Many international medical graduates (IMGs) arrive in the UK with dreams of a stable NHS job, a decent salary, and financial security. You’ve worked hard to pass your exams, applied to countless roles, and finally received your first offer letter. But once you start, reality hits: the actual money hitting your account is far less than expected.
Welcome to the world of NHS pay banding confusion—a topic that’s rarely talked about, but affects nearly every IMG stepping into their first NHS job.
In this blog post, we’ll unpack what pay banding really means, why your take-home pay can vary wildly, how to protect yourself from underpayment, and what to do if you think you’re being paid incorrectly.
Understanding NHS Pay Banding for Junior Doctors
When you accept an NHS job as an IMG doctor, especially at junior levels like FY2-equivalent, SHO, or Trust Grade, your salary isn't always as straightforward as the annual figure in your contract.
That’s because NHS junior doctor salaries are made up of:
Basic pay – Your set salary based on your level and experience.
Banding supplement – An additional percentage based on the hours you work. This is where things get murky.
A banding supplement is applied when you do unsocial hours, on-calls, night shifts, and weekends. These are defined by the rota, not your base role.
For example, a Trust Grade SHO working full-time with regular nights and weekends might receive a Band 2B or 1A supplement, meaning 30%–50% extra pay. But if you’re on a standard 9–5 job with no on-calls, your pay might just be basic—and significantly lower than peers.
Why So Many IMGs Are Shocked by Their Pay
One of the biggest pain points we hear in the TrewLink community is:
"I was expecting £3,000 a month after tax, but I’m getting £2,100. What happened?"
Here are some reasons why your pay may not match expectations:
You weren’t told your job had no banding.
The rota changed after you joined.
You’re on zero-hours or locum-style contracts with variable shifts.
You assumed your job included on-calls—but it doesn’t.
Payroll delays or BRP issues meant deductions were applied early on.
Even the job title "Trust Grade SHO" doesn’t guarantee banding. Everything depends on your department’s rota and your exact hours.
How to Find Out Your True NHS Salary Before You Start
To avoid disappointment, always ask these key questions before accepting an NHS offer:
“What is the banding for this job?”
“Is the salary advertised basic or inclusive of banding?”
“Can I see a sample rota for this post?”
“Is this job eligible for relocation reimbursement or visa sponsorship?”
“What will my estimated monthly take-home pay be?”
If you’re unsure, speak to current IMGs in that Trust or department – our forum is full of doctors sharing honest insights about what their pay looks like in real life.
What to Do If You’re Being Underpaid
If you’ve already started working and suspect that your pay is off:
Check your contract – Look for banding info or vague lines like “salary in line with NHS T&Cs.”
Ask payroll or HR – Politely ask for a breakdown of how your pay is calculated.
Speak to your rota coordinator or supervisor – Ask if your rota qualifies for higher banding.
Compare with others – If colleagues with the same shifts are getting more, raise it.
Contact the BMA – If you're a member, they can review your contract and offer support.
Moving Forward: How to Maximize Your Earnings in the NHS
If your current role isn’t paying enough or has no banding, you don’t have to stay stuck. Here are some ways IMGs improve their income:
Apply for roles with on-calls or night shifts – Medical, surgical, or A&E Trust Grade posts often have higher banding.
Pick up extra locum shifts – Once settled, you can sign up for bank shifts or NHS locum work.
Transition into training – Training roles come with more predictable pay structures and long-term benefits.
Negotiate future offers smartly – Use your experience to ask for transparency in future contracts.
Know Your Worth and Ask the Right Questions
Pay banding might sound like a boring technicality, but for IMGs building a new life in the UK, it can be the difference between financial stress and stability. NHS jobs are rewarding, but they also need to work for you.
Whether you’re applying for your first job, or already in one and considering your next move, don’t be afraid to ask questions, compare notes, and speak up if something feels off. And most importantly—you don’t have to figure this out alone.
Join our growing IMG community and get real talk from real doctors, find answers to tricky questions like these, and learn how others are navigating the same challenges—without sugarcoating the journey.
Your future self will thank you.