Policy paper

Supplementary evidence to pay review bodies: hospital and community health sector, 2026 to 2027

Published 30 October 2025

Applies to England

Data summary

The accompanying spreadsheet ‘Supplementary data to support pay review bodies: hospital and community health sector, 2026 to 2027’ 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. This estimates the average cost for a unit of capacity and differs from average earnings or paybill per person, which is impacted by factors including the level of part-time working. Under Agenda for Change (AfC) one FTE is equal to 37.5 hours per week.

Data provides estimates for 2024 to 2025 based on outturn data from the electronic staff record (ESR) and estimates for 2025 to 2026 based on the updated pay scales and historical relationship between basic pay, earnings and paybill. Paybill estimates for 2025 to 2026 include an adjustment to take account of increases to employer NI contributions from April 2025.

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 AfC
• the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) covers medical staff
• the Review Body on Senior Salaries (SSRB) covers very senior managers in NHS trusts, integrated care boards (ICBs) and executive senior managers in arm’s length bodies and other central support organisations

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 can be estimated based on the known value of the pay award and using the historical relationship between pay, earnings and paybill.     

What data has been published

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

• general practice
• social care
• the independent sector
• temporary staff engaged via bank or agency routes

This data provides 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 2024 to 2025
• estimates for 2025 to 2026 based on the updated pay scales and previous relationship between pay, earnings and paybill

We include estimates for 2025 to 2026 because this helps show the impact of the 2025 to 2026 pay award, before outturn data is available, and sets the context for the 2026 to 2027 pay round. Paybill estimates for 2025 to 2026 are adjusted to take account of increases to employer NI contributions applied from April 2025, which mean the expected increase to paybill is higher than the expected increase to basic pay or earnings.

All figures are provided on a FTE basis. This estimates the average cost for a unit of capacity and differs from average earnings or paybill per person, which is impacted by factors such as the rate of part-time working. Under AfC one FTE is equal to 37.5 hours per week.

The table below outlines the statistics provided.

Table 1: summary of information provided

Statistics	What this means	Provided for 2024 to 2025	Provided for 2025 to 2026
Estimated FTE	The average number of FTE in the group	Yes (if more than 5)	No
Pay scale value (£)	The basic pay value for the pay point	Yes	Yes
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 paybill per FTE (£)	Estimated paybill cost per unit of activity including basic pay, additional earnings, pension and NI contributions	Yes	Yes
Estimated ratio of total earnings to total basic pay	Estimate of average additional earnings above basic pay	Yes	No
Estimated ratio of total paybill to total earnings	Estimates the cost of employer pension contributions and employer NI compared to total earnings	Yes	No

How to use these estimates

These estimates may be used to:

• provide estimates of the cost of employing different types of staff in 2024 to 2025 based on average pay, earnings and employer on-costs. Data is provided on a per FTE basis (the average per full time unit of activity) 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 2025 to 2026 using the updated basic pay value and estimate of the relationship between pay, earnings and paybill from historical data. Paybill estimates for 2025 to 2026 are adjusted to account for increases to employer NI contributions from April 2025
• use 2025 to 2026 pay estimates as part of the process to determine pay recommendations in 2026 to 2027. 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). The multipliers provided for 2024 to 2025 do not include the impact of higher NI contributions applied from April 2025

Important caveats when using this data

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

Estimates for 2024 to 2025 are based on Department of Health and Social Care 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 2025 to 2026 are based on the results of the 2024 to 2025 analysis and an estimate of the impact of changes to employer NI contributions.

The method used to derive the estimated increase to employer NI contributions is an estimate based on assumptions around the average amount of earnings which will be subject to employer NI before and after the change.

Estimates are based on data extracted from the payroll system which has been subject to limited data processing steps. Where staff may have received negative payments, for example to correct payment errors, these are not excluded and can lead to scenarios where total earnings is less than basic pay.

All estimates are standardised to the level of basic pay for the pay point and the ratio of earnings to basic pay should not be impacted by any payments made in one financial year which relate to a previous financial year.

Some consultants remain in receipt of old-style Clinical Excellence Awards which are consolidated and therefore impact payments for additional programmed activities (in effect they operate in the same way as additional basic pay). We cannot separately identify the value of these payments from administrative data.

FTE forecasts for 2025 to 2026 are not provided. FTE estimates carry much higher uncertainty 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 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 GPs or most dentists who operate outside of the HCHS sector.

Methodology

Estimates are based on analysis of a large sample of data (over 1.5 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 undertake 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 that month or be temporarily out of the active workforce. Provided basic pay is within the tolerance level we permit negative payments in other payment categories as these can be correct if required to correct previous overpayments.

FTE estimates

For 2024 to 2025 we provide estimates of the number of staff FTE in each staffing combination. Estimates are based on data extracted from ESR which are then scaled to maintain consistency with official NHS workforce statistics. For example, workforce statistics include the number of nurses in band 5 (to estimate the number of nurses in individual pay points we use ESR data and estimate the proportion of band 5 nurses in each pay step) this proportion is then applied to the published band total.  

FTE estimates are not available for 2025 to 2026. Changes in FTE at pay point level are subject to variation due to workforce growth, or changes in either ‘band mix’ or ‘point mix’, which mean that robust estimates of future FTE at granular levels are not possible.

Pay estimates

Pay estimates are based on the following:

• basic pay is taken from the annual pay circular published by NHS Employers
• 2024 to 2025 non-medical pay scales
• 2025 to 2026 non-medical pay scales
• the following pay and conditions circulars for medical and dental staff:
  • 2024 to 2025 medical pay and conditions circular 5/2024 (published 24 February 2025)
  • 2025 to 2026 medical pay and conditions circular 2/2025 (published 23 June 2025)
• for a small number of contracts or pay steps there is no published pay scale (for example, VSMs or non-AfC non-medical staff). Where this is the case figures are based on averages derived from ESR
• previous medical pay circulars are published by NHS Employers

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 consultants we provide separate estimates of payments in the ‘medical awards’ payment category which include Clinical Excellence Awards 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). It is assumed that the value of medical awards in 2025 to 2026 will be the same as those in 2024 to 2025.

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 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 2025 to 2026.

Table 2: AfC band 5 structure from 1 April 2025

Years of experience	Band 5 pay 2025 to 2026	Pay band	Pay point	Pay step
Less than 1 year	£31,049	5	1	1
1 to 2 years	£31,049	5	1	2
2 to 3 years	£33,487	5	2	3
3 to 4 years	£33,487	5	2	4
4 to 5 years	£37,796	5	3	5
5 to 6 years	£37,796	5	3	6
6 to 7 years	£37,796	5	3	7
7 years and more	£37,796	5	3	8

The spreadsheet includes ‘pay band’ and ‘pay step’ components for non-medical staff. For medical staff estimates are provided by medical grade (for example, consultant), contract and pay step.

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. For 2025 to 2026 it is assumed that pay would increase by 3.25% consistent with the central recommendation of the 2025 to 2026 Senior Salaries Review Body.

Non-AfC grade

A small number of non-medical staff cannot be assigned to any AfC pay band but do not have earnings or other characteristics which make them candidates to be VSMs. If this is the case these staff are classified as being ‘non-AfC’. It is assumed they would see pay increases of 3.6% in 2025 to 2026 consistent with wider non-medical pay.  

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 cost of earnings per FTE member of staff includes basic pay and additional earnings.

Medical awards

A payment category used in ESR for the payment of various types of ‘medical award’ including Clinical Excellence Awards and Clinical Impact 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 per full time equivalent member of staff includes 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 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. ESR is not used in social care, general practice or the independent sector. ESR does not include information on any other ‘outside’ earnings.

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 2024 to 2025 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 2025 to 2026 are based on updated pay scale values after the 2025 to 2026 pay award and use the earnings and paybill multipliers from 2024 to 2025 data with additional adjustments to take account of the increase to employer NI contributions from April 2025. 

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 and are most common for medical staff on closed or legacy contracts.

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 a quality assurance on this analysis, which includes:

• a full internal review of the method used to extract data from ESR, process data and then scale to ensure consistency with NHS England statistics
• checking all pay point values against the relevant pay circulars
• comparing workforce (FTE) estimates and overall pay totals with NHS workforce statistics

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.