Tax · Professions
NHS Consultant Take-Home Pay, and the 60% Trap on Three of Five Pay Points
Three of the five consultant pay thresholds in England sit inside the personal allowance taper. Here is what each one actually pays, and what the next pound is really worth.
2026/27 tax year · England, Wales & Northern Ireland
The consultant contract in England has five pay thresholds. Published pay scales make the gross figures public, but the number that matters to a consultant deciding whether to take on extra sessions is not the gross, it is what survives tax on the next pound. On three of the five thresholds that answer is unpleasant.
The numbers
| Pay point | Gross | Take-home | Monthly | Marginal rate |
|---|---|---|---|---|
| Threshold 1 (entry) | £113,565 | £73,712 | £6,143 | 62% |
| Threshold 2a (3 years) | £120,249 | £76,252 | £6,354 | 62% |
| Threshold 2b (4 years) | £123,672 | £77,553 | £6,463 | 62% |
| Threshold 3 (8 years) | £135,645 | £83,678 | £6,973 | 47% |
| Threshold 4 (14 years) | £150,569 | £91,588 | £7,632 | 47% |
Marginal rate is the tax on the next £1 earned, for someone with no children and no student loan. With two children and a Plan 2 loan it is higher wherever the Child Benefit charge or the taper bites.
What it means
The pattern is specific rather than general: it is the £100,000 to £125,140 band that does the damage, because the personal allowance is withdrawn at £1 for every £2 earned. A consultant at threshold 1 who takes on extra sessions keeps materially less of them than one at threshold 4, who has already passed through the taper. Pension contributions are the usual route out, though the annual allowance taper needs checking at these incomes.
Run your own figures with the take-home pay calculator, or see whether a pension contribution escapes the taper with the high-earner optimiser.
Sources
- All five gross figures: NHS consultant pay scale, England, in force from 1 April 2026 after the 3.5% DDRB award (published by NHS Employers, and by the BMA). Take-home, monthly and marginal figures are derived from the 2026/27 income tax and National Insurance rates.
General information, not financial or tax advice. Pay scales change; check the current published scale before relying on a figure.