The decision of resident doctors – qualified medical practitioners in postgraduate training – in England to strike has intensified the interest in their pay. To provide independent analysis on the topic, we have revisited some key measures relating to their (and other doctors’) earnings, including how they compare to the wider labour market, and outline key considerations when interpreting comparisons to historic pay levels.
Commenting on pay is inherently challenging given the sensitivities and complications around the topic. There are many ways to present earnings and put them in perspective, and all have their own limitations and are dependent on the choice of assumptions. These words of caution extend to the measures presented here. We have not sought to provide an exhaustive overview but rather provide some additional objective evidence to help inform the policy debate.
How much will doctors earn in 2025/26?
In May this year, the government confirmed a 4% pay rise for consultants, specialty and associate specialist (SAS) doctors, and salaried GPs. For resident doctors, the uplift includes an additional consolidated £750 over and above the 4% increase.
Doctors’ earnings consist of a basic salary and additional (non-basic) earnings – which on average account for a further 27% in pay – covering, for example, additional and unsocial hours, being on call, and geographical allowances. The uplift means that, for the year to March 2026, resident doctors starting postgraduate training (foundation year 1) will have a full-time basic salary of £38,831, and we estimate they will receive around £45,900 in total NHS earnings. Specialty registrars will receive a basic salary of between £52,656 and £73,992 depending on which year of training they are in, with estimated total NHS earnings – across all specialty registrars – averaging £80,500 for full-time staff once wider pay, including for additional hours worked, are taken into account.
For NHS consultants, the pay deal means their basic salaries start at £109,725, rising to £145,478 for those with 14 years of experience at that grade. Including non-basic NHS pay elements, we estimate their average annual total NHS earnings – across all consultants – will be in the region of £161,600 for those with a full-time contract. The table below contains the latest three annual pay uplifts, and taken together this equates to, on average, a 24% increase in basic pay (before adjusting for inflation) for consultants and nearly 30% for resident doctors since 2022/23.
Published earnings data for GPs are less up to date, with their 2022/23 average earnings – including those working part-time – reported as £140,200 for partners and £69,200 for salaried GPs. We used two approaches for calculating full-time equivalent earnings (see the methodology for further details), which suggested these may average in the region of £163,500 (alternative method: £168,000) for partners and £108,300 (£92,400) for salaried GPs in 2022/23.
However, both methods are susceptible to be overestimates as the earnings data includes non-NHS earnings, but participation data is for only GPs’ NHS employment (so the figures capture earnings from non-NHS work, but not the hours taken on it). We have included estimates for their pay in 2025/26; however, GP earnings are harder to predict than for other NHS doctors given, for example, partners’ pay is not linked to a specific pay framework but rather derived from practice profits.
How have doctors’ salaries varied over time?
We have on many occasions charted how average salaries have changed for resident doctors. We estimate that, even after accounting for these latest uplifts, average real-terms earnings for 2025/26 still fall behind 2010/11 levels by between 4% and 10%. That said, the position has markedly improved since 2023/24, against a backdrop of high inflation and doctors sacrificing pay – particularly in 2023/24 – to go on strike (Figure 1).
As we have previously highlighted, this form of trend analysis is highly sensitive to the choice of baseline year, inflation measure and pay data used. Some have argued for using a 2008 baseline and retail price index, RPI (given it is applied to student loan interest). But the Office for National Statistics “do not think RPI is a good measure of inflation and discourage its use”, and the data collection on actual earnings changed in 2010. Therefore, we have used the consumer price index (CPI) to adjust for inflation and typically a 2010 baseline (although present trends over a longer timeframe below).
On baselines, it is relevant to note that data from their professional regulator (GMC) suggests the majority of current resident doctors will have started their medical degrees after 2012.
What is the longer-term trend in doctors’ pay?
Using different information on pay settlements – shown in Figure 2 below – we can look further back and explore whether pay has been eroded on a longer timeframe. The trend reveals a striking picture of sustained periods of real-terms increases followed by similarly sustained periods of real-terms decreases in pay. These ebbs and flows are problematic as people are typically loss-averse, feeling the downside of real-terms cuts more acutely than the upside of real-terms increases.
The trend again reveals the importance of the choice of baseline when looking at changes over time. Since 2023, the pay scales of resident doctors and consultants have started to increase again in real terms following a fall over the decade or so prior to this. Looking even further back to the late nineties and early noughties, they have fared well compared to inflation.
This approach (using pay settlements) is not biased by changes in the seniority and experience within grades, which may affect the previous analysis based on actual earnings. However, this too came with challenges – the information about what was implemented is somewhat patchy and some pay deals were staggered over the year. Looking just at the pay settlements also does not necessarily capture the effect of other contractual changes (notably, in the year to 2003/04 – which covered the introduction of consultants’ new contract – total earnings per full-time equivalent consultant were reported to increase by 12% in real terms, although the pay settlement that year was just 2% in real terms).
More recently, the broader terms of 2019’s multi-year pay settlement included adding an extra pay increment level (meaning, for example, that the total investment for 2020/21 was in reality 3%, as opposed to the headline 2%).
Do these trends over time give the whole picture?
There have been various changes to NHS employment terms and conditions, which also need to be factored in when comparing pay over time. For example, the gradual introduction of the European Working Time Directive reduced resident doctors’ maximum weekly work hours from 56 to 48 in the five years to 2009, which impacted the hourly equivalent wage over this period. The 2015 NHS Pension Scheme is also typically less generous that the predecessor schemes in that it is based on career average as opposed to final salaries. More recently, changes to pension tax will particularly benefit consultants financially but, as with other wider changes, are not picked up in the analysis of pay uplifts or average earnings.
The trend in average salaries for resident doctors does not reflect the experience of individuals, whose pay will also typically benefit from career progression. As a way to demonstrate this, if a newly qualified first year foundation doctor in 2017 (with a starting salary of £26,614) continued straight through to core / specialty training then their pay would have nearly doubled to £50,017 within four years, representing a 75% real-terms increase. Within eight years, by 2025, their basic salary could have been over four times higher (£109,725), or more than doubled (211%) in real terms.
That said, the progression from foundation level to consultant is likely to be longer and some doctors may also opt for a different career pathway, such as becoming SAS doctors – a grade that is typically reached with at least four years of postgraduate training.
Importantly, strikes – particularly during 2023/24, where 40 days of action were staged – will have had an effect on the reported earnings of resident doctors, where those undertaking industrial action will have sacrificed 1/365th of their pay per strike day. Further complications arise from backdated pay deals, especially in July last year where newly appointed Secretary of State for Health and Social Care, Wes Streeting, agreed an additional uplift to 2023/24 pay a quarter of the way into the following financial year. This was therefore likely to be received, and recorded in the data, in 2024/25.
That said, comparing actual pay data to expected pay uplifts, we estimate that the cumulative resident doctor NHS earnings over the last three years (2022/23 to 2024/25) were between £2,200-£2,900 less than would be expected based on the headline pay settlements, which may be – at least in part – due to pay foregone during the strikes.
How do doctors’ salaries compare to earnings in the wider economy?
It is also informative to consider how doctor pay compares to salaries across the wider economy in England (Figure 3). This latter data is based on HM Revenue and Customs Pay As You Earn (PAYE) records for a 1% sample of employee jobs covering the wider labour market. Such comparisons are not straightforward, but we estimate that – for 2024/25 – the average NHS earnings of doctors in their first year of work was above the median, so more than the majority of all workers, but below the (mean) average wage. Specialty registrars’ average NHS earnings were higher than the salaries of nearly nine in 10 of the wider workforce, while GP partner and consultants’ NHS earnings sat between the 98th and 99th percentiles.
Figure 3: Average estimated total NHS earnings of doctors compared to all jobs in England, 2024/25
ChartFor consultants, this relative pay level has been consistent since at least 2010, but resident doctors’ pay has slipped down the percentiles over time. If comparing to just public sector earnings, doctors fare better still, with specialty registrars in the 95th to 96th percentiles and GP partners and NHS consultants well above the 99th percentile.
However, there are also other approaches to comparing doctors’ earnings. For example, the pay review body presented analysis suggesting that total pay for resident doctors was just above market median pay at the same job level (see methodology for further details). Other approaches include looking at data on outcomes for graduates, which suggest that, in 2021/22, median earnings for those with a medical or dentistry degree one year after graduation (£39,100) were substantially higher than the upper quartile earnings for any other subject.
How do NHS doctors’ earnings in England compare to other UK counterparts?
Note: this section was updated in January 2026 to include Scotland's newly agreed pay uplifts.
It is useful to also consider differences in pay across the UK. However, doing so for resident doctors highlights the challenges of comparing earnings. Specifically, while the basic salaries for resident doctors are higher in England than in Wales and Northern Ireland (and Scotland, with the exception of second year foundation doctors and those in their second year of specialty training) (Figure 4), the doctors’ pay review body reported that non-basic pay (comprising 28-33% of total resident doctors’ earnings) was lower than in Wales (at 32-44%), Northern Ireland (47-62%) and Scotland (84%).
Any apparent differences in pay across the UK must be interpreted in the context of significant contractual differences for resident doctors between the four countries. However, the piecemeal data in the same report suggests that average total earnings for resident doctors in England were:
- fairly similar to that in Northern Ireland (where foundation doctors had marginally higher pay but core and specialty training roles had marginally lower total pay at September 2024, compared to their counterparts in England across 2024/25)
- significantly lower than in Scotland in 2023/24, where average earnings across foundation doctors, specialty training and clinical fellows were £80,322, although – as charted above – average reported resident doctor pay in England that year (£61,200) was a low point, in real terms.
Comparison of consultant salaries across UK countries should be treated with caution, but – as shown in the figure below – it is notable that in Wales the progression of basic pay is more significant in the first few years as a consultant than elsewhere in the UK.
The latest available data for GPs – from 2022/23 – suggests substantial variation in total earnings for this profession across the four UK countries. In that year, average earnings per GP partner (not accounting for part-time working) compared to England (£140,200) were £20,200 (14%) less in Scotland, £24,900 (18%) less in Wales and £31,900 (23%) less in Northern Ireland. This disparity has been fairly consistent since 2015/16 between England and Scotland, but has grown in comparison to Wales (11% in 2015/16) and Northern Ireland (12%). However, these comparisons should be treated with caution due to differences in the responsibilities and working patterns between GPs in the four countries.
How much do pay increases cost?
Based on the reported NHS earnings last year of doctors in hospital and community services (excluding doctors in general practice), a 1% uplift to 2025/26 earnings is equivalent to a direct overall salary cost of around £160 million, assuming current staffing levels and before accounting for additional pension contribution and national insurance costs, for example. This figure includes £93 million for a 1% uplift for consultants and £51 million for resident doctors. Therefore, in terms of direct salary costs, the announced 2025/26 uplift will add around £690 million in direct salary costs.
The costs of strikes are difficult to quantify. However, based on financial reporting by NHS England, the average cost of an NHS strike day is broadly in the region of £40 million.
Overcoming the impasse
While pay is inevitably central to discussions around the current industrial dispute and also a very tangible way to value doctors’ contributions, policy-makers need to be more creative and proactive on wider factors affecting staff retention and wellbeing. Better work-life balance, delivering high-quality care and appropriate autonomy are all, for example, known to be important. The pressure of the pandemic and efforts to clear the elective backlog have left staff feeling undervalued and exhausted, which only emphasises the importance of looking at improving these wider working conditions.
The situation appears to have contributed to some concerning figures on doctors’ participation and retention in NHS services. In 2023, only one in five (22%) of foundation year 2 doctors continued straight into specialty training. We also previously found that around one in four (24%) doctors in core training – typically the middle section of their postgraduate medical training – had left the NHS within two years.
However, there appear to be opportunities to, for example, improve the design and management of staffing rotas and develop leadership skills. The recently published 10 Year Health Plan sets out the ambition to create 1,000 new specialty training posts for doctors, although it is unclear whether this is sufficient to address concerns that some doctors have about job security. A scheme in Canada to provide employment opportunities through centrally funded additional posts for newly registered nurses on top of employers’ existing establishment – paired with additional support to help the transition from education – is a useful model to consider.
On pay itself, we have previously called for reforms to the official pay review process which is currently impeded by, for example, an inadequate evidence base. The longer-term trends in pay outlined earlier also presents a cautionary tale, with the risk that government increases pay above what it perceives as affordable and then – painfully – will follow it with periods of sub-inflationary deals to claw back costs.
A long-term strategy on pay could help overcome this. The government and NHS employers could also improve effective take-home pay by funding some of the ongoing exam and training costs which are currently out-of-pocket expenses. As we have suggested previously, they could also look at forgiving student debt or providing loans repayment holidays which, if interest free, would also provide a longer-term financial benefit to doctors.
No one measure is sufficient to determine what pay deal should be offered or considered fair. But a shortage of independent analysis has meant that much of the debate has been based on flawed figures. All too often, true levels of inflation have been misrepresented, basic pay conflated with total pay, starting pay presented as average pay, whereas affordability arguments often do not recognise that some additional pay is returned to the public purse in taxes. Given the potential impact of strikes on doctors and their colleagues, as well as on patients and the public, the topic warrants a better-informed discussion and bold, holistic policy-making.
*The previous version of this explainer, which was published in 2023, can be found here.
Methodology
A note on inflation
We have used consumer price index (CPI) in this analysis. A similar measure, which includes owner occupiers’ housing costs and council tax (CPIH), would give similar results as the two indices have tracked closely in recent years. Some other analyses have used retail price index (RPI) as the measure of inflation, although it does not meet the required standards for designation as a national statistic and is widely considered to overstate inflation.
To estimate inflation over 2025/26, we have used forecast quarterly CPI estimates from the Office for Budget Responsibility. This equates to an estimate of 3.2%, although it is important to note there is a large degree of uncertainty around this. The pay review body noted, at the time of receiving their evidence, the OBR had expected inflation to average 3.7% over 2025/26.
Table 1. Overview of recent doctor pay settlements, basic salary and average earnings
For hospital staff, total NHS earnings are based on the sum of mean basic pay per full-time equivalent and mean non-basic pay per person, and rounded to the nearest £100. This therefore includes some earnings for additional work conducted in addition to a full-time contract. Salaries of those working in a specialty training post in general practice are excluded.
Numbers employed include those in both general practice and NHS hospital and community services, as at March this year. Headcount data exclude foundation year doctors working in general practice (as published data was not sufficiently disaggregated) and would exclude GP registrars from any practices that did not submit data.
The pay settlement and estimated earnings for 2025/26 for SAS doctors is based on the 4% uplift for this staff group across all contracts.
As part of 2023/24 consultant negotiations, the pay scale was adjusted so that doctors could reach the top pay point earlier, as well as uplifting salaries of those with eight years’ experience – rather than receiving the increase after nine years. For the latter, this meant an increase of 19.6%, but the average uplift across all grades was 12.5%. We have presented the full ranges in the table for completeness.
We used two approaches to calculate full-time equivalent GP earnings. Our principle calculation was to adjust reported earnings per person by the average participation level (full-time equivalent numbers divided by headcount) based on the NHS Digital general practice workforce data. Our secondary approach involved taking the average full-time salaries (for those working 37.5 hours or more) in 2018/19 (the latest this data was available), and adjusting for changes in average salaries and participation since then. Both methods may potentially over-estimate full-time equivalent earnings given the earnings data include non-NHS earnings, but the participation information is for NHS only.
GP partner uplifts (2023/24, 2024/25, and 2025/26) are based on headline changes to funding levels to practices and may not reflect how actual salaries change.
Figure 1. Real-terms changes to pay for resident doctors since 2010/11
Our analysis uses NHS England’s Annual Earnings Estimates, including basic pay and non-basic earnings adjusted for full-time working. Real-terms adjustments have been calculated using average CPI for each financial year, and changes to actual pay have been compared to 2010/11 levels. Estimated earnings for 2025/26 were calculated by uplifting 2024/25 earnings by 4% + £750 as per the latest settlement. Earnings for all resident doctors were calculated by using the weighted average salaries of foundation year doctors, doctors in core training and specialty registrars.
Our previous analysis showed that against a 2010/11 baseline and using average annual pay settlements, the retail price index (RPI) measure of inflation shows a decrease in pay of over 15%, but the fall is only 1.6% using CPI. However, our analysis in Figure 1 analyses changes to actual pay packets, showing a larger average decrease of 6.9% against CPI.
Figure 2. Real-terms pay settlements for consultants and resident doctors since 1990
The real-terms uplift is calculated by adjusting for inflation (CPI) over given financial year from the pay uplifts as outlined/published by the Department over that corresponding year (from 1 April). There are a few exceptions. In 2006, the pay uplift was staggered with a first uplift in April followed by a second in November. In these instances, we have taken the total uplift for the year (for example, 2.2% in 2006 where 1% was given in April followed by 1.2% in November).
For almost all years, the pay award is set out as a percentage (relative) pay uplift. However, in some years (2007, 2023, 2024 and 2025), an absolute uplift (i.e. the same amount for all pay points) is used. As this results in a different percentage uplift depending on where you sit on the pay points, an average percentage uplift has been taken. These percentage uplifts are cross-checked with figures published in Appendix G of the 2025 Review Body on Doctors’ and Dentists Renumeration.
In some years, the total investment or changes in total pay may differ from the pay uplift because of specific changes to the other sources of income (such as local or national Clinical Excellence Awards), or introducing a new spine point for resident doctors such as in 2019. Some of these have been annotated on the chart.
A new contract for consultants was introduced in 2003, so from this point forward on the chart, pay uplifts are those for the new (2003) contract as most consultants will have moved onto it. For most years there is no difference between pay uplifts in the two contracts, although in the initial years following the adoption of the new contract, 2003 uplifts were higher than pre-2003. Similarly, resident doctor uplifts post-2016 are those as specified for the 2016 resident doctor contract.
Figure 3. Average estimated NHS earnings of doctors compared to all jobs in England, 2024/25
All estimates are for full-time staff. For median, mean and 75th to 90th percentiles, hourly earnings are used and weighted to a 40-hour contract. Hourly data are not available for 95th percentiles and above, so these are based on annual salaries, which represent a slight underestimate given these particular data count full-time as 30 hours and above. These wider economy hourly (for April 2024) and annual (for year to April 2024) salaries are inflated to estimate the 2024/25 levels. The NHS earnings are the average for full-time staff in that grade and include non-basic pay.
Doctors will often take considerably longer to reach more senior grades than the typical minimum given and also have among the longest pre-registration training (typically five years as an undergraduate). The ’specialty registrar’ group will include some in run-through training who will typically start a minimum of two rather than four years into employment.
The calculation of earnings is described in methods for the first table above. Wider labour market salaries are based on the Annual Survey for Hours and Earnings (ASHE), which includes employer responses for a 1% sample of employee jobs, using HM Revenue and Customs Pay As You Earn (PAYE) records. This analysis is for 2024/25 so does not cover the latest announced pay deal (for 2025/26).
Comparison to market pay at same job level
We quote analysis undertaken using a job evaluation system to identify comparable job levels to the different doctor grades. The evaluation used job functional knowledge; business expertise; leadership; problem-solving; nature of impact; area of impact; and interpersonal skills and compared to an overall database including 1,259 organisations and over 175,000 job roles. We have not externally validated the methodology or results of this work. Further details are available here.
Figure 4. Basic pay for resident doctors and consultants for 2025/26, by UK country
This chart includes the newly agreed pay uplifts recommended by the 2025/26 Doctors and Dentists Renumeration Body (DDRB) report. A deal for resident doctors in Scotland has yet to be agreed for 2025/26, so they have been excluded. Wales and Northern Ireland have additional higher basic pay points for FY1 and FY2 (the initial stages of training after graduating from medical school) for those who take longer than one year to complete this stage of training, but we have excluded these for simplicity. The number of pay points for specialty training posts also varies between countries. For example, doctors in Wales and Northern Ireland have a ninth and tenth pay band. This analysis excludes non-basic pay components, which are calculated differently across the countries, so comparisons should be treated with caution. Figures for England exclude geographical allowances, i.e. “London weighting”.
Suggested citation
Palmer W and Rolewicz L (2025) “Exploring the earnings of NHS doctors in England (2025 update)”. Explainer, Nuffield Trust.
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Updated 08/01/2026
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The section 'How do NHS doctors’ earnings in England compare to other UK counterparts?' and figure 4 were updated to include Scotland's newly agreed pay uplifts.