Transferring between the NHS and university employment

This guidance aims to outline your rights when transferring employment between the NHS in England and a university, including in particular as part of clinical academic training or with an approved training programme.

Location: England
Audience: Junior doctors
Updated: Tuesday 12 December 2023
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Doctors typically first transfer from NHS employment to university employment during OOPR (Out of Programme Research), or research between core and higher training without an NTN (National Training Number). Trainees will also usually transfer to university employment when they obtain a clinical lecturer post as part of their academic training. If not already employed by a university, post-CCT clinical academics will then usually take clinical senior lecturer posts at a university.

Transferring involves potential changes in terms and conditions of service, so it is important to be aware of the issues.

Please raise any queries with your prospective university employer, as all situations are unique. We can also check both your substantive and honorary contracts before you accept them if you are a member of the BMA.

For trainees, this guidance should also be read in connection with the UK clinical academic training in medicine and dentistry: principles and obligations published by the funders in March 2018. In particular, attention should be paid to the third bullet point in the 'Obligations of those responsible for clinical academic training' section.

Please also note that this guidance may not apply to trainees receiving stipends as part of their PHD programme.


Key considerations

  • Before taking up the post, be clear about which organisation is offering you your contract. Will it include an honorary NHS contract, or will you need to arrange one yourself?
  • Discuss your request for OOPR with your clinical supervisor and identify which NHS clinical duties you may still wish to carry out.
  • If you are a trainee, do you need prospective GMC approval for your OOPR? Arrange an honorary NHS contract so that your time spent during OOPR will not be considered a break in NHS service and you can therefore return to NHS employment. Please note that a research passport (see below) is not an alternative to an honorary NHS contract.
  • Before taking up the post, be clear about which organisation is offering you your contract. Will it include an honorary NHS contract, or will you need to arrange one yourself?
  • If there are any changes to your plans, inform your supervisors and the postgraduate dean as soon as possible.
  • Find out the rate of pay and whether you need to include it in your grant application. If you are a clinical academic trainee or consultant clinical academic or academic GP your pay point is agreed between the BMA and your employer and will match the pay points in the NHS. Please see the relevant pay-scales.
  • If you continue to do NHS work as part of your job (for example in an NIHR Doctoral Fellowship) you must be clear about the proportion of academic time you will have, and the impact of any on-call rotas.
  • Will your occupational benefits, accrued as a result of continuous employment with the NHS be protected? The Principles and Obligations document noted above states that the relevant circumstances include “any changes in employer from a NHS trust/board to an academic institution or vice versa” and that “in principle there should be no detriment to moving in either direction.”

Getting approval for OOPR

You only need GMC approval for OOPR if you wish to count the time towards your CCT. Otherwise, you will just need approval from your educational supervisor, training programme director, and postgraduate dean (Gold Guide Appendix 4).

Here are the steps you should follow

  1. Tell your educational supervisor that you are considering going out of programme (OOP) to undertake research (R).
  2. Contact the university where you wish to study and work out a formal research proposal. If funding is not already in place, you may need to build in time to apply for external funding. Be aware that this could take several months, so you must plan accordingly.
  3. Find out who you need formal approval from and whether this needs to be done before or after you apply for funding. Each deanery has its own process, some of which can take several months, so make sure you build in enough time.
  4. Forward your postgraduate dean’s approval to the relevant college/SAC (specialty advisory committee) for their approval, copied to HEE and your training school or equivalent.
  5. If you would like OOPR to count towards your CCT, you should send the college/SAC approval back to the dean to send on to the GMC for approval. This process can take a number of months, so the earlier you send off the paperwork the better. Section 6 of the Gold Guide contains further information.



Pay scales for university-employed clinical academics (including those employed during OOPR) are agreed in principle between the BMA, university employers and the NHS as part of the agreement on clinical academic pay. 

If you were already in training at ST3 and above on 2 August 2016, or were on a lead employer contract to the end of your training, you will remain on the same pre-2016 pay arrangements until:

  • you exit training,
  • 3 August 2022,
  • or once four years of continuous employment have elapsed - whichever is sooner.

See the relevant university pay scales and our guidance on university pay arrangements and the 2016 junior doctor contract.

Grants and fellowships

Before you accept the post or prepare your funding application, check whether your grant or fellowship covers the cost of your salary, and takes into account incremental and annual pay increases.

Moving without taking OOPR

If you break from your clinical training programme and move to the university sector without taking OOPR, the question of which pay scale applies is more complex.

While you may negotiate pay rates equivalent to those in the NHS, you could be offered a lower rate of pay than on the clinical scales if you do no clinical work in the NHS.

Because non-clinical pay scales are longer, you may be able to move without a reduction in your pay. Find out if the university will match your current NHS pay rate. Before you accept a post, ensure you get a clear statement of what your pay will be and the incremental date.

If your pay decreases

If your pay decreases during your employment with a university, you may be entitled to a reduced BMA subscription rate or lower medical defence organisation fees.


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Employment rights - leave and expenses entitlements

You may wish to continue to work for the NHS during OOPR, or it may be a formal part of your academic training programme. Whether to inform your research, for the clinical experience, or to maintain your previous level of income, make sure you understand your rights and entitlements when working during OOPR.

Working in the NHS

You must have an honorary NHS contract to work in the NHS. Your university may provide one with their contract package, or you may need to arrange one yourself.

If you gain a place on a rota, your university may add the appropriate pay supplement to your monthly pay (and be reimbursed by the NHS employer) or the NHS employer may pay you directly. There should also be opportunities to carry out locum shifts.

Make sure to tell your employers what proportion of your time you will devote to clinical work.

Research passports

Some NHS organisations offer university-employed trainees research passports rather than an honorary NHS contract. Research passports are not appropriate, as they are linked to a specific research project and do not provide the wider benefits of an honorary contract. You should seek a written or electronic honorary contract instead, especially if you are unclear about what you have been offered. Have your contract checked by the BMA.

Exception reporting for OOH

If you find that clinical work is taking up too much of your academic time, you can use exception reporting to keep track. Even if it is not in your contract, NHS employers should still allow you to use exception reporting where it pertains to clinical activity or educational opportunities. Read our guidance on exception reporting for junior doctors.

We also recommend that you highlight your concerns about clinical activity with both your academic and clinical supervisors so that they can consider how best to resolve the issue.

Travel reimbursement

Ask your employer if you are entitled to reimbursement of travel and telephone expenses when working under an honorary NHS contract.


Medical negligence cover

NHS indemnity applies to everyone working in the NHS, whether on a paid contract or an honorary NHS contract.

There is no formal or standard model honorary contract for trainees however, so we recommend you take steps to clarify how indemnity works with your position.

You should also contact your medical defence organisation to ensure you are appropriately covered for any clinical work you undertake out of programme.

Read our guidance on medical indemnity


European working time directive

Clinical academics employed by the NHS are expected to comply with the same working time regulations as all other doctors in training. This could lead to a more formal record of hours worked in the academic part of the job than is currently the case.

Regardless of whether or not your employer regards you as being covered by the European Working Time Directive, you should bear in mind the GMC’s 'duties of a doctor' when taking on extra work, and ensure that you are rested enough to look after patients safely.

You should also make use of exception reporting processes where these are available to you.


Flexible pay premia

The 2016 junior doctor contract introduced a new range of flexible pay premia (FPPs) intended to encourage recruitment in certain areas of medicine. It is also to ensure that those completing extended training programmes are not disadvantaged. The premia are only payable to those who are on the new pay scale.

For eligible trainees, UCEA have recommended that university employers match the flexible pay premia being offered to junior doctors in the NHS, including the specific academic pay premium.

The academic pay premium is paid to those who have successfully completed an approved higher degree and returned to clinical training. As such, we anticipate that most university-employed academic trainees will be eligible.

The university employers have also agreed that academic trainees eligible for any of the other pay premia should be paid them subject to the same qualifying criteria as their clinical colleagues.


Return to the NHS

The Gold Guide says that you should provide at least six months’ notice before you return to programme. It is important to be aware that, although training programmes may provide flexibility, you will need to negotiate when you return to the clinical programme well in advance. The BMA can provide advice if you experience difficulties in negotiating your return and are a BMA member.

If you return before 2 August 2022

If you return to training from OOPR before 2 August 2022, your pay will be protected, and you will receive the incremental point you would have reached had you not been absent from training.

If you had an honorary contract

If you held an honorary contract with an NHS employer during OOPR, you will simply move back to the NHS on the pay scale you were paid at when employed by the university.

If you had an honorary contract with the NHS during your academic employment, your time at the university is not regarded as a break in service. Therefore, once you return to NHS employment, you will regain the maternity and paternity leave and pay, sick pay and redundancy rights you had prior to leaving.

If you did not have an honorary NHS contract

If you did not have an honorary NHS contract while employed in the academic sector, it is still worth asking your new NHS employer to consider the skills and experience you have gained in your research post, and treat you as if you had had an honorary NHS contract. This is within an NHS employer’s discretion.


Get in touch

If you have any comments or suggestions on the guidance itself please send them to the medical academic committee.