NHS VSM Pay Uplift 2026/27: Why It's Delayed and What Happens Next

Every year the most senior NHS managers receive a pay award set separately from the one for the rest of the workforce. In 2026/27 the headline figure was settled in May, yet NHS England's guidance still tells committees to hold it. This page explains why, using NHS England's own published guidance, and what the position is for people on VSM terms.

What was awarded

On 21 May 2026 the government accepted the Senior Salaries Review Body's headline pay recommendation and awarded a 3.0% uplift for VSMs in the NHS in England, with effect from 1 April 2026. The VSM pay ranges for provider trusts and integrated care boards (ICBs) for 2026/27 were also uplifted by 3.0% from the same date. NHS England published its guidance on the award on 1 July 2026.

Medical directors on consultant contracts are covered separately by the consultant pay award rather than this one.

Why it's delayed

Unlike the Agenda for Change award, a VSM's uplift is not automatic. Under the VSM Pay Framework, eligibility for the annual award is linked to how the employing organisation is performing, measured through the NHS Oversight Framework (NOF) segmentation, unless an exemption applies. NHS England has advised remuneration committees not to apply the 2026/27 uplift until all three of these are in place:

• • The organisation's NOF segmentation is known (the segment score that places an organisation by performance and level of support needed).
• • The organisation's capability rating has been determined.
• • Ministerial confirmation has been received on the eligibility criteria for the 2026/27 award.

The reason the third condition matters is that the criteria for withholding the award are currently under review. Subject to ministerial confirmation, the updated criteria will appear in Version 2 of the VSM Pay Framework, which is to be published once the new capability ratings are confirmed and a ministerial steer is received. NHS England's VSM page also lists a second pay circular for 2026 (circular 02/2026) as pending.

Timeline so far

What happened with the 2025/26 award

The previous year gives a guide to the likely shape of the process, though not a guarantee of how this year will end. The 2025/26 VSM award was 3.25%, effective 1 April 2025. In June 2025, NHS England wrote to ICB and trust chairs and chief people officers advising them to refrain from applying it until segmentation was known. The first segmentation results were published at the end of August 2025, and an update letter (listed on NHS England's site as October 2025) confirmed that organisations not in segment 5 could proceed to pay the award, while VSMs in segment 5 organisations were not eligible unless they met exemption criteria. The letter named 19 trusts and 3 ICBs in the Recovery Support Programme.

So last year's uplift was cleared for payment around six months after its effective date. Whether 2026/27 follows the same pattern depends on the review of the criteria and ministerial confirmation.

Who is affected, and who isn't

Some board-level posts, such as a chief nurse at a very large organisation, can sit on Agenda for Change Band 9 rather than VSM terms. Our Band 9 salary guide explains the difference between Band 9 and VSM pay, and Agenda for Change explained covers who falls outside the system.

What VSMs and remuneration committees should do

• ✓ Follow the NHS England guidance and hold the uplift until segmentation, capability rating and the ministerial confirmation are in place.
• ✓ Record the decision. It is sensible for committees to minute that the uplift is being held under national advice (our suggestion, not NHS England's), so there is a clear paper trail.
• ✓ Check your own segment. Know which NOF segment your organisation is in, because segment 5 was the eligibility cut-off last year and the 2026/27 criteria are under review.
• ✓ Check pay-case thresholds. No pay case is needed if the annual award is the only reason a salary exceeds a threshold, but cases are still required where other increases breach thresholds.
• ✓ Use NHS England's VSM cases mailbox for individual case advice rather than relying on informal guidance. The address is on the NHS England pay award page.
• ✓ Don't assume a payment date or amount. The award is stated to take effect from 1 April 2026, but wait for written confirmation from your employer before planning around it.

What we don't know yet

As of 10 October 2026, we cannot find a published date for Version 2 of the VSM Pay Framework or for circular 02/2026, and the final eligibility criteria have not been published. We also cannot say how many organisations would be affected or whether any VSM salaries will be withheld in full. We will update this page when NHS England publishes the circular or the framework.

Sources

Our figures and dates come from NHS England's published pages: Very senior managers pay award for 2026/27, the VSM pay framework page, and for last year, the 2025/26 award guidance and its segmentation update letter.

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