NHS Ambulance Care Assistant Pay 2026/27

Last updated: 24 October 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

What does an ambulance care assistant do?

Ambulance care assistants (ACAs) staff the patient transport service. They drive specially adapted vehicles and look after patients travelling to and from planned care: outpatient clinics, dialysis, radiotherapy, rehabilitation and hospital appointments. A typical shift mixes driving, helping patients in and out of the vehicle, moving stretchers and wheelchairs, and keeping accurate journey records. The patients are often elderly, frail or living with long-term conditions, so patience and steady communication matter as much as safe driving.

The key distinction is the type of call. ACAs do planned, non-emergency transport. They do not answer 999 calls, they do not work to blue lights, and they do not provide emergency clinical treatment. That is the paramedic's job. The two roles sit in the same ambulance service and wear similar uniforms, which is why adverts and applicants often blur them, but the pay, the training and the daily work are different. See paramedic salary for the emergency side of the service.

Most patient transport services are run directly by NHS ambulance trusts, so most ACAs are Agenda for Change staff on the rates on this page. Some transport work is contracted out to private providers, and those staff are employed on the contractor's terms rather than AfC bands. As with porter posts, the employer named in the advert tells you which pay system applies.

What band is an ambulance care assistant?

ACA posts evaluated under Agenda for Change are Band 2. Banding follows the AfC job evaluation scheme, which scores each post on effort, skill, responsibility and working conditions (see how NHS jobs are banded). Patient transport scores at Band 2: the work is physically demanding and safety-critical, and it needs driving skill and patient-handling competence, but it does not require a clinical qualification.

Band 2 has no pay steps: it is a single spot rate, so a first-year ACA and a twenty-year ACA earn the same basic salary full-time. Senior ACA posts and patient transport team-leader posts, which carry extra responsibility for rostering, training new starters or leading a crew, are typically evaluated at Band 3. Read NHS Band 2 pay and NHS Band 3 pay for the full picture of both bands.

Ambulance care assistant salary 2026/27

Hourly rates use the standard AfC method: annual salary divided by 52.2 weeks and 37.5 hours. A Band 3 post has two pay points, entry and top, and staff move between them on the normal AfC progression rules for their trust. Band 2 has no such move: the only way up from Band 2 basic pay is into a Band 3 post, or into a different role altogether.

Pay breakdown: hourly, weekly and monthly

These are full-time equivalent figures. Part-time ACAs are paid pro rata: at 0.6 whole-time equivalent, a Band 2 ACA earns £15,163.20 a year, which is £1,263.60 a month gross and £290.48 a week. See NHS part-time pay for how pro-rata pay, leave and enhancements work. You can also run your own figures through the hourly rate calculator.

Pay across the UK nations

Wales applies its Real Living Wage floor to the bottom of the scale, which lifts the Band 2 spot rate to £26,300. In Scotland the 36-hour week changes the hourly conversion, so use the Scottish figures on our Scotland page rather than converting the English annual rate. Northern Ireland staff should not budget on the 3.3% until implementation is confirmed; see NHS Northern Ireland pay.

The 2026/27 pay rise for ambulance care assistants

The 3.3% award for 2026/27 took effect on 1 April 2026 and was accepted in full (see the 2026/27 pay rise). For ACAs in England it moved the Band 2 spot rate from £24,465 to £25,272, an increase of £807 a year, or about £67 a month gross before deductions. Band 3 moved from £24,937 to £25,760 at entry (up £823) and from £26,598 to £27,476 at the top (up £878). Wales applied the same 3.3% alongside its £13.45 Real Living Wage floor for Band 2.

Unsocial hours pay for ambulance care assistants

Patient transport runs early mornings, evenings and weekends, because clinics and dialysis units run outside office hours. Under AfC Section 2, unsocial hours are weekday nights from 8pm to 6am, all of Saturday, and Sundays plus public holidays. The enhancements are:

Worked example: a full 7.5-hour Saturday shift is worth £96.83 at plain time for a Band 2 ACA, but £136.52 with the Saturday enhancement. The same 7.5 hours on a Sunday or bank holiday is worth £177.19. These are the verified 2026/27 Section 2 rates. Older figures sometimes quoted online, such as 44% and 88% for Band 2, were superseded by the 2018 AfC framework agreement and are wrong. Where unsocial hours form a regular pattern, some trusts average the enhancement into salary under Annex 5 instead of paying it shift by shift; ask your trust which system applies to your post. Full detail: unsocial hours and overtime.

Do ambulance care assistants get overtime?

Yes. Overtime is any hours worked above 37.5 a week (36 hours in Scotland from April 2026). For Bands 1 to 7, AfC Section 3 sets overtime at time-and-a-half, rising to double time on bank and public holidays. For a Band 2 ACA on £12.91 an hour, that means £19.37 an hour weekday overtime and £25.82 an hour on bank holidays. At Band 3, weekday overtime is £19.74 an hour at entry and £21.06 at the top, and bank holiday overtime is £26.32 and £28.08 respectively. Two limits apply: overtime and unsocial-hours enhancement cannot both be claimed for the same hours, and staff may elect time off in lieu instead of overtime pay. Part-timers are paid at plain time for hours above their contracted hours up to 37.5, with overtime rates only above that line.

Ambulance care assistant pay in London: HCAS

ACAs in London get High Cost Area Supplement (HCAS) on top of basic pay. At Band 2 and at Band 3 entry, the percentage calculation falls below the HCAS minimums, so the minimum payment applies. At the top of Band 3, the fringe percentage finally passes the minimum:

HCAS counts as basic pay for pension and enhancement calculations. See London weighting (HCAS) for zone boundaries and the full rates.

NHS pension contributions for ambulance care assistants

ACAs are automatically enrolled in the NHS Pension Scheme. For 2026/27 the provisional contribution tiers put both Band 2 and Band 3 ACA salaries in the 6.5% tier (£13,260 to £28,854), which is £136.89 a month at Band 2, £139.53 a month at Band 3 entry and £148.83 a month at the top of Band 3. The employer pays 23.7% on top at no cost to the employee. These are provisional tiers: the official 2026/27 tiers have not yet been published. See NHS pension contributions for the full table.

Mileage and uniform tax relief

Two smaller items regularly affect ACA take-home pay. First, mileage: most patient transport work is done in trust vehicles, which the trust fuels and maintains, so no mileage is due for those journeys. Where you use your own car for a business journey, AfC Section 17 pays 59p a mile up to 4,500 miles in the year and 36p a mile above that. A 5,000-mile year in your own car would therefore be worth £2,655 for the first 4,500 miles plus £180 for the remaining 500 miles, a total of £2,835. Home to your normal workplace is not claimable. See NHS mileage rates for the full rules, including the January 2027 review date.

Second, uniform tax relief: the HMRC flat-rate expenses list puts ambulance staff at £185 a year, which is worth £37 a year in tax relief at the 20% rate and £74 at the 40% rate, where the employer provides no laundry service or allowance and no receipts are needed. See NHS uniform tax rebate for how to claim and how far back you can go.

Annual leave and bank work

ACAs get the standard AfC leave: 27 days plus 8 bank holidays (35 total) with under five years of service, rising to 29 plus 8 (37) at five years and 33 plus 8 (41) at ten years. Part-time staff get pro-rata leave. See NHS annual leave for the full rules.

Many ACAs top up earnings with bank shifts through their trust's staff bank, paid at the hourly rate for the grade with unsocial-hours enhancements applying to hours worked at unsocial times. Bank work suits patient transport well, because planned clinics create predictable extra shifts. Whether bank or agency pays better depends on shift patterns and agency fees; we compare the two in agency vs bank pay.

Frequently asked questions

How much does an NHS ambulance care assistant earn per hour?

In England, an ambulance care assistant earns £12.91 an hour in 2026/27 (£25,272 a year full-time, 37.5 hours a week) at Band 2. Senior ambulance care assistants at Band 3 earn £13.16 to £14.04 an hour (£25,760 to £27,476 a year). In Wales the Band 2 rate is £13.44 an hour (£26,300 a year) under the Real Living Wage floor.

Is an ambulance care assistant always Band 2?

Most ambulance care assistant posts are Band 2, but senior and team-leader posts in patient transport are typically evaluated at Band 3 (£25,760 to £27,476 in 2026/27). The band follows the evaluated duties of the post, not the job title, so check the band stated in the advert.

What is the difference between an ambulance care assistant and a paramedic?

An ambulance care assistant works in non-emergency patient transport: planned journeys to and from clinics, dialysis, radiotherapy and hospital appointments. A paramedic works in emergency response, assesses and treats patients at the scene, and is a registered clinician at Band 5 or Band 6. The two roles sit in the same ambulance service but do different jobs with different pay.

Do ambulance care assistants get paid extra for nights and weekends?

Yes, where the hours are unsocial. Under AfC Section 2, Band 2 staff get time plus 41% for Saturdays and weekday nights (8pm to 6am), and time plus 83% for Sundays and public holidays. On a £12.91 base rate that is £18.20 an hour on Saturdays and nights, and £23.63 an hour on Sundays and bank holidays. Band 3 rates are time plus 35% and time plus 69%.

Do ambulance care assistants get overtime pay?

Yes. Overtime above 37.5 hours a week is paid at time-and-a-half for Bands 1 to 7, and double time on bank and public holidays. For a Band 2 ambulance care assistant that is £19.37 an hour weekday overtime and £25.82 an hour on bank holidays. Overtime and unsocial-hours enhancement cannot both be claimed for the same hours.

What does an ambulance care assistant earn in London?

With High Cost Area Supplement, a Band 2 ambulance care assistant in 2026/27 earns £31,066 in inner London (£25,272 plus the £5,794 minimum HCAS), £30,142 in outer London (£25,272 plus £4,870) and £26,618 in the fringe zone (£25,272 plus £1,346). The percentage calculation falls below the HCAS minimums at Band 2, so the minimum payment applies in each zone.

Can ambulance care assistants claim mileage?

Only for business journeys in your own vehicle. Most patient transport work is done in trust vehicles, which the trust fuels and maintains, so no mileage is due. Where you do use your own car for work journeys, AfC Section 17 pays 59p a mile up to 4,500 miles in the year and 36p a mile above that. Home to your normal workplace is not claimable.

Can you progress from ambulance care assistant to paramedic?

Yes, and it is one of the best-known routes into the ambulance service. Paramedic posts sit at Band 5 (£32,073 to £39,043 in 2026/27), rising to Band 6 (£39,959 to £48,117). The usual routes are a university paramedic science degree or a paramedic degree apprenticeship with an ambulance trust. Time served as an ambulance care assistant counts as service, but the paramedic post itself requires the qualification and HCPC registration.

Source: NHS Employers 2026/27 pay award announcement.

Source: NHS Employers unsocial hours payments.

Source: Health Careers NHS pay rates.