NHS Consultant Salary 2026/27: Pay Scale and Thresholds

Last updated: 28 September 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

The 2026/27 consultant pay scale

Consultant basic pay is set in thresholds linked to completed years of service as a consultant — not annual increments. The 2026/27 values, effective 1 April 2026, reflect the 3.5% DDRB award accepted by the government:

Between the headline thresholds, the scale contains repeated annual pay points at the same value — this does not mean pay rises every year, but that the threshold value applies across several years until the next eligibility point is reached. National pay awards can still change the scale values in the meantime.

How the 2026/27 award was decided

Consultant pay is not set by the NHS Pay Review Body (which covers Agenda for Change staff) but by the Review Body on Doctors' and Dentists' Remuneration (DDRB) — a separate independent body that takes evidence from the BMA, NHS Employers, the Department of Health and Social Care and the devolved administrations, then recommends pay uplifts to the government.

For 2026/27, the DDRB recommended 3.5%, and the government accepted the recommendation on 25 March 2026, with the award effective from 1 April 2026 and published in NHS Employers' Pay and Conditions Circular (M&D) 1/2026. That is the uplift baked into every figure on this page: the 2025/26 Threshold 1 of £109,725 became £113,565, and the top threshold of £145,478 became £150,569.

For context, Agenda for Change staff received 3.3% for 2026/27 via the NHSPRB — a slightly smaller award, decided through a parallel but separate process. The two review bodies weigh similar evidence (recruitment, retention, morale, affordability) but reach independent conclusions, which is why medical and AfC awards differ in most years. The devolved nations then decide their own awards: Scotland, Wales and Northern Ireland each respond to the DDRB separately, so consultant scales outside England differ — sometimes slightly, sometimes materially. The figures on this page are England only.

How threshold progression works

Progression is automatic on completing the required years of consultant-level service — there is no application, appraisal gate or competition. Count your whole years as a substantive consultant (locum consultant service is treated differently), and the threshold follows:

• Years 0–2: Threshold 1 — £113,565
• Year 3: Threshold 2a — £120,249
• Years 4–7: Threshold 2b — £123,672
• Years 8–13: Threshold 3 — £135,645
• Year 14+: Threshold 4 — £150,569

The early thresholds come quickly — £10,107 more by year 4 — then progression slows: six years at Threshold 3 before the final step. This back-loaded shape is deliberate, rewarding long consultant careers. Note the scale is entirely separate from the resident doctor nodal scale: completing training (CCT) and taking up a consultant post is a move between pay frameworks, from a top registrar salary of £77,348 to a starting consultant salary of £113,565 — a £36,217 jump.

Programmed activities: the 10-PA contract

A full-time consultant contract is 10 programmed activities (PAs) per week — each PA a 4-hour block, so 40 hours. PAs are split between direct clinical care (clinics, operating lists, ward rounds) and supporting professional activities (teaching, audit, CPD, management), with the split agreed in the annual job plan.

Work beyond 10 PAs is common and is paid pro rata — each additional PA is typically worth 10% of basic salary. At Threshold 1, one extra PA is worth about £11,357 a year; at Threshold 4, about £15,057. Consultants in surgical, emergency and acute specialties routinely contract for 11 or 12 PAs, adding £11,000–£30,000 to basic pay. Part-time consultants are paid pro rata: an 8-PA contract is 80% of the threshold salary.

On-call work attracts separate on-call supplements based on rota frequency and intensity, and unpredictable emergency work can attract additional payments. These are set out in the consultant contract and vary considerably by specialty — an on-call-heavy acute rota pays substantially more than a largely elective one.

Take-home pay

Consultants pay 12.5% NHS pension contributions, 40% income tax on most of their income, and tapered personal allowances at the top end — so take-home rises much more slowly than gross pay:

Figures assume a standard tax code, no student loan, and 2026/27 thresholds. Two tax effects bite hard at this level. First, the personal allowance taper: above £100,000 of adjusted income, the £12,570 allowance shrinks by £1 for every £2, disappearing entirely at £125,140 — creating an effective 60% marginal rate in the taper zone. Second, income above £125,140 is taxed at 45%. A Threshold 4 consultant keeps only about 57% of gross pay — which is why additional PAs and private income are often weighed against their after-tax value, not their headline value.

Most consultants still carry Plan 1 or Plan 2 student loans: 9% above the threshold deducts a further £500–£900 a month at these salaries until the loan is cleared or written off.

Additional earnings

Beyond basic pay and extra PAs, consultants can earn more through:

• On-call supplements — for frequency and intensity of on-call rotas.
• Medical manager roles — clinical directors and medical directors receive responsibility allowances.
• National Clinical Impact Awards (formerly Clinical Excellence Awards) — competitive national awards for work beyond the job plan, worth significant annual sums for holders.
• Additional NHS work — waiting-list initiatives and extra sessions, usually paid at plain-time or premium rates locally.
• Medico-legal and advisory work — expert witness and advisory roles, fully private income.

Total earnings for established consultants therefore commonly exceed basic pay by 10–40%, and in some specialties by more. When comparing consultant pay with private-sector alternatives, total earnings — not the threshold table — is the right comparator.

One tax trap to plan for early: because total income includes all of these extras, consultants can drift into the personal allowance taper (£100,000–£125,140) without realising it — the zone where the effective marginal rate reaches 60%. Salary sacrifice into pension arrangements, where your trust offers them, is one legitimate way to manage this, but it interacts with the annual allowance, so take specialist advice before acting.

Private practice

Consultants may undertake private practice alongside their NHS work, provided it does not conflict with NHS commitments, is declared, and follows the employing trust's private-practice policy. Many consultants do a mix: NHS job plans of 10 PAs plus private clinics or operating lists in their own time.

Private income is fully taxable as self-employment or employment income depending on the arrangement, and it is not pensionable in the NHS scheme. It also interacts with the annual allowance and can push total income into the 45% band. The financial logic varies hugely by specialty — procedure-heavy specialties (orthopaedics, ophthalmology, cardiology) command far higher private fees than others — so national averages are meaningless; specialty-specific advice matters.

NHS pension and the annual allowance

Consultants are in the same 2015 career-average scheme: 12.5% employee contributions (about £1,185 a month at Threshold 1), 23.7% employer contributions, 1/54 accrual. The pension is one of the most valuable parts of consultant reward — a Threshold 4 consultant accrues roughly £2,788 of annual pension per year of service, plus the employer's £35,685 yearly contribution.

The complication is tax. The standard annual allowance (£60,000 of pension growth) and the tapered annual allowance (falling to £10,000 for the highest earners) can generate annual allowance tax charges for consultants, particularly in years with large pay rises or promotions. The scheme offers "scheme pays", where the tax charge is met from your pension benefits — reducing your eventual pension but avoiding an immediate cash bill. This is complex, high-stakes territory: consultants affected should take specialist financial advice, not rely on general guidance.

The route to consultant

The consultant salary is the summit of a long climb: 5–6 years of medical school, 2 foundation years (see FY1 and FY2 salary: £41,226–£47,610), then 6–8+ years of specialty training through the registrar grades (£55,355–£77,348). Total: roughly 13–16 years from starting medical school to the first consultant post — longer for dual training or less-than-full-time routes.

Alternative senior medical careers exist for those who do not pursue the consultant route: SAS doctors (specialty doctors and specialist grade, £63,696–£115,341) and GPs offer senior clinical careers with different trade-offs. And throughout training, locum work can supplement income significantly.

Frequently asked questions

How much does an NHS consultant earn in 2026/27?

NHS consultants in England earn a basic salary of £113,565 to £150,569 in 2026/27, depending on completed years as a consultant. Most earn more than basic through additional programmed activities, on-call supplements and private practice.

What is the starting salary for an NHS consultant?

£113,565 in 2026/27 (Threshold 1). After 3 years it rises to £120,249, after 4 years £123,672, after 8 years £135,645, and after 14 years £150,569.

Are NHS consultants on Agenda for Change?

No. Consultants are employed on the national consultant contract — a medical and dental framework reviewed by the Doctors and Dentists Review Body (DDRB), not the NHS Pay Review Body. Agenda for Change bands do not apply.

What is a programmed activity (PA)?

A programmed activity is a 4-hour block of timetabled work. A full-time consultant contract is 10 PAs per week (40 hours). Additional PAs above 10 are typically paid at 10% of basic salary each.

What is NHS consultant take-home pay?

On 2026/27 basic pay, a Threshold 1 consultant (£113,565) keeps about £5,660 a month after tax, National Insurance and 12.5% NHS pension contributions. Senior consultants face 40–45% tax rates and personal allowance taper, so take-home rises more slowly than gross pay.

Can NHS consultants do private practice?

Yes, provided it does not conflict with NHS commitments and is declared. Many consultants do private work alongside their NHS job plans; it is fully taxable and usually outside the NHS pension.

How long does it take to become a consultant?

Typically 5–6 years of medical school, 2 foundation years and 6–8 years of specialty training — around 13–16 years after starting medical school. See FY1 and FY2 doctor salary for the start of the journey.

Do consultants get the NHS pension?

Yes — the same 2015 career-average scheme, with 12.5% employee contributions and 23.7% employer contributions. High-earning consultants should watch the annual allowance and tapered annual allowance, which can trigger tax charges handled via 'scheme pays'.

Sources and independence

Source: NHS Employers Pay and Conditions Circular (M&D) 1/2026 — consultant pay values effective 1 April 2026 following the DDRB 3.5% award; GOV.UK — Income Tax rates and bands.

Take-home figures are estimates using 2026/27 thresholds with a standard tax code. Private practice and additional earnings vary by specialty and arrangement.

This is an independent guide and is not affiliated with the NHS. Consultants are employed on medical and dental terms, not Agenda for Change. Always confirm pay with your employer's payroll.