Specialty Doctor and SAS Doctor Pay 2026/27

This page is for specialty doctors, specialists and associate specialists, and for doctors thinking about leaving a training programme for a career-grade post. Search results for "SAS doctor pay" mix up grades, contracts and years, so we have gone back to the official circular and the 2021 terms and conditions to give one clear picture of 2026/27 pay in England, how you move up the scale, what is added for on-call and extra work, and how Scotland and Wales differ. For the whole doctor ladder, see NHS doctors' pay explained. FrontlinePay is independent: we read figures from the official circular, not job adverts.

Who counts as an SAS doctor

SAS stands for specialty, specialist and associate specialist. These are career-grade doctors: they are not foundation doctors, not in a national specialty training programme, and not consultants. Doctors reach these grades by different routes: some have spent years in a speciality they chose to practise without completing the full training route, and some have trained overseas or left a training programme and later returned to a career post.

In England the grades are:

• Specialty doctor (2021 contract). The main SAS grade for new appointments, with a five-point scale.
• Specialist (2021 contract). A more senior grade created by the same contract, with a three-point scale and a higher entry bar.
• Specialty doctor (2008 contract). Closed to new entrants from April 2021 but still paid to those who stayed on it.
• Associate specialist (2008 contract and earlier). Closed to new entrants: the grade closed on 1 April 2008.

Do not confuse a specialty doctor with a specialty registrar. A specialty registrar (ST1 and above) is a doctor in a national training programme, paid on the nodal point scale and covered in our doctors' pay explained page. A specialty doctor is a permanent career grade on a different contract and a different pay scale.

2026/27 pay scales in England

The figures below come from NHS Employers' Pay and Conditions Circular (M&D) 1/2026 R2. The circular says specialty and specialist doctors on the 2021 contracts, and the closed SAS grades, received a 3.5% increase to basic pay from 1 April 2026. Basic pay is for a full-time post of ten programmed activities, and part-time doctors are paid pro rata.

Specialty doctor, 2021 contract

Specialist, 2021 contract

For comparison, a new consultant in England starts at £113,565, which is £9,164 above the specialist starting point and £10,876 above the top of the specialty doctor scale. The consultant scale and what sits on it are in our consultant pay scale guide.

Closed grades still being paid

Doctors who stayed on the 2008 contracts remain on those scales. The 2008 specialty doctor scale runs from £55,176 to £101,511 over eleven pay points, and the closed 2008 associate specialist scale from £76,717 to £125,251. Moving between the 2008 and 2021 contracts is a decision to take with the BMA's advice, because the scales and the progression rules differ.

How progression works

The specialty doctor scale is five pay points. Under Schedule 13 of the 2021 terms and conditions, a doctor is expected to spend a minimum of three years on each pay point and to evidence the criteria before moving to the next. That is where the "12 years from bottom to top" in the table comes from: it is the fastest route, not a guarantee.

If you think a pay progression decision is wrong, the contract has a mediation route, and the BMA can advise its members. If your pay is not moving when it should, speak to your clinical director and your medical staffing team first.

Getting in: entry criteria

Both grades need full registration with the GMC and a licence to practise. After that the entry rules differ.

• ✓ Specialty doctor: at least four years of full-time postgraduate training, or its equivalent gained part-time or flexibly, with at least two of them in a specialty training programme in a relevant specialty or as a fixed-term specialty trainee in a relevant specialty. Equivalent experience and competencies can also qualify. (2021 terms, Schedule 1.)
• ✓ Specialist: a minimum of 12 years of medical work since your primary medical qualification, either continuous or in aggregate, of which at least six years should have been in a relevant specialty in the specialty doctor grade or the closed SAS grades. Equivalent experience in a relevant specialty from other grades, including overseas, is accepted. You must also meet the specialist generic capabilities framework. (2021 terms, Schedule 1.)

The terms allow an employer to appoint a doctor with equivalent experience, which is one reason doctors who trained overseas or who left a training programme can be appointed. Your starting point on the scale is set under the contract's rules on starting salaries and counting of service, so ask for your placement in writing.

Pay on top of basic

SAS doctors in England are on a job plan built from programmed activities (PAs). A standard full-time job plan has ten PAs, and a PA has a timetable value of four hours. At least one PA is set aside for supporting professional activities, which cover job planning, appraisal and revalidation. Three things add to basic salary.

Additional programmed activities

If you agree to work additional PAs, each is paid at 10% of full-time basic salary (2021 terms, Schedule 12, paragraph 15). At the top of the specialty doctor scale that is about £10,269 a year per additional PA, and at the bottom of the specialist scale about £10,440. Additional PAs are agreed, not imposed: the contract says a doctor who wants to take them on first discusses it with the employer.

On-call availability supplement

A doctor who has to be on an on-call rota receives an availability supplement as a percentage of full-time basic salary. The employer decides the category from the typical response: category A means you typically have to return immediately to site or carry out an intervention of similar complexity remotely, category B means you can typically give telephone advice or return to work later.

If your on-call duties change, the supplement is amended going forward, and the contract says there is no protection if it falls. You can challenge the assessment through job planning.

Out of hours work and London weighting

Each programmed activity worked out of hours can be reduced to three hours, or another PA reduced by an hour, by mutual agreement. If an out-of-hours PA lasts four hours or more, an enhanced rate of time and a third may be agreed. Doctors working in the former London health authority areas also receive London weighting at the rate set in the pay circular.

Other things worth knowing: annual leave for a specialty doctor on first appointment is five weeks and two days, rising to six weeks and two days after two years in the grade or equivalent, and six weeks and three days after seven years (2021 terms, Schedule 15). Doctors on the NHS Pension Scheme build a career average pension, and our NHS Pension Calculator projects it.

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 any on-call supplement or additional PAs, outside a High Cost Area Supplement zone and with no student loan.