Respiratory Nurse Salary 2026/27

Last updated: 31 October 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

Respiratory nurse pay 2026/27: the Band 6 to Band 7 scales

England awarded Agenda for Change staff 3.3% from 1 April 2026, and the award was paid on time in April salaries. The scales below are 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 and overtime 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. For the wider picture at each band, including the roles that share these scales, see the Band 6 salary guide and the Band 7 salary guide.

The step structure tells the story of this ladder. Inside each band, the journey is worth £8,158 at Band 6 and £7,128 at Band 7. Between bands, the step is small: £1,270 from the top of Band 6 to the entry of Band 7. A nurse who moves from Band 6 top to Band 7 entry gains just over £105 a month in basic pay, which surprises people who expect a promotion to transform their salary. The real gain at Band 7 is the higher ceiling, £56,515 against £48,117, and the different work: a caseload and a service to shape rather than a caseload to run. The full journey from Band 6 entry to Band 7 top is worth £16,556 a year in basic pay.

One point that trips up newcomers: the band follows the post, not the person and not the job title. A trust can advertise a Band 6 respiratory nurse post and a Band 7 respiratory nurse specialist post in the same service, with overlapping clinical duties, and pay them from different scales. The job evaluation behind each post decides the band, based on the knowledge, responsibility and effort the post demands. That is why this page quotes bands and steps rather than a single salary figure. Anyone comparing offers should ask for the band and the step, not just the headline annual figure, because the step alone can be worth £2,211 at Band 6, from £39,959 at entry to £42,170 at the intermediate step.

What a respiratory nurse actually does

Respiratory disease is mostly long-term disease, and the respiratory nurse is the clinician who stays with the patient across months and years, not just across one admission. The work splits into three settings that look quite different in practice, even though the same nurse may cover all three in one week: the acute ward, the community caseload, and the clinic. On the ward, the nurse cares for patients admitted with breathlessness, pneumonia, an asthma attack or a flare of chronic obstructive pulmonary disease (COPD), checks oxygen levels, breathing rate and blood gases alongside the medical team, and helps plan the discharge so the patient does not come straight back. In the community, the same nurse carries a caseload of patients at home, visits them between clinic appointments, and spots deterioration early, often by a small change in breathlessness, a new cough, or a patient who says they can no longer walk to the shops without stopping. In clinic, the nurse runs follow-up appointments, reviews symptoms, inhaler technique and oxygen needs, and adjusts care within agreed protocols.

Non-invasive ventilation (NIV) wards and clinics are the most technical part of the specialty, and they are kept deliberately separate from general respiratory wards in how services organise them. Some patients with COPD or other breathing conditions need a mask ventilator at night or during a flare, to support breathing while the lungs recover. The NIV nurse sets up and monitors that support, checks mask fit and blood gases, and works with the medical and physiotherapy teams when a patient needs a change of settings or a move to a higher level of care. Not every respiratory nurse works with NIV, and a nurse applying for a post should ask whether NIV work is part of the role, because it needs extra training, it changes the shape of the week, and it usually brings night and weekend cover into the rota. A service that combines NIV and general respiratory work in one nurse post is asking for a broader skill set than a service that keeps them apart.

Pulmonary rehabilitation and oxygen assessment form a second specialist strand, and they suit nurses who like steady, measurable progress rather than crisis work. Pulmonary rehabilitation is a course of exercise and education for people with COPD and other long-term lung conditions, run over several weeks, that improves breathlessness, walking distance and confidence. The respiratory nurse assesses patients for the course, runs or supports the sessions, and reviews progress at the end. Home oxygen assessment is quieter work with a direct effect on daily life: the nurse checks whether a patient needs oxygen at home, for how many hours a day, and whether it should be continuous or only on exertion, then arranges the equipment and reviews it. Both strands need sound knowledge of lung conditions, confidence in reading oxygen saturations and blood gases, and the judgement to pause a plan when the readings say stop. That judgement is built over time, and it is one reason respiratory posts sit at Band 6 and above rather than at Band 5.

Education runs through all three settings. Respiratory nurses teach patients to use inhalers correctly, to recognise the early signs of a flare, to manage breathlessness in plain terms, and to know when to call the service rather than waiting for the next appointment. They also teach families, who are often the first to notice that a patient is more breathless or more tired than last week. On the ward, they teach ward nurses the early signs of deterioration and the discharge checks that prevent readmission. Smoking cessation advice sits inside the same conversations, and it is offered as help, not as a lecture, because most patients with COPD have smoked and many still do. The closest neighbouring roles are the intensive care nurse, who cares for critically ill patients on a unit, and the clinical nurse specialist in other long-term conditions, whose caseload model is the closest parallel to respiratory work.

The emotional weight of the job deserves a plain statement. COPD, interstitial lung disease and other long-term respiratory conditions are progressive, and nurses in this specialty look after patients over years, through good periods and through decline. They build long relationships, and they lose patients they have known well. They also support families through advance care planning conversations, including honest talk about what to do when breathlessness worsens and hospital admission stops helping. Nurses who last in the role tend to be people who value continuity, who can hold a long relationship with a patient without losing clinical distance, and who can have a difficult conversation kindly and clearly. A nurse weighing a move into respiratory care should ask what supervision and support the service offers, because the pay scales on this page say nothing about that part of the job.

Band 6 versus Band 7: what actually changes

At Band 6, a respiratory nurse runs a caseload and clinics within a service someone else leads. The nurse assesses patients, runs spirometry and oxygen assessments, visits patients at home, and keeps records and referrals in order. At Band 7, the nurse carries a specialist caseload and also carries responsibility for the service itself: shaping clinic templates, setting referral criteria, leading audit, supervising Band 6 nurses, and representing the service in meetings with respiratory medicine, physiotherapy, pharmacy, primary care and community teams. The clinical skills overlap a great deal, which is why the pay step between the bands is only £1,270, from £48,117 at the top of Band 6 to £49,387 at the entry of Band 7. What changes is accountability: when a clinic is overbooked, when a referral pathway stalls, or when a new guideline needs to be turned into local practice, the Band 7 nurse is the person expected to fix it.

That difference matters for anyone planning a move. A Band 6 nurse who loves direct patient contact and dislikes committee work may be happier staying at the top of Band 6, where the pay is £48,117 and the week is mostly clinical. A nurse who wants to change how the service works, to lead a team, and to carry the argument for more clinic time or more community capacity, needs the Band 7 post, even though the first year of it pays only £1,270 more than the top of Band 6. The payoff comes later in the band: Band 7 tops out at £56,515, which is £8,398 above the top of Band 6, and the Band 7 nurse builds pension on that higher figure. For the full scales at each band, see the Band 6 salary guide and the Band 7 salary guide, and for the wider specialist ladder, the clinical nurse specialist salary guide.

Experience also shapes where a nurse lands within a band. A nurse moving from a general medical ward into a first respiratory post usually starts at Band 6 entry, £39,959, and moves through the steps as service and experience grow. A nurse with several years of respiratory experience, a prescribing qualification, or NIV competence may be appointed higher in the band or straight into a Band 7 post. Prescribing is worth asking about in any job description: a respiratory nurse who can prescribe can adjust inhalers and other medicines in clinic without waiting for a doctor's signature, which makes the clinic run faster and makes the nurse more valuable to the service. It does not automatically change the band, since the band follows the evaluated post, but it strengthens a Band 7 application and it changes the daily work for the better.

Unsocial hours: weekends, nights and the community rota

Respiratory care runs seven days a week in most services, though the pattern differs between acute and community posts. Ward-based nurses cover weekend and night shifts on the rota, and NIV wards need overnight cover every night. Community nurses more often work weekday visits with a weekend on-call or visit rota for urgent reviews, for example a COPD patient whose breathlessness has worsened over the weekend. Agenda for Change Section 2 pays Bands 4 to 9 time plus 30% for Saturday and weekday night hours (8pm to 6am) and time plus 60% for Sunday and public-holiday hours. The table below applies those percentages to the rounded hourly rates from the scales above. For the full unsocial-hours rules, including overtime and time off in lieu, see the unsocial hours and overtime guide.

Worked example: a Band 7 respiratory nurse specialist at entry works a Sunday shift of 7.5 hours. Plain time for the shift would be £189.23 (7.5 hours at £25.23). At time plus 60%, the same shift pays £302.78 (7.5 hours at £40.37). The enhancement alone is worth £113.55 for that one shift. A nurse who regularly works weekends will see a payslip well above the basic monthly figure, and a nurse whose post is mainly weekday clinics will see a payslip close to it. That is why two nurses on the same band and step can take home different amounts, and why asking about the rota matters as much as asking about the band.

Overtime: time and a half, double on bank holidays

Overtime in Agenda for Change is paid at time and a half for hours above the standard week, and at double time for hours worked on a public holiday, subject to the usual conditions on the service. For a respiratory nurse, overtime usually means staying past the end of a clinic, covering a colleague's sickness absence, or working an extra shift when the caseload is under pressure. The hourly overtime rates below are calculated from the rounded plain-time rates.

Worked example: a Band 6 respiratory nurse at the intermediate step works 5 extra hours in a week at time and a half. That is 5 hours at £32.31, or £161.55, against £107.70 at plain time, an extra £53.85 for the week. Overtime is not a reliable part of the salary, and services vary in how much they offer. A nurse budgeting on overtime every week is budgeting on something the service may withdraw, so the figures above are best read as the value of an occasional extra shift, not as a second salary.

On-call: the figure this page does not quote

On-call is the one part of respiratory nurse pay that cannot be quoted nationally, and this page does not pretend otherwise. Some services pay an on-call availability payment for being contactable out of hours, plus a payment for each call or visit. Others fold on-call into a rota allowance, and community services vary in whether they run a formal on-call rota at all, with urgent out-of-hours calls going to a general community or district nursing service instead. Respiratory on-call is often tied to NIV: a service that runs home NIV needs someone contactable when a mask fails or a patient deteriorates at night, and that call may mean a phone triage, a home visit, or an admission. The frequency matters as much as the rate: a service that calls its nurse out several times a weekend pays very differently from a service that calls once a month, even on the same availability payment. The only figure that counts for a specific post is the one in that trust's local terms. Ask for it in writing before accepting a post, along with the rota pattern, the expected call-out frequency, and how travel time for call-out visits is treated.

London weighting: what HCAS adds

High Cost Area Supplement is paid on top of basic pay for staff working in London and the fringe zone. In 2026/27, inner London pays 20% of basic pay (minimum £5,794, maximum £8,746), outer London pays 15% (minimum £4,870, maximum £6,137) and the fringe zone pays 5% (minimum £1,346, maximum £2,270). The cap binds across this ladder: a Band 6 nurse at the top in inner London receives the £8,746 maximum, not 20% of £48,117, for a total of £56,863, and a Band 7 specialist at entry in inner London also receives £8,746, for a total of £58,133. For the full HCAS rules, see the London weighting guide.

The outer London minimum rarely binds at these bands, and the caps do the work instead. A Band 6 nurse at entry in outer London receives £5,993.85, which is 15% of the basic, above the £4,870 minimum, for a total of £45,952.85. The same nurse in the fringe zone receives £1,997.95, which is 5% of the basic, above the £1,346 minimum, for a total of £41,956.95. At the top of the ladder the fringe cap binds: a Band 7 specialist at the top receives £2,270 in the fringe zone, not 5% of £56,515, for a total of £58,785. These small rules are the ones that catch people out when they estimate London pay from a percentage alone, so the table above gives totals, not just percentages.

Pension: what comes off the payslip

NHS pension contributions are the largest regular deduction after tax for most respiratory nurses, and they are also the most valuable part of the package. Under the provisional 2026/27 England and Wales tiers, Band 6 nurses pay 9.8% at every step, from £326.33 a month at entry to £392.96 a month at the top, with £344.39 a month at the intermediate step. Band 7 specialists pay 9.8% at entry and the intermediate step, £403.33 and £424.11 a month, and 10.7% at the top, £503.93 a month. The employer contributes 23.7% on top of pensionable pay, which is £9,470.28 a year at Band 6 entry and £13,394.06 a year at the top of Band 7. The tiers are provisional, calculated from the published 2025/26 tiers, and have not yet been formally published, so a nurse should check the final tiers when they are confirmed. For the full tier table, see the pension contributions guide.

Pensionable pay is basic pay plus any pensionable allowances, and for most respiratory nurses that means basic pay alone, since unsocial-hours enhancements and overtime are not pensionable. That distinction matters when comparing a respiratory payslip with a ward payslip: a nurse who earns a lot of unsocial-hours money takes home more in the month, but builds pension on the basic only. The pension itself is a career average scheme, so each year's pensionable pay adds a slice to the retirement pension, and the slices from higher-band years are worth more than the slices from lower-band years. A nurse who spends the last years of a career at Band 7 retires on a pension built from those years at their full value, which is one reason the Band 7 ceiling matters beyond the monthly pay.

Part-time work, annual leave, mileage and uniform relief

Part-time pay in Agenda for Change is pro rata to the whole-time equivalent fraction. A Band 6 respiratory nurse at entry on a 0.8 whole-time equivalent contract earns £31,967.20 a year, and a Band 7 specialist at the top on a 0.6 contract earns £33,909 a year. Unsocial-hours percentages and HCAS apply to the pro rata basic in the same way as to a full-time basic, and pension contributions are calculated on the actual pensionable pay, not the whole-time equivalent figure. Respiratory services often offer part-time posts, because clinic sessions and community caseloads can both be split, but the on-call commitment of a part-time post should be checked, since some services expect part-time nurses to take a full share of on-call.

Annual leave follows the Agenda for Change tiers: 27 days on joining, 29 days after five years of service and 33 days after ten years, plus eight bank holidays, with part-time leave calculated pro rata in hours. A nurse who works weekends will take some of those bank holidays as working days and receive the unsocial-hours enhancement instead, which is the standard trade in seven-day services. For the full leave rules, see the annual leave guide on this site.

Mileage is the other regular money for community respiratory nurses, who drive between home visits all week. Under Agenda for Change Section 17, a car user is paid 59p a mile for the first 4,500 miles in a year and 36p a mile after that. A nurse driving 5,000 miles in a year receives £2,835, and a nurse driving 4,000 miles receives £2,360. Mileage is an expense reimbursement, not pay, and it is kept separate from salary in every example on this page. For the full rates and more worked examples, see the mileage rates guide. Nurses who wear a uniform can also claim flat-rate tax relief for laundry: £125 a year for nurses, worth £25 a year at the 20% tax rate and £50 a year at the 40% rate. It is a small sum, but it is claimed through the tax code and costs nothing to ask for.

Community versus acute: two versions of the same job

The same band and step can mean two quite different weeks, depending on whether the post is community or acute. The acute respiratory nurse works on wards and in clinics inside the hospital, sees patients at their sickest, and hands them over to the community team at discharge. The day is structured by ward rounds, clinic lists, NIV checks and referrals, and the nurse rarely travels. The community respiratory nurse works from a base and spends the day visiting patients at home, often alone, making clinical judgements without a doctor down the corridor. The day is structured by a visit list, driving time, and phone calls between visits, and the nurse needs confidence in lone working and in deciding when a home visit must become a hospital admission.

Pay differs between the two versions mainly through unsocial hours and mileage, not through basic pay. The acute nurse earns more unsocial-hours money from weekend and night ward shifts, especially on NIV wards. The community nurse earns more mileage, and may earn less unsocial-hours money if the community rota is mainly weekdays with a lighter weekend commitment. Both earn the same basic for the same band and step, and both earn the same HCAS for the same zone. A nurse choosing between the two should weigh the working pattern honestly: acute work offers a team on hand and a faster pace, community work offers autonomy, long patient relationships, and a car full of notes and equipment. The district nurse salary guide covers the closest community nursing parallel, and its visit-based working pattern will feel familiar to anyone who has worked a community respiratory caseload.

Private-sector comparison, kept qualitative as it should be: private respiratory and home-care providers do employ nurses with respiratory skills, and their pay is set by the employer rather than by a national scale, so it varies by provider, region and role. Some private posts pay above the NHS basic for the same experience, and some pay below it once pension, leave and sick pay are counted. The NHS package at Band 6 and Band 7 includes the career average pension with a 23.7% employer contribution, Agenda for Change leave tiers, and nationally set unsocial-hours rates, which are hard to match post for post in a private contract. A nurse comparing an NHS respiratory post with a private offer should compare the whole package, including pension and leave, not just the headline annual figure.

Scotland, Wales and Northern Ireland

Scotland has a 3.75% award from 1 April 2026 and a 36-hour week, which changes the hourly maths even where the annual figure looks close to England. The shorter week is worth real money in hourly terms, and it also changes the overtime threshold, since overtime in Scotland starts above 36 hours rather than 37.5. Wales has a 3.3% award implemented 1 April 2026. Northern Ireland has a 3.3% recommendation for 2026/27 that has not been implemented, so no 2026/27 Northern Ireland figure is quoted here. No Scotland or Wales Band 6 or Band 7 salary figures are quoted on this page, because the data file does not hold them, and this page does not fill the gap by guessing.

The honest picture: what respiratory nurse pay does and does not do

Respiratory nurse pay is solid, transparent and nationally set, which is its strength. A nurse can look up the band scale, add the unsocial-hours percentage for the rota, add HCAS for London, and know the gross figure within a few pounds. There are no hidden bonuses and no negotiation over the basic: the scale is the scale. The ceiling is the weakness. Band 6 tops out at £48,117, and a nurse who wants more must move to Band 7, which means a service to lead, not simply more years in the same job. On-call pay, which can be a meaningful part of a respiratory income in services that run home NIV, is set locally and varies, so the national scales alone do not tell the whole story for this specialty. The job itself is the reason to take it: long relationships with patients, clinics where better inhaler technique and timely treatment keep people out of hospital, and a specialty where one nurse's work changes how a patient breathes day to day. The pay is fair for the band. The rota, the caseload size, and the split between acute and community work are what should decide the choice between two respiratory posts at the same band.

Frequently asked questions

What band is a respiratory nurse?

Most respiratory nurses sit at Band 6, and respiratory nurse specialists and service leads sit at Band 7. In England in 2026/27, Band 6 pays £39,959 at entry, £42,170 at the intermediate step and £48,117 at the top, and Band 7 pays £49,387 at entry, £51,932 at the intermediate step and £56,515 at the top. The band follows the post, not the job title, so one trust can employ a Band 6 respiratory nurse and a Band 7 respiratory lead in the same service, with the lead carrying service responsibility on top of the clinical caseload.

How much does a respiratory nurse earn a month?

In England in 2026/27, a Band 6 respiratory nurse earns £3,329.92 a month at entry, £3,514.17 at the intermediate step and £4,009.75 at the top, before tax, National Insurance and pension deductions. A Band 7 respiratory nurse specialist earns £4,115.58 a month at entry, £4,327.67 at the intermediate step and £4,709.58 at the top. Those are gross figures for a full-time 37.5-hour week, before any unsocial-hours enhancement, on-call payment or London weighting.

Do respiratory nurses get unsocial-hours pay?

Yes, when the hours are worked. Agenda for Change Section 2 pays Bands 4 to 9 time plus 30% for Saturday and weekday night hours (8pm to 6am) and time plus 60% for Sunday and public-holiday hours. A Band 6 respiratory nurse at entry earns £26.53 an hour on a Saturday or at night and £32.66 on a Sunday or bank holiday, against £20.41 plain time. At the top of Band 7, £28.87 an hour becomes £37.53 and £46.19. Community respiratory nurses who visit patients at weekends and acute nurses who cover ward and NIV shifts at night both earn these enhancements for the qualifying hours they actually work.

Do respiratory nurses get London weighting?

Yes, in London. High Cost Area Supplement in 2026/27 is 20% of basic pay 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). A Band 6 respiratory nurse at entry in inner London earns £47,950.80 in total, and a Band 7 respiratory nurse specialist at entry in inner London earns £58,133, because the 20% supplement is capped at £8,746. A Band 7 specialist at the top in inner London earns £65,261 in total.

What pension contribution does a respiratory nurse pay?

Under the provisional 2026/27 England and Wales tiers, Band 6 respiratory nurses pay 9.8% of pensionable pay at every step, from £326.33 a month at entry to £392.96 a month at the top. Band 7 respiratory nurse specialists pay 9.8% at entry and the intermediate step, £403.33 and £424.11 a month, and 10.7% at the top, £503.93 a month. The employer contributes 23.7% on top, which is £13,394.06 a year at the top of Band 7. The 2026/27 member tiers are provisional, calculated from the published 2025/26 tiers, and have not yet been formally published.

Can a respiratory nurse work part-time?

Yes. Part-time pay in Agenda for Change is pro rata to the whole-time equivalent fraction. A Band 6 respiratory nurse at entry on a 0.8 whole-time equivalent contract earns £31,967.20 a year, and a Band 7 respiratory nurse specialist at the top on a 0.6 contract earns £33,909 a year. Unsocial-hours percentages and High Cost Area Supplement apply to the pro rata basic in the same way as to a full-time basic, and pension contributions are calculated on the actual pensionable pay, not the whole-time equivalent figure. Community caseloads and clinic sessions can both be split across part-time posts, though the on-call share of a part-time post should be checked before accepting it.

Do respiratory nurses get paid mileage?

Yes, when driving is part of the job, under Agenda for Change Section 17. A car user is paid 59p a mile for the first 4,500 miles in a year and 36p a mile after that. A nurse driving 5,000 miles in a year receives £2,835: £2,655 for the first 4,500 miles plus £180 for the remaining 500. Mileage is an expense reimbursement, not pay, so it is kept separate from salary in every example on this page. Community respiratory nurses who visit patients at home will claim far more mileage than nurses based on a single ward.

How does respiratory nurse pay differ in Scotland, Wales and Northern Ireland?

Scotland has a 3.75% award from 1 April 2026 and a 36-hour week, which changes the hourly maths and the overtime threshold, since overtime in Scotland starts above 36 hours rather than 37.5. Wales has a 3.3% award implemented 1 April 2026. Northern Ireland has a 3.3% recommendation for 2026/27 that has not been implemented, so no 2026/27 Northern Ireland figure is quoted here. No Scotland or Wales Band 6 or Band 7 salary figures are quoted on this page, because the data file does not hold them, and this page does not invent the rest.