How NHS doctors’ pay is decided

How much doctors earn in the NHS is reviewed annually by the DDRB, which makes recommendations to the Government.

Location: UK
Audience: All doctors
Updated: Monday 7 September 2020
Wallet and notes illustration

This page discusses how doctors pay is decided by what kind of doctor you are. Choose your branch of practice on the left.

 

What the DDRB do

NHS doctors’ pay is reviewed annually by the DDRB, the independent review body for doctors’ and dentists’ remuneration. It makes recommendations to all UK governments.

As health is devolved from Westminster, there may be differences in approach to the DDRB from individual governments.

DDRB recommendations are not legally binding. Governments can and have chosen not to implement recommendations in full, or in some cases, at all. This might be by reducing or ignoring a recommended increase for parts of the profession, or by staging the award to reduce real-terms costs and therefore the value of an increase to doctors.

BMA demands on DDRB

 

The DDRB's recommendations

In making its recommendations, the DDRB takes into account:

  • the need to recruit, retain and motivate doctors
  • regional/local variations in labour markets and their effects on recruitment and retention
  • funds available to the health departments as set out in the Government’s departmental expenditure limits
  • the Government’s inflation target
  • the overall strategy that the NHS should place patients at the heart of all it does, and the mechanisms for that to be achieved.

It reports to the prime minister in the new year and the report is made public, with the Government’s decision, for implementation on 1 April. This covers the salaries of:

  • consultants
  • SAS (staff, associate specialist and specialty) doctors
  • doctors in training
  • doctors in public health medicine and community health
  • GPs (independent contractors, salaried and trainees)
  • ophthalmic medical practitioners.

The BMA has argued than an increase to London weighting is overdue and merited given the large rise in cost of living in the capital.

 

Giving evidence to the DDRB

The health departments, NHS Employers, NHS England, Health Education England and the BMA provide evidence to the DDRB each September. 

The BMA’s review body evidence committee oversees our written evidence, with representatives from each of the major groups of practising NHS doctors and expert input from BMA staff.

 

GPs

GPs as independent contractors
  • Most GPs are self-employed contractors.
  • The GMS (general medical services) contract covers around 60% of practices. 
  • The rest are PMS (personal medical services or section 17 in Scotland) practices.
  • GP practices, rather than individual GPs, contract with the PCO (primary care organisation) to provide general medical services.
  • This contract, and thus practices, are funded via different streams
  • Practices’ entitlements to this funding are detailed in the Statement of Financial Entitlements.
  • GPs’ earnings are then determined by the practice’s own business arrangement, whether as a single-handed practitioner, a partnership, or a company limited by shares.
  • The levels of funding and entitlements to practices are negotiated nationally​​.
Salaried GPs
  • GPs can work as salaried employees.
  • The BMA’s model contract for salaried GPs shows minimum terms and conditions and salary range, updated annually by the DDRB
  • The DDRB has tended to consider salaried GPs the same as employed doctors when recommending a pay uplift.
  • A salaried GP may be employed by a GP practice (GMS, PMS or Section 17c), by a PCO or a private provider commissioned by the PCO to provide primary medical services.
  • In Wales, there is a separately negotiated contract for salaried GPs employed directly by the GMS practice and local health board.
GP trainees

GP trainees’ pay is calculated on their basic salary in their last junior hospital or consultant post, plus a supplement of 45%. The DDRB reviews this annually.

PMS and section 17c schemes

PMS and Section 17C agreements are local alternatives to the national GMS contracts.

Although the contract budget is locally negotiated between contractor and PCO, and the elements of that budget are not nationally protected, these agreements are becoming increasingly similar to GMS.

PMS contractors have equal access to many of the income sources under the GMS contract, such as the quality and outcomes framework.

Doctors’ retainer and flexible careers scheme
  • Doctors’ retainer and flexible careers schemes combine a service commitment with an educational component.
  • They ensure doctors who can only do a small amount of paid professional work keep in touch with general practice, retain their skills and progress their careers, with a view to returning to NHS general practice in the future.
  • These doctors are classed as salaried GPs, so the agreed minimum terms and conditions and salary range for salaried GPs apply when employed by a GMS practice or PCO.

Clinical excellence awards

There is a system of clinical awards for which consultants – and, for some awards, SAS doctors – may be eligible. The type and rate of awards varies by UK country, and the values are subject to review by the DDRB.

Doctors who are still on the discretionary point and distinction award system keep their points and awards until they successfully apply for a CEA. Discretionary points and distinction awards also continue to be up-rated annually by the DDRB (when up-rating happens).

Clinical excellence awards

 

Medical academics

Clinical academic staff

These are medical and dental academics with an honorary NHS contract. University employers and the UK Government ensure pay parity between this group and their NHS equivalents. Pay scales reflect those in the NHS and it has been agreed that the DDRB award should translate almost automatically.

Any changes to NHS pay scales still has to be agreed by negotiation between the BMA on behalf of medical academics, UCEA (the Universities and Colleges Employers Association) on behalf of employers, the British Dental Association and the University and College Union.

Non-clinical medical academic staff

Medical academics without a clinical commitment in the NHS, and thus without an honorary NHS contract, are paid on the standard pay scales for academic staff. These are negotiated by the University and College Union, and rates are generally much lower than those of their clinical colleagues.

The BMA does not have negotiating rights, but has engaged with university employers on issues such as the gender pay gap, career progression, pensions, appraisal and revalidation.

MRC staff

The pay of MRC (Medical Research Council) staff is broadly in line with that of clinical academic or non-clinical staff, as appropriate – the MRC has recently joined UCEA.

The BMA represents medical staff employed by the MRC and is represented at meetings of the joint trade unions.

Civil service medical officers

Full-time civil service medical officers
  • Pay is negotiated annually by the trade union Prospect, the individual employing departments and agencies e.g. the Ministry of Defence and Veterans Agency.
  • As a consequence of delegated pay, there is no longer a link between pay and terms and conditions for medical officers in different organisations within the civil service.
  • Many of the pay systems include an element of performance-related pay.
  • Prison medical officers also receive an environmental supplement.
Civilian medical practitioners
  • CMPs (civilian medical practitioners) have the terms of service of the civil service, but their pay is under a separate analogue established by the MoD.
  • Discussions are underway on a new analogue, such as the pay range for salaried NHS GPs.
  • Pay is superannuable under the non-contributory civil service scheme.
  • Practitioners involved in GP training receive the trainer allowance at the rate payable to armed forces doctors.
  • A small number of civilian consultant posts are paid at the same rate as in the NHS, but without discretionary points or distinction awards.
  • Discussions are underway on implementing the NHS consultant contract for civilian consultants employed by the MoD.
Prison medical officers (part-time)
  • Part-time prison medical officers’ pay is agreed between the BMA civil and public services committee and the Home Office.
  • It is linked to the mid-point of the NHS hospital practitioner grade and therefore increases according to government pay awards.
  • The Prison Service also employs doctors, usually consultants, on a sessional basis.
  • These ‘visiting person medical officers’ are paid at rates issued by the Prison Service, following discussions with the BMA professional fees committee.

Armed forces doctors

  • Doctors’ pay in the DMS (defence medical services) is determined by the Armed Forces Pay Review Body.
  • It considers both its own award for armed forces personnel and the DDRB.
  • Pay is based on NHS consultant pay, adjusted to allow for the difference in the armed forces and NHS pension schemes, and uplifted by what is known as the ‘x’ factor to compensate for the turbulence of service life.
  • The DMS consultant pay scale includes a distinction awards scheme modelled on the NHS version, though the awards are not pensionable.
  • DMS GMPs are also entitled to sustained quality payments along similar lines to their NHS colleagues, and those that are trainers also receive trainer pay, but currently at a lower rate than in the NHS.
  • Neither of these payments is superannuable.

Armed forces pay

 

Physicians

Forensic physicians
  • Forensic physicians are not salaried; most work part-time outside their main contract.
  • Fees are agreed nationally by the BMA through the Joint Negotiating Committee for Forensic Medical Examiners.
  • Increases are based on those for NHS doctors, but fees must be agreed each year.
  • They are a mix of retainer, sessional and item of service fees.
Occupational physicians

Through the occupational health committee the BMA updates its own guidance on rates for occupational physicians from 1 April each year, in line with the award to NHS doctors.

Pharmaceutical physicians

Pay varies widely depending on seniority and company size, but generally it equates to levels on the NHS hospital consultant scale.

Fees

  • Some fees, such as for family planning in hospitals, are included in the DDRB remit.
  • Others are negotiated by the BMA professional fees committee, which generally seeks increases in line with GP remuneration.
  • Each March, the committee also reviews its suggested fees for part-time work by a patient’s own GP or other attending doctor that isn’t governed by statute or negotiated agreements.

Guidance and information on doctors' fees