Becoming an NHS consultant

You become an NHS consultant by completing specialty training, gaining a Certificate of Completion of Training (CCT) or equivalent, joining the GMC specialist register, and then winning a consultant post through a formal appointment panel. In England, consultant basic pay on the 2003 contract starts at £113,565 for 2026/27 and rises through fixed thresholds to £150,569 after 14 years, before extra sessions, on-call and awards.

The route to the specialist register

Most consultants reach the post through a national training programme that ends in a CCT. Training follows foundation and core or run-through specialty years, labelled up to ST8 depending on the specialty, and involves passing Royal College exams, annual reviews of progress and a growing level of responsibility. Resident doctors explained covers the earlier stages.

Doctors who have not completed a UK training programme but have equivalent training and experience have another route. They apply to the GMC for specialist registration through the portfolio pathway, providing evidence that their training and experience match the curriculum. Many specialty and specialist (SAS) doctors and internationally trained doctors use it.

You can apply for consultant posts in the final months of training, ahead of your expected CCT date.

Getting appointed

Consultant posts in NHS trusts are filled through an Advisory Appointments Committee (AAC) or equivalent panel, which includes trust representatives and an external assessor from the relevant Royal College. The process typically involves:

• an application with a full CV and supporting information
• informal visits to the department, which are expected for many posts
• a panel interview, sometimes with a presentation
• references from consultants who have supervised you

Panels look at clinical skill, and also at leadership, teaching, quality improvement and how you would fit and develop the service.

How consultant pay is built

Basic pay for consultants on the 2003 contract in England for 2026/27 follows the scale below. These are the 2025/26 values plus the 3.5% DDRB award from 1 April 2026, as published by the BMA (whose page was still being updated in August 2026).

Years as consultant	Basic pay, 2003 contract
Start	£113,565
After 3 years	£120,249
After 4 years	£123,672
After 8 years	£135,645
After 14 years	£150,569

A newer consultant contract introduced in 2023 has a different pay structure. Its 2026/27 scale was not available when this guide was written, so check the BMA consultant pay pages or NHS Employers for current figures.

Basic pay covers a standard job plan made up of programmed activities (PAs) for direct clinical care, supporting professional activities such as teaching and audit, and other duties. On top of basic pay you can receive:

• pay for additional PAs if your job plan includes extra sessions
• an on-call availability supplement, depending on how often you are on call and how intense it is
• National Clinical Impact Awards (NCIAs), which from 1 April 2025 are worth £21,000, £31,500 or £42,000 a year; the older clinical excellence award schemes are closed and frozen
• fees for some extra work, and earnings from private practice where your contract allows it

Scotland, Wales and Northern Ireland have their own consultant contracts and pay scales. Doctors’ pay in the NHS has an overview.

Job plans

Every consultant has a job plan agreed with their clinical director and reviewed at least yearly. It sets out how your time is split between clinics, theatre lists, ward rounds, on-call, teaching, management and other activity, and it is the basis of your pay. Disagreements over job plans have formal routes, including mediation and appeal, and the BMA advises members on them.

Tax and pension at consultant pay

All consultant salaries are above the higher rate threshold of £50,270 in England, Wales and Northern Ireland. Above £100,000 of adjusted net income the personal allowance is withdrawn at £1 for every £2, disappearing completely at £125,140, so income in that range is taxed at a very high effective rate; see the £100,000 tax trap. NHS Pension Scheme contributions are 12.5% on pensionable pay above £67,669.

Large increases in pensionable pay, such as on appointment, can create an annual allowance tax charge. Pension annual allowance explains how it works. For decisions about your own pension or tax, a regulated financial adviser or accountant familiar with NHS doctors can help.

Life as a consultant

Consultants hold final responsibility for their patients’ care and lead the clinical team, including supervising resident doctors. The job usually brings more control over the working week than training, an end to frequent rotations, and the chance to build a service. It also brings on-call responsibility, management meetings, complaints and pressure to meet waiting time targets. Many consultants also take on roles such as clinical director, educational supervisor, college tutor or research lead, which are recognised in the job plan. Moving to another trust means going through a new appointment panel, so many consultants stay with one organisation for long periods.

Search NHS Jobs and Trac for consultant posts in your specialty, or browse doctors’ jobs.