NHS adverts talk about "substantive", "bank" and "fixed-term" posts, and the difference matters more than most applicants realise. This guide explains what each contract type means in practice — pay, leave, pension, security — so you can read a NHS vacancy properly before applying.
The three ways to work for the NHS
- Substantive: a permanent contract with a trust, on an Agenda for Change band, with annual leave, sick pay, pension membership and incremental progression.
- Bank: you join the trust's own pool of flexible staff and pick up shifts as they are offered, usually via an app. You are employed for each shift, not guaranteed hours.
- Agency: you work the same kinds of shifts through a commercial agency. Rates can be higher, but you are outside the trust's bank and usually last in line when shifts are allocated.
What bank working gives you — and what it does not
The draw of bank work is control: you choose when you work, across different wards and sometimes different sites. Bank shifts are paid at the band rate for the role, and bank workers accrue paid holiday. What a bank arrangement generally does not give you is guaranteed income, occupational sick pay on the substantive model, or the same continuity for career progression — there is no ward that "owns" your development, no appraisal cycle pushing you toward the next band, and mortgage lenders treat variable income more cautiously.
The combination most people miss
Many NHS staff hold both: a substantive post for security, plus membership of the trust bank for extra shifts on their own terms. If you already work for a trust, joining its bank is usually a short internal process rather than a full application. If you are joining the NHS fresh, it can also work the other way round — bank shifts are a genuine route to a substantive post, because ward managers recruit people they have already seen work.
How to join a staff bank
Trusts advertise bank recruitment like any other vacancy — search for "bank" in the job title on our NHS jobs page. The application runs through the same systems as substantive posts (see our TRAC guide), with the same pre-employment checks: references, occupational health, and a DBS check where the role requires one. Registered professionals need current registration exactly as for a substantive post.
Quick comparison
- Income security: substantive wins — guaranteed contracted hours.
- Flexibility: bank wins — you accept only the shifts you want.
- Progression: substantive wins — appraisals, development time, band progression.
- Variety: bank wins — different wards, specialties and sometimes sites.
- Both at once: allowed and common, within working-time limits.
This is general information, not financial or careers advice. Contract terms vary by trust — the advert and the trust's bank office are the authoritative sources.