The question of doctor’s pay in England has become a focal point of public discourse, especially amidst recent industrial action within the National Health Service (NHS). In a climate often characterized by emotionally charged debates and lacking in-depth analysis, it’s crucial to delve into the data and provide a clear picture of doctors’ earnings. This article aims to offer a fresh perspective on medical professionals’ salaries in England, addressing frequently asked questions about how their pay has evolved over time, how it compares to the broader UK workforce, and how it measures up against international counterparts.
Navigating the topic of remuneration is inherently complex and sensitive. There are numerous ways to interpret and present earnings data, each with its own set of limitations and potential biases depending on the assumptions made. Therefore, the insights presented here should be viewed as contributing to a nuanced understanding, rather than offering an exhaustive or definitive account. Our goal is not to arbitrate on what constitutes a “fair” level of pay, but rather to inject objective, data-driven evidence into what has become a contentious issue.
Understanding the Recent Pay Deal for Doctors in England
In July, a new pay deal was announced impacting NHS staff, covering the financial year up to March 2024. This agreement stipulated a 6% pay increase for consultants, while doctors in training were to receive a £1,250 uplift in addition to this percentage rise, averaging an 8.8% total increase.
As a result of this deal, the basic NHS salary for consultants now ranges between £93,666 and £126,281. Considering additional earnings from on-call duties, clinical excellence awards, geographical allowances, and extra work, the average full-time NHS consultant’s earnings are likely to be around £143,100.
For junior doctors, the basic pay scale now falls between £32,397 and £63,162. For those in their initial year of practice, average total full-time earnings are estimated to be approximately £41,300. Specialty registrars nearing the completion of their training can expect to earn around £71,300 on average in total full-time earnings (as detailed in Table 1 below).
How Doctor’s Salaries in England Have Changed Over Time
Looking back, it’s evident that doctors’ salaries have experienced considerable fluctuations in real terms. Previous analysis has indicated that, adjusting for inflation, consultant and junior doctor salaries were approximately 14-15% lower in the year leading up to March 2023 compared to their levels 12 years prior. These figures were estimations dependent on inflation rates and pay levels during that financial year, but they closely mirrored the actual trend.
By examining historical pay settlement data, we can extend our analysis further back in time and also account for shifts in seniority and experience within different grades, which can influence broader pay trend interpretations. This historical analysis, however, is not without its challenges, as detailed records of implemented pay adjustments are somewhat inconsistent, and some pay agreements were phased in over the course of a year.
Despite these complexities, the long-term trend reveals a distinct pattern of alternating periods of sustained real-terms pay increases followed by equally prolonged periods of decline. This cyclical nature is significant because doctors, like many individuals, tend to be loss-averse. The negative impact of real-terms pay cuts is often felt more acutely than the perceived benefit of equivalent real-terms increases. For instance, while the minimum basic starting salary for consultants in 2022/23 (around £88,000) was less in real terms than it was a decade earlier (£96,000 in 2012/13 prices), it was comparable to the salary two decades prior (also £88,000 in 2002/03 prices) and higher than three decades earlier (£75,000 in 1992/93 prices). It’s important to note that this data pertains to underlying pay frameworks and not individual pay packets, which can increase due to promotions to more senior training positions and consultants’ years of service, as illustrated in Figure 4.
The trend highlights how crucial the choice of baseline is when assessing changes over time. While junior doctor and consultant pay scales have decreased in real terms in the last decade or so, over a longer period, they have, in fact, kept pace with inflation. The chart also underscores the challenges that arise when the employment landscape shifts. Junior doctors and consultants have typically experienced similar pay settlements, but the four-year deal for junior doctors, averaging 2% annually, was agreed before the pressures of the pandemic and the subsequent surge in inflation, quickly making it appear unfavorable.
While this analytical approach has its advantages, it primarily focuses on pay settlements and does not capture the effects of other contractual modifications. Notably, in the year 2003/04, which saw the introduction of a new contract for consultants, total earnings per full-time equivalent consultant reportedly increased by 12% in real terms, with basic salaries rising by about a quarter. A survey from that time indicated that consultants who transitioned to the new contract received an average annual pay increase of £12,454. Although this was two decades ago, it highlights a potentially problematic scenario where government initially increases pay beyond perceived affordability and then subsequently implements sub-inflationary deals to recover costs. More recently, pension tax changes will offer financial benefits to consultants, but like other broader changes, these are not reflected in the analysis of basic pay increases.
Various changes to junior doctors’ NHS employment terms and conditions have also occurred, which must be considered when comparing pay over time. For example, the phased implementation of the European Working Time Directive reduced their maximum weekly working hours from 56 to 48 in the five years leading up to 2009, affecting their hourly equivalent wage during this period. While the 2016 contract for junior doctors aimed to maintain average earnings, it altered the distribution of earnings between basic and additional pay and rates. More recently, the broader terms of the 2019 multi-year pay settlement included an additional pay increment level, meaning that the total investment for 2020/21 was actually 3%, rather than the headline 2%. This nuance is not captured in the chart above, which is limited to reported pay uplifts.
Doctor’s Salary in England vs. the Wider Economy
It’s also valuable to contextualize doctor’s pay against salaries in the broader English economy. While comprehensive data for the wider economy is only available up to 2021/22, comparisons can still be informative. In 2021/22, the average NHS earnings for doctors in their first year of work exceeded the median wage across all professions in England, placing them above the majority of workers but below the mean wage. Specialty registrars’ average NHS earnings surpassed the salaries of nearly 90% of the wider workforce, while consultants’ earnings positioned them between the 98th and 99th percentiles. For consultants, this relative pay standing has remained consistent over the past decade, but for junior doctors, their percentile ranking has declined over time.
GP partner earnings, which are derived from practice profits rather than a national pay framework, are even higher relative to wider labour market earnings. However, it’s important to note that GP partner earnings increased by 17% in the most recent year of available data, likely due, at least in part, to additional payments made during the pandemic. Some of this funding may not be ongoing. Furthermore, these figures are sensitive to assumptions made when converting GP earnings per head (£142,000 for a partner) to earnings per full-time GP. At the time, GP partners were contracted to work, on average, 87% of a full-time contract. It is not guaranteed that increasing their contracted hours would result in a proportionate increase in their take-home pay.
These analyses are limited to NHS earnings, and doctors may also have income from private practice. Data on earnings outside the NHS are limited. A previous, though dated, survey indicated that only one in eight NHS employers had accurate data on their consultants’ private practice work. However, older research suggested that private practice accounted for, on average, nearly a third of consultants’ total earnings, with significant variation by specialty, and this proportion may have changed since. Wider labour market earnings data are also limited to employees and do not include profits earned by business owners, who represent a significant portion of high earners. Additionally, these comparisons do not account for the financial value of pensions, with NHS schemes being particularly generous.
Given the competitive nature of medical school admissions, the substantial student debt often incurred, and the demanding nature of medical training and work, it is reasonable to expect doctors to be among the highest earners. Ideally, comparisons would be made with professions of similar complexity and demands, but available data is insufficient for such granular comparisons. However, research on the impact of a medical degree on lifetime earnings suggests a favorable outcome, even when controlling for factors like prior academic achievement.
International Comparison of Doctor’s Salaries
In light of media reports about clinicians seeking opportunities abroad, examining how doctor’s salaries in England compare internationally is particularly relevant. The BBC specifically requested analysis on this aspect. Again, data limitations exist, with a lack of readily available information on junior doctor salaries internationally and variations in employment terms and conditions, including pensions and working hours. Available earnings data for ‘specialists’ (which includes consultants) are inconsistent; some countries, like England, only provide data for salaried doctors, while potentially useful comparisons with countries like the USA and Australia are only available for self-employed doctors, who typically earn more.
International earnings comparisons can be made in various ways, including adjusting for exchange rates, purchasing power parity, or relative to average earnings within each country. Despite the general caution needed when making international comparisons, regardless of the method used, England appears to rank lower than some countries like Germany but higher than others like France in terms of specialist salaries.
Regional Differences in Doctor’s Pay within the UK
It is also insightful to consider pay variations within the UK. Although comprehensive data on hospital doctors’ overall earnings (including non-basic pay) is not readily available for nations other than England, basic salary comparisons can be made. For junior doctors in Scotland, Wales, and Northern Ireland, which share similar contract terms, pay increases incrementally each year of training. In contrast, England, where the junior doctor contract diverged from the other UK nations in 2016, offers larger but less frequent pay rises. For instance, junior doctors in their sixth year of specialty training in England earn £63,152 annually, whereas their counterparts in Northern Ireland earn £50,903 (with potential to increase to £60,260 depending on training program length).
For consultants, pay increases based on years of service differ across UK nations. After four years as a consultant in England, Scotland, and Northern Ireland, basic pay increases by 2.9%, while in Wales, it increases by 5.7%. However, basic pay appears to plateau earlier for the most experienced consultants in Wales compared to their counterparts in the other three nations. Again, caution is needed in interpreting these comparisons. In England, non-basic pay constitutes about a quarter of consultants’ earnings, so variations in how these additional earnings are allocated could significantly impact actual take-home pay differences.
Overcoming the Impasse
While pay is undeniably central to the ongoing discussions around industrial disputes and serves as a tangible measure of valuing doctors’ contributions, policymakers need to adopt more innovative and proactive approaches to address broader factors influencing staff retention and wellbeing. Aspects such as improved work-life balance, the ability to deliver high-quality patient care, and appropriate professional autonomy are all recognized as crucial. The sustained pressures of the pandemic and efforts to reduce elective care backlogs have left many staff feeling undervalued and exhausted, underscoring the importance of focusing on improving these wider working conditions.
No single metric can definitively determine a “fair” pay deal. However, a lack of independent analysis has contributed to debates often based on inaccurate figures. Frequently, true inflation levels are misrepresented, basic pay is confused with total pay, and starting salaries are presented as average pay, while affordability arguments often overlook the fact that some additional pay returns to the public treasury through taxation. Given the potential consequences of strikes on doctors, their colleagues, patients, and the public, a more informed and nuanced discussion is essential. This, coupled with necessary reforms to the official pay review process, could help bridge the current impasse and lead to more sustainable solutions.
