NHS Pay Dispute: A Personal Reflection

The NHS, often dubbed the “national religion” of the UK, naturally stirs strong emotions. Few public institutions command the same kind of loyalty, scrutiny, and symbolism. Recently, media coverage has focused on the escalating pay disputes between the government and doctors. After a bruising cycle of strikes, more may be on the horizon.

In this piece, I offer my personal reflections on NHS consultant pay—how it has evolved, how it compares, and where I think the system is headed.

Has doctor pay been eroded?

The short answer: yes.

I used the Bank of England’s inflation calculator to assess the starting salary of a consultant with zero years’ experience. In 2008, this was £73,403. Adjusted for inflation, that figure should be £119,908 in 2025. The actual current starting salary is £105,504—a real-terms erosion of £14,404.

It’s not a pure like-for-like comparison, of course. Pay progression has shortened (consultants now reach the top of the scale in 14 years vs. 20), and the NHS pension has shifted from a final salary to a career-average scheme—generally a downgrade, though still relatively generous. Taken together, these changes suggest that a newly appointed consultant in 2025 is materially worse off than one who started in 2008.

Are doctors overpaid or underpaid?

That depends entirely on the comparison group.

Engineers typically complete a 3-year undergraduate degree, with optional postgraduate training. Lawyers take around six years to qualify. Accountants require roughly 3–6 years, depending on the route.

In contrast, a typical doctor completes a 5–6 year MBBS, a two-year Foundation Programme, three years of core training, and five years of higher specialty training—plus mandatory postgraduate exams and the real-world reality of delays due to intense competition and career breaks. The average age of a newly appointed consultant today is around 36.

If we’re being generous, the starting salary of a new consultant (£105,504) is comparable to what many lawyers, engineers, or accountants earn after 10 years—but that’s only part of the story.

Unlike in other fields, NHS consultants face capped long-term progression. From £105k, they rise to around £132k after 14 years—then stop. No equity. No bonuses. No acceleration. Just incremental DDRB uplifts. If you’re 50 and at the top of your band, where is the motivation?

Location, Location, Inequity

NHS pay is geographically flat. A consultant in rural Staffordshire earns the same as one in central London—despite dramatically different living costs.

Yes, there’s a London weighting. But it’s a mere £2,162 per year. Meanwhile, a year’s travelcard from Zone 5 to Zone 1 costs £3,427. The maths doesn’t add up. And yet, this issue affecting nearly 20% of the consultant workforce has received little attention.

The Private Practice Argument

A common rebuttal is that consultants “make up for it” in private practice. But the data doesn’t fully support this.

Only ~14% of the UK population holds private medical insurance (up from 11% in 2004). A 2003–04 study suggested full-time NHS consultants earned around 26% of their NHS income again in private fees. Even if we generously assume this figure has risen to 30%, that still leaves the average full-time NHS consultant with a relatively modest total compensation when benchmarked against equivalently trained professionals in law, finance, or tech.

Does the NHS deliver value for money?

It’s a fair question.

The 2024–25 NHS budget is £192 billion—about £2,800 per person. For comparison, I recently paid £1,400 annually for private insurance for a healthy family of four. That plan offered limited cover—three consults a year, no pre-existing conditions, and no hospitalisation.

Now let’s do a crude cost breakdown. I personally see ~35 patients per week over 42 weeks—a total of 1,470 patients annually. Divide my salary by that, and you get ~£73 per consultation—without factoring in admin, teaching, or other clinical responsibilities. That’s staggeringly good value for a highly trained professional.

So, what’s the bottom line?

The NHS still offers exceptional value. But yes—NHS consultants are underpaid. The data, adjusted for inflation, training, progression, and private opportunity cost, makes that clear.

But is industrial action the way forward? I don’t know. Strikes hurt patients more than they hurt governments. And in a tax-funded system where the users are not the direct payers, political accountability is murky. The state controls the budget; the public bears the brunt. The dissociation between payer and user creates inefficiencies that are difficult to fix.

I’m not advocating privatisation. But I am certain there are smarter ways to allocate public resources—ways that don’t demoralise the very professionals we rely on to keep the system afloat.

The reality is this: the NHS is a monopoly employer. In most industries, if you’re unhappy with your pay, you switch companies. In medicine, your only real options are emigration or exit. And both are happening—steadily.

I can attest from recruitment experience: it’s getting harder to attract good candidates. We may get 200 applicants, but few are appointable. When I speak to peers in India, many of the most capable doctors no longer see the UK as an aspirational destination. The opportunity cost is too high.

Yes, I understand the UK’s economic pressures. It’s been a tough decade since 2008. But it’s time to decide, as a society, what kind of healthcare system we truly want.

If pay stagnation continues, we risk normalising the attrition of talent. The future won’t be a dismantling of the NHS—it will be a quiet bifurcation: a public service for those who can’t afford alternatives, and a private parallel for those who can. The two-tier system won’t be announced. It will just… happen.

And by the time we notice, it might be too late.