High cost area supplement (London weighting)

The Agenda for Change terms and conditions, published by NHS Employers, say high cost area supplements apply to all NHS staff groups covered by the agreement in the areas concerned. The supplement is a proportion of basic pay, including any long-term recruitment and retention premium, but with a minimum and maximum cash amount. It is reviewed every year on the recommendations of the NHS Pay Review Body.

Annex 9 of the NHS Terms and Conditions of Service Handbook sets these rates from 1 April 2026:

• Inner London: 20% of basic salary, minimum £5,794, maximum £8,746 a year
• Outer London: 15% of basic salary, minimum £4,870, maximum £6,137 a year
• Fringe: 5% of basic salary, minimum £1,346, maximum £2,270 a year

So a newly qualified Band 5 nurse in an inner London trust gets 20% of basic pay, or the £5,794 minimum if that is higher. Our NHS take-home pay calculator adds it for you.

Annex 8 defines the zones using 2005 primary care trust boundaries. In outline:

• Inner London includes Camden, City and Hackney, Hammersmith and Fulham, Islington, Kensington and Chelsea, Lambeth, Lewisham, Southwark, Tower Hamlets, Wandsworth and Westminster.
• Outer London includes the other London boroughs, such as Barnet, Brent, Croydon, Ealing, Newham and Redbridge.
• Fringe covers named areas just outside London, including Dartford, Basildon, Thurrock, Harlow, Watford, St Albans, Slough, Bracknell Forest, Guildford and parts of Surrey.

Your contractual work base decides your zone, not where you live. For contractual homeworkers, the handbook says the home postcode is used.

The handbook says HCAS is pensionable, so it counts for the NHS Pension Scheme, but it does not count as basic pay when working out overtime, unsocial hours or on-call payments. Doctors and others not on Agenda for Change contracts may receive a London payment under their own contract at a different rate, so check your contract.

The rates rise with each pay award. For comparison, from 1 April 2025 the handbook set inner London at 20% with a minimum of £5,609 and a maximum of £8,466, outer London at 15% with £4,714 to £5,941, and fringe at 5% with £1,303 to £2,198. The handbook also lets employers that have staff in more than one zone agree a harmonised local rate, subject to agreement with neighbouring employers if it would exceed the average rate in their area, and lets employers and unions in an area propose a new or higher supplement where they can show higher costs and recruitment problems. Separately, employers can pay recruitment and retention premia for hard-to-fill posts.

• Comparing only basic salaries between a London and a non-London offer.
• Assuming the supplement covers London costs. Weigh rent and travel too.
• Using last year's figures. The 2025/26 inner London range was lower.

See our nurse salary comparison and the pay band explorer.