NHS Doctors' Pay Explained 2026/27

If you've read our overview of doctors' careers and pay, you'll already know the broad shape of the ladder from FY1 to consultant. This page goes further into the mechanics: exactly how nodal points and pay banding combine into a real number, worked examples at different grades and rotas, why banding varies so much between specialties and trusts, and what a high banding percentage can do to your tax position. This is genuinely one of the most-searched and least-understood corners of NHS pay — two doctors quoting their "salary" can mean two very different things depending on whether they're talking about basic pay or their actual banded gross pay.

Nodal points: basic pay only

Resident doctors — the current term covering FY1 through ST6+, previously "junior doctors" — aren't paid on Agenda for Change bands. Instead, each stage of training sits on its own nodal point, a single basic-pay figure that applies regardless of specialty:

Nodal point	Grade	Description	2026/27 basic annual pay
NP1	FY1	Foundation Year 1	£40,190
NP2	FY2	Foundation Year 2	£45,994
NP3	ST1-2 / CT1-2	Core / Specialty Training (early years)	£54,499
NP4	ST3-5 / CT3-4	Specialty Registrar (mid years)	£67,325
NP5	ST6+	Specialty Registrar (senior years)	£76,582

These figures are basic pay only — before any banding supplement, additional hours, on-call payments, or High Cost Area Supplement. Moving up a nodal point happens when you progress to the next stage of training (e.g. from ST1-2 to ST3-5), not automatically with time served within a stage.

Consultant pay: a genuinely different structure

Consultant pay isn't banded in the same way at all, which is a common source of confusion when people compare a senior registrar's payslip to a consultant's. Consultants enter the scale at £113,565 and progress through 4 pay thresholds over 14 years of service to reach £150,569 at the top of the scale — progression that happens through a small number of large steps, not annual increments and not a banding percentage. On top of that basic scale, consultants are typically contracted for a fixed number of weekly Programmed Activities (PAs), with any additional PAs, genuine on-call availability supplements, or (for some) Clinical Excellence Awards calculated and added separately. The mechanism is different from resident doctor banding, but the underlying logic is similar: basic pay reflects a standard working pattern, and anything beyond that standard pattern is paid on top of it, not folded into a single higher basic rate.

Pay banding: how it actually combines with basic pay

Pay banding is a percentage supplement added on top of basic pay, set entirely by how many hours a rota involves beyond a standard working week and how intense or frequent the unsocial (evening, night, weekend) element of that rota is. It is assessed rota by rota, not doctor by doctor and not by grade — which is exactly why it causes so much confusion. Two doctors on an identical nodal point, in the same hospital, can be on completely different bands simply because they're covering different rotas.

Band	Supplement	Typical rota pattern
Band 1A	+50%	Full shift pattern, most onerous
Band 1B	+40%	Full shift pattern
Band 1C	+20%	Full shift pattern, least onerous
Band 2A	+80%	Partial shift / on-call, high frequency
Band 2B	+50%	Partial shift / on-call
Band 3	+15%	Low intensity on-call

The calculation itself is simple once you know your basic pay and your band: total gross pay = basic pay × (1 + banding percentage). The part that trips people up isn't the maths — it's realising just how large the banding component can be relative to the "headline" nodal point figure most people quote.

Worked example 1: ST3-5 registrar on a Band 1A rota

An ST3-5 doctor (NP4) on basic pay of £67,325, working a full-shift Band 1A rota (+50%):

£67,325 × 1.50 = roughly £100,988 in total gross pay before tax and pension deductions — over £33,000 higher than the basic-pay figure alone.

Worked example 2: FY2 doctor on a Band 2A rota

An FY2 doctor (NP2) on basic pay of £45,994, covering a high-frequency partial-shift/on-call Band 2A rota (+80%):

£45,994 × 1.80 = roughly £82,789 in total gross pay — close to the basic pay of an ST3-5 registrar three nodal points ahead of them, purely because of rota intensity.

Worked example 3: ST6+ registrar on a Band 1C rota

An ST6+ doctor (NP5) on basic pay of £76,582, on a lower-intensity full-shift Band 1C rota (+20%):

£76,582 × 1.20 = roughly £91,898 — a smaller uplift in percentage terms than either example above, despite being the most senior resident doctor grade, because this particular rota is assessed as less onerous.

Put the three examples side by side and the pattern is clear: banding, not seniority, is often the single biggest swing factor in a resident doctor's gross pay. A junior doctor on a brutal rota can out-earn a senior registrar on a gentler one, at least before any consultant-level PAs or awards come into play.

Why banding varies so much between rotas, specialties and trusts

This is consistently one of the most-searched and most-misunderstood parts of doctors' pay, so it's worth being direct about the mechanism. Banding isn't a reward for specialty prestige or difficulty in the abstract — it's a formula-driven reflection of two things:

• Hours worked beyond a standard working week. Rotas built around longer shifts, more frequent night cover, or less rest between shifts score higher.
• Intensity and frequency of out-of-hours work. A rota with frequent, disruptive on-call demands (being called in repeatedly overnight, for example) scores differently from a rota with occasional, lighter on-call cover, even if the total contracted hours look similar on paper.

That's why banding varies so much in practice. Specialties with heavy acute or emergency workloads — emergency medicine, acute general surgery, obstetrics — tend to cluster in the higher bands (1A, 2A) because their rotas are built around round-the-clock, high-frequency cover. Specialties with more predictable, outpatient-heavy workloads more often sit in the lower bands (1C, 3). And the same specialty can carry a different banding at different trusts, because the number of doctors sharing a rota, local staffing levels, and how a rota is actually built all affect the assessed intensity — a rota shared across a larger team of doctors can come out less intense (and therefore lower-banded) than an identical clinical workload covered by a smaller team. Banding is monitored through periodic rota-monitoring exercises, and disputes over incorrect banding are common enough that most trusts run a formal review and appeals process — if your actual working pattern doesn't match what your banding suggests, it's worth raising it rather than assuming payroll has it right.

Tax implications: what banding actually does to your marginal rate

Because banding is added straight into pensionable, taxable pay, a high banding percentage doesn't just increase your gross pay — it can genuinely change your tax position. UK income tax bands have been frozen in cash terms for several years and remain unchanged for 2026/27: the personal allowance is £12,570, the higher rate (40%) applies from £50,270, and the additional rate (45%) applies above £125,140. Crucially, the personal allowance itself is tapered away by £1 for every £2 earned between £100,000 and £125,140 — creating an effective marginal rate of around 60% across that band, regardless of your job title.

Look back at worked example 1: an ST3-5 registrar on a Band 1A rota reaches roughly £100,988 in gross pay — comfortably inside that £100,000-£125,140 taper zone, despite being years away from consultant status. It's entirely possible for a registrar on a heavy rota to face a higher effective marginal tax rate on part of their income than a consultant on basic pay alone. Consultants, meanwhile, start even closer to (or inside) that zone: entry-level consultant pay of £113,565 sits within the taper band already, and anyone progressing toward the top of the consultant scale, taking on additional PAs, or receiving a Clinical Excellence Award can cross into additional-rate territory above £125,140 without a dramatic jump in headline pay. Doctors in this position are also the group most likely to run into NHS Pension annual allowance tax charges, given typically high pensionable pay — see our annual allowance tax charge explained guide for how that mechanism works and what to check if it might affect you.

None of this is a reason to avoid extra sessions or a higher-banded rota if it suits you — but it's a genuine reason to check your actual take-home increase before assuming a bigger gross number automatically means a proportionally bigger net one.

How banding actually gets set and challenged, rota by rota

The banding table above explains what each band is worth, but not how a rota actually ends up on a given band in the first place, or what happens when the reality of a job doesn't match the banding it was assessed at. That process is genuinely local — run at trust and rota level, not set centrally in a single national decision — and understanding it matters if your own banding ever looks wrong.

• Banding starts with how a rota is designed. When a trust or deanery builds a resident doctor rota, it has to be designed within the working-time and rest limits set out in the national terms and conditions. The initial banding assigned to that rota is a prospective assessment of how intensive and unsocial it's expected to be, based on the shift pattern, before anyone has actually worked it.
• Rota monitoring tests that assessment against reality. After a rota goes live, trusts are required to run monitoring exercises — a defined period where doctors on that rota log their actual hours worked, including any additional time beyond the rostered shift — to check whether the real working pattern matches the banding it was assessed at. If monitoring shows the rota is consistently more (or less) intensive than assessed, the banding is meant to be adjusted, or the rota itself redesigned to bring it back within safe limits.
• Exception reporting feeds into this in real time. Between formal monitoring periods, individual doctors can flag when their actual hours deviate from what the rota expects through exception reporting (see the FAQ below), which goes to the trust's Guardian of Safe Working Hours. A pattern of exception reports across a rota is often what triggers a fresh formal monitoring exercise or banding review, rather than someone having to notice the problem unprompted.
• Disputes are generally handled locally, often with BMA involvement. If a doctor or group of doctors disagrees with a banding decision, that's typically raised first with the trust's medical staffing or rota coordination team, with local BMA representatives or the Local Negotiating Committee (LNC) able to support the case where a resolution isn't straightforward. Because banding is assessed per rota rather than nationally fixed, these disputes are resolved trust by trust, which is exactly why the same specialty can end up banded differently at different hospitals.

Why you can rely on the figures on this page

• ✓ Nodal point and consultant pay figures are drawn from the most recently confirmed values at time of writing, not projected or estimated
• ✓ We explicitly flag resident doctor pay as provisional given the ongoing BMA-government negotiation, rather than presenting it as a final settled number
• ✓ Every worked example shows the full calculation (basic pay × banding multiplier) so you can check the method, not just trust a final figure
• ✓ We link directly to bma.org.uk and gov.uk for readers who need to verify the current position before relying on a number for something like a mortgage application

Get notified when doctors' pay figures next change

Resident doctor pay is under active negotiation and consultant pay updates annually via the DDRB. We'll email you the moment either changes.

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Where to go next

For the full career ladder — Foundation training through specialty training to consultant, SAS doctors, GPs and how registration works for UK and international graduates — see our doctors' careers and pay overview. And if you want a quick estimate of your own take-home pay, the NHS Pay Calculator is useful as a general reference — but it currently models Agenda for Change bands, not doctors' nodal points and banding supplements directly, so treat any result it gives a doctor as a rough figure rather than an exact one for your grade and rota. We'd rather be upfront about that limitation than let the tool imply a precision it doesn't have.

Frequently asked questions

What exactly is a 'nodal point' in doctors' pay? +

A nodal point is simply the basic-pay figure attached to a specific stage of resident doctor training — FY1, FY2, ST1-2, ST3-5 and ST6+ each sit on their own nodal point, rather than doctors moving through the incremental points and bands used for Agenda for Change staff. Everyone at the same nodal point is on the same basic pay, regardless of specialty — the differences you see on payslips between two doctors at the same nodal point come from banding, additional hours and location supplements, not from a different basic rate.

Why do two doctors on the same nodal point take home such different amounts? +

Because basic pay is only ever part of the picture. Pay banding supplements — a percentage uplift set entirely by how intensive and unsocial an individual rota is — can add anywhere from 15% to 80% on top of identical basic pay. A doctor on a Band 3 rota and a doctor on a Band 2A rota at the exact same nodal point can be tens of thousands of pounds apart in gross annual pay, purely because of rota intensity, not seniority or performance.

Is pay banding pensionable and taxable in the same way as basic pay? +

Yes. Pay banding supplements are treated as ordinary pensionable and taxable pay — they aren't a separate allowance or expense payment. That means a high banding percentage increases your NHS Pension Scheme pensionable pay (which can affect your pension contribution tier) and is taxed through PAYE exactly like basic salary, which is precisely why high-banding registrars can move into a materially different tax position than the headline nodal point figure suggests.

Do consultants get pay banding supplements like resident doctors? +

No — this is a common point of confusion. Pay banding (Bands 1A through 3) applies specifically to resident doctors' rotas. Consultants are instead typically contracted for a fixed number of Programmed Activities (PAs) a week, with any additional PAs, genuine on-call availability, or (for some) Clinical Excellence Awards calculated separately rather than as a percentage banding uplift on basic pay. The two systems solve a similar problem — paying for extra and unsocial work — but they're structured completely differently.

Can my banding change during a training rotation? +

Yes, and it's one of the more disruptive aspects of the system. Banding is assessed rota by rota, not doctor by doctor, so when you rotate to a new post — which resident doctors typically do every six to twelve months — your banding can change even though your nodal point and basic pay stay the same. A move from a high-intensity on-call rota to a lower-intensity one (or vice versa) can shift your gross monthly pay noticeably from one placement to the next.

Does my payslip show basic pay and banding separately? +

It should. NHS payslips for resident doctors typically itemise basic pay and the banding supplement as distinct lines, alongside any additional hours or on-call payments and (where applicable) High Cost Area Supplement for London and the South East. If your payslip doesn't clearly separate these, or the banding percentage shown doesn't match what your rota coordinator or BMA representative believes your rota should attract, it's worth raising it through your trust's banding monitoring process rather than assuming it will resolve itself.

What is a Guardian of Safe Working Hours? +

The Guardian of Safe Working Hours is a role that trusts are required to have, specifically to oversee resident doctors' working hours and rota safety, independently of the normal line-management structure. Guardians review exception reports (see below), monitor patterns across a trust, and can require a rota to be reviewed or a doctor's hours addressed if a pattern of unsafe or excessive working emerges. They sit somewhat apart from the pay banding process itself, but the two are closely linked in practice, since a rota that's consistently generating safety concerns is often the same rota that ends up being formally re-monitored for banding purposes.

What is exception reporting, and how is it different from a formal banding review? +

Exception reporting is a mechanism that lets a resident doctor flag, close to real time, when their actual hours or working pattern differ from what their rota was designed for — for example working significantly beyond a rostered shift, or missing rest breaks. It goes to the Guardian of Safe Working Hours and is meant to catch immediate, individual problems quickly. A formal banding review is a slower, more structural process that looks at whether an entire rota's assessed intensity still matches how it's actually being worked, typically informed by patterns across multiple doctors and exception reports over time, rather than a single incident.

Do resident doctors get High Cost Area Supplement (HCAS)? +

Yes — resident doctors working in and around London are generally eligible for a High Cost Area Supplement in the same way Agenda for Change staff are, added on top of basic pay and any banding supplement. As with Agenda for Change roles, HCAS only applies to designated areas in and around London, not nationally, so doctors working outside that zone don't receive it.

How does GP pay differ from resident doctor and consultant pay? +

GPs sit largely outside both the resident doctor nodal point system and the consultant scale described on this page. Most GPs working in general practice are either self-employed GP partners, whose income depends on their practice's finances rather than a national salary scale, or salaried GPs, who are employed on nationally negotiated terms that are still structured differently from resident doctor banding or the consultant pay thresholds. GP trainees (GPST), by contrast, are resident doctors during their training years and are paid on the same nodal point system as other specialties. See our doctors' careers overview for how the GP route differs from the hospital specialty pathway.