NHS pay and pensions

This briefing is part of a series of briefings on the NHS workforce.

Health policy is devolved. The following text applies to England unless otherwise stated.

Pay in the NHS

Data for the year ending June 2025, shows that basic pay for both full-time equivalent (FTE) doctors and nurses increased in real terms (that is, when adjusted for inflation) compared with June 2024 estimates.

Over a 10-year period, the pay of FTE doctors also increased in real terms, but the pay of FTE nurses fell in real terms.

The average basic pay of FTE doctors in June 2025 was £87,701, representing:

• a real-terms increase of 6.8% since June 2024 (£82,141)
• a real-terms increase of 4.6% since June 2015 (£83,114)

The average annual basic pay of FTE nurses in June 2025 was £41,431, representing:

• a real terms increase of 3.3% since June 2024 (£40,094)
• a real terms decrease of 2.2% since June 2015 (£42,368)

As shown in the chart below, the percentage change in annual basic FTE pay has been negative in four of the past 10 years for doctors and negative in five of the past 10 years for nurses.

Source: NHS Digital, NHS Staff earnings estimates - June 2025; Office for National Statistics, CPI index (all items)

How are pay decisions made?

Pay in the NHS is not set centrally but agreed through a process where pay review bodies make recommendations to the government. There are different bodies for different categories of jobs.

The NHS has sets of pay bands or “pay spines”. Each pay spine has a different body that makes recommendations to the Government on pay.

• The NHS Pay Review Body(NHSPRB) reviews the pay of all NHS staff on Agenda for Change terms and conditions (excludes doctors, dentists and senior managers).
• The Review Body on Doctor’s and Dentist’s Remuneration(DDRB) reviews the pay of medical and dental staff.

The pay review bodies are independent of Government and review evidence from relevant organisations. Final decisions on the implementation of recommendations made by the bodies are the remit of the Prime Minister and relevant health ministers.

2026 pay offers

On 25 March 2026, the government announced it had accepted the DDRB’s headline pay recommendations of:

• A 3.5% increase to pay ranges and pay elements of contracts from 1 April 2026 for resident doctors and dentists, specialty, specialist and associate specialist (SAS) doctors and dentists, consultants and salaried GPs.
• A 3.75% increase to pay for salaried dentists working in community dental services.

The Secretary of State for Health and Social Care Wes Streeting’s statement to the Commons on 25 March 2025 has further details.

2026 strikes

The BMA resident doctors committee voted to reject the pay offer. Following the government’s announcement, it confirmed that resident doctors will take 6 days of strike action from 7 April until 13 April 2026.

2025 pay offers

In May 2025, the government announced it had accepted review bodies’ headline pay recommendations and would backdate the changes to April 2025:

• The NHSPRB recommended a 3.6% pay increase to all Agenda for Change (AfC) staff.
• The DDRB recommended a 4% increase for consultants, speciality and associate specialist doctors, and salaried GPs. For resident doctors (formally known as junior doctors), it recommended the 4% increase plus an additional one-off £750 payment. This means that resident doctors have received an average pay rise of 5.4% for 2025/26.

The Secretary of State for Health and Social Care Wes Streeting’s statement to the Commons in May 2025 has further details.

2025 strikes

Following a ballot by resident doctors who were part of the British Medical Association (BMA), resident doctors took strike action between 25 July 2025 and 30 July 2025. The BMA said the real-terms pay of resident doctors had eroded since 2008/09. The Nuffield Trust, a think tank, has produced an analysis of how doctors’ pay has varied over time. The analysis said:

We estimate that, even after accounting for these latest uplifts, average real-terms earnings for 2025/26 still fall behind 2010/11 levels by between 4% and 10%. That said, the position has markedly improved since 2023/24, against a backdrop of high inflation and doctors sacrificing pay – particularly in 2023/24 – to go on strike.

However, the article also concluded that:

The longer-term trends in pay … also presents a cautionary tale, with the risk that government increases pay above what it perceives as affordable and then – painfully – will follow it with periods of sub-inflationary deals to claw back costs.

The government said that resident doctors have received “the highest pay award in the public sector” and so renegotiating this year’s pay award would be “unaffordable” and “deeply unfair to all other public servants”.

In October 2025, the BMA reported that in a vote with a turnout of 65%, 97% of newly qualified (Foundation Year 1) resident doctors in England “endorsed the option of striking” over unemployment and training place shortages. The resident doctors committee “will be contacting its members in due course to outline its plans for next steps”.

In October 2025, the BMA resident doctors committee announced industrial action from 7am on Friday 14 November to 6.59am on Wednesday 19 November 2025.

Previous years

A summary of the strikes that took place between 2022 and 2024, and the different pay offers, can be found in the Commons Library briefing NHS strike action in England 2022-2024.