Locally Employed Doctors (LEDs) – pay and work in 2023

Find out how the DDRB recommendations impact you and whether you are being over-worked in your current role

Location: England
Audience: SAS doctors Junior doctors
Updated: Thursday 17 August 2023
Wallet and notes illustration

LEDs in England - Your rights to fair pay and reasonable work scheduling

Locally employed doctors (LEDs) play an instrumental role delivering healthcare within the NHS. Yet these doctors can often face difficulty receiving what they are due from their employers.

Employed under various titles (such as Trust Grade, Clinical Fellow, Trust Doctor etc), LEDs are not provided with national contracts but instead given local variations of such contracts. These terms and conditions can vary significantly from those of their SAS and junior doctor colleagues. This can both undermine the working conditions of LEDs, and cause confusion regarding what they are expected to do.

Given the recent announcements on pay, is imperative that LEDs understand what they are owed and that they receive this.

Considering the current state of the NHS – the workforce shortages, the backlog, and the potential for extended industrial action – it is important that LEDs are not devalued and used as an inexpensive way to plug up gaps created by systemic issues or strikes.

While the BMA continues to explore how we can improve the working lives of LEDs – both locally and nationally – we wanted to take a moment now to reach out and make sure you’ve got the tools and information you need to get make sure your rights are respected.

Accordingly, we ask LEDs two questions: are you being paid what you are owed by your employer, and are you being over-worked?

Based in England? Check you are getting your pay uplift

2023/24 pay uplift – England

Following BMA campaigning, the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) has accepted that LEDs fall under its remit. As of 2022, the pay review body has begun making recommendations for this previously excluded groups of doctors.

The 2023 DDRB report explicitly states LEDs should receive a pay uplift:

We would expect our recommendations to be implemented consistently and fairly for LEDs. For those LEDs whose pay and terms and conditions mirror a national contract, we would expect them to receive the same uplift as those on the national contract that their arrangements mirror. For others, we would expect them to receive a pay uplift equal to our first pay recommendation.

This means:

  • England-based LEDs on terms mirroring the 2016 junior doctors contract or the 2002 junior doctors contract should receive a 6% pay uplift, plus £1,250 consolidated
  • England-based LEDs on terms mirroring the 2008 specialty and associate specialist contracts should receive a 6% pay uplift
  • England-based LEDs on terms mirroring the 2021 specialty and specialist contracts should receive a 3% pay uplift on top of uplifts included in the multi-year pay deal (based on your pay point and in line with the updated pay scale)
  • England-based LEDs on terms which do not mirror the above contracts should receive a 6% pay uplift

This pay uplift should also be backdated to April 2023. You should see a change in pay in your September or, at the latest, October pay slip.

Some LEDs do not have a clause in their contracts guaranteeing a pay uplift in line with DDRB recommendations. If you find yourself in this situation, we encourage you to:

  • Still approach your employer, using the template letter below
  • Push to have this clause instated in your contract. The BMA can support you with this.

Know your rights to a work schedule, job plan or contract

LEDs should possess either work schedules or job plans. These are documents that clearly outline your work commitments, as agreed by an employee and their employer.

  • England-based LEDs on terms that mirror the 2016 junior doctors’ contract should have access to a work schedule (find out more)
  • England-based LEDs on terms that mirror SAS contracts should have access to a job plan (find out more)
  • LEDs on terms that mirror none of the above contracts should still have access to one or the other depending on which grade you are – members can check which by contacting the BMA 
  • Regardless of the above, anyone legally classed as an employee or worker has the legal right (Employment Rights Act 1996) to a 'written statement of employment particulars'. The employer must provide the principal statement on the first day of employment and the wider written statement within 2 months of the start of employment. If you haven't yet got a contract ask your HR department and contact the BMA for support.

You can use your job plan, work schedule or contract detailing employment particulars to determine if you are working beyond your agreed hours/PAs.

Working your agreed hours/PAs

You are not contractually obliged to work beyond the commitments set out in your work schedule or job plan.

If you wish to complete extra hours/PAs, you should be appropriately compensated for doing so. More information – including rate cards used by junior and SAS doctors for extra-contractual work - can be located in the resources section.

What to do if you’re underpaid/over-worked

If you’re already a BMA member

As mentioned before, you will not see a change in pay slip until Autumn. Ahead of this, you may wish to raise the subject with your employer using our template letter.

  • Letter for doctors in England on locally employed contracts to send regarding pay uplifts

The BMA is also currently working with LNC chairs to raise the matter of LED pay uplifts with Trusts across England.

If by autumn you have still not seen a change in your pay slip, or your employer is questioning your eligibility for an uplift contact our advisors, and the BMA will help address this. 

If you are concerned your contract does not include what you are expected to do, you can get it checked for free through the BMA’s contract checking service


  • Your contract has no provision for a work schedule or job plan;
  • You should have access to a work schedule or job plan but if you are struggling to establish one with your employer; or
  • You employer is pressuring you to work beyond what has been agreed

You can again contact our advisors, who will help resolve the issue.

If you are not a member, join your trade union

Being a member of the BMA gives you access to employment advice throughout your career – whether you continue working as an LED or move into another grade.

As your trade union, we:

  • Understand the challenges facing LEDs and fight locally and nationally for better working conditions, helping LEDs move from temporary to permanent contract and negotiating better pay deals
  • Provide our contract checking service and specialist advisors, who understand the unique working context of LEDs, and can help address issues that arise in your workplace
  • Have created checklists for LEDs, helping to ensure your working arrangements are fit for purpose
  • Provide Trust-based LED representatives to fight for your rights locally
  • Offer financial and legal guidance, as well as pensions advice and contract checking
  • Understand the desire for career progression and development and, accordingly, provide mentoring and guidance from experienced professionals, as well as access to BMJ learning, where you can learn clinical practice and job planning skills along with hundreds of CPD learning modules covering every aspect of your professional development.

The BMA is currently offering a year’s free membership for all doctors in their first year of living in the UK.

International doctors new to the UK (IMGs)

Free BMA membership. We understand the importance of support and guidance when settling in the UK.

BMA membership is free to all doctors in their first year living in the UK.

Join now

Need help? Contact us

How to find out if you are a Locally Employed Doctor (LED)

LEDs are often employed under various titles, which can include terms such as Trust Grade, Clinical Fellow, and Trust doctor as well as others.

If you're not sure whether you are an LED, send us a copy of your contract so we can review this for you.

Make sure to also include:

  • your full name
  • BMA member number
  • your contact details

Find out more about BMA contract checking service 


join illustration
BMA: representing locally employed doctors

For almost 200 years, the BMA has been supporting doctors in non-training roles, nationally and in the workplace.

Join LEDs