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Careers/Contracts, Pay & Pensions/Identify the right terms
02
Know what governs your work

UK contracts, grades and four-nation differences

Identify the correct SAS or local contractual framework in England, Wales, Scotland or Northern Ireland without assuming uniformity.

18 min readSpecialty DoctorsSpecialist grade doctorsLocally employed doctors
Download module PDF ↓Go to knowledge check ↓
The short answer

Medical employment is not governed by one universal NHS contract. England, Wales, Scotland and Northern Ireland publish or negotiate their own arrangements, implementation dates and pay circulars. Start with the employer and nation, then the grade and contract version, and finally any local terms. Never apply a pay table or job-planning rule from another nation by analogy.

Use this now

Three next actions

  1. 1

    Write down nation, employing body, grade, contract version and whole-time-equivalent hours.

  2. 2

    Download the current national terms and latest national pay circular from the official publisher.

  3. 3

    For a local contract, create a clause-by-clause comparison with the national terms it is said to mirror.

Learning objectives

By the end of this module, you should be able to:

  • Recognise the main SAS grades and legacy arrangements.
  • Find the controlling national source for each UK nation.
  • Assess local-contract claims accurately.

Specialty Doctor, Specialist and legacy grades

The reformed SAS arrangements introduced a new Specialty Doctor contract and a Specialist grade in participating nations. Specialist grade is an employment grade requiring a senior defined scope and capability; it is not the GMC Specialist Register. Associate Specialist is generally a closed legacy grade, so historic contract wording and individual status matter.

Doctors may remain on older contracts or have transferred under national processes. Never infer the contract solely from appointment date or payroll label. Identify the actual terms accepted, any protection or transition arrangements and whether the employer completed the relevant choice or transfer process.

  • Name both grade and contract version.
  • Keep transfer letters and pay-protection calculations.
  • Do not confuse Specialist grade with specialist registration.

England

NHS Employers publishes the England SAS 2021 terms, model contracts, schedules and implementation resources. Pay is updated through medical and dental pay circulars. The 2021 terms include structured pay progression and job-planning provisions; older terms may still apply to doctors who did not transfer.

England also has distinct national terms for resident doctors and consultants. A locally employed doctor is not automatically covered merely because a local salary is benchmarked to one of those scales. Read the incorporation clause and local schedules.

  • Use NHS Employers’ current circular, not a cached salary table.
  • Check the pay scale and progression gateway separately.
  • Ask whether the role is national or local terms.

Wales

NHS Wales has its own medical and dental circulars and Welsh SAS terms. Job-planned units are commonly called sessions; a standard session is ordinarily four hours under the relevant SAS terms, but premium-time and working-pattern rules must be checked in the current document.

From August 2026 Wales began phased resident-doctor contract changes affecting in-scope locally employed doctors. That does not convert every LED into an SAS doctor or automatically rewrite every job description. The contractual wrapper, clinical scope, supervision and job design must be considered separately.

  • Use Welsh circulars and Welsh terms.
  • Do not replace ‘session’ with an English rule without checking.
  • For LEDs, confirm whether the 2026 reform applies to the individual contract.

Scotland

NHS Scotland’s SAS contractual history and pay implementation are distinct. Scottish Government pay announcements and NHS circulars should be used for current awards; the 12 August 2026 announcement confirmed a 3.5% 2026/27 increase for Specialty, Specialist and Associate Specialist doctors, backdated to 1 April 2026.

A headline award is not a complete pay table. Check the implementation circular, effective date, grade and point, and then reconcile the payslip. Scottish pension administration is through the Scottish Public Pensions Agency, not NHSBSA.

  • Separate announcement from implementation circular.
  • Check back pay after the stated payroll month.
  • Use SPPA for Scottish NHS pension records.

Northern Ireland

The Department of Health Northern Ireland publishes the SAS 2021 contract documentation, including terms, model contracts, pay-progression guidance and transfer material. Pay implementation can occur on a different timetable from Great Britain, so a UK review-body recommendation is not itself a Northern Ireland payslip instruction.

Use the current Department circular or employer confirmation for the relevant year. If an award is delayed, distinguish the eventual effective date, implementation date and date arrears are paid.

  • Use Department of Health NI documentation.
  • Do not assume GB implementation dates.
  • Check arrears and pension consequences when awards are backdated.

Locally employed doctors

A local contract may adopt selected national provisions, mirror a pay scale, or create bespoke rules. Similarity is not incorporation. Compare salary, hours, out-of-hours treatment, leave, study/professional development, pay progression, sick pay, family leave, notice, redundancy, expenses and pension access.

The safest comparison is a table that quotes the local clause, identifies the national comparator, records the difference and asks whether it is intentional. Do not assume every difference is unlawful, but do not let a familiar job title conceal material disadvantages or ambiguity.

  • Compare clause by clause.
  • Prioritise pay, hours, leave, progression and termination.
  • Obtain advice before accepting a material variation.
Pause and reflect

Can you name the official publisher of your current terms, pay circular and pension information?

Keep in mind

Three takeaways

  1. 1Begin with nation, employer, grade and contract version.
  2. 2A pay-review recommendation requires national implementation.
  3. 3Local contracts need clause-level comparison, not title-level assumptions.
Situational judgement exercise

Check your understanding

Six questions on UK contracts, grades and four-nation differences test process and practical judgement. This is educational: it does not assess your health, evidence sufficiency or decide a legal issue.

Question 1 of 6
A doctor is on the Specialist Register and works as a Specialty Doctor. What follows?
Choose one answer to continue.
Apply the learning

Recommended workbooks

Keep personal financial documents on a trusted device. Do not upload them to this website.

Contract and Offer Comparison WorkbookCompare the offer, contract, national terms, job description and local schedules clause by clause.Download PDF ↓Job Plan and Activity Diary WorkbookCapture DCC, SPA, other duties, administration, interruptions, travel and annual frequency.Download PDF ↓
Check the source

Official and professional guidance

Use the document for the relevant nation, grade, contract version, scheme and tax year.

Page last reviewed 8 September 2026. Independent education only; not individual contractual, legal, tax, financial or pensions advice.