16th December 2025
The Scottish NHS is not involved in the current doctors' dispute in England because the NHS is devolved, and pay, contracts and workforce negotiations are handled separately in Scotland and England.
Since devolution, health policy is the responsibility of the Scottish Government, not the UK Government. This means NHS Scotland operates as a distinct system from NHS England, with its own budgets, pay negotiations, contracts and workforce policies. Doctors working in Scotland are employed by NHS boards accountable to Scottish ministers, whereas doctors in England are employed within a system overseen by the UK Government's Department of Health and Social Care.
The current doctors’ dispute in England is primarily about pay restoration and working conditions, and negotiations are taking place between the British Medical Association (BMA) and the UK Government, specifically for doctors employed by NHS England. Because the Scottish Government is not the employer in England, NHS Scotland has no formal role in those talks.
Another key reason is that Scotland reached a separate pay agreement with doctors earlier. In 2023-24, the Scottish Government negotiated a deal with the BMA in Scotland that delivered higher pay rises than those offered in England, alongside commitments on working conditions.
As a result, Scottish doctors voted to accept the deal, while their counterparts in England rejected offers from the UK Government and continued industrial action. With a settlement already in place in Scotland, there is no equivalent active dispute requiring NHS Scotland’s involvement.
It is also important to note that while the BMA is a UK-wide union, it negotiates separately with each government. The BMA Scotland branch represents doctors working in Scotland and deals directly with the Scottish Government, while the BMA’s England committees negotiate with Westminster. This structure reflects the devolved nature of the NHS.
In short, NHS Scotland is not involved because it is a separate health system, the employer and negotiating government are different, and Scotland has already resolved its pay dispute, unlike England.
in general Scottish doctors are currently paid more in real terms than many of their counterparts in England, particularly because Scotland has negotiated separate pay deals that have delivered larger percentage uplifts and earlier settlements. However, the picture depends on grade (foundation doctors, specialty training, consultants) and contractual details, and comparisons are not always straightforward because of differences in pay structures and allowances.
Here’s what the data show for the 2025/26 pay year:
Foundation training doctors (junior doctors):
In England, the basic salary for a Foundation Year 1 doctor is about £36,616 and for Foundation Year 2 about £42,008.
In Scotland, the revised basic salary for Foundation Year 1 starts at about £34,500 and increases through training, with recent agreements giving around 11 % cumulative uplift over 2023-25.
Net comparison: basic pay is slightly higher in England at first glance, but additional pay for unsocial hours (called "banding") in Scotland is often more generous — meaning many Scottish trainee doctors can end up taking home more overall income.
Reddit
Specialty training and registrar doctors
In England specialty registrars earn between around £49,909 and £61,825 basic, depending on training year.
Scotland’s resident/registrar pay scale also increases with experience and has been uplifted by around 11 % over the last pay round, often resulting in competitive or higher earnings when banding is included.
Scottish Government
Consultants (senior doctors)
In England, consultant basic salaries start at about £105,504, rising with experience.
NHS Pay Bands
In Scotland, consultant pay is broadly similar with starting basic pay slightly above England’s (around £107,000+ for many posts).
Both systems allow significant additional earnings through extra sessions, discretionary points or private practice, so total earnings can be higher than the basic figures suggest.
Overall comparison
For many grades, especially at training and middle career levels, total earnings (basic + allowances) in Scotland are generally equal to or higher than in England, partly because Scotland’s government negotiated more generous uplifts and resolved talks earlier — which is a key reason Scottish doctors have not been taking industrial action.
Data from the independent Nuffield Trust also noted that across the UK, Scotland has relatively higher non-basic pay (the elements most associated with longer hours and unsocial working) compared to England.
Important caveats
These figures are basic salaries before additional payments (like on-call, overtime, unsocial hours, relocation allowances, etc.), which vary significantly between NHS systems and can skew comparisons.
Tax differences (Scotland has higher income tax rates than England at many earnings levels) can mean take-home pay differs from gross salary comparisons.
Pay data across NHS Scotland and NHS England are published under different frameworks, so exact “like-for-like” comparisons are complex.
Scottish doctors on aggregate tend to be on a pay scale that is broadly competitive with or higher than equivalent grades in England, especially when additional pay elements are taken into account, and recent negotiated deals in Scotland have given them relatively stronger uplifts — which is part of the reason Scotland has not seen the same level of dispute over pay as in England.