Policy paper

Supplementary evidence to pay review bodies: hospital and community health sector, 2025 to 2026

Published 10 December 2024

Applies to England

© Crown copyright 2024

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This publication is available at https://www.gov.uk/government/publications/supplementary-evidence-to-pay-review-bodies-hospital-and-community-health-sector-2025-to-2026/supplementary-evidence-to-pay-review-bodies-hospital-and-community-health-sector-2025-to-2026

Data summary

The accompanying spreadsheet ‘Supplementary data to support pay review bodies: hospital and community health sector, 2025 to 2026’ provides estimates on the earnings and costs of employing granular sections (for example, by staff group, pay band or pay point) of the hospital and community health services (HCHS) workforce in England. It includes information on:

  • basic pay
  • total earnings
  • paybill (including employer pension and National Insurance (NI) contributions)

All figures are provided on a ‘per full time equivalent (FTE)’ basis which reflects the average for one ‘full time’ member of staff.

Data provides estimates for 2023 to 2024 based on outturn data from the electronic staff record (ESR) and estimates for 2024 to 2025 assuming that patterns of additional earnings and total paybill remain stable.

Why this data is being published

Principally, these estimates are provided to aid the pay review bodies (PRBs) in their work making pay recommendations. PRBs are independent panels - technically, non-departmental public bodies - that gather evidence from a range of stakeholders including government and trade unions and then provide the government with advice each year on pay. In the health system:

  • the NHS Pay Review Body (NHSPRB) covers non-medical staff working under NHS Agenda for Change (AfC)
  • the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) covers medical staff
  • the Review Body on Senior Salaries (SSRB) covers very senior managers

It is important that the PRBs have access to accurate workforce and costing data, including the distribution of staff across pay bands and points, to assess pay recommendations more accurately. Because there is an unavoidable lag to payroll data, outturn information following the most recent pay award is not available. However, it is possible to estimate the expected impact based on the known value of the pay scale and using additional earnings and paybill multipliers from historical data with the assumption that patterns remain stable from year to year.  

What data has been published

This data estimates the earnings and paybill cost of substantive staff in the health community and health sector (HCHS) in England and is provided for both medical and non-medical staff. Estimates do not cover:

  • general practice
  • social care
  • the independent sector
  • those working via bank or agency routes

We are providing information for detailed sections of the workforce as defined by:

  • staff group or DDRB contract group (for example, nurses or consultants)
  • AfC band or medical contract (for example, AfC band 6 or 2003 consultant contract)
  • pay step or pay threshold (for example, top of AfC band 6 or new consultant)

We are providing 2 sets of pay information:

  • outturn estimates for 2023 to 2024
  • estimates for 2024 to 2025 based on the results of the 2023 to 2024 analysis

We include estimates for 2024 to 2025 because this helps show the impact of the 2024 to 2025 pay award, before outturn data is available, and sets the context for the 2025 to 2026 pay round.

All figures are provided on a per FTE basis which reflects the average for one full time member of staff.

The table below outlines the statistics provided.

Table 1: summary of information provided

Statistics What this means Provided for 2023 to 2024 Provided for 2024 to 2025
Estimated FTE The number of FTE in the group Yes No
Pay scale value (£) The basic pay value for the pay point Yes Yes
Estimated ‘non-basic’ pay per FTE (£) Amount of total earnings which come from sources other than basic pay Yes No
Estimated ‘other’ pay per FTE Estimated value of pay recorded in ‘other’ pay category (non-medical only) Yes No
Estimated ‘medical awards’ per FTE (£) Estimated value of pay recorded in ‘medical award’ category including Clinical Impact Awards (consultants only) Yes No
Estimated total earnings per FTE (£) Average total earnings per FTE Yes Yes
Estimated total earnings as a multiple of basic pay (excluding medical awards) Average total earnings per FTE after removing pay linked to ‘other’ pay in the ESR (non-medical only) Not applicable Not applicable
Estimated total earnings per FTE  (excluding ‘other’ pay) (£) Average total earnings per FTE after removing pay linked to ‘medical awards’ pay in the ESR (consultants only) Yes Yes
Estimated paybill per FTE (£) The average for one full time member of staff including basic pay, additional earnings, employer NI and employer pension contributions Yes Yes
Estimated paybill per FTE (excluding ‘other’ pay) (£) The average for one full time member of staff including basic pay, additional earnings, employer NI and employer pension contributions. Payments in the ‘other’ pay category are removed. (non-medical only) Yes No
Estimated total earnings per FTE as a multiple of basic pay Calculated field based on ‘total earnings per FTE’ divided by ‘pay scale value’ Yes No
Estimated total earnings per FTE (excluding ‘other’ pay) as a multiple of basic pay Calculated field based on ‘total earnings per FTE’ (excluding ‘other’ pay) divided by ‘pay scale value’ (non-medical only) Yes No
Estimated paybill per FTE as a multiple of total earnings Calculated field based on ‘paybill per FTE’ divided by ‘total earnings per FTE’ Yes No
Estimated paybill per FTE (excluding ‘other’ pay) as a multiple of total earnings Calculated field based on ‘paybill per FTE’ (excluding ‘other’ pay) divided by ‘total earnings per FTE’ (excluding ‘other’ pay, non-medical only) Yes No

How to use these estimates

These estimates may be used to:

  • provide estimates of earnings patterns for different groups of staff in 2023 to 2024 including basic pay, additional earnings and employer on-costs. Data is provided on a per FTE basis (the average for employing one full-time member of staff) which is something that is not available through other data sources and is something that the PRBs have asked for in recent years
  • estimate the cost of employing staff in 2024 to 2025 using the known basic pay values following the 2024 to 2025 pay award and the earnings and paybill multipliers identified from the 2023 to 2024 data
  • use 2024 to 2025 pay estimates as part of the process to determine pay recommendations in 2025 to 2026. In simple terms the total cost of any pay policy is linked to:
    • how staff are distributed between pay points
    • the relative cost of employing staff in different pay points
    • the size of the pay award given to each pay point

The estimate for paybill per FTE may be derived from the basic pay scale value and the multipliers provided:

  • the earnings multiplier allows users to estimate total earnings per FTE from a given rate of basic pay by estimating average additional earnings (a figure of 1.2 indicates average additional earnings are equal to 20% of basic pay)
  • the paybill multiplier allows users to derive the average paybill per FTE given total earnings per FTE by estimating average on-costs (a figure of 1.3 indicates average NI and pension contributions are equal to 30% of total earnings)

Therefore to calculate the estimated paybill per FTE from the information provided:

  • take the basic pay scale
  • multiply by the ‘additional earnings multiplier’ (to determine average total earnings per FTE)
  • multiply by the ‘paybill multiplier’ (to estimate total paybill including on-costs)

Important caveats when using this data

There are several important caveats that users must consider when using this data.

Estimates for 2023 to 2024 are based on Department of Health and Social Care (DHSC) analysis of data extracted from the ESR which has been scaled and processed to ensure consistency with national pay scales and official workforce estimates. The process is detailed in the ‘methodology’ section of this document.

Estimates of total earnings per FTE and paybill per FTE in 2024 to 2025 are based on the results of the 2023 to 2024 analysis. Users are reminded that these ‘multipliers’ may change slightly from year to year depending on factors such as workforce usage, external events or changes to the tax system.

For non-medical staff some estimates are provided exclusive of payments recorded using the ‘other’ payment category in the ESR. This payment field was used for the non-consolidated payments made as part of the 2023 to 2024 AfC pay agreement and were non-recurrent.

Paybill estimates for 2024 to 2025 include the impact of increases to employer pension contributions which took effect from April 2024. The employer pension contribution rate increased from 20.68% to 23.78%.

All pay scale values for 2023 to 2024 are based on the value of payments which were made in 2023 to 2024. They do not include additional payments made to consultants and resident doctors as part of pay agreements with these groups. This is because payments were made after the end of 2023 to 2024.

All pay scale values for 2024 to 2025 are based on pay scale values after the outcome of respective pay review body processes and additional pay agreements with the consultants, speciality and specialist doctors (SAS) and resident doctor workforces as well as the introduction of intermediate pay points in band 8a+ of the agenda for change structure.

Some consultants are in receipt of Clinical Excellence Awards which are consolidated and therefore impact payments for additional programmed activities. We are not able to identify payments in other payment categories that stem from an individuals Clinical Excellence Award.

FTE forecasts for 2024 to 2025 are not available and would  be more uncertain than the per FTE costs which are heavily driven by the known pay award. Users are reminded that the cost of any pay proposal in future pay years is dependent on:

  • the average size of the workforce
  • how those staff are distributed between pay points
  • the average cost of each pay point over the period those pay rates are in operation

These estimates cannot not be used to calculate the full ‘system cost’ of any pay award. The full cost of pay awards to HCHS staff will include ‘spillover’ costs in addition to the impact on core paybill for substantive staff. These additional costs are due to knock-on consequences for temporary staffing pay rates, and the impact of funding mechanisms for both NHS and independent sector activity which mean pay uplifts have a wider financial impact. The uplift made to activity tariff payment rates to absorb pay awards will also apply to independent sector activity payments and increase the total costs. The estimates included in this publication do not include spillovers which may differ depending on the precise coverage and mechanism used to make any pay award.

Estimates are limited to substantive staff working in the HCHS sector captured on the NHS ESR and do not cover other parts of the DDRB remit group including general practitioners or most dentists who operate outside of the HCHS sector.

Methodology

Estimates are based on analysis of a large sample of data (over 1.2 million records per month) extracted from the ESR (more information on the data source can be found in the ‘Data notes’ section of this document) which undergo a limited set of data processing and scaling to maintain consistency with official statistics published by NHS England and pay circulars published by NHS Employers.

We then undertake additional data validation to ensure that our sample represents typical pay behaviour. For each month the recorded basic pay is compared with what would be expected based on the recorded pay band, pay point and FTE and removed if there is a discrepancy of more than 5% in either direction. This impacts a relatively small (around 5%) amount of data each month and is undertaken to ensure that the sample is not biased by staff (for example, joiners or leavers) who may have unusual earnings patterns in a given month or be temporarily out of the active workforce.

FTE estimates

FTE estimates at staff group and band level are scaled to maintain consistency with the official NHS workforce statistics published by NHS England. We do this because we want to maintain trust in official statistics and avoid any inconsistencies that may be caused by things such as the additional steps that NHS England are able to carry out (for example, cross referencing with other datasets), which help to ensure that workforce estimates are as accurate as possible.

NHS England publishes workforce information by staff group, and, for non-medical staff, pay band. As NHS England does not routinely publish workforce information by pay point, we estimate the distribution of staff within each combination of staff group and pay band based on the original ESR extract. We do this to avoid any inconsistencies that may be caused by things such as the additional data validation steps that NHS England is able to carry out (for example, cross referencing with other datasets), which help to ensure that workforce estimates are as accurate as possible.

FTE estimates are not available for 2024 to 2025.

Pay estimates

Pay estimates are based on the following:

Both medical pay and conditions circulars are available to download on the NHS Employers page Pay and conditions circulars for medical and dental staff.

Total earnings and paybill estimates (which include pension and NI contributions) are based on analysis of records that pass initial validation checks and cover all other pay and on-cost categories, including geographical allowances, unsocial hours premia and employer pension contributions.

For non-medical staff we provide estimates that are inclusive and exclusive of ‘other’ pay - this is a pay type in the ESR that includes any payments not captured elsewhere as shown in table 3. We do this because ‘other’ pay may be more volatile than other pay types and in 2023 to 2024 is the payment type that was used for non-consolidated payments made as part of the agenda for change pay agreement:

  • for 2023 to 2024 we use the multiples calculated directly from ESR data
  • for 2024 to 2025 it is assumed that the same ‘multipliers’ of earnings and paybill from 2023 to 2024 apply

For consultants we provide separate estimates of payments in the ‘medical awards’ payment category which include Clinical Excellence and Clinical Impact Awards. We are not able to identify payments in other payment categories which may flow from medical awards (for example, higher rates for consolidated additional programmed activities).

Data glossary

FTE

Full time equivalent (FTE) is a standardised measure of the workload of an employed person and allows for the total workforce workload to be expressed in an equivalent number of full time staff. For non-medical staff on AfC, 1.0 FTE equates to 37.5 hours while for most medical staff 1.0 FTE would be 40 hours. This differs from headcount where all staff count as ‘1’ regardless of hours worked.

Staff group and medical grade

Used to describe the basic function of staff. For non-medical staff this is the broad staff group such as nurses, midwives or central functions. For doctors this is the medical grade which denotes seniority or level of training - for example, consultant or foundation doctor.

Medical contract

For medical staff this denotes which national contract staff are on based on the ‘grade code’ variable within the ESR. This allows us to distinguish between medical staff who may be on the same grade but are employed on a different contract (for example, distinguishing between the new 2021 specialty doctor contract and the old 2008 specialty doctor contract).

Pay and conditions circulars for medical and dental staff on different medical contracts are published by NHS Employers.

Pay bands, pay points and pay steps

Some national contracts, including NHS AfC and the 2003 consultant contract, operate across 3 levels:

  • the pay band or pay threshold, which can be used to represent the level of seniority
  • the pay point, which represents the range of pay values within the pay band or threshold
  • the pay step, which represents the current position within the pay point - in the case of AfC there are several pay steps which map to the same pay point

An example of this is provided in table 2 below - figures are based on band 5 pay values for 2023 to 2024.

Table 2: AfC band 5 structure from 1 April 2024

Years of experience Band 5 pay 2024 to 2025 Pay band Pay point Pay step
Less than 1 year £29,970 5 1 1
1 to 2 years £29,970 5 1 2
2 to 3 years £32,324 5 2 3
3 to 4 years £32,324 5 2 4
4 to 5 years £36,483 5 3 5
5 to 6 years £36,483 5 3 6
6 to 7 years £36,483 5 3 7
7 years and more £36,483 5 3 8

The spreadsheet includes ‘pay band’ and ‘pay step’ components.

Very senior manager

Senior staff who are either part of the executive team or report directly to the executive team (for example, board level director, director of finance) and are not employed on AfC. In this data, very senior managers are identified based on a combination of earnings and occupation code.

Non-AfC grade

A small number of non-medical staff cannot be assigned to any AfC pay band. If this is the case these staff are classified as being ‘non-AfC’.

Pay scale value

The published basic pay value for the combination of contract, pay band and pay step as published by NHS Employers.

Total earnings

The average amount of earnings received per full time member of staff including basic pay and additional earnings.

‘Other’ pay

This is any pay that does not fit into the standard pay categories on the ESR (as shown in table 3). Figures for 2023 to 2024 do not include the impact of the one-off payments made to staff as part of the AfC pay agreement in spring 2023 as these were paid in June 2023.

Table 3: ‘other’ pay types

Pay type Pay description
Bonus or PRP Any form of bonus or performance-related pay. Excludes discretionary points, distinction awards and Clinical Excellence Awards or Clinical Impact Awards that are grouped separately
Directors of public health supplement Specific payment type made to directors of public health
Occupational absence Occupation pay for adoption, maternity or paternity (excludes statutory absence payments)
Other Any payment that does not fit into any other category including redundancy payments
Protected Pay Payment made to staff that moved onto AfC but whose previous contracts provided higher pay overall

Source: ESR

‘Medical awards’

A payment category used in the ESR for the payment of various types of ‘medical award’ including Clinical Excellence Awards. Only captures the direct payment for that type of payment and not any other payments which may be linked. For example, higher payments for additional activity for people in receipt of consolidated excellence awards would be captured elsewhere.

Paybill

The estimated total cost of employing staff including basic pay, additional earnings, employer pension contributions and employer NI contributions.

Total earnings multiple

This compares average total earnings per FTE to the pay scale value. A figure of 1.2 would indicate that on average additional earnings are worth 20% of basic pay.

Paybill multiple

This compares paybill per FTE to total earnings per FTE. A figure of 1.3 would indicate that on average total paybill per FTE is around 30% higher than total earnings per FTE.

Data notes

Information is based on data extracted from the NHS ESR, which is the HR and payroll system used throughout the HCHS in England. This includes staff working for NHS trusts, NHS foundation trusts, integrated care boards (formerly clinical commissioning groups), arm’s length bodies and other support organisations. The ESR is not used in social care, general practice or the independent sector. The ESR does not include information on any other ‘outside’ earnings that some staff may have such as private work.

Data extracted for this publication is restricted to substantive members of the workforce (FTE greater than 0), which excludes bank or locum staff.

Outturn estimates are for 2023 to 2024 which is the most recent completed year. As earnings and workforce composition can change over the course of the year it is important to consider earnings across a full year. Estimates for 2024 to 2025 are based on updated pay scale values after the 2024 to 2025 pay award and use the earnings and paybill multipliers from 2023 to 2024 data. 

Estimates of earnings and paybill are provided inclusive and exclusive of ‘other’ pay - this is, any pay that does not fit into the standard pay categories on the ESR (as shown in table 3) and may be more volatile than other pay types. For example, ‘other’ pay would include non-consolidated payments made as part of the agenda for change pay agreement which are not expected to recur in future years.

There are a small number of rows where the recorded FTE for the combination of staff group, pay band and pay step is less than 5. To ensure we are not disclosing individuals’ pay and earnings in these cases the FTE is replaced by an asterisk - in total this impacts around 250 FTE which is around 0.02% of the HCHS workforce.

Analytical quality assurance

Quality assurance is an important part of the analytical process to ensure that the estimates provided are as robust as possible as well as communicating any unavoidable risk or uncertainty.

We have undertaken the following quality assurance on this analysis:

Because pay multipliers, and workforce distribution, will vary from year to year there will always be some uncertainty around using these estimates to cost future pay recommendations, and so we would advise that figures be rounded to an appropriate level (generally to no more than 2 significant figures) to avoid spurious accuracy.

Any queries on this publication should be sent to: payanalysis@dhsc.gov.uk.

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