NHS Band 4 Salary 2026/27: Gross Pay, Take-Home and Regional Differences

NHS Band 4 Salary 2026/27: Gross Pay and Regional Variations

The band 4 nhs salary for 2026/27 varies across the UK because each nation negotiates its own Agenda for Change pay award. In England, the official NHS Employers pay scales show a starting salary of £28,392 rising to £31,157 after three years at the top of the band. These figures represent a 3.3% increase on the previous year and are effective from 1 April 2026.

Hourly rates in England are £14.52 at entry and £15.93 at the top, based on a standard 37.5-hour week. For staff working in Inner London, a High Cost Area Supplement of 20% lifts the range to £31,836–£34,937, as reported by aftertax.org.uk.

Scotland pays the highest Band 4 rates in the UK: £31,537 to £34,303, following a 3.75% award. The working week is 36 hours, so the hourly rate is slightly higher than the English equivalent. Wales pays £28,819 to £31,626, while Northern Ireland matches England at £28,392 to £31,157.

Take-Home Pay After Deductions

Your take-home pay from a band 4 nhs salary depends on income tax, National Insurance, NHS pension contributions, and any student loan repayments. The standard tax code 1257L gives a personal allowance of £12,570. Earnings above that are taxed at 20% (basic rate) up to £50,270. National Insurance is charged at 8% on earnings above £12,570.

NHS pension contributions are deducted before tax (net pay arrangement), which reduces your tax bill. For Band 4, the contribution tier is 6.5% on pensionable pay up to £28,854, and 8.3% on pay between £28,855 and £35,155. The entry salary of £28,392 falls in the 6.5% tier, while the top point of £31,157 crosses into the 8.3% tier.

Opentaxcalculator provides a detailed monthly breakdown for England:

• Entry (£28,392): Gross £2,366.00, pension £153.79, income tax £232.94, NI £105.48, take-home £1,873.79.
• Top (£31,157): Gross £2,596.42, pension £215.50, income tax £266.68, NI £123.91, take-home £1,990.32.

Nhspaycalculator.uk gives slightly different annual figures: entry net £22,117 (£1,843/mo), top net £23,366 (£1,947/mo). The variation is due to rounding and pension tier assumptions. For the most accurate personal estimate, use the take-home calculator on this site.

Student loan repayments apply if your salary exceeds the relevant threshold. For Plan 2 loans (most English graduates), the threshold is £29,385 in 2026/27, so only those at the top of Band 4 will make repayments – 9% of earnings above that threshold.

Scotland: Higher Pay, Different Tax

Scottish Band 4 staff benefit from both higher gross pay and different income tax bands. Payslipchecker notes that at Band 4 entry, the Scottish starter and basic tax bands mean you pay no intermediate rate (21%) at all, resulting in a take-home of around £2,039 per month – noticeably more than the English equivalent of £1,874. The Scottish government sets its own tax rates, so always check your tax code (S1257L) and the latest Scottish budget.

Trainee Pay Under Annex 21

Trainees working towards a Band 4 qualified role are paid under Annex 21 of the NHS Terms and Conditions. Pay is set as a percentage of the top of Band 4, depending on time left in training: 60% (more than 3 years), 65% (2–3 years), 70% (1–2 years), and 75% (final 12 months). However, all these rates fall below the National Living Wage of £12.71 per hour, so trainees aged 21 or over are paid at least the NLW. From year two, a supplement is added to ensure a pay rise as training progresses (opentaxcalculator).

Summary

The band 4 nhs salary offers a clear progression from £28,392 to £31,157 in England, with higher rates in Scotland and London. Take-home pay after tax, NI and pension ranges from about £1,874 to £1,990 per month in England, and around £2,039 in Scotland. For more context on how this compares to other roles, see our salary articles. Always verify your personal deductions with your payslip and official GOV.UK guidance.