Introduction
This guide aims to update branches about the changes to Annex 20 of the NHS Terms and Conditions Handbook and to help branches to begin discussions with employers around the issue of progression between Band 5 and 6.
Background
Annex 20 of the NHS Terms and Conditions Handbook describes the mechanism by which certain roles can progress from band 5 to band 6 without the need for a recruitment exercise to be undertaken.
The provision pre-dates the Agenda for Change arrangements and was introduced due to a change in the model of midwifery care in the 1990s that required midwives to work with increased autonomy.
As part of the 2023 pay deal for England a series of wider workstreams were agreed including one led by the DHSC to consider improvements to career progression in nursing. Similar conversations have been taking place in the devolved administrations.
Through this work UNISON and other unions raised the misunderstandings caused by the fact that the current Annex 20 provision in the NHS Terms and Conditions of Service Handbook only specifically mentions midwifery.
Although there is information elsewhere in the Handbook explaining that Annex 20 can apply to any occupational group these misunderstandings have persisted.
As part of a wider package on nursing career progression, we were able to get agreement from the Secretary of State on a recommendation for the Staff Council to:
“Review Annex 20 of the NHS TCS handbook to clarify that the provisions do not exclude nursing.”
Summary
Annex 20 has now been revised and agreed through the NHS Staff Council to make it clearer that it can apply to nursing. UNISON and other unions pushed for this principle to be extended to allied health professions (AHPs). AHPs have now been added specifically too.
A wider review of Annex 20 is expected at a later stage under the Staff Council’s ongoing work to review the Handbook.
The revisions to Annex 20 implemented in January 2026:
- clarify language to refer to “roles” rather than staff
- clarify that career pathways continue to evolve in line with professional advancements, service demand, and organisational structures
- add “nursing” and “allied health professions” to the existing example of “midwifery” as the type of roles where annex 20 provisions could apply.
Professional development and career progression
Annex 20 has been updated to make it clearer that, in addition to career progression support, some band 5 graduate entry roles (including but not limited to midwifery, nursing and the allied health professions) should be reviewed using the NHS Job Evaluation Scheme no earlier than one year and no later than two years from the date of qualification.
This should always be underpinned by the NHS Job Evaluation Scheme and if the evaluation demonstrates that the post holder’s job weight is of sufficient size to move to the next pay band (pay band 6) this should be implemented without the need for application for a post at a higher level.
Supporting career progression through preceptorship
Preceptorship is defined as:
“a period of structured transition to guide and support newly qualified practitioners from students to autonomous professionals” [FOOTNOTE Preceptorships | NHS Employers].
Preceptorship can play an important role in supporting career progression using Annex 20 as the contractual mechanism to move from band 5 to 6.
Some professions have clear national preceptorship programmes, whereas others might require local development.
Some preceptorship schemes already have progression from band 5 to band 6 inbuilt – for example, the National Ambulance Newly Qualified Paramedic scheme.
Preceptorship schemes should be underpinned by a deployment model to ensure staff are given the opportunity to develop autonomy through structured coaching, paid protected time and mentoring and guidance from senior clinical leaders.
Starting the conversation with members
The changes to Annex 20 mean that members in eligible roles can, subject to a job evaluation review within 2 years of qualification, move to pay band 6 without the need for application for a post at a higher level.
This is a great opportunity to have conversations with members and employers about how workforce planning should take place amongst roles within scope of Annex 20.
Branches can start by mapping eligible roles and begin conversations with members about what evidence would support their roles to be eligible.
Branches in the devolved administrations should check what is in place in their jurisdiction to support career development.
Working with employers
UNISON branches should begin discussions with employers around career development and deployment models for roles that fit within the scope of Annex 20. It is important conversations with employers include how they intend to build Job Evaluation capacity as the underpinning mechanism.
For more information see our NHS Job Evaluation resources
Some important factors to consider when discussing career development and deployment models are:
- Periods of consolidated learning and/or formal preceptorship/development to operate at the required level of autonomy
- The level of accountability in the overall delivery of care, including responsibility for risk assessment and management
- The involvement or influence of other professional groups
- The autonomy of decision making and the level of required supervision (for example, is it general management supervision or supervision of clinical decision-making?)
Here are some practical openers and questions to support early conversations with employers:
- Can you confirm whether the organisation is aware of the changes to Annex 20 in the NHS TCS handbook?
- How is it currently understood and applied locally, particularly for nursing and AHP roles?
- How is Annex 20 communicated to HR teams and operational managers involved in role development and job evaluation?
- Are there any nursing or AHP roles where Annex 20 has been considered locally, and what has informed that position?
- How does the organisation ensure consistency in how Annex 20 is applied across services, rather than it depending on individual managers or teams?
- How are band 5 roles with early autonomy and accountability reviewed within the one to two-year timeframe set out in the handbook?
- What mechanisms are in place to ensure progression isn’t delayed through extended or loosely defined preceptorship arrangements?
- Given current recruitment and retention pressures, has Annex 20 been considered as part of local workforce or retention planning for early-career nurses?