When doctors reach the pinnacle of their medical career as NHS consultants, they enter a complex but potentially rewarding payment structure. Let’s break down how these senior medical professionals are paid in straightforward terms.
To become a consultant, doctors typically spend 8-10 years in specialized training after medical school, earning their Certificate of Completion of Training (CCT). This makes them eligible to practice medicine independently at the highest level.
The NHS measures consultant work using “Programmed Activities” or PAs. A standard PA is a four-hour block during regular working hours (7am to 7pm, Monday to Friday). Most full-time consultants work 10 PAs per week, which translates to about 40 hours. These hours are split between directly treating patients (known as Direct Clinical Care) and other important tasks like teaching, administration, and professional development (called Supporting Professional Activities).
When it comes to base pay, new consultants start at £88,364 per year for a full-time position. This salary increases over time through eight thresholds, potentially reaching £119,133 after about 20 years of service. To progress through these thresholds, consultants must pass their annual performance reviews.
However, the base salary is just the beginning. Consultants can significantly increase their earnings through various additional work opportunities. They might take on out-of-hours shifts, which are paid at a higher rate and are measured in three-hour blocks instead of four. They can also participate in night shifts, help reduce waiting lists through extra clinics, or take on additional PAs beyond their standard 10 per week.
Many consultants also participate in an on-call rota, where they must be available to return to the hospital quickly if needed. This responsibility typically adds 3-5% to their base salary, depending on how frequently they’re on call and how likely they are to be called in.
The NHS also offers Clinical Excellence Awards (CEAs) to recognize and reward consultants who go above and beyond their regular duties. These awards can substantially boost a consultant’s income, though they’re competitive and currently being reformed to ensure fairer representation across different groups of consultants.
For those interested in more flexible work arrangements, locum consulting can be quite lucrative. For example, a general medicine consultant working as a locum outside London can earn between £94.72 and £104.99 per hour. Working full-time hours as a locum could potentially earn over £217,000 annually. These rates can be even higher based on factors like experience, location, and specific role requirements.
It’s worth noting that this pay structure applies specifically to England’s national consultant contract from 2003. Wales, Scotland, and Northern Ireland have their own arrangements, as do certain specialties like GPs and military doctors.
The consultant pay system, while complex, reflects the high level of responsibility and expertise required for the role. Regular working hours, out-of-hours commitments, additional duties, and excellence awards combine to create a varied and potentially substantial income. Whether working in a permanent NHS position or as a locum, consultant-level doctors can expect their years of training and expertise to be reflected in their earning potential.