NHS on-call pay: availability payments and call-outs

There is no national NHS on-call rate. The handbook says an employee who is on-call is entitled to an on-call payment, set by local agreement and consistent with 12 principles. What you are paid depends on your trust or board, so the only way to know your rate is to ask where you work.

The handbook figures here are from version 63. The principles come from the Staff Council on-call guidance (updated November 2024), and the full annex text was not available in the version read, so your employer or union rep should confirm the detail.

What counts as on-call

The handbook says you are on-call when, as part of an established arrangement with your employer, you are available outside your normal working hours, at the workplace, at home or elsewhere, to work as and when required. The Staff Council guidance names three types of availability: at home, ready to be called out or to work at the workplace; at work, ready to undertake work; and sleeping in at a workplace. Sleep-ins have their own page in our guide to NHS sleep-in pay.

How the availability payment is set

Local partnerships choose the method. The guidance lists a flat rate for all staff, a flat rate by band, or a percentage of salary. The payment should reflect how often you are on-call, and take account of weekend and public holiday commitments. Frequency is described in defined periods, such as one in nine. The guidance also says there should be no distinction between tiers of on-call.

Work done while on-call

When you are called out, the work, including work at home or by telephone, is paid at the appropriate hourly rate under the handbook. Local partnerships may agree a minimum payment period. If you are available at home and have to go to the workplace, travel time is paid at the rate agreed for on-call work, and local partnerships may set a minimum or maximum claim. Expenses are covered under Section 17.

You can also ask for time off in lieu instead of payment for work done, and the guidance says that must be a genuine choice.

Rest, working time and public holidays

Compensatory rest applies to work done under the working time rules in Section 27. On-call staff count as working from the time they are required to undertake work-related activity. Time on-call that you are free to use as your own does not count as working time.

If you cover a public holiday on-call, you get a day in lieu whether or not you were called out. Work you do on that day is paid at the appropriate rates. See NHS bank holiday pay.

Not both on-call and unsocial hours for the same hours

Staff cannot be paid unsocial hours payments and on-call payments for the same hours of work. Unsocial hours payments are also left out when on-call payments are calculated. The NHS unsocial hours pay guide sets out the standard rates, and the overtime guide covers work above 37.5 hours.

Old interim percentages that may still apply locally

Before 1 April 2011, an interim arrangement paid an availability enhancement as a percentage of basic pay, by how often you were on-call. These are historical. The guidance says the principles are consistent with them, and some employers, for example parts of the ambulance service, may still use them, but only your employer can say.

How often on-call	Historical percentage of basic pay
1 in 3 or more often	9.5%
1 in 6 up to less than 1 in 3	4.5%
1 in 9 up to less than 1 in 6	3%
1 in 12 up to less than 1 in 9	2%

Under that old text, call-out work was paid for time attended, including travel, at time and a half, with double time on general public holidays and time off in lieu at plain time.

Pension

According to NHSBSA, on-call availability payments where there is a specific rota commitment are pensionable, whole-time or part-time. Additional on-call hours worked are not pensionable for whole-time staff. For part-time staff, additional on-call hours up to whole time are pensionable at the basic rate, and hours above whole time are not. See unsocial hours and your pension for related rules.

What to check with your employer

Ask for the local on-call agreement in writing. Find out which method sets your availability payment, how often you are on the rota, the minimum payment period for call-outs, and how travel time is paid. Ask how compensatory rest is arranged after a night call-out, and whether time off in lieu is offered. In Scotland, on-call arrangements are set out in circular PCS(AFC)2015/3, so ask your board for it. Your union rep can compare your terms with other trusts.