The NHS sick pay scheme, governed by Section 14 of the Agenda for Change handbook, is widely considered one of the most supportive occupational health benefits in the UK. However, the way it scales based on your years of service, and the eventual cliff edge where pay drops from full to half, requires careful understanding.
As we move through the 2026/27 financial year, it is vital to understand how your sick pay interacts with the latest 3.3% pay award and what happens to your NHS Pension if you are away from work for an extended period. This guide provides a deep-dive into the mechanics of the scheme to help you manage your financial security during times of ill health.
The Scaling Entitlement Based on Service
Unlike many private sector roles where sick pay is a flat rate from day one, the NHS scheme rewards longevity. Your entitlement to full pay and half pay increases at specific milestones in your career. It is important to note that these entitlements are calculated based on a rolling 12-month period, meaning any sickness taken in the 12 months prior to your current absence will be deducted from your total allowance.
For staff during their first year of service, the entitlement is relatively modest: one month of full pay followed by two months of half pay. This quickly scales. By the time you reach your second year, you are entitled to two months of full pay and two months of half pay. This progression continues until you have completed five years of service, at which point you reach the maximum entitlement: six months of full pay followed by six months of half pay.
This 6 and 6 protection is a cornerstone of NHS employment, providing a significant safety net for those facing serious, long-term health challenges.
Defining Full Pay and Half Pay
A common misconception is that full pay is simply your basic salary. In reality, your sick pay is calculated based on what you would have logically earned had you been at work.
- Full Pay: This includes your basic salary, inclusive of the 2026/27 3.3% rise, any High Cost Area Supplements, and regular recruitment and retention premia.
- Enhancements: For many staff, a significant portion of their income comes from unsocial hours. Under the AfC terms, these enhancements are generally included in your sick pay calculation if you are a lower-banded staff member, Bands 1 to 3. For staff in Bands 4 to 9, sick pay is typically based on basic salary plus HCAS only, unless local Trust policies state otherwise.
- Half Pay: This is simply 50% of your full pay calculation. However, it is important to remember that you also receive Statutory Sick Pay during this time. The NHS will top up your pay so that the combination of half-pay and Statutory Sick Pay does not exceed your normal full-pay figure.
The Impact on Your NHS Pension
Being on sick leave has a specific impact on how your CARE pension pot builds up. Under the rules of the 2015 Scheme, if you are on paid sick leave, either full or half pay, your pension continues to build up as if you were at work on your normal full salary.
However, your contributions are only taken based on the pay you actually receive. This is a major benefit for NHS staff. If you are on half-pay, you are effectively getting full pension growth for half the cost. If your sick leave extends into an unpaid period, after 12 months of absence, your pension buildup will stop unless you make arrangements to pay the contributions for that gap upon your return.
The Injury Allowance
If your illness or injury was caused specifically by your work, for example a needle-stick injury, a manual handling incident, or work-related psychological distress, you may be eligible for the NHS Injury Allowance.
This is a separate payment intended to top up your income to 85% of your normal pay if your sick pay has already dropped to half-pay or has run out entirely. To qualify, you must provide clear medical evidence that the injury or disease was wholly or mainly attributable to your NHS employment. This allowance is limited to a period of 12 months per episode and is a vital protection for those working in high-risk clinical environments.
Returning to Work and Phased Returns
When recovering from a long-term illness, many Trusts offer a phased return to work. This usually involves working reduced hours for a period of four to six weeks while receiving your full pay.
It is important to coordinate this with your HR department and Occupational Health. Usually, the pay for a phased return is managed by using the remainder of your full-pay sick entitlement. If you have already exhausted your full-pay sick leave, you may be required to use annual leave or accept half-pay for the hours you are not yet working.
Monitoring Your Status with the Calculator
When you are on long-term sick leave, your tax and National Insurance situation changes. Because your gross income for the year will be lower, you may find that you have overpaid tax in the earlier months of the year.
Use our Full NHS Pay Calculator to model your income. By selecting your band and adjusting for half pay, you can see exactly how your take-home pay is affected by the shift in pension tiers and the lower tax burden. This helps you plan your household budget more effectively until you are ready to return to your substantive role.
Related guides: Review NHS Unsocial Hours, check contract rules in NHS Agenda For Change, and compare deductions on the NHS Pay Calculator.