Surgeon Salary UK

The NHS Pay Scale Structure for Surgeons

The National Health Service (NHS) is the primary employer for the vast majority of surgeons in the UK. Pay is strictly regulated by national contracts, reviewed annually by the Review Body on Doctors' and Dentists' Remuneration (DDRB). In 2026, the pay structure continues to reward experience and seniority.

Junior Doctors and Trainees

The journey to becoming a consultant is long, often taking 10-14 years post-medical school. During this time, surgeons are referred to as "Junior Doctors" (a term often debated) or "Resident Doctors". The salary scales for 2026 reflect the nodal pay points introduced in previous contract reforms.

• Foundation Year 1 (FY1): ~£32,398. While not strictly "surgeons" yet, this is where the journey begins.
• Foundation Year 2 (FY2): ~£37,303.
• Core Surgical Training (CT1/CT2) / ST1-ST2: ~£43,923. At this stage, doctors have committed to the surgical pathway.
• Specialty Training (ST3-ST5): ~£55,329. The "Registrar" years begin here. Responsibilities increase significantly.
• Specialty Training (ST6-ST8): ~£63,152. These are the senior registrar years, where the surgeon is honing their sub-specialty skills and preparing for the consultant interview.

Note: The figures above represent basic pay for 40 hours. Most surgical trainees work closer to 48 hours on average, attracting an additional 37% supplement for weekends and nights, boosting the ST8 gross pay to over £85,000.

Consultant Surgeon Salary 2026

Upon receiving the Certificate of Completion of Training (CCT) and securing a permanent post, a surgeon becomes a Consultant. This is the pinnacle of the NHS career structure.

It is important to note that these figures are for a standard 10 Programmed Activity (PA) contract. Many surgeons take on additional PAs (11 or 12 PAs total) to cover extra lists or management duties, which essentially pays overtime at a rate of 10% of basic salary per PA.

Private Practice: The Wealth Multiplier

If the NHS provides stability and a solid pension, private practice is where the high net worth of surgeons is generated. Private practice income is additional to the NHS salary, assuming the surgeon fulfills their NHS contractual obligations first.

How Much Does Private Practice Pay?

Private income is fee-for-service. The more operations you do, the more you earn. However, it requires building a referral base (from GPs and insurance companies) and maintaining a pristine reputation.

• Early Career Consultant: Might earn an extra £10,000 - £30,000 in the first few years building a practice.
• Established Consultant: £50,000 - £120,000 per year is a common range for established surgeons doing one or two private lists a week.
• High-Volume / Top Tier: £200,000 - £300,000+. This level requires significant time commitment, often working late evenings and weekends.
• The "Super" Surgeons: A small percentage of surgeons, particularly in London with international clientele, can earn in excess of £500,000 per year gross from private work alone.

Most Lucrative Surgical Specialties

Not all surgery pays the same in the private sector. The demand is driven by insurance coverage and self-pay markets (cosmetic).

1. Plastic & Reconstructive Surgery: High demand for aesthetic procedures (facelifts, breast augmentation) which are often self-pay and command high fees without insurance cap limits.
2. Orthopaedics: The "bread and butter" of private hospitals. Hip and knee replacements are high volume. Spinal surgery commands even higher fees due to complexity and risk.
3. Ophthalmology: Cataract surgery is high volume, low duration. An efficient surgeon can perform many procedures in a single list.
4. Neurosurgery: While lower volume, the fees per procedure (e.g., spinal decompression) are high.
5. Cardiothoracic: Less common in private practice compared to ortho, but cardiac bypasses and valve repairs command significant fees.

Additional Allowances and Bonuses

Beyond the basic salary and private work, several other streams contribute to the total package.

Clinical Excellence Awards (CEA) / Impact Awards

The NHS rewards consultants who contribute to the development of the service, research, or teaching. While the scheme has been reformed recently to be less pensionable and more difficult to achieve, it remains a significant booster.

• Local Awards: ~£3,000 to £9,000 per year.
• National Awards (Bronze, Silver, Gold, Platinum): These are for consultants with a national or international reputation. A Platinum award can add over £40,000 to the annual salary, though legacy awards were as high as £76,748.

London Weighting

Living in the capital comes with higher costs. The NHS provides a High Cost Area Supplement:

• Inner London: 20% of basic salary (subject to a minimum of £5,132 and a maximum of £7,746).
• Outer London: 15% of basic salary (subject to a minimum of £4,313 and a maximum of £5,409).
• Fringe: 5% of basic salary (max £2,011).

The Costs of Being a Surgeon

Gross salary is one thing, but surgeons have significant professional overheads that other high-earners do not.

• GMC Registration: Every doctor must pay the General Medical Council to practice. For 2026, the full fee is approx £446.
• Royal College Fees: Membership to the Royal College of Surgeons (RCS) costs around £300-£600 annually.
• Medical Indemnity: This is the big one. NHS work is indemnified by the government. Private work is not. A spinal surgeon or obstetrician might pay £30,000 to £50,000 a year in insurance premiums. A general surgeon might pay £10,000.
• Examination Fees: The FRCS exam costs nearly £2,000.

Detailed Take-Home Pay Analysis

Let's look at three realistic scenarios for a consultant surgeon in 2026 to understand the "Real" money.

Scenario 1: New Consultant (NHS Only)

Gross Income: £93,666 (Basic) + £5,000 (On-call) = £98,666.

• Tax (2025/26 rates): Approx £24,000
• National Insurance: Approx £4,000
• NHS Pension (12.5%): Approx £12,300
• Net Take Home: ~£58,000 / year (~£4,800 / month).

Scenario 2: Mid-Career Consultant (NHS + Moderate Private)

Gross Income: £105,000 (NHS) + £45,000 (Private) = £150,000.

At £150k, the Personal Allowance (£12,570) is completely tapered away to zero (the "60% tax trap" effects are felt between £100k-£125k).

• Tax: Approx £53,000
• National Insurance: Approx £5,000
• NHS Pension: Approx £13,000 (on NHS portion only)
• Net Take Home: ~£79,000 / year (~£6,500 / month).

Notice how earning £50k extra gross only yields about £21k extra net. This is the reality of UK progressive taxation and pension costs.

Scenario 3: Senior Consultant (NHS + Heavy Private)

Gross Income: £115,000 (NHS) + £135,000 (Private) = £250,000.

• Tax: Approx £98,000
• National Insurance: Approx £7,000
• NHS Pension: Approx £14,000
• Net Take Home: ~£131,000 / year (~£10,900 / month).

Is It Worth It?

The road to becoming a surgeon is arduous. It involves debt from medical school, years of working nights and weekends, missed weddings and birthdays, and high-stress situations involving life and death. Financially, while the headline figures are high, the hourly rate during training can sometimes feel low compared to finance or tech sectors.

However, the job security is unparalleled. The pension, despite changes, remains one of the best available. And for those who succeed in private practice, the financial ceiling is very high. Beyond money, the vocational satisfaction of surgically curing a patient provides a reward that cannot be quantified on a payslip.