Correspondence

Offer to BMA UK resident doctors committee (accessible version)

Published 27 March 2026

Introduction

There are 5 parts to this offer:

1. Pay: nodal point reform in addition to annual pay awards, as informed by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) - the revised pay structure will improve retention and unlock productivity, with the values of the revised pay scale fully realised in year 3.

2. Reimbursing exam fees: funding to cover the fees of the first 2 attempts of mandatory royal college exams from April 2026.

3. Access to training places: a package of measures designed to address BMA’s concerns about access to specialty training places and secure the future employment of resident doctors.

4. Measures to improve the working lives of resident doctors: including contractual standardisation for locally employed doctors (LEDs),^{[footnote 1]} deanery process reform and improvements through the 10 Point Plan and medical education and training review (METR).

5. Future working arrangements: the BMA UK resident doctors committee (UKRDC) will be a crucial partner in the delivery and implementation of this deal. This will be operationalised through the establishment of the Industrial Relations Committee. Membership and terms of reference of this committee is to be agreed.

This deal aims to:

6. Set the foundations for more positive industrial relations between resident doctors and government and end the disputes on jobs and pay, so that doctors now and in the future can feel valued and secure working and training in the NHS.

7. Better recognise the productive value and service being delivered by resident doctors by allowing them to progress as they gain more competencies - whether they are in formal training or employed locally.

8. Address the bottlenecks that have emerged in speciality training through a combination of additional posts and the commencement of the Medical Training Prioritisation Act, which will mean that resident doctors can better progress through their training and careers.

9. Recognise the value of LEDs who play a vital role in the NHS and should benefit from the same pay, benefits and conditions as their counterparts in formal training, where possible.

10. Enable equal opportunities for pay progression for less than full time (LTFT) doctors in training who will be supported to have their annual review of competence progression (ARCP), at 12 months as the standard, while retaining the flexibility to have it later.

Part 1: pay

Pay for 2026 to 2027

11. In July 2025, Department of Health and Social Care (DHSC) remitted the independent DDRB and subsequently received pay recommendations for resident doctors in March 2026.

i. DHSC will accept the headline pay recommendation for resident doctors of DDRB of 3.5%, with an effective date of 1 April 2026. Pay will be backdated to 1 April 2026.

ii. This increase will be applied in addition to the nodal point reform, as set out below.

iii. Should the resident doctor membership accept this offer through a referendum, the BMA UKRDC will accept the DHSC decision to accept the DDRB recommendation as part of the overall deal.

Pay for 2027 to 2028 and 2028 to 2029

12. By committing to engage in the independent pay setting process for this year and beyond, both the BMA UKRDC and DHSC ensure that pay setting remains independent from government. This allows DDRB to consider various factors and evidence submitted by both the government and other organisations, including BMA.

i. DHSC and BMA UKRDC commit to continue to engage in the DDRB process as the means for setting resident doctors’ pay.

ii. As part of the commitment to engage in this deal, both DHSC and BMA UKRDC will submit evidence each year to DDRB.

13. DHSC will highlight in its remit letters and evidence to DDRB that government investment into nodal point reform is intended to recognise the greater service the system gains as resident doctors progress in training and work more productively, rather than a direct substitute for a future pay award.

Nodal point reform

14. Resident doctors gain valuable experience at each stage of their careers - both within formal training programmes and outside them. However, recognition typically occurs only at specific training milestones, which can create unnecessary obstacles for advancement - particularly for LEDs. This limits opportunities to enhance productivity across the training pathway, and in the service.

15. This proposal sets out to change the way in which the NHS recognises and remunerates resident doctor talent. It introduces additional pay steps which will allow for more frequent pay progression for both doctors in training and LEDs. These uplifts will be directly linked to competencies and productivity gains.

16. This is significant pay scale reform, which will be phased over 3 years.

Year 1

17. As a result of the DDRB award, all resident doctors will receive a minimum of 3.5%.

18. Foundation year 1 (FY1) and foundation year 2 (FY2) doctors will receive the full extent of proposed investment - with a total 6.2% and 7.1% respectively in year 1, while resident doctors at 3a, 3b, 4b and 5b will receive a minimum of 4.5%. Resident doctors on nodal points 4a and 5a still receive a minimum of 3.5%. Full details are set out in table 1 below.

Year 2

19. All resident doctors will benefit from the outcome of the independent pay review process for 2027 to 2028 when it is known. The second stage of nodal point reform will be implemented, taking the minimum increase for ‘b’s and ‘c’s up to a cumulative uplift of 6.3% (does not include pay for 2027 to 2028, which will be determined through continued engagement with the independent pay review process for that year).

Year 3

20. All resident doctors will benefit from outcome of the independent pay review process for 2028 to 2029 when it is known. The third and final stage of nodal point reform will be implemented, taking the minimum increase for nodal point 4c and 5c up to a cumulative minimum uplift of 9.1% (does not include pay for 2027 to 2028 or 2028 to 2029, which will be determined through continued government engagement with the independent pay review process for both years.)

Table 1: new pay-scale and cumulative increases compared with 2025 to 2026 by the end of the deal

	Nodal point	2025 to 2026	2026 to 2027 (note 1)	Cumulative % uplift	2027 to 2028 (note 2)	Cumulative % uplift	2028 to 2029 (note 2)	Cumulative % uplift
FY1	1	£38,831	£41,226	£2,395 or 6.2%	£41,226	£2,395 or 6.2%	£41,226	£2,395 or 6.2%
FY2	2	£44,439	£47,610	£3,171 or 7.1%	£47,610	£3,171 or 7.1%	£47,610	£3,171 or 7.1%
ST1 or CT1	3a	£52,656	£55,355	£2,699 or 5.1%	£55,534	£2,878 or 5.5%	£55,534	£2,878 or 5.5%
ST2 or CT2	3b	£52,656	£55,355	£2,699 or 5.1%	£56,925	£4,269 or 8.1%	£56,925	£4,269 or 8.1%
ST3 or CT3	4a	£65,048	£67,325	£2,277 or 3.5%	£67,325	£2,277 or 3.5%	£67,325	£2,277 or 3.5%
ST4 or CT4	4b	£65,048	£67,998	£2,950 or 4.5%	£69,345	£4,297 or 6.6%	£69,345	£4,297 or 6.6%
ST5	4c	£65,048	£67,998	£2,950 or 4.5%	£69,707	£4,659 or 7.2%	£71,415	£6,367 or 9.8%
ST6	5a	£73,992	£76,582	£2,590 or 3.5%	£76,582	£2,590 or 3.5%	£76,582	£2,590 or 3.5%
ST7	5b	£73,992	£77,348	£3,356 or 4.5%	£78,660	£4,668 or 6.3%	£78,660	£4,668 or 6.3%
ST8	5c	£73,992	£77,348	£3,356 or 4.5%	£79,039	£5,047 or 6.8%	£80,730	£6,738 or 9.1%

Note 1: the 2026 to 2027 pay scale increase includes the impact of a 3.5% DDRB recommendation which is applied after the negotiated reform increases and inflates their value.

Note 2: pay remains unknown for 2027 to 2028 and 2028 to 2029; we commit to engaging with the independent pay process for these years, respectively. The negotiated reform increases in these years are already inflated by the 2026 to 2027 DDRB outcome in this pay scale.

Exemplars for those at various nodal points are provided in annex A (below).

Details of the changes

For doctors in training programmes

21. Progression through pay points for doctors in training programmes will be linked to the achievement of competencies required for advancement during the ARCP, thereby creating the opportunity for annualised pay progression.

22. This process applies to LTFT doctors in training - to enable the opportunity for equal pace of progression, ARCPs will be set at 12 months by default for both full time and LTFT doctors in formal training. Doctors working LTFT will also retain the option for an ARCP at the equivalent to 12 months full time and inform their training programme director of their choice.

23. Where full time doctors are consistently working above 40 hours per week on average and have gained additional competencies, employers will be encouraged to more widely utilise the existing option to bring ARCP panels forward, if and where this is agreed with their clinical supervisor. Doctors will also continue to have the right to request an appeal of their ARCP outcome decision.

For locally employed doctors (LEDs)

24. NHS England will design an enhanced annual appraisal by July 2026 for LEDs that will be conducted by trusts, to allow doctors to demonstrate attainment of relevant competencies to achieve pay progression from August 2026. This appraisal process will apply to all LEDs on contracts that mirror the 2016 Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) (TCS).

25. UKRDC will be involved and consulted during the design and implementation phases of the new enhanced appraisal process.

26. This process will assess if an LED is able to perform the competencies required to work at a higher level in a specialist field.

27. Experience and competencies gained outside of formal training can be recognised in the enhanced annual appraisal. This will be the means through which LEDs are able to access the opportunity for annualised pay progression.

28. This process applies to LTFT LEDs - who can unlock the same opportunity for annualised pay progression at their enhanced annual appraisal, subject to demonstrating the relevant competencies.

29. Furthermore, on re-entry to formal training, LEDs may have their competencies recognised towards training by requesting a review of their competencies at an early ARCP within the first 3 months, after beginning training. This means that completion of that stage of formal training could be quicker on re-entry.

30. To ensure enhanced appraisals are fair and consistent for LEDs, competencies will be signed off by a supervisor or an equivalent with clinical experience.

For foundation year doctors

31. The proposal will uplift the FY1 basic salary in year 1 of this deal from £38,831 to £41,226, including DDRB, which recognises the growing complexity, pressures and increased competition recent postgraduates are experiencing.

32. Trusts will also be expected to engage and deploy their FY1s to deliver teaching to medical students, such as in anatomy, physiology, and engage in operational management and governance committees, equipping them with the necessary leadership skills early on to be the exemplar senior doctors of the future.

33. The proposal will uplift the FY2 basic salary in year 1 of this deal from £44,439 to £47,610, including DDRB, recognising they become registered doctors with the General Medical Council and are capable of offering greater productivity.

34. The increase to FY2 salaries will reflect an increased expectation that they are working at a higher level, providing greater value to the service through the delivery of more independent work and holding more responsibility, with adequate supervision.

35. By FY2, resident doctors will have learnt more about referral pathways and hospital systems (including IT, discharge, prescribing and escalation). This allows them to work faster, more safely and with fewer prompts, enabling them to progress.

36. Given the uplift for these doctors, trusts will be expected to place FY2s on the same rotas as a IMT1 or CST1 trainee in medicine, emergency department or surgery, where possible to seek to maximise their productive contribution where clinically appropriate and in line with an individuals’ competencies.

Productivity

37. By linking pay to training and competencies, we hope to reward trainees and LEDs at each step of the pathway, to make sure that they are incentivised to complete the various steps and unlock pay increments.

38. With enhanced appraisals, trusts will be supporting LEDs to illustrate how they are demonstrating the development of their skills, with their pay progressing accordingly, and as a result rewarding LEDs for the competencies that they have developed.

39. At each of these stages, we will link these additional pay increments to additional productivity gains, reflecting increasing capability, as experienced doctors progress through a training grade. These will be different at different stages, and most fruitful in later stages of training - for example, at ST5 onwards - unlocking responsibilities such as autonomous practice, supervision of trainees through procedures, board rounds and so on. These will be different for each specialty.

40. Empowering FY1s to play a central role in the operational management and FY2s to take on more responsibility and independent tasks enables them to work faster, safer and more efficiently. They will better co-ordinate follow-ups, and escalate issues confidently, improving patient flow and reducing emergency department wait times, discharge delays and enhancing elective capacity. This will support resident doctors to better connect with their organisation, develop leadership abilities and gain key insight into hospital management - essential skills for a senior doctor.

Part 2: reimbursement of exam fees

Royal college mandatory exam fees

41. Resident doctors in training and local employment experience uniquely high and frequent examination costs as they train, and in order to progress. In recognition of this pressure, we will allocate funding to reimburse certain exams:

• additional funding will be allocated to cover mandatory royal college examination fees for resident doctors in training and local employment in England (the first 2 attempts per mandatory exam)

• individual resident doctors will receive direct reimbursement from trusts, and trusts in turn will be provided funding

• we will work with BMA UKRDC and royal colleges to establish an agreed list of examinations that will be covered, which would be subject to review as requirements change

• reimbursement for an exam will be based on whether the exam is considered mandatory by the relevant royal college

• as per existing arrangements, the advanced life support training will be funded locally for resident doctors if it is mandatory for training, and for LEDs where it is mandatory for the role

• reimbursement will begin for exams sat from 1 April 2026

List of mandatory royal college exams

The mandatory royal college exams are:

• MRCP(UK) (Membership of the Royal Colleges of Physicians): essential for medical specialties; includes Part 1, Part 2 and PACES

• MRCP(UK) Specialty Certificate Examinations: required to Certificate of Completion of Training (CCT) in most medical specialties

• MRCS (Membership of the Royal College of Surgeons): intercollegiate exam (Part A and Part B OSCE) for surgical trainees

• MRCGP (Membership of the Royal College of General Practitioners): includes Applied Knowledge Test (AKT) and Simulated Consultation Assessment (SCA)

• MRCPsych (Membership of the Royal College of Psychiatrists): Paper A, Paper B and the clinical CASC exam

• FRCA (Fellowship of the Royal College of Anaesthetists): primary and final exams

• FRCR (Fellowship of the Royal College of Radiologists):  Part 1, Final Part A and Final Part B

• FRCR Clinical Oncology (CO): Part 1 CO, Final Part CO2A, Final part CO2B

• MRCOG (Membership of the Royal College of Obstetricians and Gynaecologists): Part 1, 2 and 3

• MRCOphth (Membership of the Royal College of Ophthalmologists): Part 1,  Part 2 Written, Part 2 Oral, Refraction Certificate

• MRCPCH (Membership of the Royal College of Paediatrics and Child Health): 3 theory exams and 1 clinical

• RCEM or MRCEM (Membership of the Royal College of Emergency Medicine):  2 theory exams and 1 clinical

• FRCPath (Fellowship of the Royal College of Pathologists):  Part 1 (theoretical or multiple choice questions) and Part 2 (practical or clinical)

• MFPH (Membership of the Faculty of Public Health): Diplomate (DFPH) and the Final Membership (MFPH) examinations

• FICM (Faculty of Intensive Care Medicine) - AKT and ACRE required to CCT

• MFOM (Membership of the Faculty of Occupational Medicine): MFOM part 1 and 2

• Intercollegiate Specialty Fellowship Section 1 and 2 examinations (JCIE) required to CCT in each surgical speciality:

  • cardiothoracic surgery
  • general surgery
  • neurosurgery
  • oral and maxillofacial surgery
  • otolaryngology
  • paediatric surgery
  • plastic surgery
  • trauma and orthopaedic surgery
  • urology
  • vascular surgery

See exemplars in annex B (below) to aid understanding.

Part 3: access to training places

Medical Training (Prioritisation) Act

42. As part of this deal, the government will introduce an additional 1,000 specialty training posts which will be available in April 2026 for August 2026 starts. As the Medical Training Prioritisation Act has now been commenced, prioritisation will apply for this round. The combined impact of this legislation and bringing forward the expansion of 1,000 specialty training posts mean that we can start to tackle bottlenecks almost immediately.

Up to 4,500 specialty training posts

43. Alongside addressing training bottlenecks through the Medical Training Prioritisation Act, we will increase the number of specialty training posts, while maintaining the quality and experience of training:

• a minimum of 4,000 new additional specialty posts will be delivered over the next 3 years

• 1,000 of these specialty training posts will be brought forward this year in an additional recruitment round launched in April 2026

• the remaining speciality training places will be implemented in year 2 (minimum 1,500) and year 3 (minimum 1,500).

• up to a further 500 places will be made available over the second and third year of this agreement, if there is service appetite, training capacity and patient need as advised by the Training Allocation and Distribution Group (TADG) (explained below)

• we will seek to maintain a sustainable level of workforce growth into the future subject to future spending reviews and the ongoing review of the 10 Year Workforce Plan

• working together with NHS England, who have oversight of postgraduate training, the TADG will review training post distribution to ensure workforce alignment with future population healthcare needs and to ensure alignment with post-CCT vacancies

Establish a group to manage distribution of the training places

44. With the introduction of up to 4,500 specialty training posts, the views of resident doctors will be a factor in determining where these posts should be distributed and in which specialties, alongside current and future patient need and service capacity.

45. We will establish a TADG as a forum to consider the expressions of interest for additional speciality training places from trusts. The TADG will bring together clinical and workforce planning views - including the BMA UKRDC - to assess any proposals against current and future patient need, service capacity and research and development experience. The TADG will draw on national and local data, to agree the appropriate distribution of the new specialty training posts, geographically and by specialty. The TADG will consider the distribution of additional specialty training posts in forthcoming years.

Part 4: measures to improve the working lives of resident doctors

Locally employed resident doctors contract

46. LEDs are employed on varied terms and conditions. Standardising and reforming terms and conditions for LEDs will be key to enabling them to benefit from nodal point reform, the introduction of the enhanced appraisal and supporting LEDs to have better access to supervision and workplace protections.

47. In the first instance, we will expect that trusts move LEDs onto repurposed 2016 contracts by July 2026, while a new standardised contract is developed.

48. We will expect employers to transition LEDs to substantive employment contracts, except where there is a legitimate reason to use a fixed term one (for example, where a person is employed for the purposes of covering a secondment, long term sickness, maternity, paternity or adoption leave).

49. A task and finish group will be set up with NHS England, NHS Employers, BMA UKRDC, and trusts to repurpose the 2016 contract into a standardised contract as a default for employing LEDs. The group’s purpose will be to design a new contract which aligns with the 2016 TCS. The group should also seek to clarify access to enhanced appraisals, access to a clinical supervisor and study leave days.

50. The enhanced appraisal for resident doctors will become the default mechanism to assist LEDs to identify gaps in their competencies and their development needs. It will also be the mechanism for determining pay progression. The enhanced appraisal will be developed by July 2026 and a new standardised contract for LEDs will be fully implemented by February 2027.

51. NHS trusts will be expected to offer all LEDs the opportunity to migrate to the new contract.

52. Where LED posts have been identified for conversion into training posts, DHSC will ask employers to endeavour to give as much notice as possible to the individual doctors occupying those posts. Where possible, this should be greater than the existing contractual notice period. This will need to be determined on a case-by-case basis.

2002 contract phase out

53. The expectation following the introduction of the 2016 contract has been that the 2002 contract will be phased out. However, we note that some trusts still use these terms for employing LEDs.

54. We will remove the 2002 pay scales from the circular and the current transitional pay protection will expire in August 2026 as currently described in the TCS.

55. A new pay protection mechanism for 2002 doctors transferring over to 2016 terms will be devised, which will be designed to cater to the additional pay points. There will be guidance provided on managing this transition and best practice for employers.

56. Employers should move any existing doctors either onto 2016 TCS pay points or onto locally approved scales.

57. Locally approved scales may only be available in specific situations, such as when a resident chooses to stay on 2002 TCS or where other bespoke arrangements are mutually agreed between providers and resident doctors. Trusts will need to make sure that this is appropriately recorded and logged on the NHS Electronic Staff Record workforce services.

Involvement in the medical education and training review (METR)

58. Phase 2 of the NHS England METR, chaired by Dame Jane Dacre, will address issues highlighted in the first phase, including focusing on workforce needs, better service integration and trainee wellbeing.

59. BMA UKRDC will be key stakeholders of phase 2 of the METR.

60. The BMA will be engaged in all workstreams of the METR.

61. Resident doctors, including the BMA UKRDC, will have an opportunity to be involved in the workstreams of the METR.

62. We expect the METR to impact on the role of the deaneries in the long term. More immediately, as part of the work to abolish NHS England and create a new DHSC, we are considering how more functions might be devolved to regions and trusts, in line with the aims of the 10 Year Health Plan for England. The BMA UKRDC will be engaged in these developments to ensure that any reforms result in better trainee experience and outcomes.

Continuous improvement of the 10 Point Plan

63. The 10 Point Plan sets out to fix unacceptable working practices and get the basics right for resident doctors. We will continue to deliver the 10 Point Plan.

64. As part of this deal, we will look for ways in which to enhance and go further on the 10 Point Plan.

65. New aspects included in the 10 Point Plan going forward will be:

• ensuring that trusts adopt a repurposed 2016 contract for LEDs

• determining what will be captured in the lead employer model

• ongoing support for, and continued participation of resident doctor peer leads in trusts from the senior board leads and non-executive directors

• trusts continuing to monitor their performance against the key 10 actions and include a report on this in their annual accounts

Review aspects of exception reporting

66. It is recognised that the implementation of improvements to exception reporting has proven more complicated than planned and is causing concern in many places - for example, the geolocation and corroboration requirements. These are not intended to question the probity or professionalism of doctors, and the Resident Doctors Industrial Relations Committee will review implementation and identify good practice that meets governance requirements in ways that command the support of the BMA RDC. Where mutually agreed, viable alternatives identified through this process will replace current practices.

Reframing the GP Flexible Pay Premia (FPP)

67. The 2016 TCS categorises the GP FPP as part of the ‘hard-to-fill training programmes’. In recent years, there has been a significant number of applications to general practice training posts and therefore the GP FPP would not meet the definition of ‘hard to fill’.

68. As part of the offer, we will rename the GP FPP to the General Practice Registrar Enhancement.

69. We will separate it from the hard to fill section in the Medical and Dental Pay Circular, in recognition of its actual purpose within the contract and its value to GP registrars.

70. We will commit to introduce these changes in April 2026.

Part 5: future working arrangements

71. A Resident Doctors Industrial Relations Committee, comprised of DHSC, NHS England, NHS Employers and BMA UKRDC, will be set up to monitor the implementation of all elements of this offer, ensure they are upheld in the spirit of the agreement and ensure that timelines are met.

72. ‘Task and Finish’ groups consisting of a range of relevant stakeholders will be established to report to the steering group to deliver each strand of the deal.

73. Terms of reference will be agreed which will outline a shared understanding of engagement, timelines and collaboration.

74. After implementation of the deal, future national collective bargaining arrangements will be set up to deliver regular contract maintenance and address national resident doctor grievances in a timely manner.

Implementation and timeline

Once the deal is confirmed, we will establish the Resident Doctors Industrial Relations Committee for the duration of implementation.

Part 1: pay

Proposal: nodal point reform

Year 1: phase 1, including introduction of enhanced appraisal for LEDs by July 2026

Year 2: phase 2

Year 3: to be confirmed

Proposal: headline pay

Year 1: DDRB accepted and backdated to April 2026

Years 2 and 3: engage in DDRB process

Part 2: reimbursement of mandatory exam fees

Proposal: mandatory exam fees covered

Year 1: implemented from 1 April 2026

Part 3: access to training places

Proposal: Medical Training (Prioritisation) Act 2026

Year 1: introduced

Proposal: up to 4,500 specialty training posts

Minimum 4,000 with a potential to increase by a further 500 based on trust appetite and service need in future years

Year 1: 1,000 introduced from April 2026

Year 2: 1,500 implemented in regular recruitment cycle (additional places subject to training capacity and service need)

Year 3: 1,500 implemented in regular recruitment cycle (additional places subject to training capacity and service need)

Proposal: training distribution group

Year 1: established

Years 2 and 3: review

Part 4: measures to improve the working lives of resident doctors

Proposal: locally employed resident doctors contract

Year 1: repurposed version of the 2016 TCS, by February 2027

Proposal: 2002 contract phase out

Year 1: introduced by August 2026

Proposal: deanery process reform

Year 1: introduced by June 2027

Proposal: involvement in METR

Year 1: established

Years 2 and 3: review

Proposal: continuous improvement of the 10 Point Plan

Year 1: established

Years 2 and 3: review

Proposal: rename GP FPP and list it separately in the pay circular

Year 1: in April 2026

Note: where sections refer to ‘established’ and ‘review’, this is based on work being established in this area and then reviewed in later years if the workstream is needed.

Expectations in return for reform

75. If this offer is accepted, both parties will be committing to implementing this deal and to working together in the spirit in which it has been designed.

End of the disputes on pay and training places.

76. In accepting this offer, the BMA RDC in England commits to the following:

• BMA, the RDC and its officers will consistently and firmly recommend to their members that this offer be accepted, highlighting it as the best negotiated outcome that can be secured, and representing a comprehensive, fair and reasonable settlement of the dispute

• that the acceptance of the offer by members terminates the present trade disputes with the government in relation to the resident doctor workforce in England

• that accepting the offer will see both BMA RDC and DHSC commit to facilitating industrial stability and co-operation while the deal is implemented, wherein the BMA RDC do not ballot for, organise or call national industrial action relating to pay or access to training places

Implementation of the deal

77. The BMA RDC and DHSC, along with NHS England and NHS Employers, will engage fully in the Resident Doctors Industrial Relations Committee, to implement and address any concerns about the implementation of this deal, and to ensure resident doctor grievances are addressed in a timely and collaborative manner to the benefit of resident doctors, employers and the users of the NHS.

78. In the event that either party seeks to engage a process outside of the Resident Doctors Industrial Relations Committee to resolve an issue or dispute covered by this deal, the terms of this deal will be considered to have been broken.

79. Either party may in the event that the deal is broken by the other party need to review and assess the feasibility of continuing to implement aspects of the deal. In relation to DHSC, it will review and assess feasibility. In relation to DHSC it will conduct this assessment, subject to considering affordability, capacity limitations, and other practical factors that may arise as a consequence of national industrial action.

Annex A: exemplars of nodal point reform

The examples below are intended to illustrate hypothetical scenarios and may not reflect actual circumstances.

The figures presented below reflect the nodal point reform increases over 3 years and incorporate the 2026 to 2027 DDRB outcome. Final pay scales for 2027 to 2028 and 2028 to 2029 will reflect respective DDRB outcomes for those years.

Example 1: core surgical trainee

Resident doctor W is a full time core surgical trainee (CT1) currently being paid a basic salary of £52,656. They have the intention to continue in formal training. If this offer is accepted, then their basic salary will increase to £55,355. If they complete their ARCP they will become a CT2 in August 2026.

In April 2027, the second stage of nodal point reform will be implemented. This means that as a CT2 they can expect their pay to increase to £56,925, even before that year’s DDRB outcome is applied. If they continue to progress through training annually then they would reach £69,345 during 2028 to 2029, even before the impact of future DDRB outcomes are applied.

Example 2: higher specialty trainee in paediatrics

Resident doctor X is a full time higher specialty trainee (ST6) on paediatrics, currently being paid a basic salary of £73,992. If this offer is accepted and they complete their ARCP each year, their basic salary will increase to £77,348 during first year and £80,730 by the start of the final year, excluding the impact of future DDRB outcomes.

Example 3: locally employed doctor working in emergency medicine

Resident doctor Y has been working as a full time locally employed doctor (ST1) since completing their foundation training and has been seeking to apply to core specialty training.

If this offer is accepted, then their basic salary will increase from £52,656 to £55,355. If they have been developing their competencies these will be assessed in the annual enhance appraisal and will allow higher pay steps to be unlocked. 

With the introduction of 1,000 more specialty training places this year and an April recruitment round, resident doctor Y will have a higher chance of joining a national training programme. Additionally on re-entering training, they may have their competencies recognised towards training by requesting a review of their competencies at an early ARCP within the first 3 months, after beginning training.

Furthermore, following the commencement of the Medical Training (Prioritisation) Act on 6 March 2026, will mean that because doctor Y completed their foundation training in the UK, they will be prioritised for speciality training for 2026. However, the criteria for prioritisation for future years is yet to be determined. 

Example 4: locally employed psychiatrist progressing outside formal training

Doctor Z is a locally employed psychiatrist (working at ST4-equivalent level) currently being paid a basic salary of £65,048. If this offer is accepted, then their basic salary will increase to £67,325.

If they subsequently complete their enhanced appraisal, demonstrating their competencies equivalent to ST4, their basic salary will increase to £67,998, with a further increase in April 2027 to £69,345, even before that year’s DDRB outcome is applied.

If they continue to progress annually then they would reach £71,415 during 2028 to 2029, even before the impact of future DDRB outcomes are applied.

Annex B: exemplars of reimbursed exam fees

Exam fees vary from specialty to specialty. However, for most doctors they represent a significant financial cost to progress through training.

Below are 3 illustrative examples of the types of mandatory royal college exam fees which will be reimbursed from 1 April 2026. Please note that exam fees are subject to change. These examples use the rates as of 19 March 2026.

Psychiatry

Exam	Fee
MRCPsych Paper A	£568
MRCPsych Paper B	£511
MRCPsych Paper CASC (UK)	£1,129
Total cost reimbursed	£2,208

Paediatrics and child health

Exam	Fee
MRCPCH FOP (theory exam)	£365
MRCPCH TAS (theory exam)	£365
MRCPCH AKP (theory exam)	£659
MRCPCH Clinical	£925
Total cost reimbursed	£2,314

Ophthalmology

Exam	Fee
Part 1 Fellowship Examination	£725
Part 2 Fellowship Written Examination	£725
Part 2 Fellowship Oral Examination	£1,395
Refraction Certificate	£900
Total cost reimbursed	£3,745

Obstetrics and gynaecology

Exam	Fee
MRCOG Part 1	£577
MRCOG Part 2	£577
MRCOG Part 3	£620
Total cost reimbursed	£1,774

1. Reference to LEDs throughout this document is regarding locally employed doctors paid according to a pay point equivalent to a pay point that exists under the 2016 Terms and Conditions of Service for NHS Doctors and  Dentists in Training (England) (TCS) or 2002 TCS. ↩