Locum doctor rates 2026/27
What locum doctors are paid depends on grade, specialty, location and how urgently a trust needs cover. These are the official reference points: NHS England's agency price caps, the BMA's recommended rate cards, and the hourly rate that matches each salaried grade.
- Updated for 2026/27
- Official NHS and HMRC figures
- Checked 20 October 2026
Agency price caps by grade
From 1 April 2026, these are the most an NHS trust in England should pay an agency per hour for a medical locum, including the agency's fee and excluding VAT.
| Grade | Core hours | Unsocial hours |
|---|---|---|
| FY1 | £21.43 | £25.90 |
| FY2 | £26.59 | £32.12 |
| ST1 to ST2 / core training | £30.15 | £36.43 |
| ST3 and above | £37.59 | £45.41 |
| Dental core training | £37.18 | £44.93 |
| Specialty doctor / staff grade | £55.32 | £73.75 |
| Associate specialist | £68.45 | £91.27 |
| Consultant | £80.61 | £107.47 |
Core hours: 7am to 7pm, Monday to Friday, excluding bank holidays. All other hours are unsocial. Caps are set at 2016 basic pay plus 55% and are not uprated with pay awards, so the margin they leave over salaried pay has shrunk as pay has risen.
Caps vs salaried pay
The cap is the total a trust pays, including the agency's fee, so the locum receives less than the cap. Compare it with the hourly rate a locum needs just to match the salaried take-home of the same grade:
| Grade | Salaried basic / hr | Locum break-even (PAYE) | Agency cap (core) | Cap above break-even |
|---|---|---|---|---|
| FY1 | £19.77 | £20.41 | £21.43 | £1.02 |
| FY2 | £22.83 | £23.57 | £26.59 | £3.02 |
| CT1 / ST1 | £26.54 | £27.34 | £30.15 | £2.81 |
| ST3 | £32.28 | £33.27 | £37.59 | £4.32 |
| Consultant (threshold 1) | £54.45 | £56.19 | £80.61 | £24.42 |
For junior grades the cap leaves very little room: once the agency's fee comes out, a shift paid at the FY1 or FY2 cap can pay the doctor less than their salaried equivalent. That's one reason many resident doctor shifts are paid above the cap with trust sign-off, or filled through staff banks.
Break-even is the PAYE hourly rate that matches salaried take-home over the same hours worked; see the calculator.
BMA consultant rate card
The BMA's recommended rates for consultants doing extra-contractual work in England, valid from April 2026.
| Time | Rate per hour | Programmed activity |
|---|---|---|
| Weekday 7am to 7pm | £194 | 3 hours = 1 PA |
| Weekday 7pm to 11pm | £258 | 2 hours = 1 PA |
| Weekend 7am to 11pm | £258 | 2 hours = 1 PA |
| Overnight 11pm to 7am | £323 | 1.5 hours = 1 PA |
| Non-resident on-call (available, not working) | £129 | – |
BMA SAS doctor rate card
Recommended rates for specialty and specialist (SAS) doctors in England, valid from May 2025. "Autonomous" applies to doctors working without supervision.
| Time | Autonomous | Supervised |
|---|---|---|
| Weekday 7am to 7pm | £188 | £133 |
| Weekday 7pm to 11pm | £250 | £175 |
| Weekend 7am to 11pm | £250 | £175 |
| Overnight 11pm to 7am | £313 | £219 |
| Non-resident on-call | £125 | £89 |
Salaried pay for consultants and SAS doctors
Consultants (2026/27)
| Threshold | Salary | Locum tenens / week |
|---|---|---|
| Threshold 1 (0 to 2 years) | £113,565 | £2,177.96 |
| Threshold 2a (3 years) | £120,249 | £2,306.15 |
| Threshold 2b (4 to 7 years) | £123,672 | £2,371.79 |
| Threshold 3 (8 to 13 years) | £135,645 | £2,601.41 |
| Threshold 4 (14 years or more) | £150,569 | £2,887.62 |
Specialty doctors
| Experience | Salary |
|---|---|
| 0 to 2 years | £63,696 |
| 3 to 5 years | £73,383 |
| 6 to 8 years | £81,804 |
| 9 to 11 years (after threshold) | £90,548 |
| 12 years or more | £102,689 |
Specialists
| Experience | Salary |
|---|---|
| 0 to 2 years | £104,401 |
| 3 to 5 years | £108,484 |
| 6 years or more | £115,341 |
Resident doctor salaries by grade are on the resident doctor pay page.
What affects a locum doctor's rate
- Grade and specialty. Emergency medicine, anaesthetics, psychiatry and acute medicine often pay more.
- Notice. Shifts filled at short notice usually pay more.
- Location. Hard-to-recruit areas and remote hospitals pay more.
- How you're paid. A rate paid through an umbrella company or your own limited company is worth less to you than the same rate on PAYE. Use the limited company vs umbrella calculator to compare.
Frequently asked questions
- How much do locum doctors get paid per hour?
- It depends on grade, specialty, location and how urgently the shift needs filling. NHS England's agency price caps for 2026/27 range from £21.43 an hour for FY1 to £80.61 for consultants (core hours), including the agency's fee. Many shifts pay above the cap with trust sign-off, and BMA rate cards recommend £194 to £323 an hour for consultants doing extra-contractual work.
- What is the NHS agency price cap?
- The price cap is the maximum total hourly charge an NHS trust in England should pay an agency for a locum, including the agency's fee and excluding VAT. Since November 2025, trusts need chief executive sign-off for rates 50% or more above the cap, or £100 an hour or more, and must report all shifts paid above the cap.
- Are BMA rate cards what locums actually get paid?
- No. BMA rate cards are the union's recommended minimum rates for extra-contractual work. They are not binding, and trusts and agencies set their own rates.
- How is a locum consultant paid on a salaried basis?
- A locum consultant employed by a trust (locum tenens) is paid the weekly equivalent of the relevant consultant pay threshold, which is the annual salary divided by 365 and multiplied by 7. A programmed activity (PA) is a tenth of that weekly rate.
Sources
- Agency rules, NHS England. Checked 20 October 2026.
- Agency price card, NHS England. Checked 20 October 2026.
- Consultant non-contractual rate card, BMA. Checked 20 October 2026.
- SAS doctors extra-contractual rate card for England, BMA. Checked 20 October 2026.
- Pay and rate cards, BMA. Checked 20 October 2026.
- Pay and Conditions Circular (M&D) 1/2026, NHS Employers. Checked 20 October 2026.
Last updated .