NHS Doctor Grades Explained: Trust Grade, LED, Clinical Fellow and SAS (With 2026 Pay)
Trust grade, LED, clinical fellow, SHO, specialty doctor, SAS. If you're new to the NHS, job adverts can feel like they're written in code. Two adverts for almost the same job can use completely different titles, and the pay can look very different too. This guide explains what each non-training grade actually means, how it compares with training posts, and what you can expect to be paid in England in 2026/27.
Quick answer: "trust grade" and "locally employed doctor" (LED) are two names for the same thing: a doctor employed directly by a Trust in a post that isn't part of a national training programme. Clinical fellows are LEDs with protected time for teaching, research, QI or leadership. Specialty doctors and specialists are the senior non-training grades, known together as SAS doctors. LED pay is set by each Trust, but most Trusts follow the resident doctor pay scale, so in England an FY2-level LED usually earns around £47,610 basic and an SHO-level LED around £55,355. Specialty doctors start at £63,696.
Training posts vs non-training posts
NHS doctors work in two broad types of job:
Training posts are part of a national programme run through Oriel: the Foundation Programme (FY1, FY2), core training (CT1 to CT3), and specialty training (ST1 to ST8). They lead to a CCT and consultant or GP posts. Since the Medical Training (Prioritisation) Act 2026, UK graduates and some other groups are prioritised for these places.
Non-training posts are advertised by individual Trusts on NHS Jobs or Trac. They include trust grade, LED, clinical fellow, specialty doctor and specialist posts. Most IMGs start here, and the Prioritisation Act doesn't apply to them.
The non-training grades explained
Trust grade doctor
An older name that's still widely used. It means a doctor employed by the Trust, not a training programme, usually at FY2 or SHO level. "Trust doctor", "Trust SHO" and "non-training SHO" mean the same thing.
Locally employed doctor (LED)
The modern umbrella term for all doctors employed directly by a Trust outside training, including trust grade and clinical fellow posts. The BMA uses this term, and you'll see it in many adverts. LEDs are often grouped by level: FY1, FY2 or SHO, and registrar.
Clinical fellow
An LED post with a named development theme: teaching, research, quality improvement, simulation, leadership or medical education. "Junior clinical fellow" usually means FY2 or SHO level, and "senior clinical fellow" means registrar level. Many include 10% to 50% protected non-clinical time. See our junior clinical fellow guide.
SHO
"Senior house officer" isn't an official grade any more, but everyone still uses it. It means a doctor after FY2 and before registrar: in training, that's CT1 to CT2 or ST1 to ST2. An "SHO-level trust grade" post is an LED post at that level.
Specialty doctor
A permanent, senior non-training grade on a national contract (the 2021 specialty doctor contract in England). You need at least four years of full-time postgraduate training, including at least two in the relevant specialty. Many experienced IMGs go straight into specialty doctor posts.
Specialist
The senior SAS grade, created in 2021. Specialists work autonomously at a level close to consultant, and need substantial experience (typically 12 years of medical work, including six in the specialty).
SAS doctor
Short for specialty and specialist (and the older associate specialist) doctors. It's a group name, not a single job.
How the grades line up
FY1 level: FY1 (training), or LED/trust grade FY1
FY2 level: FY2 (training), or LED/trust grade FY2, or junior clinical fellow
SHO level: CT1 to CT2 / ST1 to ST2 (training), or trust grade SHO, LED or junior clinical fellow
Registrar level: ST3 and above (training), or trust registrar, senior clinical fellow, or specialty doctor
Senior non-consultant: specialist
Pay in England, 2026/27
These are basic salaries for full-time work, before extra pay for nights, weekends, extra hours, on-call and London weighting. In practice, resident doctors earn quite a lot more than basic once rota pay is added.
Resident doctor pay scale (2016 contract)
FY1 (nodal point 1): £41,226
FY2 (nodal point 2): £47,610
CT1 to CT2 / ST1 to ST2 (nodal point 3): £55,355
CT3 / ST3 (nodal point 4a): £67,325
ST4 to ST5 (nodal point 4b/4c): £67,998
ST6 (nodal point 5a): £76,582
ST7 to ST8 (nodal point 5b/5c): £77,348
LED, trust grade and clinical fellow pay
There's no single national contract for LEDs. Each Trust sets its own terms, but most map LED posts onto the resident doctor scale above, so an FY2-level LED is usually paid around £47,610 basic and an SHO-level LED around £55,355. Some Trusts use older scales or their own grades, so always check the salary in the advert and ask HR which pay point you'll start on. Ask too whether your overseas experience counts towards your starting point.
Specialty doctor (2021 contract)
Years 0 to 2: £63,696
Years 3 to 5: £73,383
Years 6 to 8: £81,804
Years 9 to 11: £90,548
Year 12 and above: £102,689
Specialist (2021 contract)
Years 0 to 2: £104,401
Years 3 to 5: £108,484
Year 6 and above: £115,341
Scotland, Wales and Northern Ireland have their own pay scales, which differ slightly.
Which grade should you apply for?
Count your full-time postgraduate experience honestly, including your internship or house job.
Up to about two years: FY2-level LED or junior clinical fellow posts.
About two to four years: SHO-level trust grade or junior clinical fellow posts in your specialty.
Four or more years, with two in the specialty: you can apply for specialty doctor posts, as well as senior clinical fellow or trust registrar posts if your skills match.
Read the person specification for each job. It tells you exactly what experience is essential. Our guide to NHS person specifications explains how to read one.
If you're applying without UK experience, see our guide to getting your first NHS job with no UK experience.
Get your application ready
Whatever the grade, shortlisting depends on how clearly your CV and supporting statement show the essential criteria. Our £35 NHS CV review and £35 supporting statement service are built for IMG doctors applying for exactly these posts.
Frequently asked questions
What does trust grade doctor mean?
A doctor employed directly by an NHS Trust in a post that isn't part of a national training programme, usually at FY2 or SHO level. It's the same as a locally employed doctor (LED).
What is a locally employed doctor?
Any doctor employed by a Trust outside a training programme, including trust grade and clinical fellow posts. Pay and terms are set by the Trust.
How much does a trust grade doctor earn in the UK?
It depends on the Trust and level. Most Trusts follow the resident doctor scale, so in England an FY2-level post is usually around £47,610 basic and an SHO-level post around £55,355 basic in 2026/27, before rota pay.
What is the difference between a clinical fellow and a trust grade doctor?
Both are locally employed. A clinical fellow post includes protected time for teaching, research, QI or leadership; a trust grade post is usually fully clinical.
What is an SAS doctor?
A specialty doctor, specialist or associate specialist: the senior non-training grades below consultant.
Does trust grade experience count for training?
Yes. NHS experience in LED and clinical fellow posts builds your portfolio and evidence for specialty training applications, and can count towards the portfolio pathway (formerly CESR) for specialist registration.
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