NHS Consultant Salary 2026/27: Complete Pay Guide

Consultant contracts are expressed in programmed activities. A standard full-time contract is 10 PAs per week (37.5 hours). Each PA is a 4-hour block of time. PAs are divided into: • **Direct Clinical Care (DCC):** Patient-facing work including clinics, theatre, ward rounds • **Supporting Professional Activities (SPA):** Audit, research, teaching, CPD, management A typical split is 7.5 DCC PAs + 2.5 SPA PAs. Additional PAs beyond 10 are optional and paid at the PA rate — approximately £2,029 per PA per year at Nodal 1, rising with seniority.

CEAs are performance-based payments awarded for contributions above and beyond standard duties. Following reforms, new CEAs are local rather than national, capped, and based on objective criteria. • **Local CEAs (Level 1–8):** £3,000–£36,000/year • **National CEAs (Legacy):** Higher awards up to £77,000+ for existing holders • **New Impact Awards:** Replacing CEAs in some regions, focusing on measurable improvements CEAs can add between £3,000 and £50,000+ to annual income for the highest achievers. They are pensionable and can significantly boost retirement income.

All consultant salaries exceed the £50,270 higher rate threshold significantly: • **Nodal 1 (£105,504):** Higher rate tax on £55,234 of salary • **Nodal 3+ (£121,271+):** Personal allowance taper begins at £100,000 — 60% effective marginal rate on income between £100,000 and £125,140 • **Nodal 6+ (£137,095+):** Additional rate (45%) applies to earnings above £125,140 Many consultants also face Annual Allowance pension charges — the AA limit is £60,000 for 2026/27. Consultants building significant pension accrual may exceed this, triggering a tax charge. Scheme Pays elections allow this to be deducted from the pension itself rather than paid immediately.

The Annual Allowance is the biggest tax headache for consultants. It works like this: • **Pension input amount:** The growth in your defined benefit pension value in a year (not just your contributions) • **Annual Allowance limit:** £60,000 (2026/27) • **Tapered Annual Allowance:** For very high earners, this can reduce to £10,000 A consultant at Nodal 4 (£126,281) with 20 years' service may have a pension input amount of £40,000–£70,000 depending on career progression. If this exceeds £60,000, the excess is taxed at their marginal rate. Consultants who repeatedly breach the AA should consider Scheme Pays, where the tax charge is deducted from pension benefits rather than paid out of pocket.

Many consultants supplement their NHS income with private practice. Private work is done in the consultant's own time (not during NHS PAs). Typical private practice income varies enormously by specialty: • **Surgical specialties:** £30,000–£200,000+/year in private fees • **Medical specialties:** £10,000–£80,000+/year • **Radiology:** £20,000–£100,000+/year (reporting and procedures) • **Anaesthetics:** £20,000–£80,000+/year Private practice income is self-employed income — consultants must register for self-assessment and pay income tax and NI separately. No employer pension contribution applies to private work.