NHS Band 4 · London · Agenda for Change 2025/26

NHS Band 4 in London

Associate Practitioner. Gross salary £33,214 (inc. £5,392 HCAS). Net take-home after pension: £2,145/month. Rent takes 96% of take-home after pension. Shared accommodation strongly recommended.

Gross
£33,214
annual AfC salary
Net after pension
£2,145
per month
Pension input
£141
employee / month
After rent
£95
per month
Unaffordable solo — rent takes 96% of take-home after pension. Consider a shared house or outer-area flat.

Monthly Budget Breakdown — NHS Band 4 in London

Item Amount
AfC Base Salary £27,822/yr
HCAS Supplement +£5,392/yr
Total Gross £33,214/yr
Income Tax −£344/mo
National Insurance −£138/mo
NHS Pension (5.1%) −£141/mo
Net take-home £2,145/mo
Rent (1-bed median) −£2,050/mo
Council tax −£165/mo
Transport −£185/mo
Remaining −£255/mo

Tax computed using HMRC 2025/26 rates. Rent = Rightmove Q4 2025 median. All figures rounded to nearest £1.

NHS Pension Breakdown

Monthly Contributions
Employee contribution (5.1%) £141/mo
Employer contribution (23.7%) £656/mo
Total pension input £797/mo
30-Year Projection (CARE Scheme)
Annual contributions (combined) £9,564/yr
Total contributions over 30 years £286,920
Est. annual pension at retirement £18,452/yr
Should I opt out of the NHS pension?

Opting out increases take-home by £141/month, but you permanently lose the NHS employer contribution of £656/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 — London

The NHS HCAS compensates staff for higher living costs in and around London. It is paid on top of the AfC base salary and varies by zone.

Inner London
£5,392
per year supplement
Outer London
£3,839
per year supplement
Fringe Zone
£1,136
per year (SE England)

HCAS rates are set annually by NHS Employers under the AfC pay circular. The supplement is non-pensionable for some scheme members — check your individual contract.

NHS Band 4 in Other Cities

Manchester Birmingham Bristol Edinburgh Glasgow

Career Progression

↓ Band 3 — £25,149/yr ↑ Band 5 — £31,049/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? +
An NHS Band 4 in London earns £33,214 gross (including £5,392 HCAS supplement). Net take-home before pension deduction: £2,286/month. After the 5.1% pension contribution of £141/month, take-home is £2,145/month.
What does the NHS pension contribute on a Band 4 salary? +
On an NHS Band 4 salary of £33,214, the employee pays £141/month (5.1%) and the NHS employer adds £656/month (23.7%) into the 2015 Career Average (CARE) scheme. Combined annual pension input: £9,564/year. After 30 years the CARE scheme projects an estimated annual pension of approximately £18,452/year at retirement.
Can an NHS Band 4 afford to live alone in London? +
On £2,145/month net after pension, an NHS Band 4 in London has £95/month remaining after average 1-bed rent of £2,050/month. Rent-to-income ratio: 96%. Rent takes 96% 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 £5,392/year, bringing total gross to £33,214. Zone rates: Inner London £5,392, Outer London £3,839, Fringe £1,136.