Nursing Careers UK

NHS pay · Adult Nurse

Band 4 adult nurse salary

A band 4 adult nurse in England earns £28,392 to £31,157 a year on the 2026/27 Agenda for Change scale. Adult Nurses normally enter the profession at band 5, so a band 4 post in this field is more often an assistant, trainee or support role than a registered adult nurse post — check the job description before you apply. The other UK nations publish their own figures for this band and they do not match; all of them are below, each with its own pay year.

Pay year 2026/27Newly qualified
£28,392 Starting salary England, 2026/27, basic pay
£31,157 Top of the band Reached after 3 years in the band
£34,186 Inner London starting salary Calculated: basic pay plus 20% high cost area supplement
4 Nations publishing this band England, Northern Ireland, Scotland and Wales

Band 4 pay points, nation by nation

Annual full-time basic pay as published in each nation's Agenda for Change circular. The pay year differs between nations and is stated on every row — never read one nation's figure as a proxy for another's.

Band 4 adult nurse annual pay by nation
Nation Pay year Entry Top Top of band
England 2026/27 £28,392 £31,157 £31,157
Northern Ireland 2025/26 £27,485 £30,162 £30,162
Scotland 2026/27 £31,537 £34,303 £34,303
Wales 2026/27 £28,819 £31,626 £31,626

Agenda for Change scales are uplifted each April. The awards applied to these scales were 3.3% in England for 2026/27, 3.6% in Northern Ireland for 2025/26, 3.75% in Scotland for 2026/27 and 3.3% in Wales for 2026/27.

Band 4 in and around London

Posts in the London zones attract a high cost area supplement on top of basic pay. The figures below are calculated by this site, not published as a scale: they are the England band 4 range for 2026/27 plus the published supplement for each zone, with the published cash floor and ceiling applied.

Band 4 adult nurse with high cost area supplements — calculated
Zone Supplement Floor and cap Starting Top of band
Outside the zones None None £28,392 £31,157
Inner London 20% £5,794–£8,746 £34,186 £37,388
Outer London 15% £4,870–£6,137 £33,262 £36,027
Fringe 5% £1,346–£2,270 £29,812 £32,715

How this is worked out: supplement = 20% (Inner London), 15% (Outer London) and 5% (Fringe) of basic pay, then floored at the published minimum and capped at the published maximum for the zone, then added to basic pay and rounded to the pound. At this band it is the Inner London minimum at the bottom of the band and the Outer London minimum at the bottom of the band, rather than the percentage, that sets the supplement, so multiplying basic pay by the percentage alone will not reproduce these figures. Supplement values are for 2026/27 and apply in England only; Scotland, Wales and Northern Ireland have no equivalent zone system. The supplement is pensionable and is paid on basic salary alone.

What a band 4 adult nurse actually does

Band 4 is set by national job evaluation of the post rather than by the employer, so the responsibilities attached to it are consistent across the NHS even though the service around them is not.

The setting changes the job more than the band does. Adult Nurses work in NHS acute trust wards, outpatient clinics, patients' homes, community health teams and GP practices, and a band 4 post in one of those looks very different from a band 4 post in another — same evaluation, same money, different week. When you compare two adverts at this band, the questions that separate them are the caseload mix, the rota, and whether the service is staffed to establishment.

Adult nurses assess, plan, deliver and evaluate care for adults of all ages, from young adults to older people, across conditions ranging from heart disease and diabetes to cancer and traumatic injury. They build trusting relationships with patients and families while working in multidisciplinary teams alongside occupational therapists, pharmacists, radiographers and healthcare assistants. Adult nursing is the largest field of nursing practice on the NMC register, and adult nurses work across hospital wards, outpatient clinics, patients' homes and community settings.

Getting to band 4

Band 4 posts are filled by open competition. There is no automatic progression between bands: you apply for the post when it is advertised.

Note that adult nurses normally enter the profession at band 5, above this one, so a band 4 post in this service is more likely to be a support or assistant role than a registered adult nurse post. Check the job description and whether registration is required before you apply.

One thing worth planning around: basic pay is not the whole payslip. Unsocial hours enhancements for nights, weekends and bank holidays, and on-call availability payments, are paid on top where the service runs them, and they can separate two band 4 posts advertised at identical salaries. The NHS pension — a defined benefit career-average scheme with a substantial employer contribution — comes off before you see it and is genuinely part of what the post pays.

Profession
Adult Nurse
Band
Band 4
Career stage
Newly qualified
Pay year shown
2025/26 and 2026/27
Pay points in the band
2
Years to the top of the band
3
Usual entry band for this profession
Band 5
Effective from
1 April 2026
Uplifted
Each April, nation by nation

Neighbouring bands

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Where this page’s data comes from

Band figures are the numeric annual rates published in each nation's Agenda for Change circular; the London-weighted figures are calculated by this site from those rates and the published high cost area supplement percentages, floors and caps.