How the NHS Pay Award Is Decided: The Pay Review Body Timeline

Last updated: 28 September 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

The five stages, from evidence to payslip

Every NHS pay round follows the same chain. Understanding the stages explains both where the number comes from and why it so often arrives late:

The crucial point is the gap between stages 3 and 4: the Pay Review Body recommends; the government decides. Everything downstream — including strikes — flows from how that decision lands. See NHS pay disputes explained for what happens when it lands badly.

What the NHS Pay Review Body is

The NHS Pay Review Body (NHSPRB) is an independent advisory body appointed to make recommendations on the pay of Agenda for Change staff — nurses, midwives, paramedics, healthcare assistants, porters, admin and clerical staff and the rest of the AfC workforce — in England, Wales and Northern Ireland. Its members are appointed independently of government, the NHS and the unions, and are expected to weigh the evidence rather than represent a side.

Two things it is not: it is not a negotiating forum (unions and employers do not bargain across a table with the PRB), and it is not the final decision-maker. Separate review bodies cover doctors and dentists, whose contracts sit outside Agenda for Change — which is why medical and AfC pay awards can differ in the same year. This guide covers the AfC process only.

The annual timeline, month by month

A “typical” year looks like this — though, as the history section shows, typical is doing a lot of work:

• Winter (around December–February): the Secretary of State sends the PRB its remit letter, setting the scope for the coming pay round — which staff are covered and any particular factors to consider.
• Spring: the parties submit written evidence, and the PRB takes oral evidence sessions — effectively cross-examining each side’s claims about recruitment, retention and affordability.
• Early summer: the PRB deliberates and sends its report and recommendation to the government. The report is usually published alongside the decision.
• Summer: the government announces its decision — accept, reject or vary. Because the pay year starts on 1 April, a summer announcement means the award is backdated, with arrears paid in a later pay packet.
• Late summer/autumn: trusts implement the new scales through ESR and payroll; staff see the uplift plus backdated arrears.

2026/27 broke the mould: the 3.3% award for England was announced in February 2026 and paid on time from 1 April — no backdating, no arrears. For the current round, the 2027/28 remit letter was published on 15 July 2026: the round is now open and the evidence phase is under way. No award figure has been recommended yet, and the government has said it intends to take departmental evidence in the autumn with an earlier announcement where possible.

Source: NHS Pay Review Body remit letter 2027/28 — GOV.UK.

Who submits evidence — and what they argue

The PRB’s recommendation is only as good as the evidence it hears. The main parties:

• The Department of Health and Social Care sets out the government’s position: what is affordable within NHS funding, workforce data, and the wider economic picture including inflation and private-sector pay growth.
• NHS Employers represents trusts: recruitment and retention data by staff group and region, vacancy rates, agency spending, and what different award levels would cost the pay bill.
• The health unions (RCN, Unison, Unite, GMB, CSP, BMA for medical staff groups where relevant, and others) argue the staff side: real-terms pay trends, cost-of-living pressure, morale, retention risk and international comparisons.
• NHS England contributes workforce and service planning evidence.

The PRB’s published reports show it weighing these against each other — affordability against recruitment risk, headline inflation against pay-bill cost. Its recommendation is therefore a judgement call, not a formula: there is no rule that says the award must match inflation, though inflation is always central to the argument. The detail of each year’s reasoning is published in the PRB report itself, which is worth reading when a controversial award lands.

How the devolved nations differ

Pay is devolved, so the PRB process does not cover the whole UK uniformly:

• Scotland does not use the PRB for AfC staff. Pay is set through direct collective bargaining between the Scottish Government, employers and unions — which is why Scotland’s awards and timings differ (3.75% from 1 April 2026, alongside the move to a 36-hour week). See NHS Scotland pay.
• Wales is covered by the PRB’s remit, but the Welsh Government makes its own decision on the recommendation — it usually follows England’s award but is not obliged to. See NHS Wales pay.
• Northern Ireland is likewise covered by the remit, with the Executive (or the Secretary of State in the absence of devolved government) deciding implementation. Northern Ireland’s 2026/27 award — 3.3% recommended — had not been implemented at the time of writing, illustrating that a PRB recommendation is only the start. See NHS Northern Ireland pay and pay disputes explained.

What ‘the recommendation’ actually means

Because the PRB is advisory, the government of the day can:

• Accept the recommendation in full (the usual outcome — as with the 3.3% in 2026/27 and 3.6% in 2025/26);
• Vary it — for example, restructuring how the money is distributed across bands; or
• Reject it, though outright rejection is rare because it invites exactly the industrial unrest the process is meant to avoid.

What the government cannot do is pretend the PRB said something it did not: the report is published, so the gap between recommendation and decision is visible. Union responses are calibrated to that gap — an accepted recommendation usually ends the round, while a rejected or staged one starts the dispute process: consultation, ballot, and potentially industrial action.

Awards can also be staged (paid in instalments across the year) or include non-consolidated elements — one-off lump sums that do not count towards pensions or future pay rises. The 2023 deal, for example, combined a consolidated 5% with a non-consolidated 2% payment for the previous year. Non-consolidated money is worth less over time than the same amount consolidated, which is why unions scrutinise the mix.

Implementation: from announcement to payslip

Once the decision is announced, NHS Employers publishes the updated pay circular and trusts implement the new scales through the Electronic Staff Record (ESR) and payroll. When the award is late — the historical norm — the mechanics are:

• The uplift is backdated to 1 April, the start of the pay year.
• Staff receive arrears — the difference between what they were paid and what they should have been paid — usually as a lump sum in a summer or autumn pay packet.
• Arrears are taxable and pensionable in the normal way; they can nudge monthly pay into a higher pension contribution tier for that month, which occasionally surprises people.

For the current year’s figures, see the 2026/27 pay rise in detail; for the terms the award sits inside, see what Agenda for Change is and our 2026 handbook changes guide.

Pay awards 2021/22 to 2026/27

Recent history explains why each round is watched so closely. England figures below (Scotland and Wales/NI sometimes differed — see the nations section):

Sources: DHSC — the 2025 pay award; RCN — 2024 pay award in England; 2027/28 remit letter — GOV.UK.

The pattern is visible: dispute (2022/23), settlement (2023/24), then a run of above-inflation consolidated awards culminating in 2026/27’s rare on-time implementation. Whether the earlier timetable holds for 2027/28 is the open question — the remit is out, the evidence is being gathered, and the recommendation has not yet been made.

Frequently asked questions

Who decides NHS pay rises?

The government decides, acting on the recommendation of the independent NHS Pay Review Body. The PRB takes evidence from the Department of Health and Social Care, NHS Employers and unions, then recommends an award which ministers can accept, reject or vary.

Why is NHS pay always late?

The pay round — remit, evidence, recommendation, decision, payroll implementation — routinely runs past the 1 April start of the pay year, so awards are backdated with arrears. The 2026/27 award was a rare exception: announced in February 2026 and paid on time.

What is the Pay Review Body?

An independent body that advises on Agenda for Change pay in England, Wales and Northern Ireland. Its members are appointed independently, it takes evidence from all sides, and it publishes a report with its recommended award each year.

Is the PRB independent?

Yes. It is independent of government, employers and unions, and its reports are published. But its role is advisory — independence means it recommends freely, not that its recommendation is binding.

Can the government ignore the PRB?

In principle, yes: the recommendation is advisory. In practice governments usually accept it, because rejecting it visibly — the report is published — invites industrial unrest.

When will the 2027/28 pay award be announced?

Not yet known. The remit letter was published on 15 July 2026 and the evidence phase is under way; no award figure has been recommended. The government has said it aims for departmental evidence in the autumn and an earlier announcement where possible.

Why does Scotland get a different pay deal?

Pay is devolved. Scotland sets Agenda for Change pay through direct collective bargaining between the Scottish Government, employers and unions rather than the Pay Review Body process — hence different awards, such as 3.75% for 2026/27, and different timing.

Do unions have to accept the award?

No. Unions consult their members on the government’s decision; if members reject it, the union can move towards a formal dispute — including balloting for industrial action.

Sources and independence

Source: NHS Pay Review Body remit letter 2027/28 — GOV.UK.

Source: DHSC — everything you need to know about the 2025 pay award.

Source: RCN — Agenda for Change pay award in England (2024).

Source: NHS Employers — 2026/27 pay award announcement.

NHS Bands Pay is an independent guide and is not affiliated with the NHS. Figures were verified against official sources on 28 September 2026 and can change — always confirm with the relevant official body before making financial decisions.