Trust Grade Doctor Salary 2026/27

Last updated: 24 October 2026 · Figures verified against the NHS Employers 2026/27 pay circular.

By the NHS Bands Pay editorial team

What is a trust grade doctor?

A trust grade doctor is a doctor employed directly by an NHS trust in a post that sits outside the national training programme. The other common name for the same group is locally employed doctor, shortened to LED. The trust creates the post, funds it from its own budget, and writes the job description around a service need: covering a rota, staffing a ward, supporting a clinic, or filling a gap that a training post does not cover. The doctor in the post does real clinical work at the level the post requires, but the post itself carries no training number and no place on a national training rotation.

That distinction matters more than the job title. A doctor in a foundation or specialty training post is on the resident doctor scale, with nodal points that rise as training progresses, and with a training programme that carries them from one post to the next. A trust grade doctor is not on that ladder. The post may last six months or a year, it may be renewed, and it may sit at any level from foundation-equivalent work up to senior registrar-equivalent work, depending on what the trust needs and what the doctor brings. When the post ends, the next step is a fresh application, whether that is a training post, another trust grade post, or a career-grade role.

Most trust grade doctors fall into one of three groups. The largest is doctors taking time between training stages, most often an F3 year after foundation training, used to earn, to gain experience in a specialty, or to decide where to apply next. The second is doctors who have come from overseas or from a break in practice and need UK experience before entering training. The third is doctors who want a service post for its own sake, for example a year in a particular department, without committing to a multi-year training programme. Posts are often advertised under titles such as clinical fellow or trust grade doctor, and the title alone tells you little about the pay. The pay section of the advert does.

None of this makes trust grade work second-rate work. Wards and rotas depend on it, and many consultants and SAS doctors spent part of their early careers in trust grade posts. The honest way to judge a trust grade post is on its own terms: what the basic salary is, how many hours the contract covers, what unsocial-hours premia apply, whether the post offers the supervision and portfolio support you need for your next application, and whether the trust follows the June 2026 terms described below. A well-paid trust grade post with good supervision can be a better year than a poorly supported training post. A vague advert with no stated salary is a warning sign whatever the title.

Trust grade pay 2026/27: the mirrored MT01 to MT10 scale

The table below shows the mirrored nodal grade codes for locally employed doctors under NHS Employers Pay and Conditions Circular (M&D) 1/2026R2, as verified against the circular. Each MT code maps to a nodal point on the resident doctor scale, and the basic salary is the 2026/27 figure for that nodal point. Monthly figures are basic divided by 12, and hourly figures use the 2016-contract basis of basic divided by 40 hours a week divided by 52.143 weeks. The chart plots the basic salary column.

Two features of the table catch people out. The first is that the MT codes do not run in pay order. MT06 sits at nodal point 3b, below MT04 at nodal point 4a, and MT05 sits at nodal point 5a, above MT04, MT07 and MT08. That is because the codes were mapped to the reformed nodal points, which split the old points 3, 4 and 5 into sub-points in June 2026, rather than being renumbered by salary. Always read a code together with its nodal point. The second is that several codes share a salary: MT03 and MT06 both sit at £55,355, MT07 and MT08 at £67,998, and MT09 and MT10 at £77,348. Those pairs are different nodal sub-points with the same basic pay, a quirk of the June 2026 reform, not a copying error.

Worked example one: a trust grade post advertised at MT03, mirroring nodal point 3a, pays a basic of £55,355 for a full-time 40-hour week in 2026/27. That is about £4,613 a month before tax, pension and any student loan deduction, and £26.54 an hour on the 40-hour basis. Extra rostered hours on top of the basic week are a separate matter, covered below, and unsocial-hours premia depend on the rota and on whether the post follows the 2016-contract terms.

Worked example two: the gap between the top of the mirrored trust grade range and the first consultant threshold shows how far the medical ladder still runs. MT10 basic is £77,348, while a consultant in England starts at £113,565 in 2026/27, a difference of £36,217 before any programmed activities, awards or pension effects. See our consultant salary guide for the full consultant thresholds. The gap is not a criticism of trust grade pay. It is a reminder that trust grade posts are mid-ladder service posts, and that consultant pay reflects a different contract, a longer training path, and programmed activities rather than a weekly rota.

What the June 2026 deal changed

Before June 2026, trust grade pay was a patchwork. Some trusts benchmarked their rates against the resident scale, some set their own spot salaries, and some negotiated post by post, which made comparison between adverts difficult and left doctors guessing whether a rate was fair. The June 2026 deal, agreed after a member vote that ended the strikes, changed the framework even though it did not turn trust grade pay into a national scale. All locally employed doctors were offered 2016-contract terms, with nodal points mirrored from the resident scale as set out in the table above. For doctors, the practical effect is a common reference point: when a trust says a post follows the mirrored points, both sides know what MT03 or MT09 means in pounds.

The deal carried three further terms worth knowing. Enhanced appraisal for locally employed doctors applies from October 2026, which matters because appraisal and portfolio evidence feed directly into future training applications. Exam and royal college membership fees are reimbursed from April 2026, which removes a cost that previously fell on the doctor in many trust grade posts. Clinical-academic flexible pay premia rise from £5,600 to £10,000 from April 2027, for the smaller group of doctors in clinical-academic posts. None of these terms changes the basic salary in the table, but together they change the value of a trust grade year, and they are worth confirming in writing alongside the salary.

One limit of the deal needs stating plainly. An offer of 2016-contract terms is not the same as a national pay scale with automatic progression. A doctor in a training post moves up the nodal points as training progresses. A doctor in a trust grade post does not move up the MT codes automatically, because the codes describe the level of the post, not the seniority of the doctor. Moving from an MT03 post to an MT04 post means applying for and being appointed to a different post. If a trust grade post is advertised as fixed-term, assume the rate ends with the post unless the contract says otherwise.

Locally set pay: what it means in practice

Local determination sounds abstract until you read two adverts side by side. One trust may advertise a trust grade post at MT04, £67,325 basic, on 2016-contract terms with the usual premia. Another trust may advertise a similar-sounding post at a spot salary it has set itself, with different hours and a different on-call arrangement. Both are legitimate trust grade posts, and the second is not necessarily worse paid: a spot salary above the mirrored point is common where a trust struggles to recruit, and a post with a lower basic but a heavy on-call supplement can pay more in total than a higher basic with a light rota. The only reliable comparison is the full package: basic, contracted hours, rota pattern, premia, and the June 2026 terms.

Three questions sort a good advert from a vague one. First, does the advert state the basic salary as a figure, or only as a grade code or a range? A code is useful only if you know what it maps to, which is what the table on this page is for. Second, does it state the contracted hours and whether the post follows the 2016-contract terms, including how extra rostered hours are paid? Under those terms, the basic week is 40 hours, additional rostered hours in waking hours are paid at plain time, and hours between 9pm and 7am or on Sundays carry a 37% premium, with the hourly rate worked out as basic divided by 40 divided by 52.143. Third, does it state the fixed-term length and any renewal route? A twelve-month post and a six-month post at the same salary are different propositions.

Locum work is the usual alternative to a trust grade post, and the comparison is instructive. Locum rates are set shift by shift and can look high beside a trust grade basic, as our locum hourly rates guide explains, but locum work carries no guaranteed hours, no paid leave accrual in the same way, and no appraisal structure. A trust grade post trades the top locum rate for security, a regular rota, and portfolio support. Doctors who take a trust grade post mainly for the money should run both numbers over a full year, including empty weeks, before deciding. Doctors who take it for experience should weight supervision and case mix at least as heavily as the basic.

Trust grade, training grades and SAS: how the three fit together

It helps to place trust grade posts between the two better-known doctor groups. On one side are the training grades, covered in our foundation doctor pay guide and our doctor pay scales hub: FY1 at £41,226 and FY2 at £47,610, then specialty and core training through nodal points 3a to 5c, £55,355 to £77,348, exactly the figures the MT codes mirror. A doctor in training progresses through those points as training advances. A trust grade doctor at the same nodal level earns the same mirrored basic where the trust follows the points, but without the training progression attached.

On the other side are SAS doctors, the career-grade group covered in our SAS doctor pay guide. SAS doctors hold substantive posts on national contracts, not fixed-term service posts. The 2021 SAS contracts pay specialty doctors £63,696 at entry rising to £102,689 after twelve or more years, and specialists £104,401 to £115,341. Those ranges sit above the mirrored trust grade range, which tops out at £77,348, because SAS posts reward sustained service and experience in a way that fixed-term trust grade posts do not. A doctor who enjoys service work and wants to stay in it long term will usually look towards a SAS post rather than a succession of trust grade posts, and the pay reflects that choice.

Take-home pay follows the same shape for all three groups, with the usual deductions from gross pay: income tax, National Insurance, NHS pension contributions and, where applicable, student loan repayments. Our junior doctor take-home guide works through those deductions for training grades, and the method is the same for a trust grade basic at the same salary level. The one deduction to check carefully in a trust grade post is pension: confirm with payroll whether the post is pensionable under the NHS Pension Scheme and which contribution tier applies to your pensionable pay, rather than assuming the rate from a previous post. Pension tiers are set on each employment separately, so a change of post can change the tier even at a similar salary.

Getting the most from a trust grade year

A trust grade year pays best when it is chosen deliberately. Before applying, decide what the year is for: earning, gaining a specialty, building a portfolio for training, or testing whether a specialty suits you. Then judge each post against that purpose, not against other applicants. A post in your target specialty with a consultant who supervises portfolios well is worth more for a training application than a higher-paid post in an unrelated department with no teaching. Ask at interview who supervises locally employed doctors, how study leave works in the post, and whether the department supports applications to training, including time for interviews and portfolio work.

Keep your own record from day one. Note the MT code or spot salary you were appointed at, the contracted hours, the rota pattern, and any premia actually paid, and compare the first payslip against the contract. Trust grade contracts vary more than training contracts, so errors are more likely and harder to spot from a standard scale. If a payslip does not match the contract, raise it with payroll promptly and in writing, and keep the reply. The same habit applies to appraisal: with enhanced appraisal for locally employed doctors in place from October 2026, a complete appraisal record is now part of the value of the post, not an optional extra.

Finally, plan the exit before the post ends. Training applications run on annual cycles, SAS applications depend on vacancies, and a trust grade post that ends in the wrong month can leave a gap. Map the post end date against the next application window when you accept, and ask the department early whether extension is possible. A trust grade year that ends with a training offer, a SAS application, or a renewed post is a successful year. A trust grade year that ends with no plan is the commonest way doctors drift into a second and third trust grade post without meaning to, and the pay table on this page shows why that drift costs: without a move to a higher post, the basic stays where the post sits.

Frequently asked questions

What is a trust grade doctor?

A trust grade doctor, also called a locally employed doctor (LED), is a doctor employed directly by an NHS trust in a post outside the national training programme. Trust grade posts are service posts: the doctor fills a rota and delivers clinical work, but the post itself does not carry a national training number or a guaranteed training progression.

Are trust grade doctors on a national pay scale?

No, not in the way resident doctors in training are. Trust grade pay is set locally by the employing trust. Since the June 2026 deal, trusts have been offered 2016-contract terms with nodal points mirrored from the resident scale (MT01 to MT10, £41,226 to £77,348), but employers may mirror those points rather than being bound to them, so the mirrored figures are a reference, not a guarantee.

What do the MT01 to MT10 codes mean?

MT01 to MT10 are the mirrored nodal grade codes for locally employed doctors under circular 1/2026R2. Each code maps to a nodal point on the resident doctor scale: MT01 maps to nodal point 1 (£41,226), MT02 to nodal point 2 (£47,610), MT03 and MT06 to nodal points 3a and 3b (£55,355), MT04, MT07 and MT08 to nodal points 4a, 4b and 4c (£67,325 to £67,998), and MT05, MT09 and MT10 to nodal points 5a, 5b and 5c (£76,582 to £77,348).

Why are the MT codes not in numerical order?

Because the codes were mapped to the reformed nodal points, not numbered by pay. The June 2026 reform split nodal points 3, 4 and 5 into sub-points (3a and 3b, 4a to 4c, 5a to 5c), and the MT codes kept their original mapping: MT06 sits at nodal point 3b, MT07 and MT08 at 4b and 4c, and MT09 and MT10 at 5b and 5c. Read the code together with its nodal point, not on its own.

What did the June 2026 deal change for trust grade doctors?

The June 2026 deal, agreed after a member vote that ended the strikes, offered all locally employed doctors 2016-contract terms with mirrored nodal points. It also brought enhanced appraisal for locally employed doctors from October 2026, reimbursement of exam and royal college membership fees from April 2026, and a rise in clinical-academic flexible pay premia from £5,600 to £10,000 from April 2027.

Can a trust grade post lead into training?

Yes, and for many doctors that is the point of the post. A trust grade year is commonly used as an F3 year between foundation training and specialty training, or as a way to gain experience in a specialty before applying. Time in a trust grade post does not itself move you up the training scale: entry to training still comes through the normal application and appointment process.

How is a trust grade doctor different from a SAS doctor?

SAS doctors are career-grade doctors on national SAS contracts, while trust grade doctors are locally employed on trust-set terms. The 2021 SAS contracts pay considerably more at the top: specialty doctors earn £63,696 to £102,689 and specialists £104,401 to £115,341 in 2026/27, against a mirrored trust grade range of £41,226 to £77,348. A trust grade post is usually a fixed-term service post; a SAS post is a substantive career-grade appointment.

How do I check the actual pay for a trust grade job?

Read the job advert and the contract, not this guide. Because trust grade pay is locally determined, two posts with the same title at different trusts can pay different amounts, and a post that mirrors the national points will state the MT code or the nodal point it follows. If the advert is vague, ask the trust for the basic salary, the contracted hours, and whether unsocial-hours premia and the June 2026 terms apply, and get the answer in writing before you accept.

Source: NHS Employers Pay and Conditions Circular (M&D) 1/2026 and BMA SAS pay scales for England 2026/27.