How Consultants in the NHS are Paid

If you are new to the NHS, or are nearing the end of a training programme and CCT is looming, then you may be wondering more and more about what you can expect to be paid as an NHS consultant. You may also be considering reducing your hours or even swapping over to some locum work for a while. 

In this article, we help explain how NHS consultants are paid, and what rates you can expect if you decide to locum as a consultant in the UK. To keep things simple, we are only looking at England’s 2003 national consultant contract (Wales, Scotland, and NI have slightly different contracts). The majority of NHS consultants in England are on this contract, and incoming consultants will join this contract when they start working. 

*Note that the information provided in this article doesn’t apply to all post-CCT doctors. GP’s, Occupational Physicians, Armed Forces doctors, Clinical Lecturers, and SAS doctors all get paid slightly differently. 

❓  What is a Consultant?

A consultant is a medical or surgical doctor at the highest grade. To become a consultant, they have completed a specialised training programme and have passed the relevant exams to achieve their Certificate of Completion of Training (CCT) and a listing on the specialist register on the BMA, which allows them to practice medicine without supervision.

You can learn more about doctor grades in our article ‘Understanding Junior Doctor Grades’ where we also have a handy flow chart which shows you how many years of training it takes to become a consultant. Or you can keep reading and find out in the next paragraph… 

❓  How long does it take to become a Consultant?

By the time a doctor becomes a consultant, they will have been working for at least 7 years, but majority will have been through training programmes about 8-10 years. If the doctor worked less than full time during their training years, or took time out of training to pursue other degrees, research, or for parental leave, then the training can take much much longer. 

❓  What work do Consultants do?

NHS consultants work is measured in PA’s, which stands for Programmed Activities. 

‘Normal’ PA sessions are 4 hours long and occur during ‘normal’ working hours (7am - 7pm, M-F). Depending on the work the consultant is expected to do during that session, they are sub-defined as:

👉  DCC (Direct Clinical Care) which is spent directly working with patients on the wards, in clinic, in theater, in A+E, or attending meetings where the care of individual patients is discussed. 
👉  SPA (Supporting Professional Activities) which is spent doing professional admin, professional development, service improvement, teaching, mentoring and management, mandatory training, audit and quality improvement, etc. 

Generally, consultant contracts specify a 80/20 split between DCC and SPA though this can vary depending on the role. 

Most consultants are expected to do ‘other’ work in addition to or instead of their ‘normal’ PA’s, which can include:

👉  Out of hours (OOH) work which is work outside ‘normal’ hours. OOH PA’s are 3 hours long, instead of the ‘normal’ 4 hours, and are paid at a higher rate. 
👉  Night Shifts, which may be paid as enhanced rate PA’s or as extra payments on top of the base salary. 
👉  Waiting List Initiatives (WLI) which are extra clinics that help Trusts tackle long waiting lists in order to meet government targets. They may be paid as enhanced PA’s or as extra payments on top of the base salary. 
👉  Additional PA’s (APA) which are just more PA’s per week than the standard 10. They are generally capped at 2 (for a total of 12 PA’s per week) and are paid pro-rata’d on top of the base salary. 
👉  On Call work which is where you are not physically at work, but are expected to be available should any issue or emergency that requires your presence at work arise. These are paid as 3-5% of the base salary depending on how often the doctor is required to be on call, and the likelihood of you being called into work to assist with an emergency. On call consultants are required to remain close to the hospital (i.e can be on site within 15 - 30 mins) and in a appropriate-for-work physical and mental state (i.e sober and alert). 

❓  How much work is an NHS Consultant expected to do?

A full-time consultant is expected to do 10 PA’s per week, and this is generally a mix of ‘normal’ and ‘other’ PA’s. 

For example, if a consultant works only normal hours, then they would be expected to work 40 hours per week. If a consultant does only OOH work, then they would be working only 30 hours per week, though both would be considered full-time (10 PA’s). 

Though full-time consultants are contracted for 10 PA’s per week, in reality this can be flexible and in some cases consultants can group their work to have some weeks of intense work, and other weeks where they are working much less intensely, or are even off work without needing to use their Annual Leave.

❓  How much does an NHS Consultant earn?

Consultant base pay (10 PA’s / week) starts at £88,364 and increases incrementally over the years. After at least 20 years the top pay threshold is reached (£119,133 per year for threshold 8). In order to move up the thresholds consultants must meet the necessary requirements at their annual appraisal. 

The table below shows how much consultant pay increases at each threshold. 

The above salary can be supplemented by undertaking additional work, such as extra PA’s or OOH/night shifts. Extra PA’s are paid at 10% of a consultant’s basic salary plus any additional payments due to Clinical Excellence Awards (CEA). 

❓  What are Clinical Excellence Awards?

CEA’s are financial rewards for consultants who work above and beyond their regular job plan. This can mean contributions to the delivery of safe and high-quality care and the improvement of NHS services. The scheme is multi-tier; the lower levels are awarded locally, and the higher tier awarded nationally. 

Each tier has a different financial value which is outlined in the table below. 

Being awarded a clinical excellence awards is not guaranteed, despite the fact that many consultants work well beyond their job plan. The CEA system is also currently under reform as female, BAME, and less-than-full-time (LTFT) consultants are often underrepresented by the current system of awards. 

You can review the data on this here: https://www.gov.uk/government/consultations/reforming-the-national-clinical-excellence-awards-scheme/reforming-the-national-clinical-excellence-awards-scheme#the-case-for-change

❓  How much can a locum Consultant earn?

Using our Locum Salary Calculator, we collected the following data: 

A consultant in General Medicine can expect to earn around £94.72 to £104.99 per hour (outside of London) which equates to an annual salary of £217,201 if they work 5 days per week doing only normal hours or £222,930 per year if they accept some anti-social hours. 

It is worth noting that these numbers represent an average of the job postings on Messly’s site, however many consultants can negotiate even higher hourly rates based on their level of experience, how long the posting is, the requirement to take on additional responsibilities such as teaching or on-call commitments, or if a post is particularly remote or difficult to fill. 

You can experiment with the Locum Salary Calculator here: https://www.messly.com/calculator

❓  What now?

If you want to learn more about locuming as a consultant, sign up for Messly’s free locum finding service, or get in touch with our team (support@messly.co.uk) if you have any questions about locuming. You can also learn about working as a locum doctor by browsing the articles in our Locum Doctor Hub. 

This article is part of a wider series of comprehensive guides and information to help doctors ensure their F3 year is a success. We cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience.

Click here to visit our F3 Resource Hub to explore the full list of guides and articles.