NHS Agenda for Change sick pay is one of the most generous occupational sick pay schemes in the UK. Entitlement depends on your length of service and follows a three-phase structure: full pay, half pay, then Statutory Sick Pay only.
Sick Pay Entitlement by Service Length
| Length of NHS Service | Full Pay | Half Pay | Total Paid Absence |
|---|---|---|---|
| During first year | 1 month | 2 months | 3 months |
| During second year | 2 months | 2 months | 4 months |
| During third year | 4 months | 4 months | 8 months |
| 4th and 5th year | 5 months | 5 months | 10 months |
| After 5 years | 6 months | 6 months | 12 months |
Service is continuous NHS service — it doesn't reset if you move between trusts or health boards.
The Three Phases of NHS Sick Pay
Phase 1 — Full Pay: You receive your normal salary including any regular enhancements, High Cost Area Supplement, and other standard payments. Your pension contributions continue as normal.
Phase 2 — Half Pay: You receive 50% of your normal salary. Pension contributions are based on your notional full-time pay (not the reduced amount), which protects your pension accrual. You can top up with SSP if eligible.
Phase 3 — SSP Only: Once your occupational sick pay entitlement is exhausted, you fall to Statutory Sick Pay (£116.75/week in 2026/27 — approximately £506/month). If you've also exhausted SSP (maximum 28 weeks), you may be eligible for Employment and Support Allowance (ESA) or Universal Credit.
Your half pay plus SSP cannot exceed your normal full pay.
The Rolling 12-Month Rule
NHS sick pay operates on a rolling 12-month basis — not a calendar year or a fixed annual allowance. This means:
• Your entitlement is calculated by looking back 12 months from your current sick date
• Any sick days taken in the previous 12 months reduce your remaining entitlement
• Once you've used (for example) 3 months of full pay in the last 12 months, you cannot access more full pay until those earlier absences "drop off" the 12-month window
This is one of the most commonly misunderstood aspects of NHS sick pay. It's not "6 months per year" — it's "6 months in any rolling 12-month period".
⚠️Rolling Period Example — If you were off sick for 3 months (January–March 2026), then returned to work, and then went off sick again in October 2026, you would only have 3 months of full pay remaining (not a fresh 6 months) because the January–March absence is still within the 12-month lookback window. From April 2027, those earlier months drop off and your entitlement resets.
What Counts as "Full Pay" During Sickness?
During full-pay sickness, you receive what you would have earned if you'd been at work, including:
• Basic salary
• High Cost Area Supplements (Inner/Outer/Fringe London)
• Recruitment and retention premiums
• Long-term regular overtime (if it would have been worked)
However, ad hoc overtime, bank shifts, and occasional enhancements are typically NOT included in sick pay calculations. Only regular, contractual payments are counted.
Sick Pay and Your Pension
During both full-pay and half-pay phases, your pension contributions and accrual are protected:
• Full pay: Pension contributions deducted as normal from your full salary
• Half pay: Contributions are based on your "assumed pensionable pay" (what you would have earned), not the reduced amount. You pay the employee contribution on the reduced amount, and the shortfall is covered by the scheme
• SSP only: You can choose to continue pension membership. If you do, contributions are based on assumed pensionable pay. If you don't, you get a "break" in pension accrual for that period
This pension protection during sickness is another significant benefit of NHS employment.
Fit Notes and Return to Work
For absences of 7 days or fewer, you can self-certify. For absences longer than 7 days, you need a fit note (formerly "sick note") from your GP or hospital doctor.
Your trust's sickness absence policy will typically require:
• Day 1: Notify your line manager
• Day 7+: Provide a fit note
• Regular contact during absence (frequency varies by trust)
• Return-to-work interview with your manager
• Possible Occupational Health referral for longer absences
• Formal review meetings if absence triggers policy thresholds
Phased Return and Reasonable Adjustments
If you're returning from a long absence, your trust should consider:
• Phased return: Temporarily reduced hours at full pay (usually 4–6 weeks)
• Adjusted duties: Modified role or reduced physical demands
• Workplace adjustments: Equipment, scheduling, or environmental changes
• Occupational Health support: Ongoing assessment and recommendations
Under the Equality Act 2010, if your condition qualifies as a disability, your employer has a legal duty to make reasonable adjustments. This applies even if the condition isn't permanent — conditions expected to last 12 months or more are typically covered.
Statutory Sick Pay Rates 2026/27
Once occupational sick pay is exhausted:
| Provision | Amount | Notes |
|---|---|---|
| SSP weekly rate | £116.75/week | ~£506/month |
| SSP duration | Up to 28 weeks | From first qualifying day |
| Qualifying earnings | £123/week minimum | You must earn this to qualify |
| Waiting days | 3 days | SSP starts from 4th day of absence |
SSP is offset against occupational half pay — your half pay + SSP cannot exceed your normal full pay.
Long-Term Sickness and Ill-Health Retirement
If you're unable to return to work due to permanent ill health, you may be eligible for ill-health retirement through the NHS Pension Scheme. There are two tiers:
• Tier 1: You're permanently unable to do your current NHS role (but could do other work). Pension based on accrued benefits only, payable immediately.
• Tier 2: You're permanently unable to do any regular employment. Pension based on accrued benefits PLUS a proportion of prospective service to your Normal Pension Age.
Ill-health retirement must be supported by medical evidence and approved by NHS Pensions. Occupational Health will assess your case and make a recommendation.