Highest Paid Jobs in the NHS 2026/27

Last updated: 7 November 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

The ranking: highest paid NHS jobs 2026/27

The table below ranks the highest paid NHS roles by the maximum gross pay each can reach in 2026/27, from verified figures. Read the basis column with the figure: some rows are national pay steps anyone in the role can reach, some are the top of a published range that only the largest organisations pay, and some are a basic salary plus an award that most holders never receive. The ranking is by annual gross pay before tax, National Insurance and pension, and the monthly column is the annual figure divided by 12. All figures are for England unless the row says otherwise.

Three things jump out of the ranking. First, the top two rows are chief executives, not clinicians, and they are a long way clear of everything else: the largest integrated care board chief executive range tops out at £304,500, which is £76,611 a year more than the highest clinical total on the page, and £174,717 a year more than the top of Agenda for Change. Second, the clinical top is not a salary at all, it is a salary plus an award: a consultant's basic pay tops out at £150,569, and the extra £42,000 of a National 3 award, or £77,320 of a legacy Platinum award, is what lifts the total past £190,000. Third, the gap between the top of Agenda for Change and the medical scale is smaller than most people expect: Band 9 tops out at £129,783, and a consultant at Threshold 4 earns £150,569, which is £20,786 a year more, or 16.02% higher. The sections below take each group in turn, with the rules that decide who actually gets these figures.

Chief executives and the Very Senior Managers framework

Chief executives and executive directors sit outside Agenda for Change on the Very Senior Managers, or VSM, pay framework, which has applied to all NHS provider trusts and integrated care boards since 1 April 2025. Pay is not set by national steps. Each organisation's remuneration committee sets an individually negotiated spot salary inside a published range, and the range depends on the size of the organisation: turnover for provider trusts, weighted population for integrated care boards. Each range has a minimum, an operational maximum and an exception zone above the operational maximum, and the exception zone needs a formal pay case approved by NHS England, which may refer it to the Department of Health and Social Care.

The ranges below are those published by NHS England at the framework's launch in May 2025. They are uprated annually with government pay decisions, so treat them as the structure and check the current NHS England publication or a trust's annual report for the latest numbers. The trust chief executive ranges run from a £140,595 minimum in the smallest trusts, with turnover up to £250 million, to a £270,375 operational maximum in trusts with turnover over £1 billion, with an exception zone to £299,250. The smallest-trust minimum alone is £10,812 a year above the top of Agenda for Change, which is why the framework advises similar consideration when a VSM was previously in a Band 9 role earning more than the VSM band minimum.

Integrated care board chief executives have their own ranges, set by weighted population rather than turnover, and they run higher than the trust ranges at every size. The smallest ICBs, under 1 million weighted population, run from £183,750 to £207,375 at the operational maximum, with an exception zone to £231,000. The largest, over 2 million, run from £262,500 to £283,500 at the operational maximum, with an exception zone to £304,500. That £304,500 is the single highest published figure on this page, and it is £13,125 a year above the largest trust chief executive's operational maximum of £270,375.

Executive directors who report to the chief executive sit in lower ranges, but they still sit above most of Agenda for Change. In the smallest trusts their range runs from £97,335 to £151,410 at the operational maximum, with an exception zone to £178,500, and in trusts with turnover over £1 billion it runs from £151,410 to £200,078, with an exception zone to £220,500. The lowest VSM minimum of all, £97,335 for some executive directors in the smallest trusts, still sits near the top of Agenda for Change, which is the point the framework itself makes: VSM pay starts where AfC pay ends.

Two controls sit on top of the ranges. The first is the £170,000 scrutiny threshold: any proposed VSM salary above £170,000 must be submitted to NHS England as a pay case, and cases that do not comply with the framework go to the Department of Health and Social Care for approval. For integrated care board chief executives the trigger is different, exceeding the operational maximum instead of the £170,000 figure. The second is disclosure: every trust and integrated care board must publish a remuneration report in its annual report and accounts, naming senior managers and disclosing their salary bands, pension benefits and any bonuses. That is why chief executive pay appears in the news every year: it is a legal and regulatory requirement, not a leak.

Ranges describe what can be paid, and the Department of Health and Social Care's evidence to the Senior Salaries Review Body describes what is paid. For the 12 months to March 2025, chief executives averaged around £211,988 basic pay per full-time equivalent and around £231,355 in total earnings, a gap of £19,367 that covers pension benefits and other elements on top of basic pay. Executive directors averaged less: finance directors around £156,739 basic, medical directors around £153,892 basic but £188,087 in total earnings, a gap of £34,195 that reflects clinical work paid on top of the VSM salary, and directors of nursing around £143,714. These are mean averages across all trusts, so individual salaries vary widely with organisation size: a chief executive of a small community trust and one running a £1 billion-plus teaching hospital group sit at opposite ends of the published ranges. Our NHS managers' pay guide sets out the full framework, including the executive director ranges and the disclosure rules.

Consultants: the highest paid clinicians

Consultants are outside Agenda for Change, on the 2003 consultant contract, with pay recommended by the Review Body on Doctors' and Dentists' Remuneration. The DDRB recommended a 3.5% award for 2026/27, announced on 25 March 2026 and effective from 1 April 2026. Basic pay runs through five thresholds, set by years as a consultant: Threshold 1 on entry at £113,565, Threshold 2a after three years at £120,249, Threshold 2b after four years at £123,672, Threshold 3 after eight years at £135,645, and Threshold 4 after 14 years at £150,569. Full-time means 10 programmed activities, and each extra programmed activity is paid at one tenth of basic pay, which is £11,356.50 a year at Threshold 1 and £15,056.90 a year at Threshold 4. Our NHS consultant salary guide sets out the thresholds in full, and our doctor pay scales hub compares every medical scale from FY1 to consultant in one place.

Basic pay alone puts a Threshold 4 consultant at £150,569 a year, which is £12,547.42 a month before deductions. What lifts consultants above every other clinical group is the award on top of basic pay. A current National Clinical Impact Award pays £21,000 a year at National 1, £31,500 at National 2 and £42,000 at National 3, and a Threshold 4 consultant with a National 3 award earns £192,569 a year, which is £16,047.42 a month before deductions. The award is worth 27.89% of basic pay at Threshold 4, and 36.98% at Threshold 1, where the same award lifts £113,565 to £155,565, or £12,963.75 a month. New awards last five years, so a National 3 award is worth £210,000 over its full term, and up to 600 new awards are made a year in England, which means the scheme can carry up to around 3,000 current holders at a time if every round fills. Most consultants hold no award at all, and their pay is the threshold basic alone.

The largest clinical total on this page comes from the old scheme, not the new one. National Clinical Excellence Awards were replaced by National Clinical Impact Awards on 1 April 2022, but consultants who already held an award keep transitional values: Bronze £36,192, Silver £47,582, Gold £47,582 to £59,477 and Platinum £47,582 to £77,320. A Threshold 4 consultant holding a Platinum award at the top of its range earns £227,889 a year, which is £18,990.75 a month before deductions, and £35,320 a year more than the same consultant with a new National 3 award. A Platinum award is worth 51.35% of a Threshold 4 basic salary, and 68.08% of a Threshold 1 basic salary. Our Clinical Impact Awards guide works through every level, the pension difference between new and legacy awards, and the take-home figures.

The devolved nations pay more at the top of the consultant scale than England does. Wales runs from £114,099 to £166,585, which is £16,016 a year, or 10.64%, above the England Threshold 4 figure of £150,569. Scotland runs from £115,331 to £153,247 across eight points over twenty years to the top, which is £2,678 a year, or 1.78%, above the England top. The figures on this page are for England under the 2003 contract, and the nation guides are NHS Scotland pay, NHS Wales pay and NHS Northern Ireland pay. Scotland also has its own income tax bands, so the England take-home figures in the table below do not transfer.

Band 9: the top of Agenda for Change

Band 9 is the ceiling of Agenda for Change, and it is the highest pay available on the national band system. In 2026/27 Band 9 pays £112,782 at entry, £119,583 at the intermediate step and £129,783 at the top, which is £10,815.25 a month or £66.30 an hour at the top, against £57.62 an hour at entry. The 3.3% award for 2026/27, effective from 1 April 2026, applies to Band 9 exactly as it applies to every other band, and the steps are national: a Band 9 post in any English trust pays the same three figures. Our Band 9 pay guide sets out the roles, the progression from Band 8d, and the pension and time-off-in-lieu rules.

Band 9 posts are director-level roles: directors of nursing, finance directors, directors of operations, and consultant-level clinical leaders in highly specialist fields. They are board-level or near-board-level roles with organisation-wide responsibility, and they are the point where the clinical and managerial ladders meet: a director of nursing and a finance director can both sit on the same band. The step below, Band 8d, tops out at £108,814, with an entry of £94,356 and an intermediate step of £100,140, so the move from Band 8d top to Band 9 top is worth £20,969 a year. The bands below that run down through Band 8c at £79,504 to £91,609, Band 8b at £66,582 to £77,368 and Band 8a at £57,528 to £64,750, which is why most senior managers in the NHS sit somewhere in the 8a to 8d range rather than at Band 9 itself.

The honest way to read Band 9 is as a ceiling, not a destination. A Band 5 staff nurse tops out at £39,043 and a Band 6 senior staff nurse at £48,117, so Band 9 top is 3.32 times Band 5 top, and a Band 2 healthcare assistant on the £25,272 spot rate would need 5.14 Band 2 salaries to match one Band 9 top salary. The jump from Band 8d to Band 9 is the last step on the Agenda for Change ladder, and anything above it means leaving the band system altogether: consultants on medical contracts, or chief executives and executive directors on the Very Senior Managers framework. That is the structural point of this page. The highest pay in the NHS is not at the top of the band system. It is outside it.

SAS doctors, salaried GPs and salaried dentists

Below consultants and above most of Agenda for Change sits a group that rarely appears in highest-paid lists, because their contracts are less well known. Associate specialists on the closed 2008 contract top out at £125,251 after ten years, which is only £4,532 a year below Band 9 top, and 96.51% of it. That is the highest SAS figure on this page, and it belongs to a closed contract, so no new entrants join it. Specialists on the 2021 contract run from £104,401 at 0 to 2 years, through £108,484 at 3 to 5 years, to £115,341 at 6 years and above, which is £2,559 a year above Band 9 entry. Specialty doctors on the 2021 contract top out at £102,689 after 12 years, and on the closed 2008 contract at £101,511 after ten years. Our SAS doctor salary guide sets out every SAS scale, and the doctor pay scales hub puts them alongside the resident doctor and consultant scales.

Salaried dentists in primary care run a separate scale with three bands, and the top of it belongs in this ranking. Band C, for managerial posts, runs from £101,434 to £116,573, which is £3,791 a year above Band 9 entry. Band B runs from £84,781 to £99,163 and Band A from £54,502 to £84,781, with the 2026/27 figures carrying a 3.75% uplift from 1 April 2026. Most high-street NHS dentists are self-employed contractors on the UDA system, not salaried, so this scale covers employed dentists in the salaried primary-care dental service, and our NHS dentist salary guide explains the difference.

Salaried GPs sit in a similar position, with one important difference: the figure is a summary range, not a full verified scale. The pay circular gives a salaried GP range for qualified GPs of £78,699 to £118,759 for 2026/27, after the 3.5% award from 1 April 2026. That top figure of £118,759 would sit between the associate specialist top and the salaried dentist Band C top in the ranking, but it is flagged as a summary range in the source, with no published sessional maths or model-contract minimum in the verified data, so it is shown with that caveat rather than presented as a step on a scale. GP partners are paid differently again, from practice profits rather than a salary, so they cannot be ranked on a pay scale at all, and our salaried versus partner GP guide explains the two models. Trainee GPs sit on the resident doctor scale, with GPST1 and GPST2 at £55,355 and GPST3 at £67,325, and our GP registrar salary guide sets those figures out.

What the top jobs pay after tax

Gross pay is not take-home pay, and at these levels the gap is wide. The table below works out monthly take-home pay for the top of Agenda for Change and for consultants, using England and Wales tax, Category A National Insurance, and the NHS pension contribution. Pension is deducted before income tax is calculated, National Insurance is calculated on gross pay, and the personal allowance tapers by £1 for every £2 of adjusted income above £100,000, reaching zero at £125,140. The pension contribution is 12.5% of pensionable pay at these incomes, because every figure in the table sits above the £67,669 tier boundary. Student loan repayments are left out, as they depend on the plan and the balance, and the take-home figures are before any loan.

The pattern in the table is the pattern of the whole page. A Band 9 consultant-level salary of £129,783 a year becomes £6,115 a month after pension, tax and National Insurance, and a Band 9 entry salary of £112,782 becomes £5,626 a month. A Threshold 4 consultant keeps £6,770 a month on basic pay alone, and £8,625 a month with a National 3 award, because the award is taxable and subject to National Insurance but not pensionable, so no pension contribution shelters any of it. At Threshold 4 the personal allowance is already zero, so the award is taxed at a steady marginal rate, which is why the kept share is higher there than at Threshold 1, where the award eats into the allowance. Our consultant take-home pay guide works out the same calculation for every threshold and award level, and the pension annual allowance guide is worth reading alongside it, because total pay at these levels is high enough for the tapered annual allowance to bite. For the rest of the workforce, the Band 5 pay guide and the Band 6 pay guide show what the same calculation looks like at the bands most staff actually sit on, and the 2026/27 pay rise guide sets out the 3.3% award that lifted every AfC band this year.

The honest caveat: how few staff reach the top

This ranking shows the ceiling of NHS pay, not the typical pay packet, and the distance between the two is the most important fact on the page. Most NHS staff sit on Bands 2 to 6. Band 2 pays £25,272, Band 5 tops out at £39,043 and Band 6 at £48,117. Band 9 top of £129,783 is 5.14 times Band 2 pay and 3.32 times Band 5 top, and the largest chief executive exception-zone figure of £304,500 is 12.05 times Band 2 pay. Those multiples are not a complaint, they are arithmetic, and they are the reason the ranking needs its caveat in plain language: the jobs on this page are real, the figures are verified, and very few staff ever reach them.

Each top job is also gated by something the table cannot show. Chief executive posts are few in number, one per trust or integrated care board, and they are filled from a small pool of senior leaders. Consultant posts need a medical degree and the full training pathway, and the awards that lift consultant pay past £190,000 are competitive, with up to 600 new awards a year in England against a consultant workforce in the tens of thousands. Band 9 posts are director-level, and most staff who reach Band 8 never move past it. None of that makes the figures wrong. It makes them a ceiling, and a ceiling is useful only if the reader knows it is a ceiling. If the question behind the search is what a nurse, a paramedic or a healthcare assistant can expect to earn, the answer is in the band guides, not in this ranking, and the Agenda for Change guide is the place to start.

How people get to the top jobs

The routes to the top jobs are different for each group, and they are worth stating plainly because the ranking alone hides them. A consultant starts with a medical degree, then foundation training and specialty training on the nodal scale, which runs from FY1 at £41,226 through FY2, the CT and ST grades, to ST8 at £77,348, ten years of postgraduate training stages, before a consultant appointment at Threshold 1 of £113,565. The award that lifts pay past £190,000 comes later still, after years as a consultant with demonstrable impact beyond the job plan. A Band 9 director usually comes up through the band system, from Band 5 or 6 through Band 7 and the 8a to 8d steps, gathering the leadership and management experience the director role needs, and the step from Band 8d to Band 9 is a competitive appointment, not an automatic progression.

A chief executive comes from senior leadership, often from a director role inside or outside the NHS, and the appointment is made by the organisation's board on the recommendation of its remuneration committee, inside the published VSM range for the size of the organisation. There is no single qualification that leads to it, and there is no automatic route: it is a board appointment, and the salary is set as a spot rate inside the range, not as a step on a scale. That is the practical difference between the top of this ranking and the top of Agenda for Change. Band 9 is a step you can reach by progression and appointment inside a national system. A VSM salary is a negotiation inside a published range, and the range is the only national part of it.

Frequently asked questions

What is the highest paid job in the NHS?

A chief executive of the largest NHS trust or integrated care board. Under the published Very Senior Managers pay framework, a trust chief executive in an organisation with turnover over £1 billion can be paid up to £270,375 at the operational maximum, or £299,250 in the exception zone, and an integrated care board chief executive in an area with over 2 million weighted population can be paid up to £283,500 at the operational maximum, or £304,500 in the exception zone. Those are the top of the published ranges, and the exception zone needs a formal pay case. The highest-paid clinical role is a senior consultant: a Threshold 4 consultant holding a legacy Platinum award earns £227,889 a year, and the same consultant with a current National 3 award earns £192,569 a year.

How much does an NHS chief executive earn?

It depends on the size of the organisation. Under the published Very Senior Managers framework, chief executive pay ranges run from a £140,595 minimum in the smallest trusts to a £270,375 operational maximum in trusts with turnover over £1 billion, with an exception zone to £299,250. Integrated care board chief executives run from £183,750 to £283,500 at the operational maximum, with an exception zone to £304,500. What chief executives actually earn is lower than the top of the range: the Department of Health and Social Care's evidence to the Senior Salaries Review Body gives a mean basic pay of around £211,988 per full-time equivalent and mean total earnings of around £231,355 for the 12 months to March 2025. Actual salaries are published in each trust's annual report and accounts.

What is the highest paid job on Agenda for Change?

Band 9, the top of Agenda for Change. In 2026/27 Band 9 pays £112,782 at entry, £119,583 at the intermediate step and £129,783 at the top, which is £10,815.25 a month or £66.30 an hour. Band 9 posts are director-level roles: directors of nursing, finance directors, directors of operations, and consultant-level clinical leaders in highly specialist fields. The step below, Band 8d, tops out at £108,814. Anything above Band 9 sits outside Agenda for Change entirely: consultants on medical contracts and chief executives and executive directors on the Very Senior Managers framework.

How much does a consultant earn at the top?

A consultant on the England 2003 contract earns £150,569 a year at Threshold 4, after 14 years as a consultant, which is £12,547.42 a month before deductions. With a current National 3 Clinical Impact Award of £42,000 the total is £192,569 a year, and with a legacy Platinum award at the top of its range the total is £227,889 a year. The devolved nations pay more at the top: Wales runs from £114,099 to £166,585 and Scotland from £115,331 to £153,247. After tax, National Insurance and pension, a Threshold 4 consultant keeps about £6,770 a month on basic pay alone and about £8,625 a month with a National 3 award, before any student loan.

Do NHS managers earn more than doctors?

Some do and most do not. Chief executives and executive directors on the Very Senior Managers framework can earn more than consultants: the top VSM ranges run to £299,250 for trust chief executives and £304,500 for integrated care board chief executives, against £150,569 basic pay for a Threshold 4 consultant, though a consultant with a legacy Platinum award reaches £227,889. Most managers, though, are on Agenda for Change bands 6 to 8, which top out at £48,117, £56,515 and £64,750 to £108,814, well below consultant pay. Medical directors are a special case: they can choose whether to move to a VSM contract or stay on medical terms with a management allowance, and many stay on medical terms because consultant pay plus the allowance can exceed the VSM range.

What is the highest paid nursing job in the NHS?

The highest paid nursing roles sit at Band 9, which pays £112,782 to £129,783 in 2026/27. The roles are director-level: directors of nursing, and consultant-level clinical leaders in highly specialist fields. Below that, senior nurses sit at Band 8a to Band 8d, which top out at £64,750, £77,368, £91,609 and £108,814. A Band 5 staff nurse tops out at £39,043 and a Band 6 senior staff nurse at £48,117, so the gap between the ward and the boardroom is wide: Band 9 top is 3.32 times Band 5 top. Nursing pay above Band 9 does not exist on Agenda for Change; a nurse who moves into a chief executive role leaves the band system for the Very Senior Managers framework.

How far is the top from what most NHS staff earn?

A long way. Most NHS staff sit on Bands 2 to 6: Band 2 pays £25,272, Band 5 tops out at £39,043 and Band 6 at £48,117. Band 9 top of £129,783 is 5.14 times Band 2 pay and 3.32 times Band 5 top, and the largest chief executive exception-zone figure of £304,500 is 12.05 times Band 2 pay. That is the honest caveat behind this ranking: the jobs on this page are real, and the figures are verified, but very few staff ever reach them. The ranking shows the ceiling of NHS pay, not the typical pay packet, and most of the roles on it need a decade or more of training, senior leadership experience, or both.

Are NHS salaries published?

Yes, in different ways for different groups. Agenda for Change pay scales are published nationally by NHS Employers, so every band from Band 2 to Band 9 is public. Consultant thresholds and award values are published the same way. Very Senior Managers are different again: every trust and integrated care board must publish a remuneration report in its annual report and accounts, naming senior managers and disclosing their salary bands, pension benefits and any bonuses, and any proposed VSM salary above £170,000 must be submitted to NHS England as a pay case. To find a specific person's salary, check the organisation's annual report and accounts: it is the authoritative, audited source, and it is free to download from every trust's website.

Sources and independence

Source: NHS Employers, Pay and Conditions Circular (M&D) 1/2026R2 (updated 24 Jul 2026).

Source: NHS England: The NHS very senior managers pay framework.

Source: NHS England: VSM pay framework, provider and ICB pay ranges (May 2025).

Source: DHSC written evidence to the Senior Salaries Review Body, pay round 2026–27.

Source: GOV.UK, Employers' guide: 2026 awards round (Advisory Committee on Clinical Impact Awards).

NHS Bands Pay is an independent guide and is not affiliated with the NHS. Figures were verified against official sources on 7 November 2026 and can change, always confirm with the relevant official body before making financial decisions. VSM ranges shown are the published launch ranges (May 2025) and are uprated annually, confirm current figures in the NHS England publication or the relevant trust's annual report and accounts.