NHS Consultant Salary 2026/27 & Take-Home Pay Calculator

NHS consultant pay 2026/27 (England, 3.5% DDRB uplift from 1 April 2026:

The basic NHS consultant salary in England is £113,565 to £150,569 a year from 1 April 2026. This is the confirmed 2026/27 scale for consultants on the 2003 contract. A new consultant normally starts at £113,565, with higher thresholds reached after the required years of completed consultant service and satisfactory pay progression.

These figures are basic salary for a standard full-time job plan. Actual gross pay can be higher where a contract includes additional programmed activities, on-call availability, recruitment and retention premia, management responsibilities or eligible clinical awards. Take-home pay then depends on tax code, pension membership, student loan deductions and other taxable income.

NHS Consultant Pay Scale 2026/27 — England

The 2026/27 NHS consultant pay scale is confirmed at four thresholds, following the DDRB’s 3.5% recommendation accepted by the government on 25 March 2026. Unlike Agenda for Change pay bands, consultant pay sits on an entirely separate framework — it is reviewed by the Doctors and Dentists Review Body (DDRB), not the NHSPRB, and has its own progression rules.

Source: NHS Employers, Pay and Conditions Circular (M&D) 1/2026, effective 1 April 2026.

The pay scale contains repeated annual scale points between the main thresholds. This does not mean basic pay rises every year through an individual increment. Instead, the same threshold value can apply for several years until the consultant reaches the next eligibility point. National pay awards may still change the value of the scale in the meantime.

Full-time consultants work 10 Programmed Activities (PAs) per week — each PA is a 4-hour block. Additional PAs above 10 are paid at 10% of basic salary per PA. At Threshold 1, one extra PA is worth approximately £11,357 per year, so consultants negotiating 11 or 12 PAs — common in surgical and emergency specialties — earn meaningfully more than the base figure.

NHS Consultant Pay Rise 2026/27

The government accepted the DDRB’s headline recommendation in full: a 3.5% increase from 1 April 2026, applying to consultants, resident doctors, SAS doctors, and salaried GPs. This was above the government’s own affordability reference of 2.5%, and Health Secretary Wes Streeting accepted the higher figure. Secondary care doctors will receive the uplift in June — two months earlier than last year.

For context, consultants received 4% for 2025/26. The 3.5% award for 2026/27 is slightly lower but remains above OBR inflation forecasts of 2.2%. Clinical Excellence Awards remain frozen with no new uplifts.

How consultant pay progression works

Consultant pay is not an Agenda for Change band and it does not use the same annual step system as Bands 2 to 9. Under the England 2003 consultant contract, progression is linked to specified thresholds and completed years of consultant service.

Progression is expected where the contractual criteria are met, but it should be confirmed through the employer’s pay-progression process. Consultants approaching a threshold should check that their job plan and appraisal are up to date, mandatory training is complete, and any required pay-progression meeting has been arranged. If a threshold payment appears to be missing, contact medical staffing or payroll and ask them to verify the recognised service date and ESR pay point.

Experience gained in another consultant post may affect starting pay. Doctors moving from overseas, from a locum post or between employers should ask how previous equivalent consultant-level service will be recognised before accepting the offer. The appointment letter and contract should state the agreed salary and pay point.

NHS Consultant Salary After Tax — What You Actually Take Home

A consultant’s net pay cannot be read directly from the basic salary table. PAYE income tax, National Insurance, NHS Pension contributions, student loan deductions and other payroll adjustments all affect the amount paid into the bank each month.

Consultant salaries also interact with the personal allowance taper. Where adjusted net income exceeds £100,000, the personal allowance is reduced by £1 for every £2 above that level and is fully withdrawn at £125,140. Additional NHS work, private income and other taxable income can therefore change the final tax position. Pension contributions and some other reliefs can affect adjusted net income, so a generic estimate should not be treated as a payslip guarantee.

Use the calculator on this page for an estimate based on your inputs. For financial decisions or a complex tax position, check the figures against your payslip, HMRC Personal Tax Account or a suitably qualified adviser.

Every consultant sits above the £100,000 personal allowance taper threshold. For every £2 earned above £100,000, £1 of the £12,570 personal allowance is lost — creating a 60% effective marginal tax rate on income between £100,000 and £125,140. This is something many new consultants don’t anticipate. Our NHS tax calculator lets you model your specific position including salary sacrifice adjustments.

All consultants also pay the maximum 12.5% NHS pension contribution, since all thresholds exceed the £66,801 tier.

Threshold 1 (~£113,565) — Monthly take-home, England:

Threshold 4 (~£150,570): estimated monthly take-home is approximately £5,700–£5,900, depending on tax code and any salary sacrifice in place.

These figures are estimates. Your actual net pay depends on tax code, student loans, and additional income sources. If you’re salary sacrificing into AVCs to bring taxable income below £100,000 — restoring your personal allowance — the picture changes materially. Use the NHS pay calculator for a personalised figure across all UK nations.

How NHS Consultant Pay Works: The 2003 Contract

Most NHS consultants in England work under the 2003 national consultant contract. The structure is threshold-based — not annual increments as in AfC. You remain at the same threshold until you have completed the required years as a consultant, then progress automatically.

A small number of consultants — those appointed before 1 November 2003 — remain on the pre-2003 contract. The top of that scale sits at approximately £111,133, which is actually below the starting salary on the 2003 contract. If you are on the pre-2003 contract and have not reviewed your position, you are likely being significantly underpaid relative to colleagues doing equivalent work.

NHS Consultant Pay Scale by UK Nation

Pay uplifts are devolved — the 2003 contract applies across all four nations, but each negotiates separately.

England: ~£113,565 to ~£150,570 (3.5% DDRB uplift applied). Final figures in the M&D Pay Circular.

Wales: £111,300 to £154,760 — the highest top salary of any UK nation, using the 2003 contract with different progression points.

Scotland: Scotland follows DDRB recommendations implemented via Scottish Government pay circulars. Scottish consultants on the 2003 contract receive the same threshold structure with devolved uplifts, but Scotland’s five income tax bands — compared to England’s three — mean a consultant earning £120,000 gross in Glasgow takes home less than an identical earner in Manchester. Our NHS Scotland pay rise guide covers the devolved figures in full.

Northern Ireland: Follows Health and Social Care (HSC) pay circulars, typically tracking the DDRB recommendation closely.

Programmed activities and additional NHS earnings

A standard full-time consultant job plan is commonly expressed as 10 programmed activities (PAs) a week. A PA is normally four hours during premium time, although the contractual treatment of work outside that period can differ. The job plan separates direct clinical care from supporting professional activities and should identify on-call duties and any additional responsibilities.

An agreed additional PA is generally valued as one tenth of full-time basic salary. For example, one additional PA at the 2026/27 starting salary is approximately £11,356.50 a year before tax and other deductions. Do not assume extra work will automatically be paid at that rate: the arrangement should be agreed and documented in the job plan or a separate contract.

What can increase total consultant earnings?

Total earnings may include additional programmed activities, separately agreed extra work, on-call availability supplements, clinical or management responsibilities, approved recruitment and retention premia, eligible National Clinical Impact Awards, and retained historic awards. Private practice and medico-legal work sit outside NHS basic salary and may create separate tax obligations.

Substantive and fixed-term locum consultant pay

The national consultant scale can apply to both substantive and fixed-term locum consultant appointments. A substantive post is permanent, while a fixed-term locum appointment has an end date. Agency locum work is different: rates are usually expressed hourly or per session and are not the same as the national annual salary table.

Consultants trained outside the UK

An overseas-trained doctor’s starting salary is not determined by nationality. The employer should consider the role, eligibility for appointment and relevant recognised consultant-level experience. Before accepting a post, ask the trust to confirm in writing which previous service has been recognised and the threshold or pay point that will appear in the contract.

CCT, Specialist Register and local job titles

A consultant appointment and its pay depend on the post and the person’s eligibility under the applicable appointment rules. “Locum consultant”, “acting consultant” and locally created titles should not be treated as interchangeable. Candidates should check the job description, person specification, GMC registration requirements, contract type and salary stated by the employing trust.

NHS Pension for Consultants

The NHS Pension Scheme is a defined benefit scheme — retirement income is guaranteed based on earnings and service. Employer contributions sit at 23.7%, meaning the total pension input exceeds 36% of salary. At consultant salary levels this is an exceptionally valuable benefit that would cost far more to replicate privately.

The 12.5% employee contribution is tax-relieved, which partially offsets the take-home impact. For consultants earning between £100,000 and £125,140, making additional voluntary contributions (AVCs) can restore the personal allowance and actually increase monthly take-home net of the contribution. You can model this with our NHS pension calculator.

Consultant Pay vs Agenda for Change: Key Differences

A significant portion of search traffic on this topic comes from people expecting consultant salaries to appear on AfC pay scales. They do not — the frameworks are completely separate.

Consultants are not on Band 9, Band 8, or any AfC band. The highest AfC band tops out below the consultant starting salary. Understanding the NHS pay bands 2026/27 structure helps clarify where the two systems diverge.

Pay Progression Under the Revised 2003 Contract

Pay progression rules were reformed as part of the 2024 consultant pay deal. From 1 April 2025, progression requires a formal meeting with a clinical manager to confirm the required criteria have been met before payroll records are updated. This is not designed to prevent progression — it is the expected norm — but delays at the employer end can push back the effective date, and backdating creates complexity for both parties. Consultants approaching a threshold change should ensure the progression meeting is scheduled no later than three months before the relevant date.

Sickness and Pay Continuity

Consultants follow the same sick pay rules as other NHS staff: full pay for six months, then half pay for a further six months within any rolling 12-month period. At Threshold 2, moving from full to half pay removes approximately £3,800 per month from gross before any tax or pension calculation. Tracking cumulative absence is therefore important — the NHS 12-month rolling sickness calculator helps monitor where you sit within the rolling window.

FAQs

Daniel Carter

Daniel Carter is a senior NHS Payroll Accountant with over 10 years of experience in Agenda for Change pay structures, tax, and pensions. He created the NHS Pay Calculators platform to help NHS staff easily understand their take-home pay, sick pay, maternity pay, and pension entitlements through simple, accurate online tools.