Electronic Staff Record (ESR) system via Employee Self-Service. It should also appear on your contract of employment. If you cannot locate it, your line manager or HR department can confirm it. ESR sends automated reminder notifications approximately four months and one month before your PSD.
Does a pay step affect my NHS pension contributions?
Yes — a salary increase can move you into a higher pension contribution tier, which slightly offsets the gross pay rise in your take-home pay. Use the NHS pension calculator to model the net impact on your monthly income. For broader questions about pension value, see the guide on opting out of the NHS pension.
Summary
NHS pay progression under Agenda for Change works as follows: you are appointed to the bottom of your band, and you move to the next pay step point on your pay step date — provided you have a satisfactory appraisal, no live capability or disciplinary process, and up-to-date mandatory training. Bands 2–4 have one pay step; bands 5–9 have two. Pay steps happen every two to five years depending on your band. A deferred step can be appealed, and certain absences such as maternity and long-term sickness cannot legally prevent progression.
For practical tools: use the NHS take-home pay calculator to model your salary after a step increase, the NHS pension calculator to see the contribution tier impact, and the NHS payslip explained guide to verify a step has been correctly applied.
Trust-level pay progression policies may contain additional local requirements. Always refer to your employer’s policy alongside the national AfC handbook. If you believe your pay step has been unfairly handled, contact your trade union representative.
Daniel Carter is a senior NHS Payroll Accountant with over 10 years of experience in Agenda for Change pay structures, tax, and pensions. He created the NHS Pay Calculators platform to help NHS staff easily understand their take-home pay, sick pay, maternity pay, and pension entitlements through simple, accurate online tools.