The Complete Guide To NHS Pay For Doctors (2024)

An NHS doctor’s salary is more complicated than it might at first appear and varies according to grade, years in role, and where in the UK the job is based. NHS pay is reviewed annually by the Review Body on Doctors' and Dentists' Remuneration (DDRB), who make recommendations to the government; new rates apply from the 1st of April. This guide provides a comprehensive overview of the latest pay scales for NHS doctors in the UK.

Junior Doctor Pay Scale

Pay arrangements vary between home countries in the UK. Whilst England began implementing a new junior doctor contract in 2016, Scotland, Wales, and Northern Ireland continue to apply the old 2002 contract (1). However, there are still some doctors in England who are working on the 2002 contract; this may be the case with lead employer arrangements or doctors with a long-term contract based on 2002 terms which is yet to expire (2).

Basic Pay

In Scotland, Wales, and Northern Ireland, basic pay increases by small increments at the end of each year of training (3). The new 2016 contract in England removed incremental annual pay rises; instead, your salary increases by larger amounts at so-called nodal points.These refer to the point in your training when you move up a grade, e.g. the first day you commence work as a specialty registrar (core training) after FY2 (Table 1). In October 2020, a 5th nodal point was added for trainees at ST6 and above (4).

Table 1 Junior Doctor Basic Pay in England (2016 contract; rates apply from April 1st 2021), Scotland (2002 contract; rates for 2021-22), Wales (2002 contract; rates for 2021-22), and Northern Ireland (2002 contract; rates for 2021-22) (4, 5).

Furthermore, under the 2002 contract, if it takes more years than usual to complete a grade, your salary would still rise by annual increments, as set by a separate pay scale within each grade. For instance, if it took you 3 years to complete your FY2 in Scotland, your basic pay in your 2nd year would increase from £32,822 to £34,969, and £37,116 in your 3rd year. Then, upon commencement of core or specialty training, you would not be placed on the minimum point for that grade as this would result in a reduction in salary. Instead, you would be placed on the next most favourable point, ie £40,020 (5).

Other Allowances: Scotland, Wales, and Northern Ireland

The 2002 contract utilises a banding system whereby junior doctors receive a base salary and are remunerated depending on their band, which reflects a number of factors: the number of additional hours worked; the degree to which these hours are unsociable; the on-call commitment; and the workload. (Table 2) (5).

Table 2 Banding System in Scotland, Wales, and Northern Ireland (2002 contract) (5).

Other Allowances: England

Under the 2016 contract, a junior doctor’s pay depends on a multitude of factors (4,6):

1. Additional Hours

This is the average number of hours worked in addition to a 40-hour week. These are remunerated at the basic pay rate respective to your nodal point (ie 1/40th of your basic pay for each additional hour worked).

2. Enhanced Hours

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These are hours worked at "unsociable" times as defined by the 2016 terms and conditions of service (eg between 21.00 and 07.00 on any weekday) and are subject to an enhancement of 37% of the hourly basic pay rate.

3. Weekend Allowance

A doctor rostered to work at the weekend (defined as one or more shifts/duty periods beginning on a Saturday or a Sunday) at a minimum frequency of 1 in 8 across the length of the rota cycle will be paid an allowance. These are set as a percentage of full-time basic salary in accordance with your nodal point (Table 3).

Table 3 Weekend Allowances (2016 contract) (4).

4. On-Call Allowance

This is paid at a flat rate and is not determined by frequency. See the table below for figures (4).

Table 4 On-Call Allowance (2016 contract). Rates apply from April 1st 2022(4,6).

Furthermore, additional bonuses (flexible pay premia) are paid to trainees under certain conditions, such as those on hard-to-fill training programmes (Table 5) (5).

Table 5 Flexible Pay Premia in England (2016 contract). Rates from April 1st 2022(4).

Consultant Pay Scale

Basic Pay

The vast majority of consultants in England work under the 2003 national consultant contract. Only a small number appointed before 1 November 2003 still retain the pre-2003 contract. The other home countries have their own consultant contracts in place. The 2003 contract is based on a full-time work commitment of 10 programmed activities (PAs) per week, each having a time-tabled value of four hours (1). Basic pay thresholds in England and their equivalents in the rest of the home countries are shown below.

Table 6 Basic Pay Threshold in England (2003 contract) and equivalent in Scotland (2004 contract), Wales (2003 contract), and Northern Ireland (2004 contract). Rates for 2022(5).

The annual rate for an additional PA is 10% of basic salary, where basic salary includes the pay thresholds and any local clinical excellence awards held (7).

Local and National Clinical Excellence Schemes

In England and Wales, academic consultants and GPs who contribute most to the delivery of safe and high-quality care and the improvement of NHS services are eligible for a Clinical Excellence Award (CEA). In Wales, consultants can also receive commitment awards, whereas in Scotland, they can apply for discretionary points.

The scheme operates at a local and national level. The lower value local awards (levels 1-9) are made by Employer Based Awards Committees (EBACs). The higher value national awards (9-12) will be reviewed by the Advisory Committee on Clinical Excellence Awards (ACCEA). A level 9 award may be assessed by either depending on the achievement (8). Refer to Table 6 for figures.

Table 7 Clinical Excellence Awards. Rates for 2019-20 (7).

Specialist and Associate Specialist (SAS) Doctor Pay Scale

SAS pay arrangements are based on the 2008 contract in all four home countries (Table 8) (1).

Table 8 SAS Doctor Pay Scales (2008 contract). Rates for 2022-23(5).

Other Doctors

GP

There is no pay scale for GPs. The pay ranges as set by the DDRB are outlined below. Note that although the pay range in England goes up to 93,965, there is no upper limit. Your salary reflects your level of responsibility, qualifications and experience (5).

Table 9 DDRP GP Pay Ranges. Rates for 2022-23(5).

Medical Academic

Those returning to clinical practice after successfully completing a higher degree are paid an academic pay premium of 4,204 per annum on the 2016 contract (5). The pay scales for clinical lecturers (2009 contract) are summarised in table 9.

Table 10 Clinical Lecturer Pay Scale (2009 contract). Rates for 2022-23 England; 2021-22 Scotland, Wales, Northern Ireland (5).

Armed Forces

The Armed Forces' Pay Review Body provides independent advice to the prime minister and the secretary of state for defence on the remuneration and charges for members of the naval, military and air forces of the crown. Below is a comparison of median salaries between NHS and Medical Defence Service (DMS) consultants and junior doctors in England (5). DMS staff is also eligible for armed forced doctor pension scheme; the figures in Table 10 are shown with and without adjustment for pensions in (5).

Table 11 Comparison of Median DMS and NHS Salaries. Rates for 2018 (5).

Occupational Physicians

Occupational physicians in the NHS are paid according to the pay scales for specialty trainees and consultants. Of course most occupational physicians will be employed outside the NHS and the BMA recommends that salaries are negotiated based on typical salary ranges for full-time hospital doctors working in the NHS (5). These are shown in Table 12.

Table 12 Occupational Physician Pay Ranges (5).

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References:

1. Contracts [Internet]. British Medical Association. [cited 25 July 2022] Available from: https://www.bma.org.uk/pay-and-contracts/contracts

2. 2016 Junior Contract Implementation [Internet]. NHS Employers. [cited 25 July 2022] Available from: https://www.nhsemployers.org/publications/faqs-2016-doctors-training-contract

3. 2002 Terms and Conditions of Service [Internet]. NHS Employers. [cited 25 July 2022]. Available from: https://www.nhsemployers.org/sites/default/files/2021-06/Terms-and-Conditions-of-Service-2002-NHS-Medical-dental-staff.pdf

4. Pay and Conditions Circular [Internet]. NHS Employers. [cited 25 July 2022]. Available from: https://peoplefirst.nhsbt.nhs.uk/NHSBT-DOCUMENT-LIBRARY/PayBenefitsandPensions/Document-Medical-Consultant-Pay-Circular.pdf

5. Pay [Internet]. British Medical Association. [cited 25 July 2022]. Available from: https://www.bma.org.uk/pay-and-contracts/pay

6. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 [Internet]. NHS Employers. [cited 25 July 2022] Available from: https://www.nhsemployers.org/publications/doctors-and-dentists-training-terms-and-conditions-england-2016

7. Terms and Conditions – Consultants (England) 2003 [Internet]. NHS Employers. [cited 25 July 2022] Available from: https://www.nhsemployers.org/articles/consultant-contract-2003

8. Clinical Excellence Scheme [Internet]. British Medical Association. [cited 25 july 2022]. Available from: https://www.bma.org.uk/pay-and-contracts/pay/consultant-award-schemes/consultant-award-schemes-and-clinical-excellence-awards-cea