What is the take-home pay for an NHS Band 8d Top in 2026/27?

An NHS Band 8d on the top step has a basic salary of £108,814. After the Tier 6 · 12.5% NHS pension contribution (£13,602), £25,517 PAYE income tax and £4,187 Class 1 National Insurance, the net take-home is £65,508 per year — £5,459.04 per month.

How much more does Band 8d earn with London weighting?

On top of the £108,814 basic, Inner London adds a £8,746 HCAS supplement (20%, clamped to the statutory floor/cap) and Outer London adds £6,137 (15%). That lifts the monthly take-home to £5,779 (Inner) and £5,708 (Outer) respectively — though a larger HCAS can push pensionable pay into a higher cliff-edge pension tier.

Which NHS pension tier applies to Band 8d Top?

At a pensionable gross of £108,814, an NHS Band 8d Top falls in Tier 6 · 12.5%. 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 8d top step.

Penny-accurate take-home for an NHS Band 8d on the top step — basic pay of £108,814, the cliff-edge Tier 6 · 12.5% 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): £108,814
Net monthly: £5,459
Effective rate: 39.8%

National

No HCAS supplement

Monthly take-home

£5,459

Annual take-home: £65,508
Pensionable gross: £108,814
HCAS supplement: —

Outer London

15% HCAS · floor / cap clamped

Monthly take-home

£5,708

Annual take-home: £68,491
Pensionable gross: £114,951
HCAS supplement: +£6,137

Inner London

20% HCAS · floor / cap clamped

Monthly take-home

£5,779

Annual take-home: £69,352
Pensionable gross: £117,560
HCAS supplement: +£8,746

Deduction stack · NHS Band 8d 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	£108,814	£114,951	£117,560
HCAS supplement	£0	£6,137	£8,746
NHS pension	£13,602	£14,369	£14,695
Income tax (PAYE)	£25,517	£27,781	£29,151
National Insurance	£4,187	£4,310	£4,362
Annual take-home	£65,508	£68,491	£69,352
Monthly take-home	£5,459	£5,708	£5,779

Reference · 2026/27 FROZEN

The Tier 6 · 12.5% NHS pension and HMRC thresholds driving the national column above.

Basic salary £108,814
NHS pension tier Tier 6 · 12.5%
Pension contribution £13,602
Inner London HCAS £8,746
Outer London HCAS £6,137
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.