Clinical leadership staff can receive a salary boost of almost 40% for working in the largest acute providers, but pay for medical directors has accelerated faster than for nursing colleagues.
The indicative salaries are included in new guidance on pay levels for very senior managers (VSM) in the NHS. The NHS Improvement guidance includes indicative salaries for 10 VSM roles in acute, specialist, mental health, ambulance and community trusts.
The salaries are grouped according to size of organisation and into lower quartile, median or upper quartiles bands (see tables below).
The guidance reveals that a medical director’s salary is recommended to be over a quarter higher in the very largest acute trusts, compared to the smallest.
The median pay for a medical director in the trusts is set at £215,000, although it may reach as high as £230,000. In contrast the smallest trusts median pay for this role is £170,000.
But it is suggested that nursing directors at the largest trusts are paid a lower median rate of £142,500, with the pay differential between the smallest and largest acute providers significantly wider at 39%.
However, whereas the median pay gap between medical and nursing directors at the smallest trusts is £67,500, it increases to £72,500 at very large trusts.
NHS Improvement said the indicative salaries were being published ahead of a new very senior manager pay framework due to be drawn up by the Department of Health. NHS trusts are expected to use the salaries as a guide when they seek approval from NHS Improvement for VSM pay.
Foundation trusts are expected to have regard to the salary levels, although they are free to set their own pay. It also said that small and medium sized specialist trusts can apply for a 15% salary premium.
In medium sized mental health trusts, a medical directors median salary is set at £15,000 less than a person in the same role in a medium sized acute trust. There are currently no large or very large mental health NHS providers in England.
However, pay disparity between nursing directors at acute and mental health trusts is reversed, with the average mental health trust recommended to pay £5,000 more for nursing directors.
Medium sized mental health trusts should offer a median salary for this role of £122,500, compared to £117,500 in medium sized acute trusts.
The regulator has also said that medium sized mental health trusts with high secure psychiatric hospitals can apply for a 10% pay premium.
|Medical director salaries||Lower quartile||Median||Upper quartile|
|Small acute NHS trusts and foundation trusts (£0-£200m turnover)||£134,000||£170,000||£198,500|
|Medium acute NHS trusts and foundation trusts (£200m-400m)||£169,000||£178,000||£199,000|
|Large acute NHS trusts and foundation trusts (£400m-£500m)||£170,000||£182,000||£202,000|
|Very large acute NHS trusts and foundatin trusts (£500m+)||£189,000||£215,000||£230,000|
|Nursing director salaries||Lower quartile||Median||Upper quartile|
|Small acute NHS trusts and foundation trusts (£0-£200m turnover)||£95,000||£102,500||£107,500|
|Medium acute NHS trusts and foundation trusts (£200m-400m)||£103,000||£117,500||£127,500|
|Large acute NHS trusts and foundation trusts (£400m-£500m)||£115,000||£131,000||£137,500|
|Very large acute NHS trusts and foundatin trusts (£500m+)||£130,000||£142,500||£157,500|