NHS Doctors Pay by Grade: FY1 to Consultant

Doctors have the longest and most structured career ladder in the NHS, and it's also the one where headline salary figures are most likely to mislead you. A newly qualified FY1's basic pay is a single, publicly quoted number — but what actually lands in most doctors' bank accounts depends heavily on rota intensity, unsocial hours, and where they are in a specialty training programme that can run for the best part of a decade. This page walks through the whole ladder, the real pay at each stage, and the supplements that do more to move take-home pay than the nodal point itself.

The doctor career ladder, in order

Almost every hospital doctor in the NHS follows some version of this sequence, even though the timing and branch points vary a lot by specialty:

• • Medical degree — a 5-6 year undergraduate MBBS/MBChB, or a 4-year graduate-entry course for those with a prior degree
• • Foundation Programme (FY1 → FY2) — two years of general postgraduate training rotating through several specialties, required before you can practise unsupervised
• • Core or Specialty Training (CT1-2 / ST1-2) — the first structured step into a chosen specialty, or a core training route (e.g. Core Medical Training, Core Surgical Training) that later branches into a specialty
• • Higher Specialty Training / Registrar (ST3 upwards, often called SpR) — years spent building the specific competencies of your chosen specialty, increasingly senior and increasingly independent
• • Consultant — reached on award of a CCT (Certificate of Completion of Training) or equivalent, and entry to the substantive consultant grade and pay scale

Two well-established alternatives run alongside this main ladder. SAS (Specialty and Associate Specialist) doctors are experienced doctors working outside the formal numbered training programme — some by choice, for better control over hours and location, others as a route back into training later. General Practice branches off after Foundation training into its own 3-year GP training programme, leading to independent practice as a GP rather than a hospital consultant post — a genuinely different career shape with its own pay structure (partnership drawings or salaried GP pay), which we cover separately from the hospital-based figures below.

Resident doctor and consultant pay: the nodal points

Doctors aren't paid on Agenda for Change bands like most other NHS staff. Resident doctors (the current term covering FY1 through ST6+ — previously called "junior doctors") are paid on a set of nodal points, and consultants sit on a separate scale entirely.

Grade	Description	2026/27 basic annual pay
FY1	Foundation Year 1	£40,190
FY2	Foundation Year 2	£45,994
ST1-2 / CT1-2	Core / Specialty Training (early years)	£54,499
ST3-5 / CT3-4	Specialty Registrar (mid years)	£67,325
ST6+	Specialty Registrar (senior years)	£76,582
Consultant (entry)	Newly appointed consultant, all specialties	£113,565
Consultant (top of scale)	After 4 pay thresholds over 14 years' service	£150,569

These are basic pay only — before any banding supplement, additional hours, or location weighting. Consultants progress through the scale via 4 pay thresholds spread across 14 years of service from the entry point, rather than moving up every year automatically.

Pay banding: the part that actually moves your take-home the most

For most resident doctors, basic pay is genuinely just the starting figure. On top of it sits a pay banding supplement — a percentage addition set by how intensive and unsocial your specific rota is, not by your grade or specialty. This is one of the most-searched and least-understood parts of doctors' pay, because two people on an identical nodal point can end up with very different payslips depending on which band their rota falls into.

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

In other words, a rota attracting the top Band 2A supplement adds 80% on top of basic pay — which on an ST3-5 nodal point of £67,325 is worth over £53,000 a year in banding alone, before tax. At the other end, a low-intensity on-call rota (Band 3) adds only 15%. Banding is assessed and monitored rota-by-rota, not chosen by the doctor, and disputes over incorrect banding are common enough that most trusts have a formal monitoring and appeals process — it's worth checking your banding matches your actual rota rather than assuming payroll has it right.

Because banding is so rota-specific, our NHS Pay Calculator currently models Agenda for Change bands rather than doctors' nodal points and banding supplements directly — if you're a doctor, treat any figure it gives you as a rough general reference only, not an exact result for your grade and rota. We're honest about that limitation rather than pretending the tool covers doctors precisely.

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Resident doctor pay is under active negotiation. We'll email you as soon as new nodal point figures or a fresh pay award are confirmed.

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SAS doctors and GPs: the alternative paths

SAS doctors — Specialty Doctors and Specialist grade — are experienced, qualified doctors (typically with at least four years of postgraduate training, two of them in a relevant specialty) who work outside the formal, numbered specialty training programme. It's a genuine career choice for many: SAS roles often come with more predictable hours and location stability than training posts, which move doctors between hospitals every year or two. Others use SAS time deliberately as a stepping stone, gaining experience before re-entering formal training or applying for a CESR (Certificate of Eligibility for Specialist Registration) as an alternative route to the specialist or GP register.

General Practice is the other major branch point. After Foundation training, GP trainees complete a 3-year GP training programme before becoming qualified GPs — either as salaried GPs employed by a practice, or as partners with a share in the practice business itself. Partner income works completely differently from a nodal point salary, since it's drawn from practice profits rather than paid on a fixed scale, which is why we treat GP pay as its own topic rather than folding it into the hospital doctor figures above.

Registration: the GMC and the international route

Every doctor practising in the UK — UK-trained or otherwise — must be registered with the General Medical Council (GMC), with a licence to practise. UK medical graduates register on completion of their degree via provisional registration moving to full registration after FY1. International Medical Graduates (IMGs) most commonly register via the PLAB (Professional and Linguistic Assessments Board) test, or via an accepted postgraduate qualification recognised as equivalent. See our international recruitment guide for the full PLAB route, typical costs, and realistic timelines from application to starting an NHS post.

Pensions: the other half of doctors' total reward

Doctors are automatically enrolled in the NHS Pension Scheme, and for most of a medical career it's a genuinely significant part of total reward — arguably more so than for many other NHS staff, given how long a full medical career runs and how the scheme's defined benefit structure rewards sustained membership. Doctors also sit at the sharper end of pension tax rules given typically higher pensionable pay, particularly once banding and additional sessions are factored in, so it's worth understanding the scheme properly rather than treating it as background noise. Read our NHS Pension Scheme (2015) explained guide for the full breakdown.

The real bottleneck: getting into higher specialty training

Ask most resident doctors where a medical career actually gets held up, and the honest answer usually isn't Foundation training or even getting a medical degree place — it's the step from core or early specialty training into higher specialty training (ST3 and above) in a competitive specialty. This is where the career ladder genuinely narrows.

Foundation and core training posts are run at a scale designed to take in most graduating UK medical students, so the first few years after qualifying tend to feel relatively structured and predictable. Applying for higher specialty training is different: doctors are competing nationally for a fixed number of posts in their chosen specialty, and demand is very unevenly spread. Specialties like dermatology, ophthalmology, clinical radiology, plastic surgery and some surgical sub-specialties routinely attract far more applicants than there are training places, while other specialties — some areas of psychiatry and parts of general/internal medicine among them — are typically easier to enter at ST3. The result is that two doctors who trained together through Foundation and core training can end up on very different timelines from that point on: one moving straight into their preferred specialty, another needing extra years building a stronger portfolio, taking on research or audit work, or applying more than once before securing a competitive post.

This matters for pay because time spent reapplying, taking a non-training "bridging" post, or working as a Locally Employed Doctor while strengthening an application doesn't automatically track the resident doctor nodal points at the pace a straight-through training run would. It's one of the most consequential, least-discussed realities of planning a medical career around a specific specialty — and it's genuinely specialty-dependent rather than something that applies evenly across medicine as a whole, so it's worth researching competition levels in your specific target specialty early rather than assuming your Foundation-year experience predicts what comes next.

Why you can trust these figures

• ✓ Nodal points and consultant scale figures cross-checked against the most recently confirmed BMA and DDRB outcomes
• ✓ Flagged explicitly wherever resident doctor pay is still under active, multi-year negotiation rather than settled
• ✓ No NHS, DHSC, GMC or BMA affiliation — an independent, source-checked reference, not official guidance
• ✓ Updated within days of a new pay award, nodal point revision or banding change being confirmed

Related pay guides, tools and careers

Frequently asked questions

Why do doctors' payslips look so different from their basic salary? +

Because basic pay (the nodal point figures — e.g. £40,190 for FY1) is only the starting point. Most resident doctors also receive a pay banding supplement of 0-83% on top, reflecting how intensive and unsocial their rota is, plus separate payments for any additional hours, on-call availability, and (in London and the South East) a High Cost Area Supplement. Two doctors on the same nodal point can take home noticeably different amounts depending on their rota.

Is resident doctors' pay the same as consultants' pay process? +

No, and this trips a lot of people up. Resident doctor pay (FY1 through ST6+) has been under direct, multi-year negotiation between the BMA and the government since 2023, running outside the normal annual mechanism. Consultant, SAS and dentist pay instead goes through the DDRB (Review Body on Doctors' and Dentists' Remuneration), which reports annually to government. The two tracks move independently and on different timetables.

How long does it take to become a consultant? +

There's no single answer because it depends on specialty, but a typical path is roughly 5-6 years of medical school, 2 years as a Foundation doctor (FY1-FY2), then specialty training of anywhere from 3 years (some GP and core medical routes) to 8+ years (surgical specialties, with additional fellowship time common). Ten to fourteen years from graduation to CCT (Certificate of Completion of Training) is a realistic overall range for most hospital specialties.

What's the difference between an SAS doctor and a Specialty Registrar? +

A Specialty Registrar (StR/SpR) is in a formal, time-limited training programme working towards a CCT and eventual consultant eligibility. An SAS (Specialty and Associate Specialist) doctor has substantial postgraduate experience but sits outside that formal training numbers system — some choose SAS grades deliberately for better work-life balance or portfolio careers, others use it as a stepping stone back into training. SAS pay is a distinct scale from both resident doctor nodal points and the consultant scale.

Can international medical graduates work as NHS doctors? +

Yes — IMGs make up a large share of the NHS medical workforce. The standard route is GMC registration via the PLAB (Professional and Linguistic Assessments Board) test or an accepted postgraduate qualification, plus the right to work in the UK. See our international recruitment guide for the full route, typical costs and realistic timelines.

What is a Locally Employed Doctor (LED)? +

A Locally Employed Doctor (sometimes called a Trust Grade doctor) is employed directly by an individual NHS trust to fill a service gap, rather than holding a place on a national, numbered specialty training programme. Pay is set locally by the trust rather than nationally, and while it's typically benchmarked against the closest equivalent resident doctor nodal point, it isn't guaranteed to match it exactly — always check the specific trust's offer rather than assuming parity with the national scale.

Do doctors get High Cost Area Supplements like other NHS staff? +

Yes. Doctors working in and around London receive the same style of High Cost Area Supplement (HCAS) uplift as any other NHS employee, applied on top of their basic nodal point or consultant salary rather than an Agenda for Change band, since doctors aren't paid on the Agenda for Change scale.

How does GP partner income differ from a salaried GP's pay? +

A salaried GP is paid a fixed salary set by their employing practice, broadly comparable in structure to a nodal point or scale salary. A GP partner instead takes a share of the practice's profits after expenses — known as 'drawings' — so their income depends on the practice's patient list size, contract type (GMS, PMS or APMS) and overall financial performance, and can vary noticeably year to year in a way a salaried post doesn't.

Do doctors get paid extra for working beyond their standard contracted hours? +

Yes, though the mechanism differs by grade. Resident doctors working hours beyond their rostered rota are paid for that additional time separately from their banding supplement. Consultants and SAS doctors working extra sessions beyond their standard contracted Programmed Activities (PAs) are paid an additional amount per session, on top of their basic scale salary.