What is the take-home pay for an NHS Band 4 Top in 2026/27?

An NHS Band 4 on the top step has a basic salary of £31,157. After the Tier 3 · 8.3% NHS pension contribution (£2,586), £3,200 PAYE income tax and £1,487 Class 1 National Insurance, the net take-home is £23,884 per year — £1,990.32 per month.

How much more does Band 4 earn with London weighting?

On top of the £31,157 basic, Inner London adds a £6,231 HCAS supplement (20%, clamped to the statutory floor/cap) and Outer London adds £4,870 (15%). That lifts the monthly take-home to £2,292 (Inner) and £2,220 (Outer) respectively — though a larger HCAS can push pensionable pay into a higher cliff-edge pension tier.

Which NHS pension tier applies to Band 4 Top?

At a pensionable gross of £31,157, an NHS Band 4 Top falls in Tier 3 · 8.3%. The NHS scheme is a Net Pay Arrangement, so the contribution is deducted before PAYE — granting immediate tax relief — while National Insurance is still charged on the full gross.

NHS · Agenda for Change · FY 2026/27 Calc-engine routed

NHS Band 4 top step.

Penny-accurate take-home for an NHS Band 4 on the top step — basic pay of £31,157, the cliff-edge Tier 3 · 8.3% NHS pension as a Net Pay Arrangement, and Inner / Outer London HCAS side by side.

Engine note · `computeNhsBreakdown()` — HCAS floor/cap clamp, cliff-edge pension on the whole gross, NI on full gross, PAYE on the post-pension base. Integer pence, no float drift.

Basic (national): £31,157
Net monthly: £1,990
Effective rate: 23.3%

National

No HCAS supplement

Monthly take-home

£1,990

Annual take-home: £23,884
Pensionable gross: £31,157
HCAS supplement: —

Outer London

15% HCAS · floor / cap clamped

Monthly take-home

£2,220

Annual take-home: £26,635
Pensionable gross: £36,027
HCAS supplement: +£4,870

Inner London

20% HCAS · floor / cap clamped

Monthly take-home

£2,292

Annual take-home: £27,508
Pensionable gross: £37,388
HCAS supplement: +£6,231

Deduction stack · NHS Band 4 Top

Standard tax code 1257L, no student loan. NHS pension is a Net Pay Arrangement (deducted before PAYE); NI is charged on the full pensionable gross. Layer pension tiers, HCAS and student loans live in the NHS calculator.

Line item	National	Outer London	Inner London
Pensionable gross	£31,157	£36,027	£37,388
HCAS supplement	£0	£4,870	£6,231
NHS pension	£2,586	£3,531	£3,664
Income tax (PAYE)	£3,200	£3,985	£4,231
National Insurance	£1,487	£1,877	£1,985
Annual take-home	£23,884	£26,635	£27,508
Monthly take-home	£1,990	£2,220	£2,292

Reference · 2026/27 FROZEN

The Tier 3 · 8.3% NHS pension and HMRC thresholds driving the national column above.

Basic salary £31,157
NHS pension tier Tier 3 · 8.3%
Pension contribution £2,586
Inner London HCAS £6,231
Outer London HCAS £4,870
Personal Allowance £12,570

Step through the pay grid

Adjacent steps in this band and the same step on neighbouring bands — plus the interactive tool for pension, HCAS and student-loan overlays.