If you work for the NHS in England or Wales, you will almost certainly have heard of “Agenda for Change” and “Band 5” – but that does not mean the details are clear. When you’re tired, under pressure, and trying to plan your future, it can be surprisingly hard to work out what your band really means, how pay progression works, and what happens if your job changes.

This guide is written for NHS staff in England and Wales. It explains Agenda for Change in plain language, looks at typical Band 5 roles, and walks through how pay and progression usually work so you can make more informed decisions.

Table of contents

1. How Agenda for Change works in the NHS
   The basics of bands, pay points and job evaluation.
   
   

2. What roles are in NHS Agenda for Change Band 5?
   Typical examples and why titles can be misleading.
   
   

3. How Band 5 pay, increments and progression work
   Pay points, part‑time work and unsocial hours in practice.
   
   

4. Moving between bands: what changes if you move up or down?
   Pay, responsibility and longer‑term impact.
   
   

5. When your job might be re‑banded
   Why re‑banding happens and what to look for.
   
   

6. Review checks before you make big decisions about band or hours
   Practical checks to run before you sign anything.
   
   

7. Using Caira to understand contracts, job descriptions and pay letters
   How an AI assistant can help you read the paperwork.
   
   

8. Review checks for this article and meta information
   Final checks before publishing.
   
   

How Agenda for Change works in the NHS

Agenda for Change (AfC) is the national pay and grading system for most NHS staff in the UK, including England and Wales. Doctors, dentists, and very senior managers are usually on different arrangements, but nearly all clinical and non-clinical staff fall under AfC.

AfC is built around three main ideas:

• Bands: Jobs are placed into bands (usually Band 2–9) based on the level of knowledge, responsibility, decision-making, and skills required.

• Pay points: Each band has a set of pay points (sometimes called spine points). You usually move up through these over time, as long as you meet local performance and appraisal requirements.

• Job evaluation: Roles are evaluated against a national framework so that, in theory, a job with similar demands sits in a similar band wherever you work.

In practice, national terms and conditions set the basic pay structure and general rules. Individual Trusts and NHS organisations then have local policies covering things like re-banding, redeployment, organisational change, and pay protection. Two jobs with the same title in different Trusts may have slightly different duties or banding, even though they sit on the same national pay scale.

The key point: when you’re trying to understand your band or pay, you need to look at both the national AfC framework and your local Trust policies.

What roles are in NHS Agenda for Change Band 5?

Band 5 is often described as the first level of fully qualified practitioner. It usually sits above assistant or support roles and below more senior or specialist practitioners.

Common Band 5 roles in England and Wales include:

• Registered nurses, such as staff nurses on wards or in community teams.

• Allied health professionals at entry practitioner level, including physiotherapists, occupational therapists, radiographers, and speech and language therapists.

• Some mental health practitioners and psychological wellbeing practitioners.

• Certain clinical scientists or biomedical scientists.

• Some non-clinical professionals—for example, in HR, informatics, governance, or finance—where the role requires degree-level knowledge and a defined level of responsibility.

Doctors and dentists—such as junior doctors, consultants, and surgeons—are usually on separate national medical and dental contracts rather than Agenda for Change. If you’re in one of those roles, the pay and progression rules in this article won’t apply directly, but it can help you understand how your nursing, allied health, and administrative colleagues are banded.

A few practical nuances:

• Job titles can be deceptive. Two jobs called “staff nurse” or “project officer” may not have the same band if one involves more complex decision-making or supervision.

• Trusts structure teams differently. A role that is Band 5 in one Trust might be Band 4 or Band 6 elsewhere, depending on how duties are divided.

• Banding follows the job, not the person. It’s the job description and job evaluation that determine the band, even though experience and qualifications are relevant.

If you’re unsure why your role is Band 5 rather than 4 or 6, check your job description, person specification, and any job evaluation paperwork used when the role was created or reviewed.

How Band 5 pay, increments and progression work

Each Agenda for Change band has a scale made up of pay points. You normally move up to the next point each year, subject to satisfactory performance and completion of mandatory training.

For Band 5 in England and Wales:

• You usually start at the bottom of the band (the entry point), unless your Trust agrees to recognise previous relevant experience.

• You then move up one pay step each year until you reach the top of the Band 5 scale.

• If you work part-time, your basic pay is pro-rated to your contracted hours, but you still move up the pay points in the same way.

• Unsocial hours, on-call payments, and high-cost-area supplements (where they apply) are usually calculated on top of your basic Band 5 salary.

Most Trusts link progression to:

• An annual appraisal or performance review.

• Completion of mandatory training.

• Satisfactory conduct and performance.

If a pay step is delayed or withheld, you should expect clear reasons in writing—such as an appraisal where objectives haven’t been met—and evidence that concerns were raised with you earlier, not just at the point of progression.

If you’re surprised to find an increment has been held back, it’s reasonable to ask which policy has been applied, which objectives or standards are said not to have been met, and what you would need to do (and over what timescale) for the increment to be released.

Moving between bands: what changes if you move up or down?

Many NHS staff move between bands for different reasons:

• Taking a promotion to Band 6 or 7 with more responsibility, supervision, or leadership.

• Moving sideways into a different Band 5 role in another service or Trust.

• Accepting a role at a lower band, sometimes linked to health, capability processes, or organisational change.

When you move up a band:

• Your basic pay normally jumps to at least the minimum of the higher band, sometimes more depending on local rules.

• You often take on extra responsibility—such as supervising others, managing a caseload, holding more complex clinical risk, or leading projects.

• Expectations around decision-making and autonomy usually increase.

When you move down a band:

• Your day-to-day duties should reflect a lower level of responsibility than your previous band.

• Your pay may reduce, although local pay protection policies sometimes cushion this for a limited period.

• The move might be voluntary (for example, to reduce stress or responsibility) or part of a redeployment or organisational change process.

Because moving bands affects your income, stress levels, and long-term pension, it’s worth stepping back and asking: Do I understand exactly what will change in the new role day-to-day? What will my pay be now, in a year, and in three years if I take this job? Is this move being treated as a promotion, redeployment, or capability outcome, and which policy applies?

A separate article on demotion, re-banding, and redeployment for NHS staff goes into more detail on your rights if you’re being asked to move down a band or accept “suitable alternative employment”.

When your job might be re-banded

Re-banding is when the same job is re-evaluated and placed in a different band. This can result in a band going up or down. Typical triggers include:

• The role has grown over time and now carries more responsibility than the original job description.

• A team is going through organisational change, with roles merged, split, or fundamentally redesigned.

• There has been a formal job evaluation challenge through Agenda for Change processes.

If you’re told your job is being re-banded, it’s sensible to ask which policy or procedure is being followed (for example, your Trust’s job evaluation or organisational change policy), request the new job description and person specification, and compare them carefully with your current documents. Check whether there will be pay protection if the proposed band is lower, and for how long. Ask what happens if you do not agree with the new band—is there a review or appeal route, and what are the time limits?

In England and Wales, the detail of re-banding and appeals sits in local policies, but it should still be consistent with the general principles of Agenda for Change and employment law.

Review checks before you make big decisions about band or hours

Before you say yes or no to a new role, a band change, or a major change in hours, it helps to run some structured checks. These aren’t legal advice, but they can highlight areas to explore with HR, your union, or a legal adviser.

Review check 1 – Do you fully understand the job description and person specification?

• Have you read the new job description line by line, not just the title?

• Does it clearly sit at Band 5 (or whatever band is proposed), or are you seeing Band 6 or Band 2-type tasks mixed in?

• Are there responsibilities in the new description that you do not have now, or significant duties you currently do that are missing?
  
  

Review check 2 – Do you know what will happen to your pay now and over the next few years?

• What will your basic salary be on day one, and which pay point is that?

• How will unsocial hours, on-call, or high-cost supplements change, if at all?

• If pay protection is mentioned, how long will it last and what happens when it ends?

Review check 3 – Have you seen the local policies, and do they fit with what you are being told?

• Have you read the relevant organisational change, redeployment, job evaluation, and pay protection policies for your Trust in England or Wales?

• Does the process being followed match those documents, or are there gaps?

• Have you had a chance to get union or independent advice before you make a final decision?

If any of these checks flag problems—such as a mismatch between what’s written in a letter and what the policy says—it’s usually safer to ask questions and get clarity in writing before signing.

It’s also worth remembering that some protections depend on your situation:

• If you have less than two years’ continuous service with the NHS, your rights around unfair dismissal and redundancy are more limited, although protection from discrimination still applies.

• If you are on long-term sick leave or maternity leave, your employer still has duties to consult you properly about reorganisations and potential changes to your role.

A separate article on NHS demotion, re-banding, and redeployment goes into more detail about how these issues play out in practice.

Using Caira to understand contracts, job descriptions and pay letters

When you’re in the middle of a busy rota or a stressful restructure, sitting down with a long policy or pay letter can feel impossible. That’s where a focused tool can help you break things down.

Caira is an AI-powered, privacy-first legal assistant built for people dealing with law and procedure in England and Wales. It’s designed to help you:

• Upload job descriptions, contracts, rotas, organisational change letters, redeployment paperwork, pay protection policies, and emails as PDFs, Word documents, spreadsheets, photos, or screenshots.

• Ask clear questions in plain English, such as “What happens to my Band 5 pay if I accept this Band 4 redeployment?” or “Where in this policy does it talk about suitable alternative employment?”

• Get draft emails, questions for HR, notes for union meetings, or checklists in seconds, so you feel more prepared before difficult conversations.

• Ask Caira to compare two documents side by side—for example, an old and new job description, or two versions of a contract—and highlight the practical differences.

Behind the scenes, Caira reads both the documents you upload and a large library of more than 10,000 legal and tax documents relevant to England and Wales. It then combines that with generative AI to give you context-aware answers.

From a privacy perspective:

• Caira is built to be privacy-first. Your documents are not used to train public AI models.

• Your information is not sent off for third-party human review.

You can try Caira with a 14-day free trial that takes under a minute to start and doesn’t require a credit card. After that, it’s an affordable, low-cost subscription—about the price of a cheap takeaway each month—at £15/month, available 24/7 on your phone, tablet, or laptop.

Used well, it won’t replace legal advice where that’s needed, but it can help you feel more confident and less anxious before you speak to HR, your union, or a solicitor.