The financial decision facing every GP approaching CCT — or any qualified GP considering a change — is rarely presented with actual numbers. Forum advice ranges from "locum is amazing, I earn twice what salaried GPs earn" to "partnership is dead, don't do it." Neither is helpful without modelling the real economics across 5+ years.
This guide provides that model — with current 2025/26 figures, tax analysis, pension comparison, and the hidden costs that change the calculation.
Salaried GP
Typical earnings (2025/26). Salaried GPs are paid per session, typically £10,000-13,000 per session per annum. Most salaried GPs work 6-8 sessions per week. A full-time equivalent (8 sessions) earns approximately £80,000-104,000 per annum. The 2026 GP contract includes a 3.5% uplift applied to contract funding. Entry-level salaried positions typically start around £60,000-65,000 for 6 sessions.
Benefits. NHS pension (employer contribution ~14.38% on top of salary — this is worth £8,600-15,000/year in employer contributions alone). Statutory sick pay. Maternity/paternity leave (enhanced in many practices). Annual leave (typically 5-6 weeks plus bank holidays). Study leave. Indemnity often covered by practice (check your contract). No business risk — if the practice struggles financially, your salary is protected.
Drawbacks. Limited control over working patterns (the practice determines your sessions, patient load, and admin expectations). BMA guidance suggests 4 hours 10 minutes per session — many practices expect 5-5.5 hours. No equity in the practice. Salary progression is limited beyond the per-session rate. You are an employee — if the practice closes or restructures, your position may be at risk (though employment protections apply).
5-year model (8 sessions, starting £90,000): Year 1-5 gross salary approximately £90,000-97,000 (assuming 2-3% annual uplifts). NHS pension employer contributions: ~£13,000-14,000/year. Total 5-year compensation: approximately £515,000-545,000 including pension contributions.
Locum GP
Typical earnings (2025/26). Locum day rates vary significantly by region, urgency, and whether the booking is inside or outside IR35. Current market rates: £550-800/day for standard in-hours sessions, £800-1,200/day for hard-to-fill, rural, or urgent bookings. A locum working 4 days/week, 44 weeks/year (allowing for unpaid leave) at £700/day earns approximately £123,200 gross.
Tax efficiency. Locums working through a limited company (outside IR35) can retain more post-tax income through dividend extraction, corporation tax rates, and allowable business expenses. Inside IR35 (which many NHS locum bookings now are), the tax treatment is closer to employment — PAYE deductions apply. The IR35 determination depends on the specific engagement and is assessed by the hiring practice or agency. An experienced medical accountant (typical cost: £1,500-3,000/year) is essential for optimising tax position.
Hidden costs that reduce effective earnings. Medical defence indemnity: £6,000-8,000/year (not covered by the practice — you pay this yourself). Professional subscriptions: GMC (£443/year), RCGP membership, BMA. Accountancy fees: £1,500-3,000/year. CPD costs: courses, conferences, study leave (unpaid — you lose earnings for every study day). No employer pension contribution (you must fund your own pension — NHS pension opt-in is possible but complex for locums; many use a SIPP instead). No sick pay. No maternity pay. No annual leave pay — every day you do not work, you do not earn.
5-year model (4 days/week, £700/day, 44 weeks): Gross: £123,200/year. After indemnity (£7,000), accountant (£2,000), GMC/subscriptions (£1,500), pension contribution (£15,000 self-funded SIPP): net before tax approximately £97,700/year. Corporation tax (if outside IR35): ~19% on profits. After tax and pension: approximately £79,000-85,000 take-home. 5-year total: approximately £395,000-425,000 take-home + £75,000 pension.
Partnership
Typical earnings (2025/26). GP partner income is derived from practice profits — total practice income minus total practice costs, divided among partners. Survey data suggests average partner earnings of approximately £130,000-150,000 FTE, though this varies enormously by practice size, patient list, deprivation weighting, QOF achievement, and enhanced service contracts. Some partners in well-run, large practices earn £150,000+. Some in struggling practices earn less than salaried equivalents.
Benefits. Equity in a business (the practice premises may have significant property value). Control over working patterns, hiring, clinical direction, and practice development. Higher earning potential than salaried work in well-managed practices. NHS pension contributions. Partnership drawings are pensionable. Capital appreciation if the practice owns its premises.
Drawbacks. Business risk — you share liability for practice debts, staffing costs, premises costs, and CQC compliance. Goodwill (the entry cost of buying into a partnership) has largely been eliminated in England, but premises costs remain. Time commitment: partners work an average of 37-42 hours/week and carry management responsibilities (HR, finance, premises, CQC, IT) on top of clinical sessions. If the practice's income falls (contract changes, patient list shrinkage), your income falls. If a partner leaves, the remaining partners absorb the workload until a replacement is found.
5-year model (full-time partner, £140,000 average drawings): Gross: £140,000/year. NHS pension employer-equivalent contribution: ~£20,000/year (higher than salaried because pensionable income is higher). 5-year total compensation: approximately £800,000 including pension. But: management time is significant (10-15 hours/week unpaid), business risk is real, and the variability between good years and bad years can be substantial.
Portfolio GP
Many GPs combine clinical sessions with non-clinical income: medical education (training programme directorships, clinical teaching), medico-legal work (expert witness reports — £150-300/hour), occupational health, aesthetic medicine, expedition medicine, pharmaceutical advisory boards, and digital health (clinical advisory roles, content creation).
Portfolio working typically produces total earnings similar to full-time locum work (£120,000-160,000) but with greater variety, lower burnout risk, and multiple income streams that reduce dependence on any single source.
NHS Pension vs SIPP
NHS pension: A defined benefit scheme — your pension is based on your earnings and years of service, not investment performance. Extremely valuable. The employer contribution (14.38%) is essentially free money. Tiered employee contributions range from 5.2% to 14.7% depending on earnings. For salaried GPs and partners, the NHS pension is almost always the best pension option.
SIPP (Self-Invested Personal Pension): Used by locums who cannot easily access the NHS pension. A defined contribution scheme — your pension depends on how much you contribute and how the investments perform. More flexible but less predictable. Maximum annual contribution: £60,000 (2025/26 allowance). No employer contribution — you fund it entirely yourself.
The pension gap is real. A salaried GP earning £90,000 receives approximately £13,000/year in employer pension contributions — money that a locum on the same gross income must self-fund. Over a 30-year career, this difference compounds to hundreds of thousands of pounds in pension value.
How to Transition Between Models
Most GPs do not stay in one model for their entire career. A common trajectory: salaried (years 1-3 post-CCT, building experience and confidence), locum (years 3-7, maximising earnings and flexibility), partnership or portfolio (years 7+, building stability and long-term equity).
The financial key: understand the total compensation (not just gross income), factor in hidden costs and pension implications, and model the 5-year picture rather than comparing day rates to session rates in isolation.