NHS band 4 pay and jobs

Band 4 pays £28,392 a year in England from 1 April 2026, rising to £31,157 after three years at the entry point. It sits between support work and registered professional roles, and it is where assistant practitioners, nursing associates and admin team leaders usually land. In Scotland band 4 runs from £31,492 to £34,254.

The pay points

	England 2026/27	Scotland 2026/27
Entry point	£28,392	£31,492
Top point	£31,157 (after 3 years)	£34,254

The England rates reflect the 3.3% consolidated award paid from 1 April 2026. Band 4 is one of the bands with only two points, and the three-year wait at entry is longer than the two years at band 3. Moving up the step depends on meeting your employer’s progression standards, which the pay progression guide explains.

In London, the High Cost Area Supplement is added. At the entry point Inner London staff get the £5,794 minimum and Outer London staff the £4,870 minimum. At the top of the band, 20% of basic pay is above the Inner London minimum, so that is what you receive. In the fringe zone the 5% rate applies at both points. The high cost area supplement guide has the full rules.

Clinical roles at band 4

Band 4 clinical jobs carry delegated responsibility for patient care, working to a care plan set by a registered professional but with more independence than band 3.

The nursing associate is the best-known band 4 clinical role. Nursing associates are registered with the NMC and usually train through an apprenticeship, often while employed at band 3. Assistant practitioners work in a similar way in areas such as radiography, therapies and community care, usually after a foundation degree or higher apprenticeship. You will also see trainee pharmacy technicians and some senior therapy assistant posts at band 4.

For people who want to become a registered nurse without leaving work, band 4 is a common stepping stone. The HCA to nurse guide sets out the routes.

Admin and office roles at band 4

On the non-clinical side, band 4 covers jobs where you supervise others, manage a process or work with a high degree of independence:

• admin team leader or office supervisor
• medical secretary in some trusts (others place it at band 3)
• senior HR, finance or payroll officer
• patient pathway coordinator and waiting list coordinator
• data or information officer

Because banding follows job evaluation, a medical secretary at one trust can be band 3 and at another band 4. Compare the job descriptions; the NHS admin jobs guide covers what tends to push a role up a band.

What comes off your pay

The NHS Pension Scheme tier changes inside band 4. At £28,392 you are in the 6.5% tier (up to £28,854). At £31,157 you move into the 8.3% tier, which runs from £28,855 to £35,155. The rate applies to the whole of your pensionable pay, so the step up brings a slightly larger contribution as well as a higher salary.

Band 4 is also where Plan 2 student loan repayments start for many people. The Plan 2 threshold is £29,385, so you pay nothing at the entry point and 9% of earnings above the threshold once you reach the top step. Plan 1 starts at £26,900 and Plan 5 at £25,000, so those repayments apply at both points. The take-home pay calculator works out the monthly figure with all deductions included.

Band 4 outside England

Scotland pays band 4 on its own scale, from £31,492 to £34,254 in 2026/27, under a deal giving 3.75% this year and an inflation guarantee that could add a top-up in March 2027. The Scottish entry point is higher than the top of the English band.

In Wales the 2026/27 award was announced at 3.3%, the same as England, according to the RCN. Northern Ireland’s award had not been confirmed by 16 October 2026, because it depends on the Executive’s budget.

Wherever you work, the principle is the same: the job is evaluated and placed on a band, and the pay points within it follow the national agreement for that nation. Band 4 job titles are broadly recognised across the four nations, which helps if you move for family or study.

Getting into band 4 and moving on

From band 3, the usual routes are a trust-funded apprenticeship (nursing associate or assistant practitioner) or a step into supervising an admin team. External applicants with relevant qualifications can apply directly for band 4 posts; the person specification will say whether a foundation degree, a level 3 qualification or specific experience is essential.

From band 4, the next band starts at £32,073 for band 5. Clinical staff usually need a registered qualification for that move, for example a nursing degree through an apprenticeship top-up route. Admin staff move up by taking on management of a service area or specialist work. The band 5 guide covers what that level involves. Live vacancies are on the healthcare support and NHS admin job boards.