NHS sick pay

If you are on an NHS Agenda for Change contract, your sick pay depends on how long you have worked in the NHS. In your first year you get one month on full pay and, once you have four months’ service, two months on half pay. After five years’ service it reaches six months on full pay and six months on half pay. The scale is set out in Section 14 of the NHS Terms and Conditions of Service Handbook.

The sick pay scale

Length of NHS service	Full pay	Half pay
During 1st year	1 month	2 months (after 4 months’ service)
During 2nd year	2 months	2 months
During 3rd year	4 months	4 months
During 4th and 5th years	5 months	5 months
After 5 years	6 months	6 months

These are allowances over a rolling period, not per illness. When you go off sick, your employer looks at how much sick pay you have already had in the previous 12 months and takes that off your allowance. So if you have five years’ service and had two months off on full pay last winter, a new absence starts with four months of full pay left.

Service in other NHS organisations normally counts as reckonable service, so moving between trusts does not reset you to the first-year scale. The rules on what counts, and on breaks between NHS jobs, are in the handbook. Check with HR before you move if sick pay is a concern, especially if you have a long-term condition.

Full pay and half pay in practice

“Full pay” means the pay you would normally have received, so it reflects your band and pay point (see Agenda for Change pay bands). The handbook also has rules about whether regular unsocial hours payments are included, and your payroll team can tell you how your figure was worked out.

Statutory Sick Pay is not paid on top. It is counted within your NHS sick pay. During half pay, your half pay plus SSP should not come to more than full pay. Once both full and half pay are used up, you may still be getting Statutory Sick Pay of £123.25 a week (or 80 per cent of your average earnings if lower) until your 28 weeks of SSP run out.

Your pension contributions continue on the pay you actually receive. If your pay drops to half pay or to nil, your contributions fall too. The NHS Pension Scheme has rules on how periods of reduced or nil pay affect your pension, and NHSBSA or your pensions officer can explain them for your case.

Reporting sickness and fit notes

Your trust’s sickness absence policy sets out when and how to report sickness, often by phoning your manager before your shift. You can self-certify for the first 7 calendar days. After that you need a fit note, which can come from a doctor, nurse, occupational therapist, pharmacist or physiotherapist.

If a fit note says you “may be fit for work” with changes, such as reduced hours or lighter duties, your manager should discuss whether those can be made. If they can, you return on adjusted duties. If they cannot, you stay off sick and the note is treated as if it said you are not fit.

Absence management

Every NHS employer has a sickness absence policy with review meetings, usually triggered by a number of spells or days off in a set period. The triggers are local, not national, so they differ between trusts. Meetings are meant to look at support: occupational health referrals, a phased return, adjustments for a disability, or redeployment. Repeated or long absence can eventually lead to formal stages and, in some cases, dismissal on capability grounds.

You have the right to be accompanied by a colleague or union rep at formal meetings. If your sickness is linked to a disability, the Equality Act 2010 requires the employer to consider reasonable adjustments, which may include discounting some disability-related absence. Our guide to reasonable adjustments at work explains how to ask.

Injury at work and long-term ill health

If your illness or injury was caused by your NHS work, the handbook has a separate injury allowance that tops up your income during sick leave on reduced pay or no pay, subject to conditions. Ask HR whether it applies.

If you cannot go back to work because of ill health, the NHS Pension Scheme may pay early benefits. See ill-health retirement for how that is assessed.

Scotland, Wales and Northern Ireland

Agenda for Change applies across all four nations, and the sick pay scale is broadly the same. Each nation can agree its own changes, though, and NHS Scotland boards publish their own policies under the Once for Scotland approach. If you work outside England, read your board or trust policy, and your union rep (RCN, UNISON, Unite, GMB and others) can confirm the local position.