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 allowances that can add materially to take-home pay on top of the nodal point.

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.

These are basic pay only — before any weekend allowance, night work, 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.

The deal that resolved this dispute was agreed on 18 June 2026, backdated to 1 April 2026 and landing in most payslips from September 2026 — see our full pay mechanics breakdown for exactly what changed. If your backdated pay has just arrived (or is about to), use the tool below to check the arrears figure itself.

Weekend, night and on-call pay: the part that varies by rota

For most resident doctors, basic pay is just the starting figure. In England, on the 2016 contract, there is no pay banding. Instead, basic pay is topped up by a weekend allowance of 3% (1 in 8 weekends) to 10% (1 in 2 weekends) of basic pay, a night work premium of 37% on the hourly rate for hours worked at night (9pm to 7am and some other periods), and an on-call availability allowance of 8% of basic pay, plus additional rostered hours and flexible pay premia in certain specialties (BMA, understanding your payslip). On an ST3-5 nodal point of £67,325, the 8% on-call allowance alone is about £5,386 a year and a 1-in-2 weekend allowance about £6,733.

Pay banding survives only for doctors on the 2002 contract in Scotland, Wales and Northern Ireland (BMA). For full-time trainees the supplements are:

The nodal points on this page are England's, so do not apply these percentages to them. Banding is assessed rota by rota, not chosen by the doctor, and it is worth checking your pay lines match your actual rota.

Because this is so rota-specific, our NHS Pay Calculator currently models Agenda for Change bands rather than doctors' nodal points and allowances 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.

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 allowances 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 allowance change being confirmed

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