Being told your role is “at risk”, offered a lower‑band job or warned about demotion is one of the most stressful moments in any NHS career. You have to absorb complex information quickly, make decisions that affect your income and pension, and work out what is fair—often while still working full shifts.

This guide is written for NHS staff in England and Wales—including nurses, healthcare assistants, allied health professionals, junior doctors, consultants and surgeons on local contracts, as well as administrative and managerial staff. It explains, in plain language:

• What demotion and downbanding actually mean under NHS and employment law.

• How re‑banding, redeployment and “suitable alternative employment” usually work.

• When pay protection may apply.

• What you can do if you do not want to take the alternative employment that has been offered.

• Whether you can back out of a job offer after signing.

It is not legal advice, but it is designed to give you a clear, structured starting point so you can have more confident conversations with HR, your union or a legal adviser.

NHS demotion and downbanding: what these terms actually mean

People use “demotion” and “downbanding” loosely, but they have specific meanings.

• Demotion means being moved to a role with lower status, lower pay or both—often as an outcome of a capability, disciplinary or ill‑health process.

• Downbanding is the NHS‑specific idea of being placed in a role at a lower Agenda for Change band than your current one.

• Re‑banding is where the job itself is re‑evaluated and placed in a different band (this can be up or down).

Why this matters:

• Demotion or downbanding can affect your income, pension, confidence and career trajectory.

• The process and rights differ depending on whether this is part of performance management, sickness/ill‑health, disciplinary action or an organisational change/redundancy situation.

Before you react, clarify in writing:

• Which policy or procedure HR says they are using.

• Whether this is being treated as a capability/disciplinary outcome or as part of an organisational change or redeployment.
  
  

Can you go down a band in NHS? When is it lawful?

In England and Wales, an employer can move an employee to a lower‑band role if they follow the correct process and the employment contract allows it, or if the employee agrees.

Common situations include:

• Capability or performance: You cannot safely or consistently carry out the duties of your current band, even after support, and accept a lower‑band role as an alternative to dismissal.

• Disciplinary outcomes: In some Trusts, demotion is an alternative to dismissal in serious misconduct cases.

• Ill‑health: Occupational health advises you cannot safely continue in your current role but may manage a less demanding role at a lower band.

• Organisational change / redundancy: A role disappears or changes significantly, and a lower‑band role is offered as suitable alternative employment.

Key legal ideas:

• Your employer must act reasonably and follow a fair procedure.

• Major changes to your contract (like a band reduction) normally require either a lawful contractual right to make that change or your agreement.

• If you refuse a lower‑band role that your employer sees as suitable, there may be consequences for redundancy pay or dismissal outcomes.

Because the law is fact‑specific, it is usually worth taking advice before making a final decision.

What is the NHS re‑banding policy?

There is no single “NHS re‑banding policy” for all of England and Wales. Instead:

• Agenda for Change provides the national job evaluation framework.

• Each Trust has local policies on job evaluation, re‑banding and organisational change.

In broad terms:

• Roles are evaluated using national job evaluation factors (knowledge, responsibility, physical skills, emotional effort, etc.).

• Jobs are either matched to existing national profiles or fully evaluated.

• If your duties change significantly, the job may be re‑matched or re‑evaluated, which can lead to a higher or lower band.

Important questions to ask if re‑banding is mentioned:

• Has a formal job evaluation taken place and can I see the outcome?

• Have the duties genuinely changed, or is this mainly a way to reduce costs?

• What is the appeal or review route if I disagree with the outcome?

Always check the versions of policies that apply to your organisation.

NHS staff rights during restructure and organisational change

When a Trust goes through a restructure or organisational change, staff may be placed “at risk” and invited into a redeployment process.

Key principles:

• You should receive clear written information about the proposed change, the impact on your role and the timetable.

• There should be a period of consultation, where you can ask questions and suggest alternatives.

• Selection for redundancy, redeployment or ring‑fenced posts should use fair and objective criteria, set out in policy.

• There may be a redeployment register and a defined window (for example, 12–16 weeks) in which suitable alternative roles are explored.

You also have rights under general employment law, including:

• Protection from unfair dismissal (if you meet the service requirement).

• Rules around redundancy consultation and payments.

• Protection from discrimination, including where disability or other protected characteristics are relevant.

Keep in mind:

• If you have less than two years’ continuous service, your protection from unfair dismissal and your rights to redundancy pay may be more limited, although discrimination law and some other rights still apply from day one.

• If you are on long‑term sick leave or maternity leave, your employer still has duties to consult you properly about reorganisations, and pregnancy and maternity are specifically protected characteristics under equality law.
  
  

NHS suitable alternative employment at a lower band

In redundancy or redeployment situations, Trusts have a duty to look for suitable alternative employment where possible, which might include roles at the same or a lower band.

When assessing suitability, Trusts and tribunals often look at:

• Pay and band: Is the salary close to your current pay, or is there a significant drop? Are there pay‑protection arrangements?

• Location and travel: How far is the new base from your home? Does it add a manageable amount of travel?

• Hours and pattern: Are the hours similar, or would they seriously affect your caring responsibilities, health or other commitments?

• Status and type of work: Does the new role fit your skills and experience, or is it a major step down in status or field?

• Skills and training: Can any gaps reasonably be bridged with training and support?

A lower‑band role can sometimes be considered “suitable” if the other factors line up and pay protection is available. Equally, a same‑band role may be unsuitable if the travel, shift pattern or duties are unrealistic for your circumstances.

Grounds for refusing suitable alternative employment

Refusing a role that your employer reasonably views as suitable alternative employment can sometimes affect your redundancy rights. However, the test includes whether your refusal is reasonable.

Potentially reasonable grounds to refuse might include:

• A significant, permanent drop in pay without adequate pay protection.

• A new location that would add excessive travel time or cost, especially if you have caring responsibilities or a disability.

• A shift pattern that is incompatible with your medical needs, childcare or reasonable adjustments.

• A role that is outside your skills, qualifications or registration, where you could not realistically perform safely even with training.

• A substantial drop in status or responsibilities that would make the role clearly different in nature to your current post.

In practice:

• Check your Trust’s redeployment and redundancy policies.

• Set out your reasons for saying the role is not suitable in writing, using any justification forms your Trust provides.

• Take advice from your union or an adviser who understands employment law in England and Wales.
  
  

What can I do if I don't want to take the alternative employment?

If you have been offered alternative employment—especially at a lower band—and you are unsure about accepting it, you usually have three broad options:

• Accept the role, possibly with questions or conditions (for example, asking for a trial period or reasonable adjustments).

• Refuse the role, explaining why you believe it is not suitable.

• Ask for more time and information, or for a work‑trial or redeployment search to continue while you think.

Practical steps:

• Read everything carefully. Go through the job description, person specification, offer letter and any redeployment paperwork line by line.

• List your concerns: pay, hours, travel, duties, health, caring responsibilities.

• Check the policy: see what your Trust’s organisational change and redeployment policies say about suitable alternative employment, work trials and justification forms.

• Put your position in writing. Use your Trust’s justification form if there is one, or send a clear email to HR setting out why you think the role is not suitable.

• Take advice before refusing outright. Refusing a role that is later judged suitable may affect redundancy pay or how a dismissal is viewed.

If you feel pressured to decide quickly, it is reasonable to ask for a short extension to get advice, especially where the consequences are serious.

NHS downbanding and pay protection

Many Trusts have pay protection policies that apply when staff are redeployed or downbanded. The detail varies, but common features include:

• A period (for example 2–3 years) where your pay is protected at or near your previous level.

• Protection of basic pay, but not always of enhancements (such as unsocial hours or overtime).

• Conditions that you must not unreasonably refuse future suitable alternative roles that better match your protected pay.

Questions to ask if pay protection is mentioned:

• Exactly what is being protected—basic pay only, or also enhancements?

• How long does protection last, and what happens when it ends?

• What does the policy say about future offers of employment and when protection might stop early?

• How will future national pay rises be applied during the protection period?

Always ask for the relevant section of the policy in writing and keep your own copy.

How to challenge NHS banding or downbanding

If you believe your role has been incorrectly banded or that a proposed downbanding is unfair, you usually have several options:

• Job evaluation review or appeal: Many Trusts allow you and your manager (or union) to request a re‑evaluation or review under Agenda for Change processes.

• Grievance: You can raise a formal grievance about how a process has been handled, including concerns about fairness or discrimination.

• Redeployment/redundancy appeal: Organisational change policies often include an appeal process relating to selection for redundancy or offers of suitable alternative employment.

• Legal advice: In more serious cases—where dismissal or significant financial loss is a risk—it may be appropriate to take tailored legal advice.

In all cases:

• Keep a timeline of key events.

• Save all letters, emails, notes from meetings and policy extracts.

• Record what you are told verbally as soon as possible afterwards.

Can you back out of a job offer after signing?

There are two different situations to think about:

• Internal redeployment within the same Trust: Once you accept a redeployment offer, it usually becomes part of your contract of employment. If you later change your mind before the start date, your employer may treat this as a resignation from the old role, or as you refusing suitable alternative employment. The consequences can affect your redundancy rights and how any notice is handled.

• External job offers (another Trust or employer): If you have signed a contract with a new employer, backing out may technically be a breach of contract, but in practice many employers simply treat it as a withdrawal before starting. The bigger risk is relationship and reputation, rather than legal action, although this can vary.

In both cases, before backing out of an offer you have accepted, it is wise to:

• Re‑read the offer and any conditional clauses (for example, pre‑employment checks, probationary periods).

• Check how your current employer is treating your situation—are you already on notice from your old post?

• Take advice from a union, HR or a legal adviser about the likely consequences.

Acas advice on demotion at work and how it applies in the NHS

ACAS (the Advisory, Conciliation and Arbitration Service) provides general guidance on demotion and contractual changes. Key themes from ACAS that are relevant to NHS staff include:

• Employers should not impose major changes, such as demotion, without consultation and a fair process.

• Demotion is often seen as a serious sanction, which should usually come at the end of a clear performance or disciplinary process.

• In redundancy situations, employers should make reasonable efforts to find suitable alternative employment and consult staff properly about it.

• If agreement cannot be reached, employers sometimes try to impose changes and give notice to terminate and re‑engage—a step that carries legal and reputational risks.

While NHS Trusts have their own detailed policies, tribunals and advisers often look to ACAS guidance when deciding if an employer has behaved reasonably.

Worked scenarios: what this can look like in real life

Here are two simplified scenarios to make these ideas more concrete.

Scenario 1 – Band 6 nurse offered Band 5 redeployment

A Band 6 ward nurse is told her role is at risk due to a service redesign. The Trust offers a Band 5 staff nurse post on another ward as suitable alternative employment, with two years of pay protection.

• She is worried about the status drop and different shift pattern, but the pay will initially stay similar.

• The redeployment policy says she must not unreasonably refuse a suitable role or she may lose redundancy rights.

• She decides to accept the Band 5 role but asks for a work‑trial period and written confirmation of pay protection and review points.

Scenario 2 – Band 4 admin offered lower‑band post with longer commute

A Band 4 administrator’s service is centralised. She is offered a Band 3 role in another town, requiring an extra 60–70 minutes travel each way, with minimal pay protection.

• She has caring responsibilities and a medical condition that makes long commutes difficult.

• She checks the redeployment policy, which gives an example of 45 minutes maximum extra travel as a guide.

• With union support, she submits a justification form explaining why the role is not suitable given her health and caring duties.

These examples are not templates but show the kind of factors that can be relevant when deciding whether a role is “suitable”.

Review checks before you accept, refuse or challenge a new role

Before you accept or refuse an alternative role, especially at a different band, it helps to work through some deliberate checks.

Review check 1 – Do you know exactly which policy applies?

• Is this being handled under organisational change/redundancy, capability, sickness/ill‑health or disciplinary procedures?

• Have you read the relevant policy for your Trust in England or Wales, not a generic or out‑of‑date version?

Review check 2 – Have you costed the short‑ and long‑term financial impact?

• What will your take‑home pay be in the new role now, and after any pay protection ends?

• How might changes in band and hours affect your NHS pension over time?

Review check 3 – Is your decision documented and supported?

• Have you written down your reasons for accepting or refusing a role, and kept copies of all forms and emails?

• Have you spoken to your union, HR or an independent adviser, and recorded their guidance?

If any of these answers are “no”, it may be worth pausing and getting more information before committing yourself.

Using Caira to review letters, policies and offers

Trying to read a thick redeployment policy or a long letter about “suitable alternative employment” when you are anxious is hard. That is where a specialist tool can help you break the documents down.

Caira is an AI‑powered, privacy‑first legal assistant for people dealing with legal and procedural questions in England and Wales. It can help you:

• Upload redeployment letters, organisational change packs, justification forms, job descriptions, pay‑protection policies and emails as PDFs, Word files, spreadsheets, photos or screenshots.
  
  

• Ask specific questions, such as “What happens if I refuse this lower‑band role?” or “Where does this policy talk about suitable alternative employment?” so you get clear, tailored answers in seconds.
  
  

• Generate draft emails to HR, questions for consultation meetings, notes for union discussions or bullet‑point summaries of complex documents, so you do not have to start from a blank page.
  
  

• Ask Caira to compare two documents side by side—for example two alternative job offers, or an old and new job description—and highlight what has really changed.

Under the surface, Caira reads both your uploaded documents and a large library of more than 10,000 legal and tax documents for England and Wales, and then uses generative AI to give context‑aware answers.