NHS doctor pay is entirely separate from Agenda for Change — doctors are on their own national contracts with different pay scales, progression rules, and working hour regulations. Here's the complete guide from FY1 to consultant, including enhancements, on-call, and the real take-home figures.
2026/27 Doctor Pay Scales
| Grade | Year | Basic Salary | Typical Total (with enhancements) |
|---|---|---|---|
| FY1 | Year 1 | £36,616 | £40,000–£50,000 |
| FY2 | Year 2 | £42,008 | £47,000–£55,000 |
| ST1–2 (Core Training) | Years 3–4 | £49,909 | £55,000–£65,000 |
| ST3–8 (Specialty) | Years 5–10 | £58,398 | £65,000–£80,000 |
| Consultant (New) | Year 1 | £106,000 | £115,000–£140,000 |
| Consultant (10+ yrs) | 10+ | £139,882 | £145,000–£175,000 |
| GP Partner | Average | ~£100,000–£150,000 | Variable (self-employed) |
Total pay varies significantly based on banding supplements (for junior doctors), Clinical Excellence Awards (consultants), on-call frequency, and additional programmed activities.
Junior Doctor Pay — Understanding the 2023 Contract
Following the 2023–2024 industrial action — the longest in NHS history — junior doctor pay was restructured. The new contract includes:
• Higher basic salary for all grades (approximately 22% uplift for FY1 over two years)
• Simplified pay scales with fewer nodal points
• Enhanced rates for weekend and night work
• Pay premia for hard-to-fill specialties (psychiatry, emergency medicine, some surgical specialties)
• Annual pay progression linked to training milestone completion
• Improved less-than-full-time (LTFT) training provisions
The "junior doctor" label covers Foundation Year 1 through to senior specialty registrars — a massive range from day-one graduates to doctors with 8+ years of post-qualification experience.
Enhancement Pay for Junior Doctors
Junior doctors receive enhancements for unsocial and additional hours. The 2016 contract (as amended) specifies:
| Enhancement | Rate | When |
|---|---|---|
| Standard weekday OOH | 37% uplift | Hours between 9pm–7am Mon–Fri |
| Saturday daytime | 30% uplift | Hours between 7am–9pm Saturday |
| Saturday night | 37% uplift | Hours between 9pm Sat – 7am Sun |
| Sunday/Bank Holiday | 50% uplift | All hours on Sunday or bank holidays |
| Frequency supplement | Variable | Based on weekend frequency (1:2 to 1:8+) |
| Availability allowance | Variable | For on-call availability from home |
These enhancements mean total earnings can be 20–40% above basic salary, especially for emergency medicine, acute medicine, and surgical specialties with frequent on-calls.
The Foundation Programme — FY1 and FY2
Foundation doctors (FY1 and FY2) are in their first two years after medical school. Key pay facts:
• **FY1 basic**: £36,616/year — with enhancements typically £40,000–£50,000 total
• **FY2 basic**: £42,008/year — with enhancements typically £47,000–£55,000 total
• FY1 doctors pay provisional NMC registration fees and GMC fees from their salary
• Student loan repayments begin during Foundation (Plan 2: 9% of earnings above £27,295)
• Most FY1s see approximately £2,800–£3,200/month take-home after all deductions
FY1 doctors are provisionally registered with the GMC. FY2 and beyond are fully registered. Both can work locum shifts on top of their training contract — though regulations around rest hours apply.
Specialty Training (ST1–ST8)
After Foundation, doctors enter specialty training (or GP training). Pay progresses through nodal points:
• **ST1–2** (Core Training): £49,909 basic
• **ST3** (Specialty Training entry): £51,017 basic
• **ST4–5**: Incremental increases
• **ST6–8**: £58,398 at the top
Training duration varies dramatically by specialty:
• GP training: 3 years (ST1–3)
• Emergency Medicine: 6 years
• General Surgery: 8 years
• Neurosurgery: 8 years
• Dermatology: 4 years (but extremely competitive entry)
During training, doctors rotate between hospitals and departments. Some rotations involve expensive relocations — a significant hidden cost of medical training.
Consultant Pay — The Full Picture
Consultants are the most senior doctors in the NHS. The 2003 consultant contract structures pay as follows:
• **Basic salary**: £106,000 (year 1) to £139,882 (year 10+)
• **Programmed Activities (PAs)**: Standard contract is 10 PAs (4 hours each). Additional PAs for extra clinical or supporting professional activities
• **Clinical Excellence Awards (CEAs)**: Performance-related payments ranging from £3,000 (local) to £77,000+ (national)
• **On-call**: Supplement of 1–8% of basic salary depending on frequency
• **Private practice**: Many consultants earn additional income from private work (no cap in the 2003 contract)
Total consultant income (NHS + private + CEAs) can range from £120,000 for a newly appointed consultant with no extras, to £300,000+ for an established consultant with national CEAs and significant private practice.
| Consultant Year | Basic Salary | With 2 CEAs (~£12k) | With On-Call (~5%) |
|---|---|---|---|
| Year 1 | £106,000 | £118,000 | £123,300 |
| Year 5 | £120,000 | £132,000 | £138,600 |
| Year 10+ | £139,882 | £151,882 | £158,876 |
ℹ️The CEA System Is Changing — Clinical Excellence Awards are being replaced by a new "Impact Award" system in some regions. The new system aims to reward measurable impact on patient outcomes rather than seniority. Existing CEAs are being protected for current holders.
GP Income — A Complex Picture
GP income varies dramatically depending on the employment model:
**GP Partners (self-employed):**
• Income comes from the practice's GMS/PMS contract, enhanced services, QOF payments, and private work
• Average partner income: £100,000–£150,000 before tax (after practice expenses)
• Some partners in larger, efficient practices earn £200,000+
• Partners bear financial risk — practice costs (staff, premises, equipment) are deducted from income
**Salaried GPs (employed):**
• Fixed salary, typically £65,000–£100,000 depending on hours and experience
• No financial risk from practice costs
• Standard employment benefits (sick pay, annual leave, pension)
**Locum GPs:**
• Session-based (half-day): £700–£1,000+ per session
• Extremely flexible but no job security
• Self-employed — responsible for own tax, pension, insurance
Doctor vs AfC Nurse — Pay Comparison
A common question: how does doctor pay compare to senior nursing roles?
| Stage | Doctor Grade | Doctor Total Pay | Equivalent AfC | AfC Salary |
|---|---|---|---|---|
| Year 1 | FY1 | ~£45,000 | Band 5 (new nurse) | £32,073 |
| Year 3 | ST1 | ~£60,000 | Band 6 (senior nurse) | £39,959 |
| Year 8 | ST5 | ~£70,000 | Band 7 (ward manager) | £49,387 |
| Year 12 | Consultant Y1 | ~£125,000 | Band 8a (matron) | £57,528 |
Doctors earn more at every career stage, but complete 5–6 years of medical school (often with significant student debt) before earning. Nurses qualify in 3 years and start earning earlier.
Tax Considerations for Doctors
Higher-earning doctors face specific tax challenges:
• **Higher rate (40%)**: Applies above £50,270 — most specialty trainees and all consultants
• **Additional rate (45%)**: Applies above £125,140 — some senior consultants
• **Personal allowance taper**: Reduced by £1 for every £2 earned above £100,000 (completely lost at £125,140)
• **Annual Allowance**: £60,000 limit on pension growth. Consultants with high pensionable pay often breach this, triggering tax charges
• **Student loan**: Plan 1 (pre-2012) or Plan 2 (post-2012) — 9% deduction above threshold
The interaction between pension growth, annual allowance, and personal allowance taper creates a highly complex tax picture for consultants. Many use specialist medical accountants.