NHS Band 4 · London · Agenda for Change 2026/27

NHS Band 4 Salary in London 2026/27

Associate Practitioner. Gross salary £34,310 (inc. £5,570 HCAS). Net take-home after pension: £2,206/month. Rent takes 97% of take-home after pension. Shared accommodation strongly recommended.

Gross
£34,310
annual AfC salary
Net after pension
£2,206
per month
Pension input
£146
employee / month
After rent
£56
per month
Unaffordable solo — rent takes 97% of take-home after pension. Consider a shared house or outer-area flat.

NHS Pension Scheme

Employee contribution
£237/mo
8.3% of gross
Net take-home
£2,115/mo
after tax, NI & pension
After rent
−£35/mo
disposable income

Most NHS staff joined the 2015 scheme. Your payslip will show which scheme applies to you. Contribution rates from NHS Employers 2026/27.

Monthly Budget Breakdown — NHS Band 4 in London

Item Amount
AfC Base Salary £28,740/yr
HCAS Supplement +£5,570/yr
Total Gross £34,310/yr
Income Tax −£362/mo
National Insurance −£145/mo
NHS Pension (5.1%) −£146/mo
Net take-home £2,206/mo
Rent (1-bed median) −£2,150/mo
Council tax −£165/mo
Transport −£185/mo
Remaining −£294/mo

Tax computed using HMRC 2025/26 rates. AfC salaries: NHS Employers pay circular 2026/27. Rent = Rightmove Q4 2025 median. All figures rounded to nearest £1.

Updated April 2026 — 3.3% Agenda for Change pay award
2025/26 range
£26,530 – £29,114
+3.3%
2026/27 range
£27,405 – £30,075
+£875 at entry

Pay Progression — NHS Band 4 2026/27

Experience Annual gross Monthly take-home After rent RTI
0–2 years £27,405 £1,748/mo −£402/mo 123%
2–4 years £28,740 £1,819/mo −£331/mo 118%
4+ years £30,075 £1,890/mo −£260/mo 114%

Progression based on NHS Agenda for Change 2026/27 pay scales. Monthly take-home calculated after tax, NI, and 2015 CARE scheme pension at applicable tier rate. Moving to the next band requires applying for a higher-band post — progression is not automatic.

NHS Pension Breakdown

Monthly Contributions
Employee contribution (5.1%) £146/mo
Employer contribution (23.7%) £678/mo
Total pension input £824/mo
30-Year Projection (CARE Scheme)
Annual contributions (combined) £9,888/yr
Total contributions over 30 years £296,640
Est. annual pension at retirement £19,061/yr
Should I opt out of the NHS pension?

Opting out increases take-home by £146/month, but you permanently lose the NHS employer contribution of £678/month and the security of a defined-benefit guarantee. The 2015 CARE scheme provides an inflation-linked pension for life with no investment risk. For most NHS staff, staying enrolled is strongly recommended. If short-term cash flow is the concern, explore salary sacrifice for other costs (e.g. cycle-to-work, car leasing) before opting out.

High Cost Area Supplement — Select Your Zone

The NHS HCAS compensates staff for higher living costs in and around London. Your zone depends on your workplace postcode.

HCAS supplement
£5,570/yr
Total gross
£34,310/yr
Net take-home
£2,115/mo
After rent
−£35/mo

Inner London covers most central NHS trusts. Outer London covers zones 3–6. Fringe covers Reading, Oxford, Brighton and surrounding areas. HCAS rates from NHS Employers AfC pay circular 2026/27.

NHS Band 4 in Other Cities

Manchester Birmingham Bristol Edinburgh Glasgow

Career Progression

↓ Band 3 — £25,979/yr ↑ Band 5 — £32,074/yr

Affordability & Comparisons

NHS Band 4 — all cities All NHS pay bands Can I afford London on £35,000? Software Engineer salary in London

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Frequently Asked Questions

What is the take-home pay for an NHS Band 4 in London in 2026/27? +
An NHS Band 4 in London earns £34,310 gross (including £5,570 HCAS supplement). Net take-home before pension deduction: £2,352/month. After the 5.1% pension contribution of £146/month, take-home is £2,206/month.
What does the NHS pension contribute on a Band 4 salary? +
On an NHS Band 4 salary of £34,310, the employee pays £146/month (5.1%) and the NHS employer adds £678/month (23.7%) into the 2015 Career Average (CARE) scheme. Combined annual pension input: £9,888/year. After 30 years the CARE scheme projects an estimated annual pension of approximately £19,061/year at retirement.
Can an NHS Band 4 afford to live alone in London? +
On £2,206/month net after pension, an NHS Band 4 in London has £56/month remaining after average 1-bed rent of £2,150/month. Rent-to-income ratio: 97%. Rent takes 97% of take-home after pension. Shared accommodation strongly recommended.
What is the HCAS for NHS Band 4 in London? +
NHS Band 4 staff in London receive a High Cost Area Supplement of £5,570/year, bringing total gross to £34,310. Zone rates: Inner London £5,570, Outer London £3,966, Fringe £1,173.

Studying nursing? See if you can afford university in London first → Student finance in London

Data sources & methodology

NHS Employers Agenda for Change Pay Scales 2026/27 · HMRC Income Tax Rates 2025/26 · Rightmove Rental Trends Tracker Q1 2026

Analysis by the SalaryDex data team · May 2026 · Corrections: [email protected] · Full methodology · Data transparency pledge

Contains public sector information licensed under the Open Government Licence v3.0