No-one ever really explains how a junior doctor’s salary works. So when your first paycheck comes along, how do you know it’s the same as what you were promised? And how can you plan your income over the next couple of years?
Here we’ll go through the various elements of your salary and how it’s calculated. After you’re done, you might want to have a look at the pay calculator.
Who sets the salaries?
NHS junior doctor pay scales are outlined semi-annually in the Pay & Conditions Circulars published by NHS Employers, but this document is often 20-30 pages long!
The BMA helpfully condenses and outlines these pay scales on their website with very helpful tables to sort by grade, from Foundation Year 1 and 2 (FY1 and FY2) up to Core/Specialty trainee (CT/ST1-2) and Specialty Registrar (SpR/ST3+).
They also have a very good page on understanding your payslip with a sample diagram.
How a junior doctor’s salary is calculated
The junior doctor salary is made up of several components, added together to give the gross salary.
This is the amount the employer pays the employee before deductions like pensions, tax and national insurance.
The parts that add together to make up the gross salary are as described below.
The standard pay for 40 hours per week, no weekends or unsocial hours, no other supplements.
Basic pay in 2020-21 ranges from:
- £28,243 for an FY1,
- £32,691 for an FY2,
- £38,693 for a core or specialty trainee (CT1-2/ST1-2), to
- £49,036 for a registrar/SpR (at third or higher specialty training year or ST3+).
The full scales of basic pay can be found here.
In 2019, the BMA and NHS Employers came to an agreed contract with a provision to increase this by at least 2% annually (every April) until 2023. The pay scales above have been increased in line with this as of April 2020.
There is due to be a new point of increase (“nodal point”) at ST6 as part of the newly agreed contract, starting in October 2020.
(“Addn Roster Hrs NP” on your payslip).
This is extra pay for the number of hours actually worked per week, rather than just 40 hours accounted for by the basic amount.
This is paid at the rate of basic pay. For example, a doctor working 48 hours per week on average will have an additional 8 hours’ worth at the basic pay rate.
For example, a junior doctor with a base salary of £40,000 per year, working 48 hours per week instead of the standard 40 hours, would then have an extra £8,000 (8/40 of £40,000) of additional hours paid.
Enhanced rate hours
(“Night Duty” on your payslip.)
This is an extra enhanced rate for any hours that are deemed “unsocial”.
The rate for these hours is increased by 37%
There is a complicated definition for what counts as enhanced hours, but it mainly refers to:
- Hours worked between 21:00 and 07:00 for each day of the week.
- Any hours worked during a shift that starts between 20:00 and 23:59.
- Any hours worked during a shift that finishes at 10:00 or earlier and is at least 8 hours long.
This is a fixed allowance/bonus to compensate for working on weekends. The amount of the bonus is determined by how often weekend duty is required.
At the high end of the scale, a doctor working alternate weekends (“1 in 2”) will have a weekend allowance of 15% of their basic salary, added on to their entire salary. This decreases with decreasing weekend frequency.
For example, a doctor working 1 in 2 weekends with a basic salary of £40,000 will then earn an extra £6,000 annually (15% of £40,000 = £6,000).
Note that duty any less frequent than 1 in 8 weekends does not qualify for a weekend allowance.
Employees in London receive an additional £2,162 annually, to compensate for increased costs of living.
Non-resident on-call (NROC) allowance
An additional allowance for being available to work NROC shifts from time to time.
NROCs are defined as being “required by the employer to be available to return to work or give advice by telephone, but is not normally expected to be working on-site for the whole period.”
This is also paid as a fixed allowance/bonus, but is paid at a flat rate and isn’t determined by frequency.
NROC shifts are most often worked by registrars and above, in some specialties like surgery.
Flexible pay premia
These are additional miscellaneous bonuses paid at a flat rate for various reasons listed in the Pay and Conditions Circular.
Flexible pay premia are sometimes paid to trainees in hard-to-fill specialties like emergency medicine, psychiatry, general practice, histopathology and Oral and Maxillofacial surgery.
Academic trainees are also paid flexible pay premia on their return to training after successful completion of a higher degree.
Cash floor protection
This applies to some doctors who were on the “old” 2002 contract prior to being transitioned to the “2016” contract. In effect, this is an extra payment to ensure that doctors are not being paid less than they were before moving to the “new” contract.
The area around this transitional pay protection is complex and the BMA has dedicated an entire page toward discussing this.
Less-than-full-time (LTFT) allowances
Any doctor who is training less than full time will be paid an annual allowance of £1,000 for as long as they continue to train less than full time. The BMA also has a dedicated page to discuss this.
Planning for deductions
Of course, adding together your gross salary can be encouraging, but do remember that a number of deductions need to be taken out!
Following subtraction of these deductions, you can calculate your net or “take-home” salary.
The following are some examples of what deductions can be expected:
- “Pay As You Earn” (PAYE) – also known as income tax.
- National Insurance (NI).
- NHS Pension contributions (if you have opted to participate).
- Student loan repayments (if you have one).
- Other deductions like Mess fees and car parking.
How much does a junior doctor earn?
So the burning question – how much do junior doctors really earn? Unfortunately, as a result of all of the variables listed, there is no simple answer!
It varies depending on the amount of work done and during which hours and days of the week – which in turn varies greatly by specialty and around the country.
We can use an example work schedule for a new FY1 doctor, to give an idea about how these pieces add together.
This hypothetical new FY1 would work an average of 45 hours per week, 8 of which would attract a 37% enhancement. They would also work 1 in 4 weekends (roughly once a month), with no London allowance or additional bonuses or deductions.
- Basic pay: £28,243.00
- Additional pay (5 hours per week at basic rate): £3,530.38
- Enhanced rate hours (8 hours per week at extra 37% rate): £2,089.98
- Weekend allowance: £2,118.23
The sum of these is £35,981.58, which gives their gross salary!
To get an idea of the average incomes of a junior doctor, check out our pay calculator to get an idea of the compensation for different rota structures.
As a rule, doctors cannot work more than 48 hours a week on average, and not usually more than 1 in 3 weekends.
Doctors in psychiatry and general practice will work very few enhanced rate hours or weekends (if any), whereas those in emergency medicine and paediatrics will work relatively more.
If you have any questions about the above, or would like some examples of what you might be expected to work in other specialties, get in touch!