NHS Occupational Therapy Assistant Pay 2026/27

Last updated: 3 November 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

Occupational therapy assistant pay 2026/27: the Band 3 and Band 4 scales

England awarded Agenda for Change staff 3.3% from 1 April 2026, and that award is already in these figures. An occupational therapy assistant in England in 2026/27 earns £25,760 at Band 3 entry and £27,476 at the top of Band 3. At Band 4 the figures are £28,392 at entry and £31,157 at the top. The full range on this page, from Band 3 entry to Band 4 top, is £5,397 a year. Inside Band 3 the range is £1,716, and inside Band 4 it is £2,765. The step from the top of Band 3 to the entry of Band 4 is only £916 a year, which surprises people who expect a bigger jump for a technical instructor post. The jump matters less for the basic pay than for what the post carries: delegated clinical judgement, a small caseload and supervision of other support staff. An assistant who moves from Band 3 entry to Band 4 top gains £5,397 a year in basic pay, and that is the whole ladder in one number.

The 2026/27 England scales for a full-time 37.5-hour week. Hourly rates are annual pay divided by 52.2 weeks and then by 37.5 hours, rounded to the nearest penny, and enhancement rates on this page are calculated from that rounded hourly rate. Monthly pay is annual pay divided by 12. Weekly pay is annual pay divided by 52.2.

Progression within a band follows the usual Agenda for Change pattern: satisfactory appraisal and completion of required training move an assistant through the steps, but the timing follows the trust's incremental progression policy and is not a promise written into the pay scale. Band 3 has two steps, entry and top, and Band 4 has two steps, entry and top. The move from Band 3 to Band 4 is different in kind. It needs a post that carries the extra responsibility, and the post has to be vacant and applied for. That distinction explains why two assistants with similar experience can sit on different bands: one holds a technical instructor post, the other holds a standard assistant post, and Agenda for Change pays the post, not the person. For the wider band ladder, the Band 3 pay guide and the Band 4 pay guide set out what each band means across the NHS, and the assistant posts on this page follow that same ladder.

What occupational therapy assistants actually do

Occupational therapy helps people do the everyday things that illness, injury or disability has made hard: washing, dressing, cooking, getting out of the house, returning to work. The registered occupational therapist assesses the person, sets the goals and writes the plan. The assistant carries much of that plan out, day by day, session by session. That division of labour is the whole job in one sentence, and it explains both the satisfaction and the limits of the role. The assistant sees the progress first hand, a patient who could not manage the stairs on Monday and can on Friday, while the clinical decisions stay with the registered therapist.

A typical week mixes ward work, clinic sessions, group work and home visits. On a rehabilitation ward, an assistant practises personal care tasks with patients, sets up and runs activity groups, and helps patients relearn the routines of a normal day in a safe setting. In a community team, an assistant visits people at home, practises kitchen and bathroom tasks in the person's own environment, checks that equipment is being used safely, and reports back on what is working and what is not. In a clinic, an assistant may run a group for people with similar needs, prepare materials and equipment, and keep the session running smoothly so the therapist can focus on assessment and planning. Equipment is a large part of the work: ordering, fitting, demonstrating and checking aids and adaptations, from raised toilet seats and perching stools to more complex seating and bathing equipment.

The work is physical and practical, and it suits people who like to be on their feet and working directly with patients rather than at a desk. It also demands patience and observation. A patient relearning to dress after a stroke may need the same task broken into small steps, repeated over days, with encouragement that keeps dignity intact. An assistant who notices that a patient manages better in the morning than the afternoon, or that a particular grip fails when the hand is tired, gives the therapist information that changes the plan. Recording matters as much as doing: progress notes, outcome measures and handover reports are part of every session, and a good record is what lets the next clinician pick up where the last one left off. Related support roles are covered in the physiotherapy assistant pay guide, and the registered role is covered in the occupational therapist salary guide.

Band 3 and Band 4: what actually changes

At Band 3, the post is built around following plans. A Band 3 assistant sets up equipment and rooms, practises daily living tasks with patients under a plan written by the therapist, runs group activities, records progress and reports back at handover or in supervision. The assistant works under supervision, and the therapist reviews the plan and the progress regularly. The work is real clinical work with real patients, and the assistant carries responsibility for doing it safely and well, but the decisions about goals, treatment direction and discharge sit with the therapist.

At Band 4, the post adds delegated judgement. A Band 4 assistant, often titled technical instructor, plans a session within agreed goals, adapts an activity during the session when a patient struggles or progresses faster than expected, manages a small delegated caseload, and trains and supervises Band 2 and Band 3 assistants. The assistant may carry out assessments that the therapist has delegated and will review, and may be the main contact for a patient between therapist reviews. The supervision is still there, but it is lighter and less direct: the therapist sets the goals and checks the outcomes, and the assistant decides much of the detail in between. That breadth is the reason for the higher band, and it is also why Band 4 posts are fewer: a service needs many Band 3 assistants and only a smaller number of technical instructors.

The settings shape the post as much as the band. A Band 3 assistant on a stroke rehabilitation ward works a different week from a Band 3 assistant in a community reablement team, even though the pay scale is identical. One week is built around ward routines, group sessions and discharge planning. The other is built around home visits, lone working and travel between patients. The pay does not distinguish between them, and neither should a comparison of two posts: the band tells you the pay, the setting tells you the week. An assistant choosing between posts should ask about caseload size, lone working, travel time and supervision arrangements, because those factors decide the working life far more than a single pay step.

Shift patterns: mostly daytime, with evening and weekend exceptions

Most occupational therapy work is weekday daytime work: clinics, ward sessions, home visits and group programmes planned weeks ahead. That pattern suits assistants who want predictable hours, and it is one reason the profession attracts people who value a stable week. The exceptions matter for pay, though. Evening groups for working-age adults, weekend sessions on rehabilitation wards, and seven-day community rotas can fall in the unsocial windows, and those hours are paid at the enhanced rates below. A post that includes regular weekend sessions will pay more in practice than a weekday-only post at the same band, even though the basic pay is identical. Assistants weighing two posts should ask for the rota, not just the band, and should check whether evening or weekend working is rostered or occasional, because the answer decides how much of the enhancement pay is reliable and how much is occasional.

On-call working is not a standard feature of therapy assistant posts. Where a service runs inpatient wards through the night, on-call arrangements, if they exist at all, are set locally, so this page quotes no rate for them: no national on-call rate for therapy assistants exists in the pay data file, and a rate quoted from one trust would mislead readers in another. Hours actually worked when called in are paid at the plain rate plus the unsocial-hours enhancement for the window worked, on the same basis as the table below.

Unsocial hours and overtime

Section 2 of Agenda for Change pays enhancements for hours actually worked in the unsocial windows: weekdays 8pm to 6am, all Saturday, and Sundays and bank holidays. At Band 3 the rates are time plus 35% for Saturdays and weekday nights and time plus 69% for Sundays and bank holidays. At Band 4 the rates are time plus 30% and time plus 60%. A Saturday hour at Band 3 entry is worth £17.77, against a plain hourly rate of £13.16, and a Sunday hour at the top of Band 4 is worth £25.47.

Overtime follows the band. Hours above 37.5 a week are paid at time and a half, and double time on bank holidays, at Bands 3 and 4. An overtime hour at Band 3 entry is worth £19.74 (£13.16 times 1.5), at Band 3 top £21.06, at Band 4 entry £21.75 and at the top of Band 4 £23.88. On a bank holiday the double-time rates are £26.32 at Band 3 entry and £28.08 at the top of Band 3, and £29.00 at Band 4 entry and £31.84 at the top of Band 4. Staff may elect time off in lieu instead of overtime pay, which suits assistants who would rather bank the hours after a heavy week. The full rules are on the unsocial hours and overtime guide.

London weighting: the minimums bind at these bands

Assistants in London trusts receive the High Cost Area Supplement on top of basic pay: 20% of basic in inner London (minimum £5,794, maximum £8,746), 15% in outer London (minimum £4,870, maximum £6,137) and 5% in the fringe zone (minimum £1,346, maximum £2,270). At Band 3 and Band 4 the minimums bind for most steps, because the straight percentage of these salaries falls below the minimum in each case. Band 3 entry at 20% would be £5,152, so the minimum £5,794 applies instead, and the same minimum applies at Band 3 top (£5,495.20 at 20%) and Band 4 entry (£5,678.40 at 20%). Only at the top of Band 4 does the straight 20% pass the minimum, at £6,231.40. In outer London the minimum £4,870 binds at all four steps, and in the fringe zone the minimum £1,346 binds only at Band 3 entry. That pattern is worth checking on a payslip: an assistant who moves from Band 3 entry to Band 4 top gains £5,397 a year in basic pay, and the inner London supplement rises only from £5,794 to £6,231.40, because the minimum holds it flat for the first three steps. The supplement follows the base of the post, not the site visited on a given day.

Read the table as total pay, basic plus supplement. An assistant at Band 3 entry in inner London earns £31,554.00 a year, and at the top of Band 4 in inner London £37,388.40. In the fringe zone the same two posts pay £27,106.00 and £32,714.85. For the full London weighting rules and the calculator, see the London weighting and HCAS guide and the HCAS calculator.

Pension: the 8.3% tier starts only at the top of Band 4

On the provisional 2026/27 England and Wales tiers, Band 3 entry, Band 3 top and Band 4 entry all sit in the 6.5% tier. Only the top of Band 4 crosses into the 8.3% tier. The employer contributes 23.7% on top of basic pay in every case. The tier is set by whole-time-equivalent salary, so a part-time assistant is tiered on the full-time rate for the post, not on part-time earnings, and the monthly contribution below is the full-time figure unless the post is part time.

The 2026/27 tiers are provisional, calculated from the published 2025/26 tiers, not yet published as final. An assistant who crosses the 6.5% to 8.3% boundary, which happens between Band 4 entry (£28,392) and Band 4 top (£31,157), will see the monthly contribution jump by more than the pay rise alone suggests: from £153.79 to £215.50 a month. That is normal tier behaviour, not a payroll error. For the full tier table and the calculator, see the pension contributions guide and the pension calculator.

Part time, travel between patients and uniform costs

Part-time working fits therapy assistant work well, because the work is session-based and services often build a week from part-time posts. Pay and annual leave are pro rata to the contracted fraction. At 0.8 whole-time equivalent, Band 3 entry pays £20,608.00 a year and Band 4 entry pays £22,713.60 a year. At 0.6 whole-time equivalent, the top of Band 3 pays £16,485.60 a year and the top of Band 4 pays £18,694.20 a year. Hours above contracted hours up to 37.5 a week are paid at plain time, with any unsocial-hours enhancement that applies, and overtime rates only apply above 37.5 hours. Annual leave follows the Agenda for Change tiers: 27 days plus 8 bank holidays at up to 5 years of service, 29 plus 8 at 5 years and over, and 33 plus 8 at 10 years and over, pro rata for part-time staff. The part-time pay guide works through the pro rata maths in full.

Community assistants who travel between patients can claim business mileage under Section 17: 59p a mile for car travel up to 4,500 miles a year, then 36p a mile above that threshold, for journeys on or after 1 July 2026. An assistant who drives 4,000 miles in the year claims £2,360, one who drives 5,000 miles claims £2,835, and one who drives 6,000 miles claims £3,195 (59p for the first 4,500 miles, 36p for the remaining 1,500). Mileage is reimbursement for travel costs, not pay, and it is paid separately from salary. Travel between home and the normal workplace is not claimable. The full rates and worked examples are on the mileage rates guide.

Uniform costs are a smaller item, and therapy assistants do not always wear a uniform in the ward sense. Where an assistant is required to wear a uniform or protective clothing and washes it at home, with no laundry service or allowance from the employer, HMRC flat-rate expenses allow a tax claim. Therapy staff are named in the data-file list at £125 a year, worth £25 a year in tax relief at the basic rate and £50 at the higher rate, claimable for up to four previous tax years. Where the trust provides clothing and laundry, there is nothing to claim.

Scotland, Wales and Northern Ireland

Scotland awarded 3.75% from 1 April 2026 under its two-year deal, and moved to a 36-hour week from April 2026. The data file holds the Scotland Band 5 range, £34,494 to £42,977, but it does not hold Scotland Band 3 or Band 4 steps, so this page does not quote them. On the 36-hour week, the overtime threshold in Scotland is 36 hours rather than 37.5, which changes the overtime maths for part-time and full-time assistants alike. Scotland also has its own nine-tier pension structure, at 5.7% to 12.7%, with thresholds that differ from the England and Wales tiers quoted above.

Wales awarded 3.3%, implemented 1 April 2026 and paid on time. The data file holds the Wales Band 5 steps, £32,557, £35,114 and £39,631, and the Band 2 spot rate of £26,300 set by the Real Living Wage floor of £13.45 an hour. The data file does not hold Wales Band 3 or Band 4 steps, so this page does not quote them. The Real Living Wage floor applies to the lowest bands in Wales and does not bind at Band 3 or Band 4 in the same way, because both bands sit above the floor rate.

Northern Ireland is different: the 3.3% award was recommended but had not been implemented at the time the data file was last checked, so Northern Ireland assistant pay should not be budgeted on the England figures. The Scotland pay guide, the Wales pay guide and the Northern Ireland pay guide carry the nation positions in full.

Is therapy assistant work a stable NHS career?

For someone who wants hands-on clinical work without a degree first, therapy assistant work offers a direct way in: a real patient-facing role, a team around you, and a clear view of the registered profession from the inside. The posts are more plentiful than registered therapy posts, and that availability is the honest advantage. A newly recruited assistant may start on a fixed-term or part-time post, and substantive full-time posts are competitive, but the workforce is large and turnover creates openings regularly. The work itself, helping a person regain the small tasks that make a normal day possible, is concrete in a way that desk work rarely is, and progress is visible in weeks, not years.

The ceiling inside the assistant ladder is Band 4 for most assistants, with senior technical instructor and team-lead support posts as the next step for those who stay in support roles. Band 5 entry in England in 2026/27 is £32,073 a year, which puts the registered route in context: the move from Band 4 top (£31,157) to Band 5 entry is only £916 a year in basic pay, and the real change, again, is responsibility and registration rather than money. An assistant who wants a long NHS career can build it through experience, training and, for those who choose it, a degree that opens the registered ladder. The pay, while not the highest in the NHS, is solid, pensionable and predictable across a career, and the skills transfer across rehabilitation, community and mental health services.

Frequently asked questions

What band is an occupational therapy assistant in the NHS?

In England in 2026/27, occupational therapy assistants sit mainly at Band 3 and Band 4 on Agenda for Change. Band 3 pays £25,760 at entry and £27,476 at the top. Band 4 pays £28,392 at entry and £31,157 at the top. Those are full-time figures for a 37.5-hour week. A newly recruited assistant who works under close supervision, following care plans set by a registered occupational therapist, usually sits at Band 3. An assistant who carries more responsibility, runs treatment sessions on their own, holds a delegated caseload or supervises other support staff usually sits at Band 4, often under the title technical instructor. The exact band is set by the job evaluation for each post, so check the advert rather than assuming the band from the job title.

How much does an occupational therapy assistant earn a month?

In England in 2026/27, a full-time occupational therapy assistant at Band 3 earns £2,146.67 a month at entry and £2,289.67 a month at the top, before tax, National Insurance and pension deductions. At Band 4 the monthly figures are £2,366.00 at entry and £2,596.42 at the top. Those are gross figures for a full-time 37.5-hour week, before any unsocial-hours enhancement, overtime or London weighting. A part-time assistant is paid pro rata: at 0.8 whole-time equivalent, Band 3 entry pays £20,608.00 a year, and at 0.6 whole-time equivalent, the top of Band 4 pays £18,694.20 a year.

What is the difference between Band 3 and Band 4 for therapy assistants?

The difference is responsibility, not just experience. At Band 3, the assistant works to plans written by a registered occupational therapist: setting up equipment, practising daily living tasks with a patient, running a group activity, recording progress and reporting back. At Band 4, the assistant takes on delegated clinical judgement: planning a session within agreed goals, progressing or adapting an activity in the session, managing a small delegated caseload, training and supervising Band 2 and Band 3 assistants, and carrying out assessments that the therapist has delegated and will review. Band 4 posts often carry the title technical instructor, and the post holder is expected to work with less direct supervision. The pay gap reflects that step: Band 4 entry (£28,392) sits £916 above the top of Band 3 (£27,476), and the top of Band 4 (£31,157) sits £3,681 above the top of Band 3.

Do occupational therapy assistants work evenings and weekends?

Some do, but most of the work is weekday daytime work, because rehabilitation sessions, home visits and group programmes are planned in advance. Evening groups, weekend sessions on rehabilitation wards and seven-day community rotas can still fall in the unsocial windows, and those hours attract Section 2 enhancements: time plus 35% for Saturdays and weekday nights (8pm to 6am) and time plus 69% for Sundays and bank holidays at Band 3, and time plus 30% and time plus 60% at Band 4. A Saturday hour at Band 3 entry is worth £17.77 against a plain hourly rate of £13.16, and a Sunday hour at the top of Band 4 is worth £25.47. An assistant weighing two posts should ask about evening and weekend working, because a post with regular weekend sessions will pay more in practice than a weekday-only post at the same band.

Do occupational therapy assistants get overtime pay?

Yes, at Bands 3 and 4. Hours above 37.5 a week are paid at time and a half, and double time on bank holidays. An overtime hour at Band 3 entry is worth £19.74 and at the top of Band 3 £21.06. At Band 4 entry an overtime hour is worth £21.75 and at the top of Band 4 £23.88. On a bank holiday the double-time rates are £26.32 at Band 3 entry and £28.08 at the top of Band 3, and £29.00 at Band 4 entry and £31.84 at the top of Band 4. Part-time staff are paid at plain time, plus any unsocial-hours enhancement that applies, for hours above their contracted hours up to 37.5 a week, with overtime rates only above 37.5 hours. Staff may elect time off in lieu instead of overtime pay.

How much do occupational therapy assistants earn in London?

Where the post is based in a London trust, assistants receive the High Cost Area Supplement: 20% of basic in inner London (minimum £5,794, maximum £8,746), 15% in outer London (minimum £4,870, maximum £6,137) and 5% in the fringe zone (minimum £1,346, maximum £2,270). At these bands the minimums bind for most steps: the inner minimum applies at Band 3 entry, Band 3 top and Band 4 entry, while the top of Band 4 uses the straight 20% (£6,231.40); the outer minimum applies at all four steps; the fringe minimum applies only at Band 3 entry. So Band 3 entry pays £31,554 in inner London, £30,630 in outer London and £27,106 in the fringe zone, and the top of Band 4 pays £37,388.40 in inner London, £36,027.00 in outer London and £32,714.85 in the fringe zone. The supplement follows the base of the post, not the site visited on a given day.

How much pension does an occupational therapy assistant pay?

On the provisional 2026/27 England and Wales tiers, Band 3 entry, Band 3 top and Band 4 entry all sit in the 6.5% tier, at £139.53 a month on £25,760, £148.83 a month on £27,476 and £153.79 a month on £28,392. Only the top of Band 4 crosses into the 8.3% tier, at £215.50 a month on £31,157. The employer contributes 23.7% on top, which is £6,105.12 a year at Band 3 entry and £7,384.21 a year at the top of Band 4. The 2026/27 tiers are provisional, calculated from the published 2025/26 tiers, not yet published as final. The tier is set by whole-time-equivalent salary, so a part-time assistant is tiered on the full-time rate for the post, not on part-time earnings.

How do you become a registered occupational therapist from an assistant post?

The route is a degree, not time served. Assistant experience is a strong foundation for an occupational therapy degree, and many universities value it, but Agenda for Change pays the post, not the person, so years as an assistant do not convert into a registered band on their own. The usual routes are a three-year BSc in occupational therapy or a two-year accelerated MSc for graduates, followed by registration with the Health and Care Professions Council. Some trusts support staff through degree apprenticeships, which let an assistant train while staying employed, but places are limited and competitive. A Band 4 technical instructor who qualifies as an occupational therapist typically enters at Band 5, which pays £32,073 at entry in England in 2026/27, a rise of £916 a year over the top of Band 4, with a much longer ladder above it.

Sources: NHS Employers Agenda for Change pay circular 2026/27; NHS Employers unsocial hours payments; NHS Staff Council mileage mechanism (June 2026); GOV.UK flat-rate expenses list. Figures checked against the site pay data file for 2026/27.