The NHS terms and conditions handbook: national and local rules

The NHS Terms and Conditions of Service Handbook is the document that sets national pay and conditions for Agenda for Change staff. It fixes some things for everyone, such as pay bands, annual leave entitlements and sick pay, and it explicitly hands other things to each employer to agree locally. Knowing which is which shows you where to look for an answer about your own job.

Who it covers

The handbook says its terms apply in full to all staff directly employed by NHS organisations, except very senior managers and staff within the remit of the Doctors’ and Dentists’ Review Body. NHS organisations include health and social care organisations in Northern Ireland.

The list of employers at Annex 1 differs by country. In England it includes NHS trusts and foundation trusts, integrated care boards, NHS England, NICE, the Health Research Authority, NHS Blood and Transplant, the NHS Business Services Authority, NHS Counter Fraud Authority, NHS Resolution and the Health Services Safety Investigations Body. Northern Ireland, Scotland and Wales have their own lists. The NHS trusts guide explains the different kinds of employer.

How it is kept up to date

The handbook is published on the NHS Employers website and is amended whenever the NHS Staff Council agrees changes. Amendments come in numbered circulars, and the title page shows the latest amendment. The version used for this guide is amendment 63, published on 1 October 2026. Some sections and annexes apply only to specific countries, and the handbook marks them in brackets after the title.

Four nations

The Agenda for Change system covers the whole of the UK, but individual countries can agree amendments to suit themselves. The handbook includes separate versions of several sections for England, Wales, Scotland and Northern Ireland, including pay structure, round-the-clock services, career progression, sickness absence and redundancy. Scotland publishes its own version of the handbook, which also points to Partnership Information Network policies.

That is why a leave entitlement, sick pay rule or banding detail you read about for one country may not match your own. The guide to health services in Scotland, Wales and Northern Ireland explains the wider differences.

What is national

Examples of terms the handbook sets out directly include:

• the pay bands and how jobs are placed in them through the NHS Job Evaluation Scheme, covered in the pay bands guide
• pay progression standards in England, in Annex 23
• annual leave and public holidays in Section 13, covered in the NHS annual leave entitlement guide
• sickness absence, new parent leave and redundancy pay in their own sections
• flexible working principles in Section 33 and the employment break scheme in Section 34
• national protocols for resolving some disagreements, such as job evaluation reviews.

All NHS employers must also follow employment and tax law and other statutory provisions, and the handbook says so in its opening principles.

What is local

Section 19 says other terms and conditions not covered in the handbook are determined and agreed locally in partnership with staff representatives. The examples it gives are:

• arrangements for carrying over annual leave
• special leave
• removal expenses and related provisions
• the resolution of disciplinary matters and disputes procedures
• protection of pay and conditions, for example after organisational change or redeployment due to a work-related injury
• notice periods where they differ from statutory minimums.

Local terms should apply to all staff groups unless there are significant, justifiable reasons not to, in line with equal pay for work of equal value. If local partners cannot agree, any existing contractual arrangements apply. The handbook also asks employers and trade unions to work in partnership at local level to apply the pay system, which is why so many policies are agreed jointly.

You can see the effect in other guides on this site. Carry-over is covered in the annual leave carry-over guide, and discipline in the NHS disciplinary guide. In both, the national handbook says little and your trust’s policy decides.

Disagreements about the agreement

The NHS Staff Council can be consulted on interpretation where an issue has wider applicability. Locally, employers and unions agree a procedure for resolving differences. The handbook’s local appeals procedure is the model, which the NHS grievances and local appeals guide describes.

The handbook and your contract

The handbook is the national agreement, and your own contract and written statement of main terms are what your employer gave you. The employment contract guide explains what a contract should include. If the two seem to disagree, ask HR to point to the clause or policy relied on, and take advice from a union representative before assuming either is wrong.

What to check

• Which version of the handbook applies in your country.
• Whether your question is covered nationally or is listed among the locally agreed terms.
• Your trust’s policy on that subject, and its date.
• Your written statement of main terms, for anything specific to your job.
• Whether a trade union represents staff at your employer, since unions are involved in agreeing local terms.