NHS Band 4 Pay 2026/27: Salary, Hourly Rate & Career Guide
Last updated: 24 October 2026 · Figures verified against the NHS Employers 2026/27 pay circular.
Band 4 salary 2026/27
| Pay step | Annual (FTE) | Hourly |
|---|---|---|
| Entry | £28,392 | £14.50 |
| Top of band | £31,157 | £15.92 |
Band 4 has two pay steps. Hourly rates are annual salary ÷ 52.2 ÷ 37.5, the standard NHS calculation. All figures are full-time equivalent (37.5 hours a week) for England under Agenda for Change (see what is Agenda for Change); Scotland, Wales and Northern Ireland set their own awards. For Scotland, see Scotland Band 4 pay 2026/27 (£31,537 to £34,303 a year, £16.80 to £18.27 an hour on the 36-hour week). For every band's figures, see NHS pay bands 2026/27.
Band 4 NHS pay 2026 runs from £28,392 at entry to £31,157 at the top of the band, so the NHS Band 4 salary for 2026/27 sits just above Band 3 and below Band 5. Staff who complete nursing associate training and move on can compare Band 5 pay, which starts at £32,073.
Source: NHS Employers 2026/27 pay award; rates also published by Health Careers NHS.
2025/26 vs 2026/27
| 2025/26 | 2026/27 | |
|---|---|---|
| Entry | £27,485 | £28,392 |
| Top | £30,162 | £31,157 |
The NHS pay rise 2026/27 of 3.3% added roughly £907 a year at entry and £995 at the top of the band.
Typical Band 4 roles
Band 4 bridges support work and registered practice. Common roles include:
- Nursing associate
- Assistant practitioner / associate practitioner
- Pharmacy technician
- Senior medical secretary
- Clinical coder (accredited roles, often mentoring trainee coders)
- Dental nurse
- Estates officer (junior officer and senior technician posts)
- Senior therapy assistant
- Play specialist (assistant and trainee posts before HPSET registration)
- Retinal screener (diabetic eye screening, Band 4 to 5)
- Orthopaedic technician (plaster room and fracture clinic work, Band 4 to 5)
- PALS officer (patient advice and liaison, Band 4 to 6)
The nursing associate role is the flagship Band 4 post: a registered role (with the NMC) that sits between healthcare assistant and registered nurse, and a common stepping stone to a nursing degree and Band 5.
Estates roles also start at Band 4: junior estates officers and senior estates technicians sit here before moving to Band 5 officer posts. See our NHS estates officer pay guide for the Band 4 to 6 ranges, hourly rates and on-call position. Play specialist assistants and trainees also start at Band 4 before moving to a qualified Band 5 post: see our NHS play specialist pay guide for the Band 4 to 5 ranges and the HPSET registration route. IT support also starts at this level: first-line service desk analysts and desktop engineers sit at Band 3 to 4 before moving to senior analyst posts at Band 5. See our NHS IT support pay guide for the Band 3 to 5 ranges, hourly rates and on-call position. PALS officers also start at Band 4: see our NHS PALS officer pay guide for the Band 4 to 6 ranges, hourly rates and London weighting. Interpreters also sit at Bands 3 to 4: see our NHS interpreter pay guide for the Band 3 to 4 ranges, unsocial hours, overtime and London weighting, including the employed versus agency split. Payroll officers also sit at Bands 3 to 5: see our NHS payroll officer pay guide for the Band 3 to 5 ranges, hourly rates, overtime and London weighting, including the trust versus shared-service split. Social prescribing link workers also sit at Bands 4 to 5: see our social prescribing link worker pay guide for the Band 4 to 5 ranges, hourly rates, overtime and London weighting, including the network versus voluntary sector split. Care coordinators also sit at Band 4 in primary care networks: see our NHS care coordinator pay guide for the Band 4 rate, overtime and London weighting in that role. Smoking cessation advisors also sit at Bands 4 to 5: see our smoking cessation advisor pay guide for the Band 4 to 5 ranges, hourly rates, overtime and London weighting, including the trust, council and commissioned provider split.
Pay progression in Band 4
Band 4 has two pay steps: entry, then the top of the band after around 3 years' experience, subject to a satisfactory appraisal and completion of statutory and mandatory training. Progression is not automatic under the 2018 Agenda for Change framework.
Moving from Band 4 to Band 5 requires appointment to a Band 5 post, for nursing associates, that usually means completing a registered nurse qualification (see NHS Band 5 pay).
Band 4 hourly rates, overtime and unsocial hours
- Overtime: time-and-a-half for hours above 37.5 a week; double time for overtime on bank holidays. At the top of Band 4, an overtime hour is worth about £23.88 (£15.92 × 1.5).
- Unsocial hours (Section 2): bands 4–9 receive +30% for Saturday and weekday night shifts (8pm–6am) and +60% for Sundays and public holidays.
- Part-time staff: additional hours above contracted hours up to 37.5 are paid at plain time; overtime rates apply only above 37.5.
Overtime at Band 4 follows the current NHS overtime rates. See the full rules and worked examples for NHS unsocial hours pay rates.
Band 4 with London weighting (HCAS)
In 2026/27, inner London HCAS is 20% of basic salary between a £5,794 minimum and £8,746 maximum. For a Band 4 at entry (£28,392), 20% would be £5,678, below the minimum, so the £5,794 minimum applies, giving roughly £34,186 total. Outer London (15%, £4,870–£6,137) and fringe (5%, £1,346–£2,270) follow the same principle. Details: NHS London weighting 2026/27. For what those totals mean as a monthly budget, see living on Band 4 pay in London.
Pension and leave
- Pension: Band 4 straddles two employee contribution tiers in 2026/27: the entry step (£28,392) sits in the 6.5% tier (£13,260–£28,854 of actual pensionable pay) and the top step (£31,157) in the 8.3% tier (£28,855–£35,155). The employer contributes 23.7%.
- Annual leave: 27 days plus 8 bank holidays on appointment, rising to 29 days after 5 years and 33 days after 10 years (pro rata for part-time).
Frequently asked questions
How much do NHS Band 4 get paid in 2026/27?
£28,392 at entry rising to £31,157 at the top of the band (£14.50–£15.92 an hour), full-time equivalent in England, plus any overtime, unsocial-hours enhancements or London weighting.
What is a nursing associate paid?
Nursing associates are Band 4, so £28,392–£31,157 in 2026/27 in England, plus enhancements for unsocial hours and any London weighting.
What is the Band 4 hourly rate?
£14.50 an hour at entry and £15.92 at the top of the band in 2026/27, calculated as annual salary ÷ 52.2 ÷ 37.5.
What jobs are Band 4 in the NHS?
Nursing associates, assistant practitioners, pharmacy technicians, senior medical secretaries, dental nurses and senior therapy assistants are typically Band 4.
How long does it take to reach the top of Band 4?
Around 3 years' experience, subject to a satisfactory appraisal and mandatory training. Band 4 has two pay steps: entry and top.
What is the difference between Band 3 and Band 4 pay?
In 2026/27, NHS Band 3 pay runs £25,760–£27,476 while Band 4 runs £28,392–£31,157, a gap of roughly £2,600–£3,700. Band 4 roles involve greater autonomy and accountability, such as the registered nursing associate role.
What is the NHS Band 4 salary?
£28,392 at entry rising to £31,157 at the top of the band (£14.50–£15.92 an hour) in 2026/27, full-time equivalent in England, before any overtime, unsocial-hours enhancements or London weighting.
Pay progression
On £31,157 at the top of Band 4? See what Band 5 pay looks like, or compare with Band 3 pay.
This is an independent guide and is not affiliated with the NHS. Figures are full-time equivalent (37.5 hours/week) for England. Always check your trust's ESR record and your payslip for your actual pay.