Getting beyond averages: charting the variation in NHS earnings

During the industrial action, we have been exposed to myriad figures for staff pay. Average starting salaries, basic salaries and total NHS earnings all tell us something about the pay of NHS staff, but averages hide details and it is a mistake to rely solely on them to describe earnings. However, novel data published by NHS Digital allow us to have a more in-depth look at the distribution of NHS staff pay and understand the variation within it.

Specifically, the chart below shows the range for the ‘middle’ half of earners (interquartile range) as well as the levels above and below which only 1-in-20 staff earn (95^th and 5^th percentiles). The data are for 2022 and, of course, pay has been affected by subsequent pay deals. And while even this more detailed information still leaves some questions about pay distributions, there are perhaps some notable characteristics to the chart.

First, it is important to recognise that many individual clinicians’ pay packets differ substantially from the average pay across their peers. Even excluding the top and bottom quarter of earners, full-time equivalent earnings of consultants varied by well over £40,000. Even for those in their first year of doctoring (foundation year 1), the difference between the estimates for the 5^th (£33,200) and 95^th (£43,100) percentiles is nearly £10,000 due to, for example, variation in extra payments for additional activity and shift work. 

Second, opportunities for pay progression vary substantially by staff group. While doctors have high potential for pay progression – from the early years as foundation doctors potentially through to consultants, of which a quarter had full-time earnings above £153,000 – it appears somewhat limited for some other staff groups. For example, the vast majority (three-in-four) nurses will have full-time equivalent earnings below £47,700.

Third, there are very notable differences in pay between staff groups, which is important given the move towards multi-disciplinary teams and changing mix of professions. These pay distributions show that there are many consultants earning more in a day than nurses in their team will earn in a week. This level of disparity is not common internationally.

Of course, some variation in pay is to be expected and can be wholly appropriate given differences in, for example, roles, responsibilities, workload and requirements. But that does not negate the importance of recognising – and if necessary addressing – variation in pay given the importance of perceptions of relative as well as absolute pay.