NHS England » The NHS very senior managers pay framework – implementation questions and answers

These FAQs should be read in conjunction with the NHS very senior manager (VSM) pay framework and operational guidance. We will periodically review them and publish updated FAQs to expand on answers or answer new questions that arise.

The framework

1. When does the new NHS VSM pay framework take effect and to whom does it apply?

The NHS VSM pay framework (framework) is effective from 1 April 2025 and replaces all previous frameworks and guidance on VSM pay published by the Department of Health and Social Care (DHSC), NHS England and predecessor organisations.

The framework applies to new VSM appointments, salary reviews and pay awards from 1 April 2025. it does not apply retrospectively.

Nothing in the framework restricts the discretion of government ministers to make decisions on VSM pay.

2. What is the purpose of the new VSM pay framework?

The revised framework brings all NHS organisations into one pay framework to promote consistency and transparency, while offering enough flexibility to attract talented candidates into demanding roles and organisations.

No additional funding is available and organisations must meet any additional costs from their local budgets.

Scope and implementation

3. Which NHS organisations should adopt the framework?

All NHS trusts , NHS foundation trusts and integrated care boards (ICBs).

4. Who does the framework apply to?

The framework applies to all those employed on or appointed to local NHS VSM contracts, medical directors employed on consultant contracts and VSMs employed on Agenda for Change (AfC) contracts.

A VSM’s ‘principal role’ is that referenced in their main contract of employment.

VSM appointments include:

external or internal appointments following open recruitment
external or internal appointments following formal acquisitions or mergers
internal temporary promotions where the appointee receives a pay increase (‘acting up’ arrangements)
secondments
interim and fixed-term appointments
interim and fixed-term appointments that subsequently become substantive, with or without open recruitment

5. Is it just VSM board members or all VSMs?

The framework applies to all individuals who are designated as being a VSM.

6. How does the framework apply to VSMs employed on medical contracts?

Where a medical director is employed on a medical contract, the annual pay award will be in line with the government’s pay decision for the medical workforce.

Where a medical director is in receipt of a management/responsibility allowance or equivalent for their VSM role, this element of their pay will be in line with the government’s pay decision for the VSM workforce.

7. How does the framework apply to VSMs employed on the Agenda for Change (AfC) contract?

Where a VSM is employed on a AfC contract, the annual pay award will be in line with the government’s pay decision for the AfC workforce.

Where a VSM employed on an AfC contract is in receipt of a management allowance or equivalent for their VSM role, this element of their pay will be in line with the government’s pay decision for the VSM workforce.

8. Is there a requirement to review salaries for people in post before 1 April 2025?

As part of ensuring continued equality and consistency of pay determination, the local remuneration committee should consider undertaking a periodic review of its existing pay structures to ensure that salaries are in line with equal pay requirements. This means assessing how the pay of VSM roles compares to that for other roles at the same level in the organisation to maintain fairness and equality (see question 33).

9. I have VSMs whose pay exceeds the recommended scales in the framework. Are you suggesting we have to reduce their pay?

No. The framework applies to new appointments. Existing VSMs can remain on their current contracts. While it is possible for an organisation to adjust an existing VSM’s pay in accordance with their contract, the framework does not mandate a reduction in their pay.

Pay structure and ranges

10. How does this framework differ from the previous VSM benchmarked pay rates?

The new framework brings all NHS organisations onto one pay framework. It places all VSMs across all NHS organisations into the same set of salary scales.

The relevant pay ranges depends on weighted population for ICBs and turnover for provider trusts.

This differs from the previous framework where acute, community, mental health and ambulance trusts had different pay scales.

11. What is the new pay structure for NHS provider organisations set out in the framework?

The pay ranges group NHS providers into 1 of 5 pay bands (A to E) based on their financial turnover.

Within the pay ranges, there are 3 VSM pay levels (see the NHS VSM pay framework – NHS provider and ICB pay ranges).

VSM level 1:

provider trusts: the chief executive
large group model: the chief executive serving as the overall accountable officer (NHS trusts) or accounting officer (NHS foundation trusts) of the main board

VSM level 2:

provider trusts: directors who report directly to the chief executive
large group model: both voting and non-board directors reporting to the chief executive, including chief executives and managing directors of hospitals or business units. Note: site chief executives and managing directors should not be paid more than chief executives of similarly sized stand-alone provider trusts

VSM level 3:

provider trusts: VSM posts reporting to level 2; typically remunerated through AfC in most stand-alone provider trusts
large group model: other directors or VSM posts reporting to levels 1 or 2

12. What are the annual turnover thresholds for provider trusts?

Each pay band accommodates organisations that represent the highest to the lowest annual turnover within that band. Provider trusts need to be aware of their own turnover thresholds to understand their pay band.

There are 5 pay bands for provider trusts (A to E), each with a specified minimum and operational maximum salary range (see the NHS VSM pay framework – NHS provider and ICB pay ranges).

13. What should be considered when setting pay for a managing director/site chief executive in a group model?

When setting pay in group models, the local remuneration committee should be mindful of the value of similar roles in smaller stand-alone trusts. The expectation is that a managing director or site chief executive in a group setting would receive lower remuneration than a chief executive of a smaller trust, where the latter holds full autonomy and accountability for the business of the entire trust (see the NHS VSM pay framework – NHS provider and ICB pay ranges).

To ensure appropriate remuneration, national benchmark data will be provided in the future, informed by the annual pay reports and pay cases. This approach should help align remuneration for the distinct responsibilities and scale of roles within group models with that for roles in smaller stand-alone trusts.

14. What if VSM pay falls outside the pay ranges?

Local remuneration committees should consider undertaking an assessment of existing (incumbent) VSM salaries to determine whether they are above or below the ranges (see the NHS VSM pay framework – operational guidance, section 4. Implementation, Incumbent VSMs).

In circumstances where a VSM’s salary is below the pay range, a system-wide approach should be agreed, to ensure consistency in whether or not corrective action is taken.

Where a VSM’s salary is above the pay ranges, local remuneration committees should consider whether it is appropriate to withhold annual pay awards and pay reviews until such time that the pay moves into the range. This is in recognition that the new pay bands will be uprated alongside government advised pay awards.

Annual pay awards

15. Which VSMs are eligible for the annual pay award?

A VSM’s eligibility for the annual pay award is determined by their organisation’s performance as assessed by the new NHS Performance Assessment Framework (NPAF) segment.

Under the NPAF, VSMs in organisations designated segments 1 to 4 are eligible for the 2025/26 pay award, provided they meet their appraisal objectives and are not subject to any ongoing disciplinary action.

VSMs in organisations designated segment 5 (which are in the Recovery Support Programme) are not eligible to receive the 2025/26 annual pay award unless they are covered by an exemption (see the NHS VSM pay framework – operational guidance, section 8. Pay awards).

Further details on this process and effective dates will follow in due course.

16. What are the exceptions for VSMs in NPAF segment 5?

Effective from 1 April 2025, if a VSM is newly appointed to work in an organisation designated segment 5 under the NPAF, they are eligible to receive the annual pay award for up to 24 months, provided they meet their appraisal objectives and are not subject to any disciplinary sanction.

The expectation is that the organisation should make improvements within 24 months. However, it may be necessary to extend the exception period beyond 24 months to deliver the improvements agreed.

Any exception and its duration will be agreed between the local remuneration committee and NHS England.

17. Can local remuneration committees apply discretion and extend eligibility for the annual pay award for VSMs in segment 5?

The intention of the policy is articulated in the ministerial foreword to the NHS VSM Framework. If NHS organisations choose to deviate from the framework, they should explain their reasons for doing so in their annual report and accounts. In exceptional cases – for example, an incumbent VSM is on maternity leave, adoption leave or long-term sickness absence – it may not be appropriate to withhold the pay award. Decisions must be made locally on a case-by-case basis, informed by equality considerations (see the NHS VSM pay framework – operational guidance, section 4. Implementation, Equalities considerations) and local policies.

18. What happens if a VSM does not meet their individual appraisal objectives or is under disciplinary sanction?

NHS VSMs across all segments who do not meet their appraisal objectives, have conduct or capability issues are not eligible to receive the annual pay award.

Employment processes are the correct way to manage conduct or capability issues. The intention is that all NHS organisations should ensure VSMs are clear that they will be rewarded for meeting their improvement objectives and that it is wholly inappropriate to reward poor behaviour/performance.

19. Who makes the final decision for those VSMs, regardless of NPAF segment, who do not meet their appraisal objectives or are under disciplinary sanction?

The local remuneration committee is responsible for determining whether the VSM has met the criteria for receiving the annual pay award, subject to the requirements of the framework.

20. If a VSM’s local remuneration committee confirms they have failed to meet their appraisal objectives or are under disciplinary sanction, can the VSM appeal this decision?

This would be determined by the NHS organisation’s local policies and agreements.

21. When will eligible VSMs receive their annual pay award?

The pay review body process is the established mechanism for determining pay uplifts in the public sector. As per the usual process, government expects to receive a report from the independent Senior Salaries Review Body (SSRB) and will subsequently announce its pay decision. The SSRB report includes recommendations to government on the level of the pay award for NHS VSMs (and executive senior managers employed by arm’s length bodies).

The government makes the final decision, usually through a written ministerial statement (WMS). The WMS confirms the level of annual pay award and whether the award is effective from 1 April. NHS England communicates the government’s pay decision via a pay circular,

If the government’s decision is that the pay award is effective from 1 April, the pay for eligible VSMs will be backdated to 1 April.

22. How are pay awards handled for VSMs on medical and dental pay terms?

For medical directors employed on medical and dental pay terms, the pay award will be in line with the government’s pay decision for the medical workforce.

Pay progression for VSMs on medical and dental contracts will apply as normal.

In relation to eligibility to receive the annual pay award, the framework will only apply to the management responsibility allowance or equivalent element of their pay (see the NHS VSM pay framework– operational guidance, section 8. Pay awards, Medical directors).

23. What happens if a VSM has a joint role across 2 or more organisations, where one organisation is eligible for the pay award and the other is not?

This situation would likely be handled as a proportionate approach to reflect the joint role and differing eligibility statuses. For example, should a VSM be employed on a 50/50 basis at one organisation designated NPAF segment 2 and another organisation designated NPAF segment 5, they would be eligible to receive a pro-rata proportion (50%) of the annual pay award.

This approach would apply where the VSM is in receipt of a performance payment or the challenged organisation recruitment premium.

Challenged organisation recruitment premium

24. What does the term challenged organisation mean?

For the purpose of the framework, the term ‘challenged organisation’ means an ICB or provider trust that is currently in the Recovery Support Programme and designated the lowest NPAF segment 5.

25. What is the challenged organisation recruitment premium?

All VSMs newly appointed to an organisation that is in NPAF segment 5 will be eligible for a temporary, non-consolidated and non-pensionable 15% ‘challenged organisation recruitment premium’. This premium will initially last up to 24 months from the date of appointment, to be agreed between the local remuneration committee and NHS England.

The recruitment premium is applied specifically to incentivise VSMs to join challenged organisations.

26. Are all VSMs appointed to a challenged organisation eligible to receive the recruitment premium?

Yes. Any VSMs who are appointed to and take up their post at an organisation designated NPAF segment 5 on or after 1 April 2025 are eligible.

27. Can the recruitment premium be extended beyond 24 months?

If the local remuneration committee believes there is a case to extend the premium, it will need to make a case for an extension of up to a further 24 months to NHS England, which will be responsible for approving any extensions.

28. Are current VSMs in organisations designated segment 5 as part of implementation of the new NPAF eligible to receive the pay recruitment premium?

No. Current VSMs are not eligible for the pay recruitment premium. The premium is only available to those VSMs who are newly appointed to their role at an organisation designated NPAF segment 5, with the appointment date being on or after the 1 April 2025.

29. Are VSMs in post before their organisation moves into segment 5 eligible for the pay recruitment premium?

No. Only those VSMs who are appointed to and take up their post while the organisation is in NPAF segment 5 are eligible.

30. What happens to the challenged organisation recruitment premium when an organisation moves out of segment 5?

Once an organisation no longer has challenged organisation status, any new VSM appointments at the organisation would not be eligible for the recruitment premium.

Those in receipt of the recruitment premium at the time their organisation moves out of challenged provider status would retain the premium until the allocated period expires.

31. Are VSMs appointed to provide support to organisations in, for example, NPAF segment 3 or 4 eligible to receive the recruitment premium?

No. Only those VSMs in organisations designated segment 5 (and in the Recovery Support Programme) under the NPAF are eligible to receive the premium.

However, local remuneration committees, mindful of their obligations under equal pay legislation and the framework pay approval process, may wish to consider the pay flexibilities available to them to incentivise those VSMs appointed to organisations designated NPAF segments 1 to 4 to turn around specific services.

32. How should local remuneration committees consider the wider employment offer as part of their recruitment and retention strategies?

Local remuneration committees may wish to consider other benefits that will help secure the talent they need – for example, relocation expenses, access to salary sacrifice schemes and access to NHS Pension Scheme employer contribution recycling; these should be proportionate with agreement sought from NHS England. As part of the pay approval process, base pay will be considered when deciding the correct pay scale, but local remuneration committees will also be expected to set out any additional payments the VSM is receiving.

Equality considerations

33. How can we best ensure VSM pay equality?

NHS organisations should ensure there is an appropriate local mechanism for evaluating the value of a VSM role relative to the value of roles at the same level in an organisation.

The exact scope of VSM roles is completely individual and therefore it is important that they are evaluated using local arrangements and that the process is fully justified.

Organisations can use one or more of a variety of systems locally to evaluate and justify the value of the role – for example:

job evaluation
locally determined metrics for job role comparisons
relative complexity of the role and contribution of the role to the trust’s success, for example against the board’s balanced scorecard and Care Quality Commission metrics
forced pair analysis – that is, the remuneration committee considers the rank order of jobs at a similar level based on their dimensions and accountability
voting or non-voting executive responsibilities

Alongside these internal comparisons, the local remuneration committee will also need to consider evidence and (where appropriate) justify:

comparisons with people currently in post
market analysis – market value and geographical concerns
difficult to fill posts
the current salary and experience of the appointee

There should be no expectation that appointees who make a like-for-like move should receive a pay increase.

Equally, a small increase in budget or team size should not automatically trigger a pay increase.

It will be for the local remuneration committee to decide whether a pay increase is warranted, based on the organisation’s circumstances and the complexity of the role.

As part of ensuring continued equality and consistency of pay determination, the local remuneration committee should undertake a periodic review of its existing pay structures to ensure that salaries are in line with equal pay requirements.

Additionally, the local remuneration committee should ensure that a local equality impact assessment has been conducted to assess how salary variations affect equality among VSMs.

Pay approval process

34. What is the pay approval process for VSMs with a salary above £170,000?

NHS organisations will need to submit a pay case to NHS England for all appointments for which the proposed base salary exceeds £170,000, with the exception of ICB chief executive appointments.

ICB chief executive appointments for which base salary will exceed the operational maximum of the relevant pay range should be submitted as a pay case for approval to NHS England.

Where a pay proposal is planned to exceed the above thresholds, a pay case will need to be made using the pay case and justification form. These pay cases must be submitted to england.vsmcases@nhs.net for review.

Where appointments exceed the agreed pay thresholds and are not in line with the provisions in the framework, NHS England will submit these pay cases to DHSC for scrutiny.

Organisations should refer to their NHS England regional teams, via regional directors of workforce, training and education, when drafting a pay case. The pay case will be further scrutinised by the NHS England Pay and Approvals team and, if applicable, cases will subsequently be sent to DHSC for final opinion.

35. What is the approval process for VSMs eligible for the challenged organisation recruitment premium or the performance payment scheme, where salaries do not exceed £170,000?

The NHS England Pay and Approvals team will be the primary contact for providing advice and guidance, as well as for any necessary referrals to NHS England regional teams for scrutiny. A pay case will need to be made using the pay case and justification form. Contact: england.vsmcases@nhs.net for queries and onward referral.

36. What is the approval process where NHS England is seeking to appoint a VSM on behalf of a challenged organisation?