NHS On-Call Pay Explained: Availability Payments and Call-Outs

Many NHS services need staff available outside normal hours without being on site: theatre teams, radiographers, laboratory scientists, pharmacists, IT engineers, managers and many more. Being on call is different from working a shift, and it is paid differently too. Here is how it usually works for staff on Agenda for Change.

How on-call arrangements are set

Agenda for Change provides a national framework for on-call, but the detailed payment rates and rules are agreed locally by each employer with trade unions. That is why on-call pay can vary between trusts, even for similar roles. Your trust's on-call policy is the key document to read.

The two parts of on-call pay

Most arrangements pay for two different things:

1. Availability payment

You are paid for being available, even if you are not called. This is commonly worked out as:

• a percentage of your basic pay, linked to how often you are on call, or
• a set payment for each on-call period

How frequently you are on call, and whether you must be able to attend within a short time, usually affects the amount.

2. Pay for work done

When you are called, you are paid for the time you actually work, either at home or on site. This is usually paid:

• at overtime rates, time and a half, or double time on public holidays, for Bands 1 to 7, or
• as time off in lieu, if you prefer and your trust allows it

Travel time to and from the site is often included. Some trusts also have a minimum payment for each call-in.

A worked example

Suppose a Band 6 radiographer at entry (£20.44 an hour) is called in for three hours on a weekday night, and the trust pays call-outs at time and a half:

• 3 hours × £20.44 × 1.5 = £91.98, plus the availability payment for that night

At Band 6 entry, after tax at 20%, NI at 8% and no pension on overtime, they keep about £66. The overtime take-home calculator shows the after-tax value for your pay.

Rest after being called in

If you are called in during the night, you may not get enough rest before your next shift. Working time rules entitle you to 11 hours of rest in each 24-hour period, or compensatory rest where an exception applies. Many trusts let you start later the next day after a busy on-call night. See our working time rules guide.

On-call and pensions

Whether on-call payments are pensionable depends on the type of payment and your circumstances. Availability payments are often pensionable. Overtime for full-time staff usually is not. Check your payslip, which normally shows which payments are pensionable.

Band 8a and above

Senior staff often take part in management on-call rotas. Because overtime is not normally paid at enhanced rates from Band 8a, these arrangements usually focus on the availability payment and time off in lieu.

What to check in your trust's policy

1. How the availability payment is calculated
2. The rate for work done, and whether there is a minimum payment
3. Whether travel time counts
4. How rest after a call-in is handled
5. Whether time off in lieu can be taken instead of pay

Common questions

Is on-call the same as a shift? No. On a shift you are at work. On call, you are available to work if needed.

Do I get unsocial hours on top? Work done during on-call is usually paid under the on-call rules, not the unsocial hours enhancements. Check your local policy.

Can I refuse to be on call? It depends on your contract and job description. Raise concerns with your manager or union.

On-call and part-time staff

For part-time staff, work done during on-call is often paid at plain time until your total hours for the week reach the full-time equivalent of 37.5 hours. Only hours beyond that attract overtime rates, in line with the general Agenda for Change rules on additional hours.

Availability payments for part-time staff are usually based on the frequency of on-call commitments rather than contracted hours, but this depends on the local agreement. If you work part time and take part in an on-call rota, ask your manager or HR to confirm how both parts are calculated for you.

Work out what extra hours pay

Use the overtime take-home calculator to see what call-outs are worth after tax.