NHS Bank, Agency or Permanent: Which Pays Best?

Many NHS staff work in more than one way: a permanent post, extra shifts on the staff bank, or agency work. Each has a place, but comparing them on hourly rate alone is misleading. This guide shows how to compare them fairly, using a full-time Band 5 as the example.

Permanent (substantive) posts

A permanent post on Band 5 entry pays £32,073 a year, or £16.40 an hour on the standard NHS calculation. But the hourly rate hides most of the value. You also get:

• paid annual leave and public holidays: 35 days a year to start, rising to 41
• the NHS Pension employer contribution: 23.7% of pensionable pay, which is about £7,600 a year on Band 5 entry
• NHS sick pay: up to six months of full pay and six months of half pay after five years
• enhanced maternity, paternity and adoption pay
• pay progression and annual pay awards
• unsocial hours enhancements for nights and weekends

Working out the true hourly value

Here is a simple way to compare a permanent post with hourly work:

1. Hours actually worked a year. A full-time year is 52.143 weeks of 37.5 hours, which is about 1,955 hours. Take off 35 days of leave and public holidays at 7.5 hours each, which is 262.5 hours. That leaves about 1,693 hours worked.
2. Salary per hour worked. £32,073 divided by 1,693 is about £18.95.
3. Add the employer pension. £32,073 plus £7,601 is £39,674, which divided by 1,693 is about £23.44 an hour worked.

And that is before sick pay, family leave pay and progression, which are hard to put a single figure on but are worth a lot.

Staff bank

The staff bank is the NHS's own flexible workforce. Bank shifts are usually paid at the hourly rate of the band, and many trusts:

• add holiday pay on top, often about 12.07% of hours worked, or pay it as accrued leave
• pay unsocial hours enhancements, or use a flat enhanced rate for certain shifts
• allow bank workers to join the NHS Pension

With 12.07% holiday pay, a Band 5 bank hour at entry is about £18.38. That is a little below the £18.95 a permanent employee gets per hour worked, and much less once the pension is included, unless the bank worker is in the NHS Pension too. Rules vary a lot between trusts, so check your bank's terms.

Working bank shifts on top of a permanent post can be a good way to earn extra. For tax, bank pay is added to your main pay, and if the bank is treated as a second job it may have a BR tax code. Our bank tax guide explains it.

Agency work

Agency rates are often higher per hour, but:

• many agency workers are paid through an umbrella company, which deducts employer National Insurance, the apprenticeship levy and its own fee from the headline rate
• there is no NHS Pension, and the agency's pension contribution is usually the auto-enrolment minimum of 3% of qualifying earnings
• sick pay is usually Statutory Sick Pay only
• holiday pay may be "rolled up" into the hourly rate, so you must save for time off yourself
• NHS England sets price caps on what trusts pay agencies, and many trusts are reducing their use of agency staff

A headline agency rate of £30 an hour, after umbrella deductions and holiday pay, can end up close to the bank rate in real terms, and below the value of a permanent post once the pension is included.

Which is right for you?

• Permanent gives the most security and the best long-term value, especially for pension and family leave.
• Bank gives flexibility and extra income, and can come with NHS Pension membership.
• Agency can make sense for short periods or specialist shortage areas, but compare carefully.

Common questions

Can I work bank shifts while on sick leave? No. Working elsewhere while off sick is normally a disciplinary matter.

Does bank work count towards my pension? It can, if you are in the NHS Pension for your bank assignment.

Are bank shifts paid at my band's top point? Usually the bank pays the band rate set by the trust, which may not match your substantive pay point.

Compare hourly rates

The hourly rate calculator shows the NHS hourly rate for any band and step, and the overtime take-home calculator shows what extra hours are worth after tax.