Consultant Pay Scale NHS 2026/27: Thresholds and Extras

This page is for hospital doctors approaching a consultant post, newly appointed consultants, and anyone comparing medicine with other careers. It sets out the 2026/27 pay scale for consultants on the 2003 contract in England, how you move up it, what is added for extra programmed activities and on-call, and how Scotland and Wales differ. Our NHS doctors' pay explained guide covers the whole ladder from foundation to consultant: this page goes deeper on the consultant grade. FrontlinePay is independent: we read figures from the official pay circular and the contract, not from job adverts.

The 2026/27 consultant scale in England

The scale comes from NHS Employers' Pay and Conditions Circular (M&D) 1/2026 R2, which says consultant salary scales were increased by 3.5% to basic pay from 1 April 2026. The values below are for consultants whose first appointment was on or after 31 October 2003, which is nearly everyone appointed today.

The circular also lists consultants who transferred from the pre-2003 contract, who pass through the same pay levels on a different timetable depending on their seniority at transfer, and a separate pre-2003 scale for those who did not transfer. If you were appointed before October 2003, check which scale your employer has placed you on.

These are basic figures. They exclude on-call supplements, additional programmed activities, awards, London weighting and any private income, which are covered below. For comparison, the top of the specialist grade on the SAS scale is £115,341, as set out in our specialty doctor and SAS doctor pay guide, and the most senior specialty training years are paid £77,348 basic, as covered in our doctors' pay explained guide. Doctors starting out are covered in our foundation doctor pay guide.

How you move up the thresholds

For consultants first appointed on or after 31 October 2003, Schedule 14 of the terms and conditions says progression through the pay thresholds is on the anniversary of appointment, subject to being continuously employed in the NHS. The date is the day you first started work as a consultant under these terms. Unlike the SAS scales, the contract does not attach an annual evidence test to the thresholds: the movement is tied to service.

The contract also protects consultants whose training was longer for good reasons. Where training was extended by flexible training or dual qualification, the employer credits additional seniority so that you are not prevented from reaching the threshold you would have reached on a full-time, single-qualification route. For example, training extended by two years counts as two years' consultant service. Basic salary on commencement can also be set at a higher threshold to reflect approved consultant-level experience gained before appointment.

That is why two consultants appointed on the same day can be paid at different points on the scale. If your placement looks wrong, ask your employer to explain the seniority they have credited, in writing, and check the rules in Schedule 14 and the circular.

The job plan: programmed activities

A consultant's contract is built around the job plan. Schedule 3 of the terms says a standard full-time job plan contains ten programmed activities, and a programmed activity has a timetable value of four hours, scheduled in blocks of four hours or half-units of two. The job plan sets out the duties and responsibilities, including:

• direct clinical care duties, including on-call work;
• supporting professional activities, which cover job planning, appraisal, revalidation, teaching, audit and similar work;
• any additional NHS responsibilities, such as clinical director or lead roles;
• agreed external duties.

Part-time consultants are paid pro rata to the agreed number of programmed activities as a share of the standard ten. Job plans are reviewed each year, and the contract has a mediation route for disagreements, so you are not stuck with a plan you think is wrong: raise it at the job plan review and ask the BMA for advice.

Work in premium time is recognised in the schedule of PAs. Schedule 7 says a programmed activity scheduled in premium time is reduced to three hours, or another PA is reduced by an hour, up to a maximum reduction of three hours a week. If a PA in premium time lasts four hours or more, an equivalent enhancement to payment can be agreed. The contract treats three hours of unpredictable emergency work done in premium time as equivalent to one programmed activity.

Pay on top of basic

Additional programmed activities

An additional PA is paid at 10% of basic salary (Schedule 14, paragraph 7 for consultants appointed after 31 October 2003). At threshold 1 that is about £11,357 a year for each additional PA, and at the top threshold about £15,057. The terms say that additional PAs are offered by the employer and agreed with the consultant, and they can be offered on a fixed basis. They are also additional hours: a PA is four hours of work every week.

On-call availability supplement

A consultant who has to take part in an on-call rota receives a supplement on top of basic salary. The level depends on how often you contribute to the rota and the category of your on-call duties, as assessed by the employer on a prospective basis. The contract says that if the assessment changes and the supplement falls, there is no protection against the reduction, and you can challenge the assessment through job planning.

Category A means you are typically required to return immediately to site when called, or have to carry out interventions as complex as those done on site, such as telemedicine or complex telephone consultations. Category B means you can typically give telephone advice or return to work later. The percentages are of full-time basic salary, including the pay thresholds but excluding awards, London weighting, recruitment and retention premia and other supplements.

Clinical Impact Awards

The national scheme, previously the Clinical Excellence Awards, was reformed from 1 April 2022 and is now the Clinical Impact Awards. The pay circular shows three levels, worth £21,000, £31,500 and £42,000 a year. Local clinical excellence awards and predecessor awards are closed, and the circular says their values are unchanged.

A worked example

A new consultant at threshold 1 (£113,565) who takes one additional programmed activity (£11,357) and is on a high-frequency category A on-call rota, with a supplement of 8% (£9,085), would be paid £134,007 before awards, London weighting and any pay for premium time arrangements. That figure is illustrative: your own job plan decides which of these apply.

Take-home pay

Using the same 2026/27 Income Tax, National Insurance and NHS Pension Scheme rules as our NHS Pay Calculator, here is what basic pay becomes before supplements and awards, outside a High Cost Area Supplement zone and with no student loan.