NHS Pension

NHS Pension and Long-Term Sickness: What Happens to Accrual

FP FrontlinePay Editorial
Updated September 2026

Independent guidance — not affiliated with NHS England or DHSC

A long stretch of sickness absence is stressful enough without also worrying whether it's quietly damaging your NHS Pension. The genuinely reassuring news is that, for as long as you're receiving some form of NHS sick pay — full pay, half pay, or even Statutory Sick Pay alone — your pension accrual is protected using the same "deeming" mechanism this site's maternity leave guide describes. Where it changes is once pay stops altogether. This page sets out exactly where that line falls, and how long-term sickness relates to the separate, more significant step of ill health retirement.

Short answer

Throughout any paid period of NHS sick leave — full pay or half pay, and any period you have Statutory Sick Pay entitlement — your NHS Pension Scheme membership and CARE accrual continue as normal, using a deemed pensionable pay figure based on your normal, undiminished rate of pay, not the reduced amount you actually receive. It's only once you move onto genuinely unpaid ("no pay") sick leave that this stops: no contributions are due, and that period is treated as disallowed days — a real, permanent gap in your qualifying and reckonable membership, with no automatic buy-back option. Long-term sickness is separate from ill health retirement, a distinct, formally assessed route to drawing your pension early if you're not expected to return to work at all.

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NHS occupational sick pay runs through a full pay stage and then a half pay stage, with the length of each scaling by your length of continuous NHS service (see our NHS Sick Pay Policy Explained guide for the exact month-by-month table). For pension purposes, the same principle applies throughout both stages:

What you're paid

Full pay, then half pay, then (if it comes to that) Statutory Sick Pay — your actual take-home income genuinely reduces as you move through these stages.

What your pension sees

Any reduction in pay because of sickness absence is 'deemed' back to your normal, full rate for pension accrual and contribution-tier purposes, throughout every paid stage.

In practice, this means a member on half pay during a long sickness absence keeps building CARE pension as though they were on full pay, even though their actual salary that period is half what it normally is — they simply pay their pension contributions on the smaller amount they actually receive, at the contribution tier their normal (deemed) pay would put them in.

A worked example

Take a Band 5 physiotherapist on £34,000 a year of pensionable pay, with enough service to qualify for several months of full pay followed by several months of half pay during a long-term sickness absence (see our sick pay guide for the exact entitlement at different lengths of service). You can try your own pensionable pay in our NHS pension forecast calculator.

ℹIllustrative worked example

Across both the full pay and half pay stages of her absence, deeming means her pensionable pay for CARE accrual purposes is calculated as if she'd been earning her normal £34,000 a year throughout — including during the half pay stage, when her actual take-home pay for that period was only half that figure. At £34,000 pensionable pay, a full year of ordinary accrual banks £34,000 ÷ 54 ≈ £629.63 of new annual pension. Because of deeming, both her full pay and half pay months during her absence contribute their normal, full share toward that figure — not a proportionally reduced share reflecting what she actually took home during the half pay months.

Only once her occupational sick pay entitlement is fully exhausted, and she moves onto a period of genuinely unpaid sick leave, does this protection stop — that period becomes 'disallowed days' rather than continuing to accrue on a deemed basis.

Unpaid sick leave: a genuine gap

This is where long-term sickness and pension genuinely diverges from the maternity leave picture. Once occupational sick pay (and any Statutory Sick Pay entitlement) is exhausted and a member moves onto no-pay sick leave, the treatment is more absolute:

  • • No contributions are payable — there's no pay to deduct them from, and deeming doesn't apply to unpaid sick leave
  • • The period is treated as 'disallowed days' — it doesn't count as qualifying or reckonable membership at all, not just as a period with reduced accrual
  • • It shows as a distinct gap on your NHS Pension record — a real, visible break in your membership for that specific period
  • • There generally isn't a buy-back option in the way some other forms of unpaid authorised leave allow — an extended period of no-pay sick leave is typically a genuine, permanent gap for that period

⚠Special Class status and protected pension ages are generally preserved

If you hold Special Class status or a protected minimum pension age from earlier NHS Pension Scheme membership, being on unpaid sick leave or nil sick pay doesn't generally cause you to lose that protection on its own. This is a narrow but genuinely reassuring point for anyone with legacy 1995 Section protections worried that a long unpaid absence might jeopardise them — confirm your own specific position with NHS Pensions if this applies to you.

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Where this sits alongside your sick pay entitlement

How long your full pay and half pay stages actually last — before you're at risk of reaching unpaid sick leave at all — depends entirely on your length of continuous NHS service, running from 1 month full pay and 2 months half pay in your first year, up to a maximum of 6 months full pay and 6 months half pay after 5 years' service. This site's NHS Sick Pay Policy Explained guide covers that full table, the rolling 12-month rule that can reduce what's left if you've already used some sick pay recently, and what happens once Statutory Sick Pay itself runs out — this page deliberately doesn't repeat that detail, since the pension treatment described above applies identically regardless of exactly how many months you're entitled to.

NHS Sick Pay Calculator

Work out your own full pay and half pay entitlement by length of service.

Try it

When long-term sickness turns into ill health retirement

A long-term sickness absence is very often the point at which an employer's occupational health team first raises ill health retirement as a possibility — but the two are genuinely distinct processes, not different names for the same thing:

Long-term sickness (this page)

You remain linked to your employer, moving through full pay, half pay and potentially unpaid sick leave, with pension accrual treated as described above throughout.

Ill health retirement

A formal medical process that ends your active NHS employment and lets you draw your pension early — assessed on a two-tier system based on your capacity to work at all, not simply how long you've been off.

Going onto long-term sick pay doesn't automatically lead to ill health retirement, and the assessment for ill health retirement is a formal medical process run through NHS Pensions' appointed assessors, not something that happens simply because sick pay is running low. If this is a live possibility for you or someone you're supporting, see our dedicated NHS Ill Health Retirement Explained guide for the two-tier system and how the process actually starts — this page deliberately doesn't duplicate that content, since it's a genuinely separate topic from the accrual mechanics covered here.

Practical checklist

1

Check your own sick pay entitlement and where you are in it

Use our NHS Sick Pay Calculator to see how much full pay and half pay you have left, based on your length of service and any sick leave already used in the rolling 12-month period.

2

Ask your pensions team before you reach unpaid sick leave

If a long absence looks likely to run into unpaid sick leave, ask your trust's pensions team what that specific period will mean for your pension record in advance, rather than discovering the gap later on a statement.

3

Engage with occupational health early

If a return to your current role, or to work at all, looks genuinely uncertain, engaging with occupational health early opens the door to conversations about ill health retirement sooner, if it's relevant — without assuming it automatically applies.

4

Check your Annual Benefit Statement afterwards

Once you're back, or once your position is resolved, check your statement reflects paid periods correctly and query any unexpected gap with NHS Pensions or your trust's payroll team.

⚠General information, not your own confirmed figures

The deeming mechanism, the treatment of unpaid sick leave as disallowed days, and the relationship to ill health retirement described here are checked against current NHS Pensions (NHSBSA) guidance, but your own dates, pay stages and figures depend on your trust's specific payroll and HR records. Confirm your own position with your trust's pensions team and NHS Pensions. FrontlinePay is not affiliated with NHS England, NHS Pensions, the NHS Business Services Authority, or the Department of Health and Social Care, and this page is not medical, financial or legal advice.

Why trust this guide

  • ✓ The 'deeming' mechanism protecting pension accrual through paid sick leave, and its limit at unpaid ('no pay') sick leave, is verified against current NHS Pensions (NHSBSA) guidance
  • ✓ Clearly distinguishes 'disallowed days' (unpaid sick leave, no automatic buy-back) from the more flexible treatment of some other forms of unpaid authorised leave, rather than treating all unpaid absence the same
  • ✓ Cross-links this site's existing NHS Sick Pay Policy guide and Ill Health Retirement guide rather than duplicating either — this page covers specifically what happens to pension accrual
  • ✓ Written with a measured, supportive tone appropriate to a genuinely stressful topic
  • ✓ Independent and not affiliated with NHS England, NHS Pensions/NHSBSA or the DHSC — this is educational context, not medical, financial or legal advice

NHS Sick Pay Policy Explained

The full pay and half pay entitlement table by length of service.

NHS Ill Health Retirement Explained

The separate, formally assessed route to drawing your pension early.

NHS Pension and Maternity Leave

The same deeming principle, applied to paid and unpaid maternity leave.

NHS Pension Scheme (2015) Explained

The CARE accrual mechanics that deeming plugs into.

NHS Long-Term Sickness and Long COVID Support

Broader wellbeing and support resources during a long absence.

This guide is independent, general information only — not medical, financial, tax or pensions advice — and FrontlinePay is not affiliated with NHS England, NHS Pensions, the NHS Business Services Authority, or the Department of Health and Social Care. Sick pay entitlements and pension rules on paid and unpaid sickness absence can change over time. Confirm your own current figures with your trust's pensions team and NHS Pensions before relying on them for planning.

Frequently asked questions

Does my NHS Pension stop growing while I'm off sick long-term? +
Not while you're on paid sick leave, whether that's full pay or half pay — your NHS Pension Scheme membership and CARE accrual continue throughout, using a 'deemed' pensionable pay figure based on the normal pay you'd have received had you not been off sick, not the reduced amount you actually receive on half pay. It's only once you move onto unpaid sick leave, after your occupational sick pay entitlement runs out, that pension accrual stops.
If I'm on half pay, do I only get half the pension credit for that period? +
No. Your actual contribution deduction is based on what you're actually paid, but the pensionable pay used to calculate your CARE accrual and your contribution tier for that period is 'deemed' at your normal, full rate of pay — any reduction because of sickness absence is added back in for benefit purposes. In effect, full pay and half pay periods of occupational sick pay both protect your pension accrual to the same degree, even though your actual take-home pay differs significantly between them.
What happens once my occupational sick pay runs out? +
Once you've exhausted your full pay and half pay entitlement (which scales with your length of NHS service — see our NHS Sick Pay Policy guide for the exact table), you generally move onto Statutory Sick Pay for any remaining eligible period, and eventually no pay at all if that's also exhausted. Deeming applies throughout any period you're still receiving pay of some kind, including SSP-only periods where you have entitlement — it's specifically unpaid, no-pay sick leave where the protection stops.
What actually happens during unpaid ('no pay') sick leave? +
This is a genuine gap, and a more absolute one than the equivalent point in maternity leave. On no-pay sick leave, no pension contributions are payable, and the period is treated as 'disallowed days' — it doesn't count as qualifying or reckonable membership at all, and it will show as a distinct, non-membership period on your NHS Pension record. There generally isn't a buy-back option for unpaid sick leave in the way there can be for some other forms of unpaid authorised leave, so an extended period of no-pay sick leave is a real, permanent gap in your pension record for that specific period.
Does this affect Additional Pension, AVCs or ERRBO contributions I'm already paying? +
Added Years, Additional Pension and Early Retirement Reduction Buy Out (ERRBO) contributions you're already paying generally continue to be deducted on your full (not reduced) pay throughout any period of paid sick leave, in the same spirit as ordinary CARE accrual being protected — but they stop being deducted once you move onto a period of no-pay sick leave, since there's no pay to deduct them from and the underlying membership isn't accruing in the normal way during that period either.
How is long-term sickness different from ill health retirement, for pension purposes? +
They're related but distinct. Long-term sickness is about what happens to your pay and pension accrual while you're off work and still, technically, an active or newly-inactive NHS employee — covered on this page. Ill health retirement is a separate, more significant step: a formal medical process that ends your active employment altogether and lets you draw your pension early, assessed under a two-tier system, because you're not expected to return to work at all. A long-term sickness absence is very often the point at which ill health retirement first gets raised as an option, but going onto long-term sick pay doesn't automatically lead to it. See our dedicated NHS Ill Health Retirement Explained guide for that separate process.
If I'm eventually awarded ill health retirement, does my sick leave pension treatment matter? +
It can factor into the bigger picture, since your accrued pension at the point ill health retirement is assessed reflects whatever was banked (or not banked, during any unpaid stretch) through your sickness absence beforehand. But the ill health retirement decision itself — which tier applies, and the size of any enhancement — is a separate medical and scheme assessment, not something this page's sick-leave-and-accrual mechanics determine on their own. See our NHS Ill Health Retirement Explained guide for that process specifically.
Does long-term sickness affect my Annual Allowance position? +
It can reduce your Pension Input Amount for the year, but not necessarily in a straightforward way — deeming keeps your pensionable pay (and therefore your CARE accrual) at your normal rate throughout paid sick leave, so a year with a period of paid sickness absence doesn't automatically show reduced pension growth for Annual Allowance purposes. A period of genuinely unpaid sick leave, on the other hand, means less (or no) pensionable pay for that period, which would tend to reduce that year's Pension Input Amount rather than spike it. See our Annual Allowance Tax Charge Explained guide for the underlying mechanics.
Where can I check exactly how my own sick leave has been treated? +
Your trust's payroll and pensions team can confirm exactly how your specific periods of full pay, half pay, SSP and any unpaid sick leave have been recorded for pension purposes, and your Annual Benefit Statement should reflect the resulting accrual. For the pay side — how the full pay and half pay entitlement scales with your length of service — see our NHS Sick Pay Policy Explained guide and the NHS Sick Pay Calculator.

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