NHS Band 9 Pay 2026/27 — Executive Director Salary, Take-Home Pay & Taxes
Complete salary data for NHS Agenda for Change Band 9 from April 2026. All three spine points with real take-home after tax, NI and 14.5% pension. Personal allowance taper at ceiling, 60% marginal rate analysis, AVC strategy, and what lies beyond Band 9 in NHS pay.
Band 9 — The Top of Agenda for Change and Where the Tax System Gets Genuinely Punishing
Band 9 is the highest grade in the NHS Agenda for Change pay framework. Above it lies a different world entirely — Very Senior Manager (VSM) pay arrangements for NHS trust CEOs and executive chairs, medical consultant pay scales outside AfC, and bespoke contracts for senior NHS England and NHSE system leaders. Band 9 sits at the boundary between the structured AfC system that governs the vast majority of NHS employees and the unstructured world of executive pay beyond it.
From 1 April 2026, Band 9 runs from £105,385 to £121,271 following the 3.6% consolidated pay award. Three spine points span this range. Monthly take-home at entry is approximately £5,280 — but this figure assumes no personal allowance taper activation. At ceiling (£121,271), the 14.5% pension contribution reduces adjusted net income to approximately £103,587 — crossing the £100,000 taper threshold and triggering the 60% effective marginal rate on approximately £3,587 of income. This is the first AfC band where the personal allowance taper is unavoidably active at ceiling in most circumstances.
Entry salary 2026/27
£105,385
↑ 3.6% from £101,719 in 2025/26
Ceiling salary 2026/27
£121,271
Personal allowance taper active
NHS pension tier
14.5%
All three spine points
Effective marginal rate (ceiling)
~55%
60% on £3,587 above £100k taper
Band 9 Spine Points — Salary, Adjusted Net Income & Personal Allowance Status
Band 9 has three spine points. All attract the 14.5% NHS pension tier — the highest contribution rate in the scheme, applicable to all salary above £89,004. The pension contribution is significant (£1,228–£1,468/month) but also provides the primary defence against the personal allowance taper: by reducing adjusted net income, the pension keeps points 1 and 2 below the £100,000 threshold, while the ceiling point crosses it by a narrow margin.
Spine point
Annual gross
Annual pension (14.5%)
Adjusted net income
PA taper active?
Monthly take-home
Point 1 — entry
£105,385
£15,281
£90,104
No — below £100k
£5,280
Point 2
£113,328
£16,433
£96,895
No — below £100k
£5,588
Point 3 — ceiling
£121,271
£17,584
£103,687
Yes — £3,687 above £100k
£5,886
Points 1 and 2 are highlighted because the 14.5% pension contribution keeps their adjusted net income below £100,000 — avoiding the personal allowance taper. At point 3 (ceiling), adjusted net income of £103,687 crosses the threshold by £3,687. The taper reduces the personal allowance by £1 for every £2 above £100,000 — so £3,687 of excess halves to £1,844 in allowance lost, worth £738 in additional income tax (at 40% on the £1,844). This is a relatively modest taper impact at ceiling compared to Band 9 staff with London weighting or additional income, where the taper zone is much wider.
Full Monthly Deductions at All Three Band 9 Spine Points
At Band 9, the combination of 14.5% pension, 40% income tax on the majority of salary, and the personal allowance taper at ceiling creates the most complex payslip in the AfC scale. The table below shows the complete deduction picture at each spine point for an England/Wales-based Band 9 post-holder with no student loan.
Component
Point 1 (£105,385)
Point 2 (£113,328)
Point 3/ceiling (£121,271)
Gross salary
£8,782/mo
£9,444/mo
£10,106/mo
NHS Pension (14.5%)
−£1,273/mo
−£1,369/mo
−£1,465/mo
Taxable income after pension
£7,509/mo
£8,075/mo
£8,641/mo
Personal allowance
£12,570/yr (full)
£12,570/yr (full)
£10,726/yr (tapered by £1,844)
Income tax
−£2,048/mo
−£2,278/mo
−£2,570/mo
National Insurance
−£181/mo
−£209/mo
−£185/mo
Monthly take-home
£5,280
£5,588
£5,886
Gross-to-net conversion
60.1%
59.2%
58.3%
Employer pension (23.7%)
+£24,977/yr
+£26,859/yr
+£28,741/yr
NI at point 3 (£185/mo) is lower than at point 2 (£209/mo) despite higher gross salary — because NI above the upper earnings limit (£50,270) is charged at only 2%, while NI between £12,570 and £50,270 is 8%. As the salary rises above £50,270 and an ever-larger proportion attracts the 2% rate, the total NI monthly amount grows very slowly relative to gross. This is why gross-to-net conversion at Band 9 is predominantly driven by income tax and pension rather than NI — NI becomes almost negligible as a factor at these salary levels.
Band 9 Pay: 2025/26 vs 2026/27
Spine point
Gross 2025/26
Gross 2026/27
Take-home 2025/26
Take-home 2026/27
Net gain/month
Point 1 (entry)
£101,719
£105,385
£5,132
£5,280
+£148
Point 2
£109,411
£113,328
£5,435
£5,588
+£153
Point 3 (ceiling)
£117,100
£121,271
£5,722
£5,886
+£164
The 3.6% gross award produces the highest absolute net gain in the AfC scale at Band 9 — £148–164/month depending on spine point. The ceiling point generates the highest net gain despite the personal allowance taper activation because the taper effect (£738 additional tax per year / £62/month) is modest relative to the overall gross uplift of £4,171/year. The net conversion of the 3.6% gross award at Band 9 ceiling is approximately 47% — less than half the gross increment reaches take-home, with the remainder absorbed by 40% income tax, 14.5% pension, and the taper charge.
The Personal Allowance Taper at Band 9 — Exact Impact by Scenario
The personal allowance taper creates a 60% effective marginal rate on income between £100,000 and £125,140 of adjusted net income. At Band 9 ceiling in standard circumstances, only £3,687 of adjusted net income falls within this zone — limiting the taper impact. But for Band 9 staff with London weighting, enhancement income, or other earnings, the zone widens significantly.
Scenario
Total gross
Pension (14.5%)
Adjusted net income
Amount in 60% zone
Extra tax from taper
Point 1, no London
£105,385
£15,281
£90,104
£0
£0
Point 2, no London
£113,328
£16,433
£96,895
£0
£0
Point 3, no London
£121,271
£17,584
£103,687
£3,687
£738/yr (£62/mo)
Point 2, Inner London
£120,846
£17,523
£103,323
£3,323
£665/yr (£55/mo)
Point 3, Inner London
£128,789
£18,675
£110,114
£10,114
£2,023/yr (£169/mo)
Point 3, Inner London + £15k enhancements
£143,789
£20,849
£122,940
£22,940
£4,588/yr (£382/mo)
The most financially damaging scenario for a Band 9 post-holder is point 3 with Inner London weighting and significant enhancement or additional income — where over £22,000 of adjusted net income falls within the 60% effective rate zone, costing an additional £382/month in income tax above what the standard 40% rate would imply. In these situations, voluntary pension contributions (AVCs) are not merely tax-efficient — they are the most direct available mechanism to reduce the tax cost, since each £1 of AVC reduces adjusted net income by £1, removing income from the 60% zone at an effective saving of 60p.
AVC Strategy at Band 9 — The Case for Targeting Below £100,000
For Band 9 staff whose adjusted net income exceeds £100,000, Additional Voluntary Contributions are uniquely powerful — each £1 of AVC saves 60p in effective tax within the taper zone, compared to 42p at Band 7 points 3–5 and 22p at Band 5. The question is not whether to use AVCs but how much and in what structure.
AVC strategy
Monthly AVC
Annual AVC
Effective tax saving
Net cost of AVC
Adj. net income outcome
Point 3, no London — clear taper
£307/mo
£3,687
£2,212 (60% on £3,687)
£1,475/yr net
£100,000 exactly
Point 3, Inner London — clear taper
£843/mo
£10,114
£6,068 (60% on £10,114)
£4,046/yr net
£100,000 exactly
Point 3, Inner London + £15k — partial reduction
£1,000/mo
£12,000
£7,200 (60% on £12,000 in zone)
£4,800/yr net
£110,940 (still in taper)
Point 3, Inner London + £15k — full clear
£1,912/mo
£22,940
£13,764 (60% saving)
£9,176/yr net
£100,000 exactly
The AVC break-even calculation at Band 9 is compelling. A Band 9 ceiling post-holder in Inner London using £843/month in AVCs to clear the personal allowance taper saves £6,068/year in income tax — against an annual AVC cost of £10,114 and a net cost of only £4,046. This means £843/month of take-home is redirected into pension contributions, but the pension receives £10,114 — a 150% return on the net cash outlay before investment returns. The annual pension input amount impact of AVCs must be verified against the £60,000 annual allowance, particularly for Band 9 staff who are already generating significant defined benefit accrual each year.
Child Benefit at Band 9 — A Different Calculation
For most Band 9 staff without AVCs, Child Benefit is partially or fully withdrawn through the High Income Child Benefit Charge. The HICBC tapers Child Benefit between £60,000 and £80,000 adjusted net income, and eliminates it entirely above £80,000. Band 9 adjusted net income at all three spine points exceeds £80,000 — meaning Child Benefit is fully withdrawn unless pension contributions reduce adjusted net income below the taper zone.
Scenario
Adjusted net income
Child Benefit status
Annual Child Benefit lost
AVC needed to restore
Band 9 point 1, no AVC (1 child)
£90,104
Fully withdrawn
£1,331/yr
£20,208/yr AVC to reach £60k
Band 9 point 1, no AVC (2 children)
£90,104
Fully withdrawn
£2,212/yr
£20,208/yr AVC to restore fully
Band 9 point 1, existing AVCs reducing adj. income to £75,000
£75,000
75% withdrawn
£1,659/yr (2 children)
£15,000 further AVC to restore
For most Band 9 post-holders, the AVCs required to restore full Child Benefit (reducing adjusted net income below £60,000) are impractically large — £20,000+ per year — and would risk breaching the pension annual allowance when combined with defined benefit accrual. The more realistic approach is to accept the HICBC as an unavoidable cost at Band 9 and focus AVC strategy on the £100,000 personal allowance taper rather than the HICBC threshold. An independent financial adviser with NHS pension expertise should model both objectives simultaneously to find the optimal AVC level for an individual's circumstances.
NHS Pension at Band 9 — Accrual Value, Annual Allowance Risk and Proximity to Retirement
Band 9 is the final AfC band, and many post-holders are in the latter stages of their NHS careers. The combination of high pensionable pay, significant remaining service, and defined benefit accrual makes Band 9 the grade at which NHS pension planning is most consequential — and where specialist advice is most valuable.
Annual pension accrual at Band 9
Under the 2015 NHS Pension Scheme (Career Average), each year of Band 9 service accrues 1/54 of pensionable pay as guaranteed annual pension income. At Band 9 ceiling (£121,271), this is approximately £2,246/year of additional guaranteed pension per year of service. Over five years at Band 9 ceiling, a post-holder accrues approximately £11,230/year of additional guaranteed pension income — payable from State Pension Age (or earlier with actuarial reduction). Present value of this five-year accrual at a 3% discount rate is approximately £185,000. The employer contributes 23.7% of pensionable pay (£28,741/year at ceiling) to fund this accrual — the most valuable annual employer pension contribution in the AfC scale.
Annual allowance risk at Band 9
The standard annual allowance (£60,000) is most at risk for Band 9 staff who: (1) received a significant pay uplift on promotion from Band 8d to Band 9 in the same tax year; (2) hold pre-2015 scheme benefits (1995 or 2008 scheme) where the pension input valuation methodology may produce higher inputs; or (3) are also making AVCs. NHS BSA calculates the pension input amount annually and must send a statement where this exceeds the allowance. Band 9 post-holders should actively request their pension savings statements each year rather than waiting — the tax charge for annual allowance excess is significant (40% or more of the excess depending on marginal rate).
The McCloud remedy and Band 9 staff
The McCloud judgment (2023 remedy) required NHS pension scheme members who were in the 1995 or 2008 scheme before April 2015 to be given a choice between the benefits accrued under their legacy scheme or the 2015 Career Average scheme for the "remedy period" (2015–2022). For Band 9 post-holders with 1995 scheme service, this choice — made at retirement — may significantly affect final pension income and lump sum entitlement. The NHS BSA Remediable Service Statement (RSS) sets out each member's options. Legal tax advice should be sought before making the choice, as the two scheme options have different tax treatment in some circumstances.
The 1995 scheme and early retirement at Band 9
NHS staff with significant 1995 scheme service can access their pension unreduced from age 55 (for service before April 2008) or 60 (for 2008 scheme service). For a Band 9 post-holder aged 58 with 32 years of 1995 scheme service at equivalent of Band 8–9 pensionable pay, the unreduced pension available at 60 may be £40,000–60,000/year — alongside the continuation of work income until actual retirement. This "draw down and continue" strategy (formally available for those below normal pension age) requires NHS BSA approval and has tax implications that should be modelled with a pension specialist. The Abatement rules that previously limited this were removed from the 1995 scheme in 2008.
Who Works at Band 9 — Roles, Accountability and Scale
Band 9 is genuinely rare — across the entire NHS, fewer than 5,000 staff are graded at Band 9. The posts are almost exclusively executive director-level roles within NHS Foundation Trusts, NHS England regions, Integrated Care Boards, and NHS specialist bodies. The defining characteristic of a Band 9 post is accountability to the board or equivalent governance structure, typically combined with statutory or delegated authority over significant public functions.
Executive Director of Nursing (EDN)
Most common Band 9
Also titled Chief Nursing Officer at trust level. Statutory board-level accountability for nursing and midwifery practice, patient safety, and clinical governance across the entire trust. Responsible for all nursing and AHP workforce strategy and professional regulatory matters. Reports directly to the CEO. In large acute trusts, the EDN may have 2,000–5,000 nursing and AHP staff within their professional accountability — making this one of the most significant people leadership roles in UK healthcare.
Executive Director of Operations / COO
Operational leadership
Chief Operating Officers and Executives Directors of Operations at NHS Foundation Trusts. Responsible for all patient-facing services, bed management, waiting list performance, and operational efficiency across a trust with typically £300m–£1bn annual expenditure. The COO role in an NHS acute trust is equivalent in scope and accountability to a C-suite operational leadership role in a large private sector organisation — often the most demanding Band 9 post in terms of pace and public accountability.
Integrated Care Board Executive
System leadership
Executive directors at NHS Integrated Care Boards (ICBs), which oversee NHS commissioning and system strategy for populations of 500,000–3 million people. ICB executive directors typically hold portfolios including primary care, community services, mental health commissioning, or workforce development. Some ICB executive roles are VSM-graded rather than Band 9 — the grading depends on the ICB's size and the post's accountability structure.
NHS England Regional Director
National body
Band 9 (or VSM) post-holders within NHS England's regional and national directorates, responsible for overseeing NHS delivery across large geographies. These posts typically require extensive NHS leadership experience and political acuity — they sit at the interface between national NHS policy and local system delivery. Workforce, nursing, AHP, and operations director roles at NHS England regional level are commonly Band 9.
Chief AHP Officer
Professional leadership
The most senior AHP post in large NHS organisations — responsible for professional leadership of all Allied Health Professions across a trust or ICB. Rare at trust level (most trusts have AHP directors at Band 8c–8d) but increasingly common at ICB and NHS England level as AHP workforce strategy has become a national priority. The National AHP Lead for NHS England is a Band 9 equivalent post.
Medical Director (non-medical post)
Clinical governance
Some NHS trusts appoint non-medical staff to deputy medical director or equivalent governance roles at Band 9. These are distinct from the substantive Medical Director post (typically a medical consultant on BMA pay terms, not AfC) and focus on clinical governance, patient safety improvement, and regulatory compliance. Posts that carry this accountability at Band 9 are uncommon but growing as NHS trusts develop multidisciplinary clinical governance leadership structures.
What Lies Beyond Band 9 — VSM Pay, Medical Pay and NHS Executive Remuneration
Band 9 is the ceiling of the Agenda for Change framework, but it is not the ceiling of NHS pay. Three distinct pay arrangements apply above it:
Very Senior Manager (VSM) pay
NHS CEOs, Chairs, and most executive directors at the largest NHS Foundation Trusts are remunerated under VSM arrangements outside AfC entirely. VSM pay is individually negotiated within NHS England guidance ranges and approved by the trust's Remuneration Committee. NHS trust CEO salaries typically range from £135,000 to £280,000+ for the largest teaching hospitals and specialist trusts — well above the Band 9 ceiling of £121,271. VSM posts do not attract AfC terms including unsocial hours enhancements, but typically offer enhanced annual leave and may include performance-related elements. NHS BSA VSM pension terms differ from AfC in certain respects.
Medical and dental pay scales
Consultant medical staff are paid under the BMA Consultant Contract — a separate pay framework with its own spine points, Clinical Excellence Awards (CEAs), and merit award structures. Consultants at the top of the pay scale with maximum CEAs can earn £200,000+ — substantially above Band 9. Junior doctors are paid under separate terms covering foundation years through specialty training. Neither medical nor dental pay scales are part of AfC, and medical staff do not receive AfC unsocial hours enhancements — they have separate rota and on-call payment arrangements.
NHS England and NHSE national roles
Senior national roles at NHS England, NHS Improvement (now integrated into NHS England), and NICE operate under a mix of AfC Band 9, VSM, and bespoke executive pay frameworks depending on the specific post and seniority. National directors and programme directors at NHS England are often VSM-graded. The Chief Nursing Officer for England — the most senior nursing post in the country — is a VSM-graded civil service equivalent role, paid significantly above Band 9. These posts sit outside the standard AfC system entirely and are advertised with salary on application rather than a published scale.
NHS pension for VSM and medical post-holders
VSM staff remain eligible for the NHS Pension Scheme on the same terms as AfC staff — 14.5% employee contributions on salary above £89,004, and 23.7% employer contribution. Medical staff in the NHS Pension Scheme contribute at the same tiered rates but their pension benefits are calculated on a different basis than the 2015 Career Average scheme that applies to AfC. The annual allowance risk is significantly higher for VSM and medical post-holders whose pensionable pay exceeds £100,000 — specialist actuarial advice is typically required.
Worked Example — Band 9 Ceiling, Inner London, AVC Strategy to Clear £100k Taper
The most financially complex scenario in the entire AfC scale: an Executive Director of Nursing at Band 9 ceiling in Inner London, where the personal allowance taper is fully active with London weighting, and AVC strategy is being used to reduce adjusted net income to exactly £100,000.
Profile
Executive Director of Nursing, aged 56. Band 9 ceiling (£121,271), large NHS Foundation Trust, Inner London. Inner London supplement: £7,746 (maximum 20%). Total gross pensionable pay: £121,271 + £7,746 = £129,017. NHS pension: 14.5% of £129,017 = £18,707/year (£1,559/month). Adjusted net income without AVCs: £129,017 − £18,707 = £110,310. In personal allowance taper zone by £10,310. No student loan. Has received annual allowance statement from NHS BSA confirming pension input of £47,000 in 2025/26 — below the £60,000 limit, with £13,000 headroom for AVCs.
Tax position without AVC
Adjusted net income: £110,310. Personal allowance tapered: £12,570 − (£10,310 ÷ 2) = £12,570 − £5,155 = £7,415 remaining allowance. Taxable income: £110,310 − £7,415 = £102,895. Income tax: 20% on £37,700 (personal allowance to basic rate ceiling) = £7,540 + 40% on £65,195 (£50,270 to £102,895) = £26,078. Total tax: £33,618/year (£2,802/month). Monthly take-home after pension, tax, NI: approximately £5,601/month.
AVC strategy — target adjusted net income of £100,000
AVC required to reduce adjusted net income from £110,310 to £100,000: £10,310/year = £859/month AVC. Annual allowance check: existing pension input £47,000 + AVC £10,310 = £57,310 — within the £60,000 limit. Annual tax saving from AVC: £10,310 in the taper zone attracts 60% effective rate = £6,186/year tax saved. Net cost of AVC: £10,310 − £6,186 = £4,124/year (£344/month net). Take-home reduction from AVC: only £344/month — against £859/month redirected into pension. The pension receives £10,310 at a net cash cost of £4,124.
Take-home with AVC strategy applied
Without AVC: approximately £5,601/month. AVC of £859/month deducted from payroll: take-home falls by £344/month (not £859/month, because of tax relief). Take-home with AVC: approximately £5,257/month. Pension receives £1,559/month standard contribution + £859/month AVC = £2,418/month total pension contribution. Employer adds 23.7% of £129,017 = £30,577/year (£2,548/month) on top. Total pension funding: £2,418 + £2,548 = £4,966/month — against take-home of £5,257/month. The pension is receiving nearly as much per month as the post-holder takes home.
Child Benefit — unavoidable HICBC at Band 9
Even with AVC reducing adjusted net income to £100,000, this remains well above the HICBC elimination threshold of £80,000. Child Benefit for any children is fully withdrawn. For two children, this represents £2,212/year of lost benefit. To restore any Child Benefit, adjusted net income must be reduced below £80,000 — requiring an additional £20,000/year in AVC on top of the £10,310 already being contributed, bringing total AVCs to £30,310/year. This exceeds the remaining annual allowance headroom (£60,000 − £47,000 − £10,310 = £2,690 remaining). Child Benefit restoration is therefore not achievable without risking an annual allowance charge at this salary and pension input level. This is the irreducible financial cost of reaching Band 9 with children still eligible for Child Benefit.
This worked example represents the most complex individual tax position in the AfC scale. The interaction between the 14.5% pension contribution, the £100,000 personal allowance taper, the £60,000 annual pension allowance, the HICBC, and the available AVC headroom requires modelling as a system — changing one variable affects all others. Independent financial advice from a specialist in NHS pensions is not optional at this level; it is the most financially productive investment available to a Band 9 post-holder. The NHS pension scheme's complexity at this salary level, combined with the McCloud remedy considerations for longer-serving post-holders, makes DIY financial planning genuinely risky.
Frequently Asked Questions
What is the NHS Band 9 salary for 2026/27?
From 1 April 2026, Band 9 runs from £105,385 (entry, spine point 1) to £121,271 (ceiling, spine point 3), following the 3.6% consolidated AfC pay award. Monthly take-home at entry is approximately £5,280 after income tax, National Insurance and 14.5% NHS pension contributions, assuming adjusted net income remains below £100,000 (which it does at entry and point 2 when pension contributions are deducted). At ceiling, adjusted net income of approximately £103,687 falls marginally into the personal allowance taper zone, adding approximately £62/month in additional tax compared to a non-taper position.
Is the personal allowance taper unavoidable at Band 9?
At points 1 and 2, no — the 14.5% pension contribution keeps adjusted net income below £100,000. At the ceiling point (£121,271), the taper is marginally active (approximately £3,687 in the zone) for non-London staff, and significantly active for London-based staff. The taper can be eliminated or reduced through Additional Voluntary Contributions (AVCs) to the NHS pension, which reduce adjusted net income pound for pound. Each £1 of AVC within the taper zone saves 60p in effective income tax — making AVCs at Band 9 ceiling the most tax-efficient available action for post-holders subject to the taper. The annual allowance headroom remaining after defined benefit accrual limits the available AVC amount.
What is the NHS pension contribution at Band 9?
14.5% of pensionable pay — the highest tier in the NHS Pension Scheme contribution schedule. At Band 9 entry (£105,385), this is £15,281/year (£1,273/month); at ceiling (£121,271), it is £17,584/year (£1,465/month). The employer contributes a further 23.7% of pensionable pay — approximately £24,977–28,741/year depending on spine point. Combined monthly pension funding (employee plus employer) ranges from approximately £3,356 to £3,868 at ceiling — substantially exceeding the take-home figure for some Band 9 positions when London weighting and enhancements are included.
What roles are paid at Band 9?
Band 9 is almost exclusively limited to executive director-level roles in NHS Foundation Trusts, Integrated Care Boards, and NHS England regional structures — Executive Directors of Nursing, Directors of Operations/COOs, Chief AHPs, and equivalent posts. NHS CEOs and Chairs are typically paid under Very Senior Manager (VSM) arrangements outside AfC. There are estimated to be fewer than 5,000 Band 9 post-holders across the entire NHS in England. The grade requires statutory or delegated board-level accountability, typically combined with leadership of hundreds or thousands of NHS staff.
Can Band 9 staff claim Child Benefit?
Child Benefit is fully withdrawn via the High Income Child Benefit Charge for all Band 9 staff whose adjusted net income exceeds £80,000. At Band 9 entry with standard 14.5% pension deductions, adjusted net income is approximately £90,104 — above the £80,000 elimination threshold. Restoring Child Benefit would require reducing adjusted net income below £60,000 through AVCs — a reduction of approximately £30,000+/year — which is typically impossible without exceeding the £60,000 pension annual allowance when defined benefit accrual is included. For most Band 9 post-holders, Child Benefit loss must be accepted as an unavoidable consequence of their salary level.
What comes after Band 9 in NHS pay?
Band 9 is the ceiling of the Agenda for Change framework. Above it lie: Very Senior Manager (VSM) pay for NHS trust CEOs and chairs (typically £135,000–£280,000+, individually negotiated); medical consultant pay under BMA terms with Clinical Excellence Awards (potentially £200,000+); and bespoke executive contracts for NHS England national directors. VSM post-holders remain eligible for the NHS Pension Scheme on standard terms. None of these arrangements are part of AfC — they operate under different pay governance structures approved by trust Remuneration Committees or NHS England.
