Guide to London NHS pay (Agenda for Change) 2021/2022

Published on: 10 Feb 2022


Agenda for Change, the pay scale for most NHS staff including nurses, occupational therapists and psychologists, includes additional payments, called the high cost area supplement (HCAS), intended to compensate staff for the additional costs of living in London and the surrounding areas.

There are three separate bands: Inner, Outer and Fringe. The supplements are applied as a percentage of basic salary as follows: inner (+20%); outer (+15%); and fringe (+5%). The calculation includes the basic AfC salary plus any long-term recruitment and retention premium, subject to a minimum and maximum level of extra pay.

The HCAS is pensionable but does not count as basic pay for the purposes of calculating the rate of overtime payments, unsocial hours payments, on-call availability payments or any other payment, excluding sick pay.

The value of the supplement is reviewed annually, based on the recommendations of the NHS Pay Review Body (NHSPRB).

The inner, outer and fringe zones are based on 2005 primary care trust (PCT) geographical boundaries as follows:

Inner London includes 11 PCTs (Hammersmith & Fulham; Kensington & Chelsea; Westminster; Camden; Islington; City & Hackney; Tower Hamlets; Lambeth; Lewisham; Southwark; and Wandsworth)

Outer London includes 20 PCTs (Brent; Ealing; Harrow; Hillingdon; Hounslow; Barnet; Enfield; Haringey; Barking & Dagenham; Havering; Newham; Redbridge; Waltham Forrest; Bexley; Bromley; Greenwich; Croydon; Kingston; Richmond & Twickenham; and Sutton & Merton)

Fringe includes 22 PCTs (Dartford, Gravesham & Swanley; Basildon; Billericay, Brentwood & Wickford; Epping Forest; Harlow; Thurrock; Dacorum; Hertsmere; Royston, Buntingford & Bishop Stortford; South East Hertfordshire; St Albans & Harpendon; Watford & Three Rivers; Welwyn, Hatfield; Bracknell Forest; Slough; Windsor, Ascot & Maidenhead; Wokingham; East Elmbridge & Mid Surrey; East Surrey; Guildford & Waverley; North Surrey; and Surrey Heath and Woking)

Employers who employ staff in more than one high cost area zone may agree locally a harmonised rate of payment across their organisation.

The tables below showAfC pay bands for annual salaries and hourly rates in London. Staff working outside London and some surrounding areas receive the basic AfC pay rates. Details of basic AfC pay scales can be found here.

Table 1

Table 2

The AFC pay scale includes minimum periods before staff are eligible to move to higher pay points within each band. These are shown in the table below.

Table 3


1 - NHS Terms and Conditions Handbook, 13 September 2021, (accessed 3 February 2022)

2 - NHS terms and conditions pay poster 2021/22, 29 July 2021. NHS Employers. (accessed 3 February 2022)