Resident doctors rotate every few months, and each rotation can come with a different rota. Because so much resident doctor pay depends on the rota rather than the grade, take-home pay can change noticeably from one placement to the next without any change of nodal point. The calculator above builds your pay from basic salary and your rota. This guide explains how to plan for the swings.
Where the variation comes from
Basic pay is set by your nodal point and only changes when you progress. Everything else depends on the rota. Additional rostered hours above 40 a week, the 37% enhancement for hours worked at night or at weekends, the weekend allowance that rises with how often you work weekends, and on-call availability all vary between placements. A rotation from an intensive acute rota to a daytime clinic job can change gross pay by several thousand pounds a year.
A worked example: from one weekend in four to one in eight
Ali is an ST1 on nodal point 3, with basic pay of £55,355. On their current rota they work one weekend in four, which carries a weekend allowance of 7.5% of basic, about £4,152 a year. Their next rotation is one weekend in eight, where the allowance is 3%, about £1,661.
The gross difference is about £2,491 a year. Ali's pay sits in the higher-rate tax band and they repay a Plan 2 student loan, so after 40% income tax, 2% National Insurance and 9% to the loan, they keep about 49p of each pound. Take-home falls by about £1,221 a year, around £102 a month. Their NHS pension contribution doesn't change, because the weekend allowance isn't pensionable, so it doesn't build any pension either.
Budgeting across rotations
The practical answer is to budget on your lowest likely rota, not your current one. Look at the rota patterns for the next year of your training programme and estimate pay for the least intensive placement. Build fixed costs, like rent and loan payments, around that figure, and treat anything above it as savings or a buffer.
Watch the first payslip of each rotation. Payroll often needs time to update allowances when you move trusts or rotas, and backdated corrections can make one month look unusually high or low. If you change employer, check your tax code too. A new trust without your P45 may use an emergency code for a month or two.
Extra hours and exception reports
If you regularly work beyond your rostered hours, exception reporting is how those hours get recognised, either as time off in lieu or as pay. Extra hours that are paid are taxed like the rest of your pay, at your marginal rate, so at higher-rate a large share goes to tax, National Insurance and student loan. Locum shifts work similarly, though bank and agency rates and pension treatment vary, so compare them on what you'll keep.
Pay progression on nodal points
Unlike Agenda for Change staff, resident doctors don't progress through annual increments within a grade. Basic pay moves up when you reach a new nodal point, which usually follows a change of training grade. The jump from nodal point 3 to 4 is one of the largest, and it often coincides with a step up in rota intensity. Check both effects together: higher basic pay raises your pension contribution tier, while a busier rota adds non-pensionable allowances that are taxed at your marginal rate.
Next steps
Enter your nodal point and rota above to see the full breakdown. If you're comparing two rotations, run each through the calculator and use the compare two salaries calculator to set the totals side by side. The Plan 2 and Postgraduate loan calculator shows how a second loan changes your keep-rate.