Take Home Pay
Take Home Pay
This NHS consultant salary calculator estimates consultant take-home pay for 2026/27 from national consultant pay scales, Programmed Activities, on-call availability and Clinical Excellence or equivalent awards where entered. Enter threshold year, PA count, on-call category, pension and tax details to see gross, deductions and net monthly and annual pay. Use it when negotiating job plans, extra PAs or relocating between nations. Outputs separate basic consultant pay from additional activity so medical consultant earnings sit clearly beside NHS Pension and HMRC tax treatment.
Estimated net monthly pay
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| Threshold | Basic | Est. net / mo @ 10 PA |
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England consultant contract estimate for 2026/27. Local CEA / NCEA arrangements vary. Payslip remains authoritative.
Sixty free tools covering Agenda for Change pay, the NHS Pension Scheme, tax, leave, absence and leaving the NHS — updated for 2026/27. Start from a pillar hub, then drill into the cluster that matches your question.
Use this free NHS consultant salary calculator to find your exact monthly and annual take-home pay after income tax, National Insurance, NHS Pension contributions, and student loan deductions. The calculator is fully updated for the 2026/27 tax year, the confirmed five-threshold pay scale, and the 3.5% DDRB pay uplift effective from 1 April 2026.
This calculator uses the confirmed 2026/27 NHS consultant pay thresholds, current HMRC income tax bands (including Scotland's six-tier system), NHS Pension Scheme tiered contribution rates effective from 1 April 2026, and National Insurance thresholds for the 2026/27 tax year. It does not constitute financial or employment advice. For payroll queries specific to your contract, contact your NHS Trust's payroll department or the NHS Business Services Authority (NHSBSA).
NHS consultants earn between £109,725 and £145,478 basic salary in 2026/27, depending on years of experience. The 2026/27 NHS consultant pay scale is confirmed at five thresholds, following the DDRB's 3.5% recommendation. Unlike Agenda for Change pay bands, consultant pay sits on an entirely separate framework — it is reviewed by the Doctors and Dentists Review Body (DDRB), not the NHSPRB, and has its own progression rules. Most NHS consultants in England work under the 2003 national consultant contract. These figures represent basic salary for a full-time consultant working 10 programmed activities (PAs) per week, where each PA has a timetabled value of 4 hours — meaning full-time means 40 contracted hours per week.
These are basic salary figures only. Total earnings — once additional PAs, on-call supplements, and Clinical Impact Awards are included — are substantially higher for most consultants.
4 Consultants in England progress through five thresholds: Threshold 1 (entry, £113,565), Threshold 2a (after 3 years, £120,249), Threshold 2b (after 4 years, £123,672), Threshold 3 (after 8 years, £135,645), and Threshold 4 (after 14 years, £150,569).
Threshold | Years of Consultant Service | 2026/27 Basic Salary (England) |
Threshold 1 | Entry | £113,565 |
Threshold 2a | Year 3+ | £120,249 |
Threshold 2b | Year 4+ | £123,672 |
Threshold 3 | Year 8+ | £135,645 |
Threshold 4 | Year 14+ | £150,569 |
4 Progression is automatic with service, subject to job-planning and appraisal. 5 Consultant pay rises by between £3,400 and £14,900 at each threshold transition. Definitive figures are confirmed in the NHS Pay and Conditions Circular (M&D), with pay uplifts expected in June 2026 payslips, backdated to 1 April 2026.
Consultant pay differs across the four UK nations. Each nation runs its own consultant contract and pay scale, reviewed independently.
NHS consultants in Scotland on the 2004 contract earn from £109,407 to £142,369 depending on experience. Scotland has a different threshold structure than England, while NHS consultants in Wales earn from £111,300 to £154,760 — the highest top salary of any UK nation.
Nation | Entry Salary | Maximum Salary | Contract |
England | £113,565 | £150,569 | 2003 Consultant Contract |
Scotland | £109,407 | £142,369 | 2004 Scottish Consultant Contract |
Wales | £111,300 | £154,760 | Welsh Consultant Contract |
Northern Ireland | ~£109,725 | ~£145,478 | NI Consultant Contract |
Scottish-based consultants face a further take-home pay reduction because Scotland applies its own six income tax bands, with the higher rate beginning at £43,662 — significantly lower than the £50,270 threshold in England, Wales and Northern Ireland.
Consultant pay needs more than a simple basic-rate calculation. Once adjusted net income climbs past £100,000, the personal allowance tapers away, creating an effective 60% income-tax band, and income above the additional-rate threshold is taxed at 45%. Consultant pay is deduction-heavy because every salary point sits in the 12.5% NHS pension tier and above the higher-rate tax threshold. At the starting point of £113,565, employee pension alone is about £14,196 a year before tax relief.
The worked examples below are estimates for a full-time consultant in England (non-London, no student loan, standard 1257L tax code, 2015 CARE pension scheme, no salary sacrifice in place). Use the calculator above to generate a figure specific to your exact circumstances.
Item | Annual | Monthly |
Gross Basic Salary | £113,565 | £9,464 |
Income Tax (40% + 45% bands, with PA taper) | ~£34,200 | ~£2,850 |
National Insurance (8% on earnings above £50,270) | ~£5,063 | ~£422 |
NHS Pension (12.5% — Tier 6) | ~£14,196 | ~£1,183 |
Estimated Take-Home Pay | ~£60,106 | ~£5,009 |
Item | Annual | Monthly |
Gross Basic Salary | £135,645 | £11,304 |
Income Tax (40% + 45% bands, zero Personal Allowance) | ~£44,900 | ~£3,742 |
National Insurance | ~£6,827 | ~£569 |
NHS Pension (12.5%) | ~£16,956 | ~£1,413 |
Estimated Take-Home Pay | ~£66,962 | ~£5,580 |
Item | Annual | Monthly |
Gross Basic Salary | £150,569 | £12,547 |
Income Tax (40% + 45% bands, zero Personal Allowance) | ~£52,200 | ~£4,350 |
National Insurance | ~£8,026 | ~£669 |
NHS Pension (12.5%) | ~£18,821 | ~£1,568 |
Estimated Take-Home Pay | ~£71,522 | ~£5,960 |
These figures are indicative. Your actual take-home pay changes based on your London weighting zone, student loan plan, pension scheme section, salary sacrifice elections, and any self-assessment adjustments.
Every consultant sits above the £100,000 personal allowance taper threshold. For every £2 earned above £100,000, £1 of the £12,570 Personal Allowance is lost — creating a 60% effective marginal tax rate on income between £100,000 and £125,140. This is something many new consultants do not anticipate. Because Threshold 1 now starts at £113,565, every NHS consultant in England is subject to this taper from day one of their consultant career. Pension contributions can reduce adjusted net income, so the pension line can affect both pension saving and the tax calculation. A consultant on Threshold 1 who makes additional voluntary contributions (AVCs) or uses salary sacrifice to bring their adjusted net income below £100,000 restores the full £12,570 Personal Allowance — effectively earning back £5,028 in tax relief in a single year.
The two tools available to manage this trap are:
1. NHS Pension salary sacrifice (NHS Pension Scheme's Additional Pension): Salary sacrificed into the pension reduces adjusted net income pound-for-pound. Every £1 sacrificed above the £100,000 point saves 60p in tax.
2. Gift Aid donations: A charitable donation of £X, when made under Gift Aid, extends the basic rate band by £X and reduces adjusted net income by the same amount.
Use the calculator above to model how salary sacrifice adjusts your take-home pay within the £100,000–£125,140 zone.
Full-time consultants work 10 Programmed Activities (PAs) per week — each PA is a 4-hour block. The PA is the fundamental contractual unit of the 2003 NHS Consultant Contract. Every consultant's weekly job plan is built from PAs, split into two categories:
Direct Clinical Care (DCC): Patient-facing work — outpatient clinics, theatre operating lists, ward rounds, post-take rounds, and on-call duties. A standard full-time job plan allocates 7.5 DCC PAs per week.
Supporting Professional Activities (SPA): Non-clinical work that sustains clinical performance — audit, research, medical education and teaching, clinical governance, CPD, and appraisal preparation. A standard full-time job plan allocates 2.5 SPA PAs per week.
Additional PAs above 10 are paid at 10% of basic salary per PA. This means the value of a single extra PA rises at each threshold:
Threshold | Basic Salary | Value of 1 Extra PA (10%) | Value of 2 Extra PAs (12-PA contract) |
Threshold 1 | £113,565 | £11,357 | £22,713 |
Threshold 2a | £120,249 | £12,025 | £24,050 |
Threshold 2b | £123,672 | £12,367 | £24,734 |
Threshold 3 | £135,645 | £13,565 | £27,129 |
Threshold 4 | £150,569 | £15,057 | £30,114 |
7 Many consultants run at 11 or 12 PAs by agreement with their Trust. This is most common in surgical specialties, intensive care, emergency medicine, and other high-demand clinical areas. A Threshold 4 consultant on a 12-PA contract earns £30,114 per year in additional PA payments on top of their £150,569 basic — a total of £180,683 before on-call supplements or Clinical Impact Awards.
Consultants who participate in out-of-hours on-call rotas receive a pensionable availability supplement added to their basic pay. The supplement rate depends on the frequency of the on-call rota:
Category | Rota Frequency | Supplement Rate |
Category A | 1-in-1 to 1-in-4 | 8% of basic salary |
Category B | 1-in-5 to 1-in-8 | 5% of basic salary |
Category C | 1-in-9 or less frequent | 3% of basic salary |
At Threshold 3 (£135,645), a Category A on-call supplement adds £10,852 per year. At Threshold 4 (£150,569), a Category B supplement adds £7,528 per year. Both are pensionable, subject to income tax and National Insurance, and appear as a separate line on your payslip.
Consultants working in London receive a High Cost Area Supplement (HCAS) under the terms of the medical and dental contract — separate from the Agenda for Change HCAS rules. Medical-contract London weighting is not Agenda for Change HCAS. The HCAS zones and rates for consultants are as follows:
Zone | Annual HCAS (2025/26 base) | Notes |
Inner London | 20% of basic salary | Pensionable; added to PA calculations |
Outer London | 15% of basic salary | Pensionable |
London Fringe | 5% of basic salary | Pensionable |
A new consultant at Threshold 1 (£113,565) working in Inner London receives HCAS of £22,713, bringing gross pay to £136,278 before any additional PAs. This is pensionable and pushes pension contributions to the 12.5% tier — on-call supplements and HCAS both count toward pensionable pay, which determines your pension tier.
As of 1 April 2026, NHS Pension contribution rates are structured as tiered deductions from employees' pensionable pay, categorised into six tiers with rates ranging from 5.2% to 12.5%.
Tier | Pensionable Pay Band (2026/27) | Employee Rate |
1 | Up to £13,259 | 5.2% |
2 | £13,260 – £28,854 | 6.5% |
3 | £28,855 – £35,155 | 8.3% |
4 | £35,156 – £52,778 | 9.8% |
5 | £52,779 – £67,668 | 10.7% |
6 | £67,669 and above | 12.5% |
Every NHS consultant in England sits in Tier 6 and pays 12.5% on their entire pensionable salary.
Unlike income tax, which is marginal, NHS pension contributions apply to your entire salary based on which tier you fall into — this creates cliff edges at tier boundaries. This is critical for consultants approaching a threshold change: a progression from Threshold 2b to Threshold 3 does not trigger a tier change (both remain in Tier 6), but the Annual Allowance implications change significantly. Employers contribute a flat rate of 23.7% of pensionable pay, making the NHS Pension Scheme one of the most generous in the UK. A consultant paying the maximum 12.5% gross rate only pays 7.5% after tax relief if they are a higher-rate taxpayer — meaning the real cost of the pension to a consultant's take-home pay is 7.5%, not 12.5%.
The standard Annual Allowance is £60,000 for 2026/27. This is the maximum total pension input — your contributions plus employer contributions plus growth in benefits — before tax charges apply. Most NHS staff are well within this limit, but senior medical staff on Band 8d/9 or consultants may be affected. Consultants building significant pension accrual may exceed this, triggering a tax charge. Scheme Pays elections allow this to be deducted from the pension itself rather than paid immediately.
The tapered Annual Allowance also applies to very high earners. Consultants with "threshold income" above £200,000 — achieved when total NHS income plus private practice and any other earnings exceeds this — see their Annual Allowance taper, reducing to a minimum of £10,000. Use the NHS Pension Scheme's Pension Annual Allowance Calculator (available via NHSBSA) to model your specific position.
In terms of NHS basic salary, all consultants earn the same regardless of specialty. A consultant surgeon and a consultant physician on the same threshold receive identical NHS basic pay. The earnings gap between specialties comes from four sources:
1. Additional PAs: Surgical specialties routinely carry 11 or 12 PA contracts. An emergency medicine consultant may also work additional PAs to cover rotas. 5Consultants typically work a 10-Programmed-Activity job plan, where one PA is 4 hours of direct clinical care or supporting work — additional PAs are paid extra, often at one tenth of basic salary per PA.
2. On-call category: High-frequency surgical and medical take-on-call rotas attract Category A supplements (8% of basic). A low-frequency rota in a specialist outpatient role may only attract Category C (3%).
3. Clinical Impact Awards (CIAs): 5National Clinical Impact Awards — formerly Clinical Excellence Awards — are awarded for sustained contribution above contracted duties. Awards run for a fixed five-year term, are renewable, are pensionable, and approximately 3,000–4,000 consultants nationally hold a national award at any time.
4. Private practice: 5Many consultants supplement their NHS salary with private practice work outside contracted hours, which can add significantly to total earnings depending on specialty and location. The highest-earning specialties in private practice are neurosurgery, orthopaedic surgery, cardiology, ophthalmology, and dermatology.
A senior NHS consultant earning £150,569 in basic pay, with a 12-PA contract, Category A on-call, a national CIA award, and a private practice income, can realistically earn in excess of £250,000 per year in total. This is most common among surgical subspecialists.
Consultants on the 2003 contract progress through pay thresholds over 14 years. 4 Progression is automatic with service, subject to job-planning and appraisal.
Threshold Move | Years of Service Required | Gate |
Entry → Threshold 2a | 3 years of completed consultant service | Satisfactory job plan review |
Threshold 2a → Threshold 2b | 4 years | Satisfactory appraisal |
Threshold 2b → Threshold 3 | 8 years | Satisfactory job plan review |
Threshold 3 → Threshold 4 | 14 years | Satisfactory appraisal |
Consultants with prior overseas consultant experience may be assessed and placed on a higher threshold at appointment. Consultants with prior experience overseas may be assessed and placed on a higher threshold. Any such request must be made at the point of appointment — retrospective threshold adjustments are not standard practice under NHS terms.
Progression is not awarded automatically on the anniversary date. A formal job plan review meeting must occur and be recorded by the employer before payroll can update the threshold. Consultants approaching a threshold change should flag this to their Clinical Director at least three months in advance.
NHS consultants pay 40% or 45% tax on the majority of their salary. That makes professional expense relief disproportionately valuable. The following expenses are allowable against income tax when paid personally:
Expense | Typical Annual Cost | Tax Relief at 40% |
GMC registration fee | £433 | £173 |
BMA membership | ~£600 | ~£240 |
Royal College subscription (e.g. RCS, RCP, RCOG) | £200–£800 | £80–£320 |
Medical defence/indemnity (MDO) | £0–£2,000+ (specialty-dependent) | Up to £800 |
Examination fees (e.g. FRCS, FRCA, MRCP) | Varies | 40% of cost |
Specialist journals and clinical references | Varies | 40% of cost |
Claims are made either through Self Assessment (if the consultant is already registered) or by writing to HMRC to request a P87 tax code adjustment. GMC, BMA, Royal College, and MDO subscriptions are confirmed by HMRC as deductible professional subscriptions under Section 344 ITEPA 2003.
NHS consultants who hold student loans continue to repay through payroll above the plan-specific repayment threshold. Repayment rate is 9% of gross income above the threshold for Plans 1, 2, 4 and 5, and 6% for Postgraduate Loans. Loan plan repayment thresholds for 2026/27 are:
Loan Plan | Repayment Threshold (2026/27) | Rate |
Plan 1 | £24,990 | 9% |
Plan 2 | £27,295 | 9% |
Plan 4 (Scotland) | £31,395 | 9% |
Plan 5 | £25,000 | 9% |
Postgraduate Loan | £21,000 | 6% |
A consultant on Plan 2 at Threshold 1 (£113,565) repays approximately £7,764 per year in student loan deductions — equivalent to £647 per month. A Plan 5 consultant at the same salary repays approximately £7,970 per year. These deductions are made from gross pay before take-home is calculated and are included in the calculator above.
A common point of confusion is why a consultant earns more than a Band 9 Agenda for Change member of staff. Consultant pay is decided through a completely separate process. The highest AfC band (Band 9) tops out at £129,783, which is still below the top consultant threshold of £145,478.
Consultant pay sits on an entirely separate structure from Agenda for Change — consultants have their own pay structure reviewed by the DDRB (Review Body on Doctors' and Dentists' Remuneration).
AfC bands cover nurses, allied health professionals, pharmacists, healthcare scientists and non-medical managers. The consultant pay scale covers doctors and dentists in consultant-grade posts. The two systems do not interact. A consultant moving into a non-clinical management role would be subject to individual negotiation — there is no automatic AfC band equivalent for a consultant-grade doctor.
The 2026/27 England consultant scale runs from £113,565 to £150,569. These are basic NHS salaries for a 10-PA full-time contract. Total earnings including additional PAs, on-call supplements, and Clinical Impact Awards are higher for most consultants in post.
Pension, higher tax rates and the personal-allowance taper can significantly reduce monthly take-home pay. A new consultant at Threshold 1 (£113,565) takes home approximately £5,009 per month in England (no student loan, standard tax code, 2015 CARE pension, non-London). Use the calculator at the top of this page for your personal figure.
Full-time consultants work 10 Programmed Activities per week, each a 4-hour block. Additional PAs above 10 are paid at 10% of basic salary per PA. At Threshold 1, 1 extra PA is worth £11,357 per year. At Threshold 4, 1 extra PA is worth £15,057 per year.
A consultant surgeon earns the same NHS basic salary as every other consultant — £113,565 to £150,569 in 2026/27. Surgeons typically earn more in total due to higher PA counts (commonly 11–12 PAs), Category A on-call supplements, and significantly higher private practice earning potential, especially in orthopaedics, neurosurgery and ophthalmology.
No. NHS consultants have their own pay structure under the 2003 Consultant Contract. They are reviewed by the DDRB, not the NHSPRB, which covers Agenda for Change staff.
The NHS consultant PA calculator calculates your total gross pay when you work more than 10 PAs per week. It takes your threshold basic salary, applies the 10% per-PA rate to any additional PAs, and adds on-call supplements and London weighting to produce a full gross figure — which is then run through income tax, NI, and pension deductions to give your final take-home.
5 National Clinical Impact Awards — formerly Clinical Excellence Awards — are awarded for sustained contribution above contracted duties and run for a fixed five-year term, renewable. They are nationally assessed, pensionable, and worth up to £40,000 per year at the highest level. Local Clinical Impact Awards also exist, assessed by the employing Trust.
A new consultant at Threshold 1 (£113,565) working in Inner London receives Inner London HCAS of approximately £22,713 per year, bringing total gross pay to approximately £136,278 before additional PAs or on-call. A senior consultant at Threshold 4 (£150,569) in Inner London earns approximately £180,683 gross in basic pay plus HCAS before any extras.
5 The 2026 pay award adds 3.5% to basic salary across England. Consultants received 4% for 2025/26. The 3.5% award for 2026/27 is slightly lower but remains above OBR inflation forecasts of 2.2%.
The NHS Pension is a defined-benefit scheme that guarantees a pension linked to career average earnings. A consultant paying the maximum 12.5% gross rate only pays 7.5% after tax relief if they are a higher-rate taxpayer — exceptional value for a guaranteed pension. Employers also contribute 23.7% of pensionable pay on top. The main risk is the Annual Allowance charge, which can affect consultants with high pension growth in a given year.
Most consultant salary points sit above the personal allowance taper zone. Once adjusted net income is above £100,000, the personal allowance is withdrawn at £1 for every £2 of income. Because every consultant threshold is above £100,000, every NHS consultant in England loses part or all of their Personal Allowance. Consultants at Threshold 2b and above (£123,672+) lose it entirely and pay income tax from £0 of gross income.
Yes. You can opt out of the NHS Pension Scheme at any time. If you opt out, your employer's 23.7% contribution is lost — it does not convert to cash pay. Opting out does reduce your pension contributions, which increases your take-home pay. However, this also loses the tax relief, the defined-benefit accrual, and the employer contribution. Opt-out is generally only considered when facing Annual Allowance charges that make further accrual tax-inefficient in a given year.