Profession · 2026/27
Senior NHS Consultant Salary 2026/27
Consultant is the senior career grade post-CCT. NHS England 2026/27 pay range £109,725-£145,478 (BMA 2003 contract), with progression across 5 thresholds over 14 years. London, private practice and Clinical Excellence Awards add substantially.
Typical pay & take-home
- Median gross
- £127,602
- Typical range
- £109,725–£180,000
- Take-home at median
- £79,415
England, no pension applied — use the salary calculator for your scheme.
At the median for this profession, you earn about 241% above the UK full-time median (£37,430), placing you in the top 5% of UK earners.
What influences senior nhs consultant pay
NHS Consultant basic pay (England, BMA 2003 contract) sits at £109,725 at appointment (threshold 1), progressing through thresholds 2a (£116,182), 2b (£119,490), 3 (£131,058) and 4 (£145,478) over 14 years of service. Scotland and Wales have their own slightly different scales.
Many consultants supplement NHS pay with private practice — under an honorary NHS contract with agreed arrangements, this can add £50k to £300k+ for in-demand specialties (orthopaedics, plastics, ophthalmology). This is self-employment income, subject to Class 4 NI and requires Self Assessment.
Clinical Excellence Awards (CEA / local CEA) add £3k–£80k per year at senior consultant level. Abolished for new consultants in England from 2018 onwards but retained at lower rates for existing holders.
Career progression
- Consultant entry: £109,725 (threshold 1, England).
- Threshold 2a (after 3 years): £116,182.
- Threshold 2b (after 4 years): £119,490.
- Threshold 3 (after 8 years): £131,058.
- Consultant top: £145,478 (threshold 4, after 14 years).
- Associate Medical Director / Clinical Lead: £140-170k with added responsibilities.
- Medical Director / CMO track: £160-230k.
Frequently asked questions
- Does the 60% effective marginal rate hit consultants?
- Yes, and it's a significant issue. Consultants in the £100k-£125,140 PA-taper band face 60% effective marginal rates on top of NHS pension contributions (~14.5% at this salary tier). Many consultants use salary sacrifice into pension AVCs or reduce sessions to manage this.
- How is private practice income taxed?
- Self-employment - you declare it on Self Assessment, pay Income Tax at marginal rate plus Class 4 NI (6% £12,570-£50,270, 2% above). You can deduct allowable business expenses (indemnity, equipment, accounting). Incorporating as Ltd is common for high-volume consultants but requires careful IR35/Ltd company compliance.