Thousands of NHS resident doctors are beginning to benefit from a new pay and employment package that delivers salary increases, improved career progression and greater contractual security.
The changes form part of the Government’s agreement with resident doctors and include a 3.5% headline pay award for 2026/27, backdated to 1 April 2026, alongside reforms to individual pay points that mean some doctors receive considerably larger increases.
For NHS workers who have faced sustained pressure in recent years, the package represents a significant development in the continuing effort to improve recruitment, retention and working conditions across the health service.
The changes also follow the introduction of new national expectations for NHS employers, previously covered by The Workers Union in our report on new NHS staff working conditions standards.
How much are NHS resident doctors receiving?
The Government accepted a 3.5% headline pay recommendation for resident doctors for 2026/27.
However, changes to the NHS pay structure mean that doctors at certain stages of their careers will see larger increases to basic salary.
Under the revised arrangements, the increases include:
- FY1: from £38,831 to £41,226 – approximately 6.2%
- FY2: from £44,439 to £47,610 – approximately 7.1%
- ST1/CT1: from £52,656 to £55,355 – approximately 5.1%
- Other eligible training grades will receive increases reflecting the combination of the headline award and pay-point reform.
The Government has confirmed that the 2026/27 pay changes are backdated to 1 April 2026.
For workers across other industries, understanding basic wage entitlements and wider workplace protections remains equally important. The Workers Union’s guide to UK employment rights covers fair wages, working hours, rest breaks, workplace safety and other fundamental protections.
Greater job security for locally employed doctors
Pay is only one part of the reforms.
There are also significant changes affecting locally employed doctors (LEDs) – doctors employed directly by NHS organisations who may work outside traditional training arrangements.
NHS England says the reforms are intended to provide these doctors with improved stability, access to supervision, workplace protections and career progression.
From August 2026, employers are expected to transition eligible locally employed doctors to substantive employment contracts, unless there is a legitimate reason for their position to remain fixed-term, such as covering maternity leave, sickness absence or a secondment.
From September, locally employed doctors are also expected to be offered the option of moving to contracts mirroring the 2016 Terms and Conditions of Service for NHS Doctors and Dentists in Training, while work continues towards nationally agreed standard contracts.
This could provide greater certainty for doctors who have previously worked under varying local contractual arrangements.
New route from temporary roles to permanent NHS careers
Another important development began on 1 September 2026.
Eligible locally employed doctors working in roles comparable to Specialty and Specialist (SAS) doctors can now express an interest in transferring to a permanent SAS contract.
The initial six-month choice window runs from September 2026 until March 2027.
Eligibility includes doctors who have completed at least 24 months of continuous employment with the same employer in a comparable role. Employers are required to make eligible doctors aware of the process and provide support with competency assessment and verification.
Where the criteria are satisfied, the process can ultimately result in the doctor receiving a new permanent contract.
NHS Employers – SAS eligibility and permanency framework
This is particularly significant because workforce retention is not simply about recruiting more people into the NHS. Providing experienced workers with career progression, employment security and recognition of their skills can be equally important.
Doctors could gain clearer routes to higher pay
Career progression for locally employed doctors is also changing.
Under the resident doctors agreement, an enhanced appraisal system is being developed to allow eligible doctors to demonstrate the competencies they have acquired while working within the NHS.
Those competencies can then contribute towards pay progression.
NHS Employers says the enhanced appraisal process is intended to recognise skills and experience acquired outside formal training pathways, while also identifying development needs and providing a more structured progression mechanism.
The framework is expected to be developed by October 2026, with competency-based progression capable of applying from August 2026 for eligible doctors.
NHS Employers – enhanced appraisals under the resident doctors deal
Improving working conditions as well as pay
The reforms arrive during a wider effort to improve the experience of people working within the NHS.
Earlier this year, new NHS staff standards established national expectations around areas including workplace safety, management, leadership and the treatment of staff.
The Workers Union covered those developments in our article NHS staff working conditions standards launched: new rules to improve work life.
Improved pay will undoubtedly matter to workers, but retaining experienced healthcare professionals is also likely to depend upon career opportunities, manageable working conditions, job security and confidence that skills and experience will be recognised.
These latest reforms attempt to address several of those issues simultaneously.
What does this mean for NHS workers?
For resident doctors, the immediate benefit is higher basic pay and backdated increases.
For some locally employed doctors, however, the longer-term consequences could be equally important.
The reforms potentially provide:
- greater access to permanent employment
- more consistent contractual terms
- clearer routes to pay progression
- formal recognition of competencies
- improved access to supervision
- stronger workplace protections
- better-defined career pathways.
NHS England says the package for locally employed doctors is specifically intended to improve stability, supervision, workplace protections and career progression.
These are important considerations for workers throughout the UK economy. The Workers Union provides further information through its employment rights guide for UK workers, including information about wages, workplace safety, discrimination protection, working hours, leave and termination rights.
The Workers Union view
The Workers Union welcomes developments that improve pay, career progression and employment security for workers.
The NHS depends upon skilled and committed people, and recruitment alone cannot resolve workforce pressures if experienced staff subsequently leave because they cannot see a sustainable career ahead of them.
Better pay is therefore important, but so too are secure contracts, opportunities for advancement and recognition of skills gained through practical experience.
The changes affecting locally employed doctors are particularly noteworthy because they attempt to create clearer pathways from less secure local employment arrangements towards recognised and potentially permanent NHS careers.
With further employment protections also approaching across the wider economy, workers should continue to keep themselves informed about changes affecting their rights. The Workers Union has previously examined how forthcoming reforms could improve workplace security in our guide, Thinking about changing jobs? Your workplace rights are about to improve.
For thousands of NHS doctors, September therefore represents more than the arrival of a larger payslip.
It could mark the beginning of better pay, greater employment security and clearer opportunities to build a long-term career within the NHS.
Useful external resources: Government resident doctors agreement | NHS England resident doctors guidance | NHS Employers appraisal guidance | NHS Employers permanency framework
