Can you negotiate your salary in the NHS?

One of the many confusing elements of applying for a job in the NHS (especially if you’re applying for a job without prior NHS experience) is understanding why NHS jobs are normally advertised with a salary range, rather than a specific salary.

On the most basic level, these salary ranges represent the lowest to highest salaries within an Agenda for Change pay band. Agenda for Change is a standardised set of pay points used for the majority of NHS jobs, with ranges from Band 2 for the most junior staff to Band 9 for the most senior staff.

For example, using 2025/26 pay scales, a Band 5 salary could range from £31,049 to £37,796. Staff within Band 5 can be paid at one of three different rates or pay points (before taking into account High Cost Area Supplements):

• £31,049
• £33,487
• £37,796

Band 2 only has one pay point. Bands 3 and 4 have two pay points each. All other bands have three pay points.

Understanding how much control you have over the salary you are paid does have some complexities – as we’ll explain in this article.

Can I negotiate my salary as a new starter in the NHS?

Normally, new starters in the NHS begin on the bottom of the range of the advertised salary. Progression through the pay points (also sometimes called increments) is based on time in post and satisfactory yearly reviews, with a first pay increase taking place after two or three years, depending on the band.

However, there is scope to start on one of the middle or top points immediately in some circumstances. The key concept here is the idea of equivalent experience; if you can show that you have experience working at the same level of expertise and responsibility (or higher) for the length of time corresponding to progression to a higher pay point, you might be eligible to be paid at one of those higher pay points.

If you’re moving from one NHS job to another at the same band, your equivalent experience should be automatically taken into account when your salary is agreed in your new role – although it is worth checking that this has taken place!

Policies about increased starting salaries for new joiners without NHS experience vary between organisations. Some organisations have a blanket policy that all non-NHS new starters start at the bottom of the salary range. Most organisations allow hiring managers to make a business case for new starters joining on a higher pay point if there is potentially equivalent experience to consider.

If you think you have relevant equivalent experience that should be taken into account, you should speak to your hiring manager as soon as possible once you have been offered the job – or even during the interview process, if you feel comfortable doing so. If they agree you have relevant equivalent experience, the hiring manager will then work with you to create a business case for approval by the organisation’s HR department. Generally speaking, if you’ve made it as far as the business case being submitted, there is a good chance of it being approved.

It is also worth noting that some organisations extend this policy beyond the moment of joining, meaning that new starters can still try and negotiate a higher starting salary for a period of time after their start date, and receive back pay if successful. This period can be up to three months.

What is NHS rebanding?

Once you’ve started your role, pay progression will usually be limited to annual pay increases (applied to all NHS staff once the annual pay award is agreed) and movement through the pay points within your band based on years of experience.

There are some exceptional circumstances where the whole band of your role can be changed, leading to significant changes in pay.

This process – called “rebanding” – happens when the responsibilities of your job have shifted significantly from what is in your job description. For example, you may have taken on new clinical responsibilities, or begun line managing someone where that was previously not the case.

In these circumstances, you will usually need to speak to your line manager and HR team about whether rebanding your role is a possibility. This is a formal process where your current job responsibilities are evaluated (with the help of senior HR staff and trade union representatives) and a judgement is made about the appropriate Agenda for Change band for your role. You can find out more about rebanding on the Royal College of Nursing website.