Locally employed doctor (trust grade)

NHS Employers describes LED as a catch-all term for doctors employed by an NHS trust who are not on one of the nationally negotiated contracts. Instead, the trust employs them on a local contract, which often mirrors national terms such as the resident doctors' contract, or is a modified version of one. Titles vary: trust grade, trust doctor, clinical fellow, junior or senior clinical fellow, FY3, research fellow and others. There is no standard naming.

LED posts are not training posts. They do not count automatically towards a CCT, though the experience, appraisals and assessments you collect can support a later application for specialty training or the Portfolio pathway.

Most doctors who qualified abroad cannot enter the UK Foundation Programme, because it is for doctors eligible for provisional registration. After PLAB and full registration with the GMC, an LED post gives UK experience, an appraisal record and the consultant supervision needed to sign a CREST for specialty training applications. The Medical Training (Prioritisation) Act 2026 gives preference in specialty recruitment to UK graduates and doctors with significant NHS experience, so time working in the NHS can matter.

Because contracts are local, pay and terms can differ widely between employers. Where trusts mirror the doctors in training pay structure, NHS Employers advises using ESR grade codes MT01 to MT10. From 1 April 2026, Pay and Conditions Circular (M&D) 1/2026 R2 gives these mirrored values for England:

• MT01 (nodal point 1): £41,226
• MT02 (nodal point 2): £47,610
• MT03 and MT06 (3a, 3b): £55,355
• MT04 (4a): £67,325; MT07 and MT08 (4b, 4c): £67,998
• MT05 (5a): £76,582; MT09 and MT10 (5b, 5c): £77,348

The circular states there is no requirement for employers to use these values for local appointments. NHS Employers also says a national contract is being developed for LEDs paid on scales equivalent to the 2002 or 2016 doctors in training contracts, following the 2026 resident doctors' deal.

1. Secure full GMC registration with a licence to practise.
2. Search NHS Jobs and trust websites for clinical fellow, trust grade or FY2, FY3 and registrar-level posts.
3. Check the job description for the pay point, rota, study budget and supervision.
4. Confirm visa sponsorship with the trust if you need it.

• Assuming national terms apply. Read the contract; leave, study budget and pay progression can differ from training posts, because there are no national terms for LEDs.
• No educational supervisor. Ask whether you will have one; you need a consultant who has supervised you for at least 3 months to sign a CREST.
• Staying too long without a plan. Many doctors use LED years to build towards specialty training, an SAS post or the Portfolio pathway. Keep a portfolio of appraisals, audits and assessments from the start.
• Unclear grade codes. Ask which pay point and grade code the trust will use, since this decides your salary.