For many international medical graduates, securing GMC registration and your first NHS job is an exciting milestone. But naturally, the next question is how much will you actually earn, and how do the recent strikes fit into the picture?
Basic Pay in England (2025–26)
Junior doctor salaries in England are nationally agreed under the 2016 Junior Doctors’ Contract. The current basic annual salaries from April 2025 are:
| Nodal Point | Typical Grade | Annual Basic (£) |
| N1 | FY1 | 38,831 |
| N2 | FY2 | 44,439 |
| N3 | CT1, ST1, ST2 | 52,656 |
| N4 | CT2 – CT4, ST4 – ST6 | 65,048 |
| N5 | ST7-ST8 | 73,992 |
This is the pay for a standard 40-hour week, before any extras are added.
Rota Enhancements and Extra Pay
Most junior doctors earn more than their basic salary because of rota enhancements. These are additional payments for:
- Weekend work — a percentage of basic pay depending on how often you work weekends
- Night shifts and unsocial hours — paid at an uplifted hourly rate
- On-call availability — a set percentage if you are required to be available on-call
- Flexible Pay Premia — extra pay for shortage specialties like GP, EM, and psychiatry
On average, these enhancements add about 25% to 35% to your basic pay.
Basic Pay vs. Typical Total Pay with Enhancements
| Grade | Annual Basic (£) | Typical Total with Enhancements (£) |
| FY1 (N1) | 38,831 | 48,500 – 52,500 |
| FY2 (N2) | 44,439 | 55,500 – 60,000 |
| CT1 / ST1-2 (N3) | 52,656 | 66,000 -71,000 |
| CT2-4 / ST4-6 (N4) | 65,048 | 81,000 – 87,000 |
| ST7-8 (N5) | 73,992 | 92,500-99,000 |
These are rough estimates. Your actual pay will depend on your rota intensity, specialty, location, and whether you pick up locum shifts.
Why Junior Doctors Have Been Striking
The British Medical Association (BMA) has argued that junior doctors’ pay has fallen by around 26% in real terms since 2008 once inflation is factored in.
The strikes over 2023–2024 were not just about pay, but also about unsafe staffing levels, rota pressures, and retention of staff.
While a new pay offer was accepted in England in 2024, the BMA has made it clear that the fight for full pay restoration and better working conditions is ongoing. Separate negotiations have taken place in Scotland, Wales, and Northern Ireland.
What This Means for IMGs
If you are an IMG planning to start work in the NHS:
- Your basic pay is fixed nationally based on your grade.
- Enhancements can significantly increase your earnings, especially if your rota includes weekends and nights.
- NHS pension contributions are taken from your monthly salary unless you opt out.
- Industrial action may still impact clinical schedules and induction periods in some Trusts.
References
- NHS Employers. Pay and Conditions Circular (M&D) 2/2025. https://www.nhsemployers.org/system/files/2025-06/Pay-and-Conditions-Circular-MD-2-2025_0.pdf
- British Medical Association. Junior Doctor Contract and Pay Guidance. https://www.bma.org.uk/pay-and-contracts/contracts/junior-doctor-contract/junior-doctor-contract
- Pulse Jobs. Resident Junior Doctor Pay Scales in England. https://www.pulsejobs.com/news/resident-junior-doctors-pay-scales-in-england/
- The Guardian. Junior Doctors Accept Pay Offer to End Strike Action. https://www.theguardian.com/society/2024/sep/16/junior-doctors-bring-dispute-to-end-by-voting-to-accept-streetings-pay-offer
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