The 2024 BMA pay settlement substantially restructured junior (now formally "resident") doctor pay in England, with parallel arrangements in Scotland, Wales and Northern Ireland. This guide explains the 2026/27 position - how the nodal points work, how additional pay components stack on top, and how the resident doctor payslip should be read.
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The 2024 BMA settlement context
Following industrial action in 2023 and 2024, the BMA agreed a multi-year pay deal that:
- Increased nodal point base salaries by a cumulative 22.3% above 2022/23 rates.
- Restored some of the real-terms pay erosion from austerity-era pay restraint.
- Maintained the existing nodal point structure of the 2016 contract.
- Did NOT restructure the multipliers for additional rostered hours or weekend allowance.
- Set out a five-year framework for pay restoration with annual DDRB-linked uplifts beyond 2025/26.
The settlement applies in England. Scotland, Wales and Northern Ireland negotiated parallel deals with broadly similar restoration headlines.
The nodal point structure
Junior doctor pay in England operates on a series of nodal points - defined pay levels through training. A doctor's basic pay depends on which nodal point they are at, not directly on which year of training they are in. Nodal points correspond to typical training milestones:
| Nodal point | Typical stage | 2025/26 basic salary |
|---|---|---|
| Nodal Point 1 | F1 | £36,616 |
| Nodal Point 2 | F2 | £42,008 |
| Nodal Point 3 | CT/ST1, ST2 | £49,909 |
| Nodal Point 4 | CT/ST3, ST4 (post-CCT entry) | £61,825 |
| Nodal Point 5 | ST5 plus | £70,425 |
The resident progresses through nodal points as defined by the training programme structure. A doctor in core medical training (CMT) progresses from NP3 to NP4 at the start of CMT-3 or specialty entry; a surgeon may progress at ST3.
Additional Rostered Hours (ARH)
The standard contract is 40 hours per week. Most resident doctors work more than 40 hours due to rota requirements. The extra hours are Additional Rostered Hours (ARH) and are paid at:
- Plain time rate for hours within standard waking hours.
- Premium time rate (37% premium on plain time) for hours falling between 9pm and 7am or on Sundays.
The ARH calculation uses the doctor's nodal point hourly rate (basic salary / 40 / 52.143). For a doctor at NP3 (£49,909), the plain time hourly rate is £23.91 and the premium time hourly rate is £32.76.
Weekend allowance
The 2016 contract pays a weekend allowance to doctors who work 1 in 4 weekends or more frequently. The allowance is a percentage of basic salary:
| Frequency | Weekend allowance |
|---|---|
| 1 in 8 or less | 0% |
| 1 in 7 | 1.0% |
| 1 in 6 | 1.5% |
| 1 in 5 | 2.0% |
| 1 in 4 | 3.0% |
| 1 in 3 | 4.0% |
| 1 in 2 or more | 6.0% |
The allowance is added to basic salary as a separate payslip line. For a doctor at NP4 (£61,825) on a 1 in 4 rota, the weekend allowance is £1,855 a year, paid in 12 monthly instalments.
On-call availability supplement
Doctors who participate in non-resident on-call rotas receive an availability supplement of:
- 8% of basic for high frequency rotas (1 in 4 or more frequent).
- 2% of basic for less frequent on-call commitments.
This is separate from any pay for actual work performed during on-call (which is paid as ARH at the appropriate rate).
The supplement appears as a distinct payslip line and is pensionable for NHS Pension Scheme purposes.
Night shift premium pay
For nights worked beyond the standard pattern, the contract applies a 37% night premium on top of plain time. This is rolled into the ARH calculation at premium time rate where the night work falls between 9pm and 7am.
The flexible pay premia
Certain specialties and pathways attract a Flexible Pay Premium (FPP) - additional annual pay to incentivise recruitment to under-filled training programmes. The 2025/26 FPPs include:
| Specialty | FPP value |
|---|---|
| General Practice (GP training) | £20,000 (over 3 years) |
| Histopathology | £20,000 (over training) |
| Emergency Medicine | £25,000 (over training) |
| Psychiatry | £20,000 (over training) |
| Oral & Maxillofacial Surgery | £20,000 (over training) |
FPPs are typically paid in instalments through the training programme and shown as a distinct payslip line. They are pensionable.
Less Than Full Time (LTFT) working
Many resident doctors work less than full time for childcare, study, health, or career planning reasons. LTFT working is contract-protected:
- Basic pay is pro-rated to the agreed percentage of full time (usually 50%, 60%, 70%, or 80%).
- ARH is paid in proportion to hours actually worked.
- Weekend allowance is paid pro-rata to the percentage of weekends covered.
- Pension accrual continues at the LTFT salary basis.
For a doctor at NP4 (£61,825) working 70% LTFT, basic salary is £43,278 and the weekend allowance and on-call supplement scale down accordingly.
How the resident doctor payslip reads
A typical NHS resident doctor monthly payslip might show:
| Line | Monthly value |
|---|---|
| Basic salary | £4,159.08 |
| Additional Rostered Hours - plain time | £680.00 |
| Additional Rostered Hours - premium time | £210.00 |
| Weekend allowance (1 in 4) | £154.56 |
| On-call availability supplement | £83.18 |
| Total gross monthly pay | £5,286.82 |
Below this come the deductions:
- NHS Pension contribution at the appropriate tier (typically 9.8% to 12.5%).
- Income tax at marginal rate.
- National Insurance.
- Student loan repayment for those in active repayment.
Many resident doctors also have payslip locum lines for additional work in other Trusts via Bank or external locum agency. These are typically shown as separate assignment lines.
Pay protection for those returning from leave
The 2016 contract includes pay protection provisions:
- A doctor returning from maternity, paternity, adoption, parental, or shared parental leave returns to the same nodal point.
- A doctor on long-term sick leave continues to be paid through Statutory Sick Pay and any contractual sick pay enhancement.
- A doctor returning from a career break remains at the nodal point reached before the break (subject to the break duration rules).
Pay protection is one of the strongest contractual protections in the 2016 deal and applies even where a doctor moves between deaneries.
Banding and the legacy 2002 contract
The 2016 contract replaced the 2002 contract, which used a banding system (Band 1A, 1B, 1C, 2A, 2B) to apply percentage uplifts based on hours and intensity. Almost all resident doctors are now on the 2016 contract.
A small number of doctors who started training before 2016 and have continuously remained in the 2002 contract role may still be on legacy banding. Any such payslip will show:
- Banding line (e.g. "Band 1A 50%").
- Multiplier applied to a banded base salary.
These are increasingly rare and the payroll team can confirm the contract structure on request.
Out-of-programme pay
Resident doctors taking time out of their core training programme may experience pay variations:
- Out-of-programme research (OOP-R): typically funded by university or research grant, paid via host institution payroll. NHS pension may pause or continue depending on funding agreement.
- Out-of-programme training (OOP-T): typically a fellowship at another NHS Trust or internationally, paid by the host with arrangements for re-entry to home programme.
- Out-of-programme experience (OOP-E): career break style; pay is what the host arrangement provides.
Time out of programme can affect nodal point progression on return - the deanery confirms arrival nodal point on re-entry.
Pension treatment for resident doctors
Resident doctor pay is fully pensionable (basic plus weekend allowance plus on-call supplement plus ARH plus FPP). The NHS Pension Scheme contribution rate depends on tier:
| Pensionable pay | Contribution rate |
|---|---|
| Up to £25,147 | 5.2% |
| £25,148 to £29,635 | 6.5% |
| £29,636 to £33,820 | 8.3% |
| £33,821 to £41,224 | 9.8% |
| £41,225 to £52,306 | 10.7% |
| £52,307 to £61,825 | 12.5% |
| £61,826 plus | 13.5% |
Bands move with salary as the doctor progresses through nodal points. The contribution is taken under the net pay arrangement, giving automatic income tax relief at the marginal rate.
Strategic pay considerations for residents
For resident doctors managing their pay:
- Track the pay calculation against the rota - errors are common, especially for ARH and weekend allowance.
- Confirm nodal point progression at the start of each new training stage.
- Review pension tier banding annually - moving up a nodal point can move you into a higher tier mid-year.
- Use Self Assessment if you have locum income outside the main payroll - the BMA's tax helpline can help.
- Keep a record of LTFT periods for pension calculation purposes - accrual will reflect each period correctly.
Disclaimer
PayslipIQ provides automated educational guidance based on the figures you supply. It is not regulated tax or financial advice. Junior (resident) doctor pay is technical and interacts with rota patterns, NHS Pension Scheme accrual, training programme rules, and individual circumstances - for substantial pay queries or complex cases including LTFT, OOP, or pay protection disputes, consult the BMA, your medical workforce team, or a regulated tax adviser as appropriate.
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Check My Payslip FreePayslipIQ provides educational information and estimated calculations only. It does not provide tax, legal, financial, payroll, accounting, pension, benefits or employment advice. Always verify your payslip, tax code, deductions and take-home pay with your employer's payroll department, HMRC, your pension provider, a qualified accountant, tax adviser or another appropriately qualified professional.
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