Rotations, Contracts, and Return-to-Work Explained: How to Maximise Your Entitlement, Understand Your Rights, and Avoid Costly Contract Mistakes
This guide is written from personal experience and intended for informational purposes only. It does not constitute legal, financial, or professional HR advice.
NHS maternity and LTFT policies can vary between deaneries, trusts, and change over time. Always verify current entitlements with your HR department, your deanery, the BMA, and NHS Employers before making any decisions.
The author accepts no liability for decisions made based on the content of this guide. Figures quoted were correct at time of writing; always check for the latest rates at nhsemployers.org and bma.org.uk.
England-focused. Some processes differ in Scotland, Wales, and Northern Ireland.
A story about biological clocks, NHS bureaucracy, ovulation sticks, and why no doctor should have to figure this out alone.
I have wanted to write about this for a while. Not just the policy and the pay, but the messy, emotional, deeply human experience that sits underneath all of it. Because before I became someone who understood qualifying weeks and occupational maternity pay, I was a 27-year-old doctor, four years married, standing at the edge of a decision I hadn't expected to feel so complicated.
I had spent years putting children off. There was always something else first; more countries to visit, more exams to pass, more life to live. I had ingested contraception almost daily for years without a second thought, grateful for the promise of a childless existence on my own terms. And then, somewhere between graduating medical school and starting my foundation years, something shifted. Unexpectedly, almost against my will, the idea of a family stopped being something I was deferring and started being something I wanted.
What I hadn't anticipated was how quickly the desire to start a family would run up against the rigid, unforgiving structure of the National Health Service foundation training programme; where even trying for a baby had to be carefully timed to meet eligibility requirements for maternity pay.
The decision to try for a baby wasn't just personal; it became a strategic one almost immediately. I quickly realised that if I wanted to receive meaningful maternity pay, timing was everything. To qualify for Occupational Maternity Pay (the full NHS package), I needed 12 months of continuous NHS service, meaning that by the time you reach week 29 of pregnancy (roughly 11 weeks before your due date), you are still continuously employed by the NHS. That clock had started ticking from my first day as an FY1.
For ease, this meant not getting pregnant before January in FY1, and not after January in FY2 (although at the time I hadn't appreciated that I could go on maternity leave without a job to return to and still get full maternity pay). Anything later and I would cross into a gap in employment, losing my OMP eligibility entirely. If I didn't secure a training contract after FY2, I could be out of NHS employment for up to a year, resetting my continuity. If I then got into training the following year, I might face a further wait before being eligible again. All of this against the backdrop of increasing competition for training places and the unpredictability of where in the country you might be sent.
Maternity pay mattered to me. It wasn't greed; it was the difference between financial security and genuine hardship during one of the most vulnerable periods of my life. So I made a plan.
Inundated with all the planning and still unsure of exactly when my baby making window opened and closed, I did what any slightly anxious, type-A doctor would do; I gave myself a few months to conceive, knowing full well that it can take a year or more. What followed was something I suspect many women will recognise; a deep dive into the world of Trying to Conceive. Ovulation sticks. Cycle tracking. Supplements, CoQ10, vitamin D, folic acid, researched obsessively at midnight after long shifts. I went down the rabbit hole completely.
My first cycle ended in a chemical pregnancy. For those unfamiliar, this is an early pregnancy loss; a positive test, then gone, usually before week 5. It is technically common. Statistically unremarkable. And completely devastating. The week I was pregnant changed something in me. For those brief days I had started to imagine a future that felt suddenly, viscerally real. Losing it, even so early, was a grief I hadn't expected and didn't know how to hold.
Early pregnancy loss is far more common than it is spoken about, especially among women who are trying to conceive under pressure. If you have experienced this, you are not alone and your grief is valid; however brief the pregnancy was. The Miscarriage Association (miscarriageassociation.org.uk) offers support specifically for early losses.
The second month brought its own challenges. Ovulation windows were overshadowed by night shifts. I became, by my own admission, obsessive; which was not good for my mental health, my relationship, or my ability to be present at work. By the third month, my partner and I made a deliberate decision to stop trying. We had a long conversation about waiting, perhaps until training was secured, perhaps 3 to 5 years. We were young. We had time. We were lucky to be able to say that, and I knew it.
And then, the month we stopped trying, I got pregnant. Our twins were due on the 6th of December, three months into FY2.
I was fortunate. My planning worked out, not because I had inside knowledge, but because I spent an enormous amount of time piecing together information from BMA documents, NHS Employers circulars, deanery FAQs, and HR departments who sometimes gave me contradictory answers. It was exhausting, and I was doing it while sleep-deprived, emotionally stretched, and trying to be a competent doctor at the same time.
This guide is what I wish had existed. It is not a dry policy document. It is a practical, honest walkthrough of everything you actually need to know; the pay system, the timing considerations, LTFT, returning to work, written by a doctor who has lived it. Whether your pregnancy is planned or unplanned, whether you are in FY1 or a specialty trainee, whether you are just beginning to think about this or already navigating it, I hope something here saves you hours of scrolling and a great deal of unnecessary anxiety.
You should not have to figure this out alone. No one should.
Read it front-to-back for the full picture, or jump to whichever chapter is most urgent for you right now. Chapter 6 has printable checklists; go there first if you're short on time. Each chapter ends with a summary of the key points.
If you are pregnant, planning a pregnancy or returning from maternity leave, this guide is for you. It is primarily written for NHS resident doctors in England on the 2016 Terms and Conditions of Service, though much of it is relevant across grades and deaneries.
Your rights during pregnancy are broader than most doctors realise. Here is what you are entitled to from day one.
Your rights during pregnancy are broader than most doctors realise. From day one, you are protected in ways that are often poorly communicated, inconsistently applied, and frequently left out of medical training entirely.
Before we move into the complexities of maternity pay later in this book, it is important to start here: what it actually means to be pregnant while working in the NHS. This is not just a period of rota adjustments and clinic appointments. It is a transition into a new phase of your life where you will quickly realise the importance of advocating for yourself; not only for your own wellbeing, but for your baby or babies as well.
At times, it can feel like you are constantly navigating two competing responsibilities: being a safe, reliable doctor and adjusting to a changing body, energy level, and set of needs. The reality is that both matter. Learning to protect your health within the system is not optional; it is part of safe practice, even if it is not always treated that way.
This is one of the most commonly misunderstood entitlements in medicine. You have a legal right to paid time off for all antenatal care, and that covers more than just your midwife and scan appointments. It also includes any antenatal or parenting classes that have been recommended by your doctor or midwife, so if your midwife suggests an antenatal course, attending it is a protected right, not something you need to fit around annual leave.
Your partner has a statutory right to unpaid time off to accompany you to up to two antenatal appointments. If your partner also works for the NHS, they may be entitled to paid time off; it is worth them checking their own trust's policy directly.
When you decide to tell your employer you are pregnant, your line manager (usually your clinical or educational supervisor) is legally required to conduct a pregnancy risk assessment. The purpose is to identify any health and safety concerns in your working environment and any adjustments your working pattern may need. Common examples in medicine include:
You may not need any adjustments initially, and that is fine. But you are entitled to request a repeat risk assessment at any point during your pregnancy if your needs change. Common adjustments doctors negotiate include coming off nights, being removed from on-call rotas, transitioning to more desk-based or outpatient work, or reducing overall working percentage temporarily.
In some cases, adjustments are not optional or gradual. They become necessary for safety.
For me, this became clear around 32 weeks of pregnancy, when I developed severe pelvic girdle pain. My mobility became significantly restricted to the point where walking on a ward round was difficult, and prolonged standing was no longer feasible.
At the time, I was working on a ward where I was the only doctor covering approximately 30 patients, with multiple consultant-led ward rounds throughout the day. The combination of physical strain, workload intensity, and reduced mobility made the situation increasingly unsafe, both clinically and personally.
There was a point where the impact of fatigue and physical limitation became very real. After a particularly demanding shift, I was involved in a minor car incident, a clear signal that I was no longer functioning safely under the conditions I was working in. My legs were heavy and fatigued, and my overall capacity to safely manage both driving and clinical responsibility was compromised.
This is an important point that is often overlooked in healthcare culture: pregnancy-related symptoms do not only affect comfort; they can directly affect safety, clinical judgement, and functional capacity. Following review, I was signed off by my GP and removed completely from the rota, transitioning to remote clinical duties in line with occupational health advice. This adjustment was not about stepping away from responsibility. It was about recognising that safe practice changes during pregnancy, and that protecting both patient safety and personal health are not competing priorities. They are aligned.
If your working pattern is adjusted during pregnancy, your pay must remain the same. If your department cannot accommodate suitable alternative work, you must be suspended on full pay. This is a legal requirement under the NHS Terms and Conditions of Service (section 15.34).
Although these rights exist clearly in policy, many doctors experience a very different reality in practice. You may feel pressure to minimise disruption, avoid raising concerns, or push through. This is common, but it is not a requirement of your role.
Pregnancy often forces an uncomfortable shift: learning to advocate for yourself in environments where you are used to prioritising patients, colleagues, and service demands over your own needs. This is not selfishness. It is responsibility; for your health and for your pregnancy.
Sickness during pregnancy is treated differently from standard sickness absence:
If you suffer a pregnancy loss before 25 weeks, it is classified as a miscarriage under section 15.33 of the NHS Terms and Conditions of Service, and normal sickness absence provisions apply. This does not mean it is treated dismissively; it means your sick leave protections apply. You are entitled to time off to recover, and your employer should treat this with sensitivity. If you feel you need more time or support than sick leave allows, speak to your occupational health department or your educational supervisor.
This is a situation many rotational trainees worry about and very few people know the answer to. If you are due to rotate to a new trust after week 29 of pregnancy, you are entitled to choose to remain at your current trust until you give birth, with your contract extended appropriately. You do not have to rotate on your scheduled date if doing so would be clinically or practically unreasonable at that stage of pregnancy. This is set out in section 15.83 of the NHS Employers Terms and Conditions of Service handbook.
Two types of pay. Very different rules. Understanding both is essential.
NHS maternity pay has two distinct components; many doctors mistakenly assume they're either entitled to both or neither. In reality, your eligibility for each depends on completely different criteria.
This is the enhanced NHS pay, the "good stuff." It's your employer's contractual maternity pay on top of any statutory entitlement. Under the 2016 Terms and Conditions:
| Period | Pay Level | Notes |
|---|---|---|
| Weeks 1–8 | Full pay | Includes basic salary + applicable supplements |
| Weeks 9–26 | Half pay + SMP (if eligible) | Together these should not exceed full pay |
| Weeks 27–39 | SMP only (if eligible) | Statutory amount; see below |
| Weeks 40–52 | Unpaid | Unless your trust offers additional support |
To qualify for OMP, by the start of the 11th week before your Expected Week of Childbirth (EWC), around 29 weeks pregnant, you must:
If your fixed-term contract expires during maternity leave, you may not have to return to that trust at all, and you could still keep your OMP. The return obligation applies to any NHS employer, not your current one. A trust grade post, clinical fellow role, or training contract elsewhere all count. More on this in Chapter 7.
SMP is the government-funded statutory minimum. It is paid for up to 39 weeks and has different eligibility rules from OMP; this is where it can feel complicated for rotational doctors.
| Period | Rate |
|---|---|
| First 6 weeks | 90% of your average weekly earnings |
| Weeks 7–39 | Standard SMP rate (£194.32/week in 2026; check gov.uk as it is updated each April) |
To qualify for SMP, you usually need 26 weeks of continuous service with the same employer by the qualifying week. For many professions that is straightforward. For rotational trainees, it is not always so simple.
Resident doctors often rotate trusts every 4–6 months, which naturally raises the question: "If I changed trust recently, have I lost my SMP?" The good news is, not necessarily.
Some deaneries use a "lead employer" model where a single trust remains your legal employer throughout training, even while you rotate hospitals. If this applies to you, continuity is usually preserved and SMP becomes much simpler. It is worth checking with your payroll, HR, or deanery early, rather than assuming.
Even without a Lead Employer arrangement, doctors in training often have additional protection. NHS Employers guidance states that if a trainee changes employer solely because of a required training rotation and loses SMP continuity as a result, the current employer should pay the equivalent value of SMP that would otherwise have been received. So while rotational training can make the paperwork messy, it does not automatically mean you lose maternity pay. This is a really important point that many doctors are not aware of.
Your early due date is estimated from your last menstrual period (LMP), but your official due date often changes after the 12-week dating scan, sometimes by only a few days. Those few days can matter more than you'd think. A revised due date can shift your qualifying week, your OMP eligibility date, and when key forms need submitting.
You may still be entitled to Maternity Allowance (MA), a government benefit paid through HMRC. MA is worth knowing about for another reason too: unlike SMP, which is treated as income and taxed accordingly, Maternity Allowance is a non-taxable benefit. In some circumstances this means that MA can actually leave you slightly better off in take-home terms than an equivalent SMP payment, even though the headline rates look similar. It is worth checking your individual situation, particularly if you are close to a tax band threshold. For full eligibility details and to apply, visit gov.uk/maternity-allowance.
You are always entitled to take maternity leave regardless of your pay entitlement. Never let a pay concern stop you taking your full 52 weeks.
Abstract rules are hard to act on. Numbers are not. Here is a rough illustration using approximate figures for a foundation/core trainee in England with a basic salary of £38,831 per year and the 2026 SMP rate of £194.32 per week (figures vary by grade and trust; check your own payslip):
Weeks 1–6: ~90% average weekly earnings (~£671/week)
Weeks 7–39: £194.32/week statutory rate
Weeks 40–52: Unpaid
Approximate total for 52 weeks: ~£10,000–£11,000
Weeks 1–8: Full pay (~£746/week)
Weeks 9–26: Half pay + SMP (~£567/week)
Weeks 27–39: SMP only (~£194.32/week)
Weeks 40–52: Unpaid
Approximate total for 52 weeks: ~£18,700
Missing one qualifying date, failing to push back on an incorrect HR decision, or not understanding your continuous service rights can cost you the difference between OMP and SMP; around £8,000 on a foundation/core trainee salary. That is not a small administrative error. It is a significant financial loss that is entirely avoidable with the right information.
If you are growing your family through adoption, your entitlements are very closely mirrored to maternity leave. Here is a quick overview:
| Entitlement | Detail |
|---|---|
| Total leave | 52 weeks, plus accrued annual leave |
| Occupational Adoption Leave pay | 8 weeks full pay, 18 weeks half pay, 13 weeks statutory adoption pay, 13 weeks unpaid |
| Notice to change return date | 28 days |
| Pay calculation | Based on 2 payslips preceding the matching week (the week the adoption agency notifies your employer you have been matched with a child) |
If you are fostering, you can choose to start adoption leave when the placement begins. Any fostering allowances you receive will not affect your adoption leave pay. If the adoption breaks down after it has begun, you are entitled to continue your adoption leave until your original planned end date and continue to receive adoption pay as originally planned. If you are adopting from overseas, specific notification rules apply; the key requirement is giving your trust 28 days notice of the child's arrival date once you receive official permission to adopt.
One week can be the difference between receiving full NHS maternity pay or losing thousands of pounds.
Now that you understand the different types of maternity pay, it's now time to focus on one of the most important moments in the entire maternity pay process: the qualifying week. One week that determines several crucial dates.
This is not about trying to plan pregnancy with military precision. Life does not work that way, and many things are outside our control. But if timing is something you are able to consider, understanding the rules now could save you stress, confusion, and a substantial amount of money later.
| Entitlement | What's Assessed | At What Point? |
|---|---|---|
| OMP | 12 months NHS service | By start of 11th week before EWC (~29 weeks pregnant) |
| SMP eligibility | 26 weeks with current employer | By the qualifying week (15th week before EWC, ~25 weeks pregnant) |
| SMP pay rate | Average weekly earnings | 8-week window ending at approximately week 25 of pregnancy |
Your SMP rate is based on your average earnings in the 8-week period ending at approximately week 25 of pregnancy. What you earn in the weeks leading up to this point can affect what you are paid for many months afterwards. The following may all increase your SMP calculation if they appear in your payslips during this window: basic salary increases, on-call supplements, nodal pay uplifts, additional rostered enhancements, locum or bank work paid through payroll, and pay progression after ARCP. When calculating OMP, include payslips from all trusts and ensure annual leave payments are also included.
You conceive around 2 months into your first NHS post. By 29 weeks pregnant, you will have approximately 9 months of NHS service. You need 12 months. You are 3 months short, you do not qualify for OMP, and fall back on SMP only; a substantial reduction in income during maternity leave.
You conceive around 7 months after starting NHS employment. By the time you reach the OMP eligibility point, you are much more likely to have completed your required 12 months NHS service. Result: 8 weeks full pay + 18 weeks half pay + SMP; a significantly stronger overall package.
If you were on unpaid sick leave, or on sick leave attracting only half pay, during the 8-week earnings calculation window, your SMP could be unfairly reduced. Under section 15.23 of the NHS Terms and Conditions of Service, your average weekly earnings for any period of sick absence in that window should be calculated as if you had received your full notional sick pay, in line with sections 14.4 and 14.5. In plain terms: if sickness affected your pay during that period, you should not be penalised in your SMP calculation. Raise this with HR or payroll if it applies to you.
Timing a pregnancy around NHS pay rules is not something everyone wants to, or is able to, do. Life rarely runs to a perfect spreadsheet, and that is completely okay. This chapter is not about telling you when to have a baby. It is simply about giving you the information many doctors wish they had earlier, so you can make informed decisions if timing happens to be relevant to you.
One of the most common sources of confusion and missed entitlement is a misunderstanding of what counts as continuous NHS service. Many doctors assume it means unbroken time with a single trust. It does not. Continuous service spans the whole of your NHS career, across different employers, and certain breaks do not reset the clock.
NHS employers for these purposes include trusts, boards, health authorities, and the Northern Ireland Health Service. Time worked across any of these counts cumulatively towards your 12-month OMP eligibility threshold.
Some breaks preserve continuity but do not add extra service time. Employers may also choose, at their discretion, to recognise other previous NHS or external service. Trusts can extend certain time limits beyond the defaults listed here. This means the rules work in your favour more often than HR may initially suggest. Always ask payroll or HR to confirm your specific employment history in writing before accepting any decision about your eligibility.
A doctor's maternity pay qualifying weeks crossed over when she moved to a new trust in February, having over 12 months of continuous NHS service. She received two payslips for February; one from her new trust (slightly less than normal due to the start date) and a few days' pay plus annual leave owed from her old trust.
Will both payslips be included in the SMP calculation? Yes. Both payslips from the qualifying period should be included, regardless of which trust issued them. The annual leave payment from the old trust should also be included. This is worth raising explicitly with HR at your new trust, as it requires coordination between two payroll teams who do not always communicate automatically. Put it in writing and ask them to confirm in writing that both payslips will be factored into the calculation.
A GPST3 doctor approaching the end of her training found out she was 7 weeks pregnant, with an expected due date falling a couple of months after her CCT date.
1. What happens to her contract if training ends before the birth? This is where training status and employment status need to be separated. If a GP trainee has already triggered maternity entitlement while employed in training, the fixed-term training contract is normally extended for the purpose of maternity leave and maternity rights, rather than ending on the original CCT or rotation date. In practice, this means the contract does not simply terminate on the planned training end date; it is typically continued to allow access to maternity leave and any applicable maternity pay. She may therefore reach her educational CCT milestone and become a fully qualified GP during maternity leave, while remaining employed under the extended training contract for the duration of that leave. These are two separate timelines: the CCT date is an educational milestone, and the employment contract for maternity purposes is an employment protection and pay entitlement. Once maternity leave ends, the training contract would usually then come to a close unless another substantive role has been arranged.
2. What if she gives birth a week after her EDD? Entitlement to maternity pay is based on the expected week of childbirth, not the actual birth date. Provided the qualifying week falls at a point when she still has 12 months' continuous NHS service, pay entitlement is unaffected by a late birth. She does not need to return to the same trust or practice after leave and can apply for a placement in a different practice or deanery. The BMA also notes: "If there is no right to return to be exercised because the contract would have ended if pregnancy and childbirth had not occurred, the repayment provisions will not apply." This means if the training contract would have ended regardless, she is not required to repay OMP on the basis of that expired contract.
A doctor finishing her final year of specialty training has a consultant post lined up for the summer. She wants a short unpaid gap of three to four weeks between the two jobs. She is also pregnant.
Continuous NHS service: A short gap between two substantive NHS posts does not necessarily break the continuity that matters for OMP eligibility, particularly if it is a planned transition. Whether continuity is preserved depends on how the gap is categorised; confirm in writing with both trusts before anything is signed.
The SMP earnings risk: SMP is calculated by looking at what you actually earned during a specific 8-week window around week 25 of pregnancy. If those three or four weeks of unpaid leave fall inside that reference window, weeks of zero income will be included in the average, producing a meaningfully lower SMP rate, even if the new consultant salary is substantially higher. The fix: time the gap so it sits outside weeks 17 to 25 of pregnancy, or structure the transition differently. Speak to a BMA adviser before confirming your start dates with either employer.
Things you can actively do (and not do) to protect and increase your entitlement.
You must notify your employer that you're pregnant and your intended start date for maternity leave by the end of the 15th week before your EWC. Earlier notification is always better, as it triggers your employer's obligation to act and prevents any delays.
You'll need: a MATB1 form (given by your midwife or GP after week 20), a letter stating your intended start date, and confirmation of your intended return date (provisional is fine). Get everything in writing and keep copies of all correspondence.
If you do locum shifts that are paid via your main trust payslips (as opposed to a separate agency), those earnings are included in your SMP calculation window. Doing additional shifts during weeks 17–25 of pregnancy will increase your average weekly earnings and therefore your SMP rate during weeks 1–6 of maternity leave (the 90% rate).
Reimbursed expenses, including mileage and travel allowances, are excluded from the SMP earnings calculation. Only your gross pay is counted. Don't confuse the two when estimating your SMP rate.
Annual leave continues to accrue during all 52 weeks of maternity leave, including the unpaid period. How much you accrue depends on your length of NHS service:
This means that if you take a full year of maternity leave, you could return with 35 to 40 days of paid leave to use. Plan to arrange these with the HR coordinator of your new rotation before you return. Note also that annual leave continues to accrue during any annual leave you take on return; so if you use accrued leave directly after maternity leave, you are still accruing further leave during that period.
OMP is paid on the basis that you intend to return to NHS employment for at least 13 weeks after maternity leave. This is more flexible than many doctors realise:
Roles that may satisfy the 13-week return requirement include: trust grade doctor, clinical fellow, locum bank contract (depends on trust wording), GP training post, specialty training post, or another substantive NHS role. If you are unsure whether your specific situation qualifies, ask HR in writing before your leave starts.
Ask HR in writing before leave starts: "If my contract expires during maternity leave, do I need to repay OMP? Can return to another NHS employer satisfy the 13 weeks? What evidence would you need?" Getting this confirmed in advance avoids any nasty surprises on return. Remember: the BMA state that "If there is no right to return to be exercised because the contract would have ended if pregnancy and childbirth had not occurred, the repayment provisions will not apply."
Most MDOs (MDU, MPS, MDDUS) treat maternity leave as a career break and do not require you to pay full subscriptions during this period. Many doctors continue paying unnecessarily; over a full year this is hundreds of pounds wasted. Contact your MDO before going on leave to apply for a career break discount or suspension, and remember to reactivate before your first clinical shift on return.
Similarly, the GMC offers reduced registration fees during periods of non-practice. Write to them before your leave starts to apply; it is a simple process and worth doing.
Many doctors participate in salary sacrifice schemes without giving them much thought: cycle to work, pension contributions, childcare arrangements. But salary sacrifice works by reducing your gross pay, and it is your gross pay that forms the basis of your SMP calculation. If your sacrificed salary is being deducted during the 8-week earnings window around week 25 of pregnancy, your average weekly earnings will look lower than they actually are, which means a lower SMP rate. Suspending the sacrifice temporarily before that window opens is a simple step that could meaningfully improve what you receive. Speak to your payroll team before making any changes, as the process varies by trust.
The moment your midwife confirms your pregnancy, ask them to complete a FW8 form so you can apply for your Maternity Exemption certificate. This entitles you to free NHS prescriptions and free NHS dental treatment from the point your pregnancy is confirmed right through to 12 months after your baby is born.
Most doctors know they have 10 Keeping In Touch days during maternity leave. Far fewer know that when you use them makes a significant financial difference.
A KIT day is paid at your full basic daily rate regardless of when in your leave you use it. But during the first 26 weeks of maternity leave, you are already receiving either full or half pay. A KIT day taken during that period simply tops up pay you are largely already receiving, so the financial benefit is minimal. Save your KIT days for the nil-pay period, months 9 to 12 of your leave, when you are receiving nothing. Ten KIT days in the nil-pay period could add over two weeks' worth of income at a time when your bank account needs it most.
KIT days cannot be used during the two weeks of compulsory maternity leave immediately after birth. They can be taken at any other point during maternity, parental, or adoption leave. They cannot be taken during your accrued annual leave period once parental leave has officially ended. Both you and your employer must agree to each KIT day in advance; never attend without written confirmation.
If you are using KIT days or SPLiT days to do any clinical work, contact your medical defence organisation before you attend. Your standard membership may be suspended during leave, and you need to confirm you have the appropriate cover in place before you see a single patient.
Let your employer know in advance. Before you work a KIT day while breastfeeding, your employer is required to carry out a risk assessment and ensure appropriate facilities are available, including a private space to express milk that is not a toilet, somewhere to store expressed milk, and more frequent rest breaks.
Use this calculator to work out your key maternity dates and estimated pay based on your personal circumstances. All calculations are approximate; always verify figures with your HR department.
Your printable action plan. Use this alongside the earlier chapters.
Check your NHS service start date. Calculate your 12-month OMP eligibility date. Inform your midwife/GP. Contact MDO to check membership status. Join childcare waiting lists early; some nurseries have waiting lists of 1–2 years.
Your midwife or GP issues this after week 20. Keep it safe; you'll need it for your maternity leave application.
Submit your MATB1, notification letter, and intended start/return dates to HR. This is a legal deadline; do not miss it. Confirm your SMP eligibility at this point.
Your SMP rate is calculated from payslips in this window. Check that no locum/agency shifts are being miscoded. If a pay rise is due, ask HR to recalculate. Avoid unpaid leave in this window.
Discuss ARCP/portfolio requirements with your educational supervisor. Suspend MDO membership. Write to GMC to apply for reduced fees. Confirm your first payslip structure with HR. Apply for SuppoRTT if needed.
You can start maternity leave from this point. Most doctors work until 36–38 weeks if healthy, but this is your earliest option.
Notify your deanery of your return date (8 weeks notice is safer). They will confirm your next rotation. Then contact the HR coordinator of that new rotation to arrange annual leave, bank holidays, and any KIT days. Apply for LTFT if returning part-time (minimum 16 weeks notice required; apply as early as possible).
These are the errors that cost doctors money, time, or both. Real mistakes, real consequences, all avoidable.
The mistakes in this chapter are not theoretical. They are the ones that come up again and again in forums, Facebook groups, and BMA helpline calls. Most of them are invisible until it is too late. None of them need to happen to you.
| Mistake | What Goes Wrong | How to Avoid It |
|---|---|---|
| Missing the qualifying week notification deadline | If you notify HR too late, you may lose your right to OMP entirely. HR will not chase you. | Notify HR before week 25 of pregnancy, ideally by week 20 once your MATB1 is available. |
| Assuming NHS service equals trust service | Trusts sometimes wrongly tell rotational trainees they don't qualify for SMP or OMP because they haven't worked there long enough. Continuous NHS service, not trust service, is what matters for OMP. | If HR tells you that you don't qualify, push back. Ask them to confirm in writing which clause they are applying. If in doubt, call the BMA. |
| Not requesting OMP recalculation after a pay rise | If your pay increases after the SMP calculation window but before your leave starts, your OMP can be recalculated, but only if you ask. | Contact HR proactively after any pay change. Ask: "Will this affect my maternity pay calculation?" |
| Forgetting the 13-week return rule | If you don't return to any NHS job for 13 weeks after maternity leave, you repay the difference between OMP and SMP; potentially thousands of pounds. | Annual leave on return counts. Even a part-time or locum NHS role can satisfy it. Confirm with HR what counts before you leave. |
| Thinking you must physically return to the same trust | Many doctors delay returning or turn down other NHS work because they think they must return to the original trust. You don't. | Understand that trust grade, clinical fellow, and other NHS roles can all satisfy the return obligation. Ask HR for written confirmation. Remember: if your contract would have ended regardless of pregnancy, the BMA confirm repayment provisions will not apply. |
| Continuing to pay MDO and GMC fees during leave | Full MDO membership and GMC registration fees during a year of non-practice adds up to hundreds of pounds unnecessarily. | Contact your MDO before leave starts to apply for a career break. Write to the GMC to apply for reduced fees during non-practice. |
| Not getting payroll re-added before annual leave starts | Trust HR forgets to re-add you to payroll before your accrued annual leave begins. You don't get paid. Chasing it retrospectively takes weeks. | During the unpaid period of maternity leave, contact payroll at your new trust to confirm you will be re-added to payroll before annual leave starts. |
| Leaving LTFT application too late | Minimum 16 weeks notice is required. Miss the window and you lose a full rotation cycle, often 6 months. | Apply as early as possible; the moment you know you want LTFT, submit the application and tell your TPD at the same time. |
| Asking for OMP to be averaged and paid equally across 12 months | While this averaging option exists in principle, some trusts refuse the request. It can also lead to errors in pay particularly if KIT days are worked during the same period, as the calculation becomes more complex. | Be aware this option exists but is not guaranteed. If your trust agrees, verify the figures carefully on each payslip and flag any discrepancies immediately. |
Copy, adapt, and send. Always follow up verbal answers with an email to confirm in writing.
Below are ready-to-use email questions. Copy, adapt, and send. Always follow up verbal answers with an email: "Following our conversation today, I just wanted to confirm in writing that..."
"I am a rotational trainee and have worked continuously in the NHS since [date], across [Trust A] and now [Trust B]. Can you confirm in writing that my continuous NHS service for OMP eligibility purposes runs from [date], not from my start date at this trust?"
"I understand OMP is conditional on returning to NHS employment for 13 weeks. Can you confirm whether returning to any NHS employer (including trust grade or locum bank work) would satisfy this requirement, and whether accrued annual leave taken on return counts towards the 13 weeks?"
"Can you confirm whether my deanery operates a lead employer model, and if so, which trust is my lead employer for the purposes of SMP continuity?"
"Can you confirm how many days of annual leave I will have accrued during my maternity leave, including the unpaid period, and when I can take this on return? Please include bank holiday entitlement."
"I have recently received a pay increase / expect an ARCP pay progression. Can you confirm how this will affect my maternity pay calculation, and whether my OMP should be recalculated accordingly?"
"My current contract is due to end on [date] during my maternity leave. Can you confirm in writing: (a) whether I am still required to satisfy the 13-week return obligation, (b) whether returning to a different NHS employer would satisfy this, and (c) whether I would need to repay any OMP if I do not return?"
"My qualifying period spans two trusts due to my rotation date. Please can you confirm that payslips from both trusts will be included in my SMP earnings calculation, and that any annual leave payments from my previous trust are also factored in?"
"I am due to return from maternity leave on [date] and have accrued annual leave to use immediately on return. Can you confirm that I will be re-added to payroll before [annual leave start date] so that I receive my pay during that period without interruption?"
Now that you understand the NHS pay system and how to financially protect yourself, it is worth knowing that some circumstances come with an additional level of support and protection. This chapter covers what happens when pregnancy does not follow the expected path.
If your baby is born before 29 weeks, the rules around when your maternity leave starts differ slightly:
From April 2025, a new statutory entitlement exists for parents of babies who require neonatal care after birth. If your baby is admitted to hospital for neonatal care within the first 28 days of life and stays for at least 7 consecutive days, you may be entitled to additional neonatal care leave and pay on top of your maternity leave entitlement. This is a separate pot; it does not eat into your maternity leave. Full details and current eligibility criteria are available at gov.uk/neonatal-care-pay-leave.
If your baby is stillborn after the end of the 24th week of pregnancy, you are entitled to the full amount of maternity leave and pay as if your baby had been born alive, under section 15.32 of the NHS Terms and Conditions of Service. Grief does not have a schedule, and you should not feel pressured to return before you are ready. If you need more support, your occupational health department, your educational supervisor, and organisations such as Sands (the stillbirth and neonatal death charity) are available to help.
If you suffer a pregnancy loss before 25 weeks, it is classified as a miscarriage under section 15.33 of the NHS Terms and Conditions of Service, and normal sickness absence provisions apply. You are entitled to time off to recover and your employer should treat this with sensitivity. If you need more support than sick leave allows, speak to your occupational health department or educational supervisor. The Miscarriage Association (miscarriageassociation.org.uk) also offers dedicated support.
The official sources you should know about, and where to turn when things go wrong.
Comprehensive guidance on maternity rights for NHS doctors, including pay, LTFT, and contractual rights.
bma.org.ukOfficial terms and conditions, maternity guidance, pay circulars, LTFT calculators, and SMP guidance for rotational trainees.
nhsemployers.orgSMP rates (updated each April), eligibility checker, and Maternity Allowance application.
gov.uk/maternity-pay-leaveStatutory neonatal care leave and pay for parents of babies who require neonatal hospital care. A separate entitlement that sits outside your maternity leave pot.
gov.uk/neonatal-care-pay-leaveLTFT applications, SuppoRTT referrals, and local guidance. Find yours via NHS England's website.
hee.nhs.ukYour pension contributions and employer contributions continue during paid maternity leave. Check the NHS Pensions Agency for unpaid leave rules.
nhsbsa.nhs.uk/nhs-pensionsSupported Return to Training programme for doctors returning after 3+ months absence. Apply through your deanery.
hee.nhs.ukSupport and information for pregnancy loss, including early losses and chemical pregnancies.
miscarriageassociation.org.ukIf your trust is disputing your entitlements, miscalculating your pay, or treating you unfairly around maternity or LTFT, contact the BMA's employment advisers. This is exactly what your membership fees are for. They are free, confidential, and genuinely helpful.
The NHS is not always easy to navigate, especially when you're exhausted, emotional, and dealing with one of the most significant life events there is. You deserve to understand your rights and to get everything you're entitled to. Don't be afraid to ask questions, request information in writing, and push back when something doesn't seem right. You know how to advocate for your patients. Learn to advocate for yourself too.
You've got this. Dr. Naomi Cave-Browne-Cave
The return is often under-planned. It shouldn't be, and it doesn't have to mean going back full-time.
You must give your employer at least 28 days written notice of your return date, though 8 weeks is safer in practice. The process for rotational trainees works like this: you notify your deanery of your return to work first; they will confirm your next rotation. You then notify the HR coordinator of that new rotation to arrange KIT days, annual leave, and bank holiday dates. If you want to return later than originally planned, you can extend up to 52 weeks total without requiring approval.
You are entitled to up to 10 Keeping in Touch (KIT) days during your maternity leave; days where you can do work without it technically ending your leave or affecting your pay. They are not compulsory, and both you and your employer must agree to each one in advance. They are usually paid at your basic rate for hours worked. KIT days can be valuable for attending mandatory training updates (CPD, ALS), portfolio reviews or ARCPs, or simply easing back in gradually before your formal return.
Never turn up for a KIT day without written prior agreement. Any work done without agreement could be treated as a return to work, ending your maternity leave and cutting your remaining pay. An email confirmation is sufficient, but always get it before attending.
If you work a KIT, SPLiT, or SuppoRTT day, you can apply to your trust for additional funding to cover any childcare costs incurred in order to work. Payment is at the discretion of the trust, but it is worth asking, even if it is not guaranteed.
Your best option on return is to use your accrued annual leave before resuming full clinical duties. You accrue annual leave throughout all 52 weeks of maternity leave, including the unpaid period, and you continue to accrue during any annual leave you take immediately on return. After a full year of maternity leave, you could return with 35 to 40 days of paid leave to use. Arrange these with the HR coordinator of your new rotation before your return date.
Question: I worked full time before maternity leave, then went on maternity leave and continued to accrue annual leave during that time. After maternity leave ended, I took a period of annual leave immediately afterwards instead of returning straight to work. During that annual leave period, I also continued to accrue further annual leave. I was then planning to return to work at 60% LTFT. Could all of this leave be used on my new 60% rota effectively giving me more time off?
Answer: No. If your contract remained full time throughout maternity leave and the annual leave taken afterwards, that leave would normally continue on your full-time terms. Annual leave continues to accrue while you are taking annual leave. Your LTFT change only starts on your official return-to-work date; leave accrued before that point is usually still full-time leave. Only leave accrued after the LTFT change moves to the 60% rate.
After ordinary maternity leave (the first 26 weeks), you have the right to return to the same job. After additional maternity leave (weeks 27–52), you have the right to return to the same or a suitable alternative job on the same or better terms. For rotational trainees, your next training post is determined by your deanery rotation schedule; it is possible your trust or placement will change, but the principle of being treated fairly on return still applies across trusts.
Returning from maternity leave is one of the most common and well-supported reasons to apply for Less Than Full Time training. LTFT allows you to complete your training at a reduced percentage of full-time hours, typically 50–80% FTE, while completing all the same competencies; it simply takes longer.
Key things to know if you are considering LTFT on return:
Let your educational supervisor know your return plans well in advance. They can help flag any portfolio or competency requirements to complete before leaving, and can support ARCP planning around your return date.
NHSE and many deaneries offer SuppoRTT programmes for trainees who have been out for 3 or more months. These can include refresher placements, supernumerary time, coaching, and formal supported return plans. Ask your deanery about SuppoRTT well in advance of your return, as these programmes have limited capacity and require forward planning.
I personally used my SuppoRTT entitlement. I accessed coaching which helped me enormously in terms of my identity as a working mother, setting boundaries, and feeling confident about returning. I also used supernumerary days at the beginning of my return, which helped ease the transition enormously. If it's available to you, use it.
Returning to medicine after maternity leave, especially with a young baby or children, is genuinely hard. Clinical confidence wavers, energy is limited, and the emotional transition is significant. SuppoRTT exists because the profession recognises this. Use every resource available to you. You are not behind; you are returning.
This is one of the most practically important things in this guide, and often one of the least discussed. Childcare waiting lists at nurseries can be 1 to 2 years long. If you are planning to use nursery care, join waiting lists as early as possible, ideally in the first trimester. I found out I was pregnant with twins and booked a nursery place when I was just 16 weeks pregnant.
When you return to work you will be required to do night shifts and on-calls, some of which may fall on your non-working days. If your baby is not in nursery on those days, make sure you have a backup contact: a nanny, babysitter, or trusted friend or family member, whose number you can call. Living without family support nearby with twins on the way meant I had to plan this very carefully.
When you return to work as a breastfeeding mother, your employer has obligations to you under workplace health and safety regulations. A risk assessment must be carried out to identify any adjustments needed to your working pattern or environment. If your normal working pattern would prevent you from successfully breastfeeding or endanger your health, adjustments must be made; and those adjustments are pay protected. You cannot be penalised financially for needing to express milk or adjust your hours.
In practical terms, your trust is required to provide:
When you complete your SuppoRTT pre-return form with your educational supervisor, this is the right moment to raise breastfeeding needs. Your supervisor can carry out the risk assessment at that meeting, or refer you to occupational health. Don't wait until your first day back to raise it; by then the rota is set and adjustments are harder to make.
Parental leave isn't just for the person who gave birth. Here is what your partner is entitled to, and how you can share the leave between you.
You can choose to split your maternity leave between you and your partner. This chapter explains how.
New Parent Support Leave is the NHS occupational equivalent of paternity leave. It applies to the father of the child, or the mother's partner or spouse, regardless of sex or gender.
To qualify, your partner needs 12 months of continuous NHS service by the qualifying week. If they meet this threshold, they are entitled to 2 weeks of fully paid leave (minus the value of statutory paternity pay). The pay amount is calculated in the same way as maternity leave; based on average weekly earnings from the two payslips preceding week 25 of pregnancy.
If your partner doesn't yet have 12 months continuous NHS service, they are still entitled to statutory paternity leave; also 2 weeks, paid at 90% of average weekly earnings or the standard statutory rate, whichever is higher. This applies even for multiple births; you only get one period of 2 weeks regardless of how many babies arrive. If your baby is stillborn after 24 weeks, or dies after birth, the entitlement to 2 weeks still remains.
Shared Parental Leave allows you and your partner to split the 52 weeks of parental leave between you, rather than the mother taking all of it as maternity leave. It exists to give families flexibility, and to recognise that many partners now take on an equal or primary caring role.
To use SPL, the parent requesting it must have 12 months continuous NHS service by the 11th week before the due date. The other parent must meet a statutory employment and earnings test; broadly, they must have been employed or self-employed for 26 out of the 66 weeks preceding the expected week of childbirth, and earned at least £30 a week for 13 of those weeks.
If you request one single continuous block of SPL, your employer cannot refuse it. This is worth knowing if you are concerned about flexibility on the trust's part. Plan your single block request carefully, and you have certainty.
Say the mother takes 19 weeks of maternity leave. That leaves 33 weeks of SPL to share (19 + 33 = 52). Her partner takes 10 weeks of SPL directly after her maternity leave ends. The mother then returns to work while her partner is on leave. The mother then decides to take the remaining 23 weeks of SPL after her partner returns. The partner separately takes 2 weeks of new parent support leave immediately after the birth, which sits outside the SPL pot entirely.
This kind of arrangement gives both parents extended time at home with the baby while allowing career continuity for both. It is worth planning carefully with HR well in advance, as the paperwork and notice periods need managing.
A common and frustrating problem: HR at the new trust forgets to re-add you to payroll before your accrued annual leave period begins. This means you do not get paid during your annual leave, even though you are entitled to it. Touch base with payroll during the unpaid part of your maternity or SPL to confirm the return to payroll is being set up in time.
A final word from the author.
The NHS is extraordinary. It is also, at times, bewildering to navigate — particularly when you are pregnant, exhausted, and trying to figure out whether the HR advice you just received is actually correct. This guide exists because too many doctors have lost money, missed entitlements, or returned to work before they were ready, simply because no one gave them the full picture.
What I hope you take from this is not just the facts, but the confidence to use them. To ask the questions. To push back when something does not seem right. To take every week of leave you are entitled to without guilt.
You have spent years learning to advocate for your patients. This is your permission to advocate for yourself with the same rigour.
A few things worth remembering as you close this guide:
Pregnancy in medicine is not a career setback. It is a chapter; one that comes with its own challenges, its own joys, and, as it turns out, its own surprisingly complex pay structure.
You've got this.
Dr. Naomi Cave-Browne-Cave
Quick answers with links directly to the relevant section of this guide.
Each question below links directly to the relevant section. Click the question or the arrow to jump straight there.
No. You have a legal right to paid time off for all antenatal care, including recommended classes, without needing to use annual leave. Read more →
When you tell your employer you are pregnant, they are legally required to carry out a pregnancy risk assessment. This is how adjustments such as coming off nights or on-calls are arranged. Read more →
No. If your working pattern is adjusted during pregnancy your pay must remain the same. If the trust cannot accommodate suitable alternative work, you must be suspended on full pay. Read more →
Pregnancy-related sickness is treated separately from standard sick leave and will not normally count against your sickness record. The rules change in the final four weeks before your due date. Read more →
No. If you are due to rotate after week 29 of pregnancy, you are entitled to choose to remain at your current trust until you give birth, with your contract extended accordingly. Read more →
OMP is the enhanced NHS maternity pay package. To qualify, you need 12 months of continuous NHS service by around week 29 of pregnancy and must intend to return to NHS work for at least 13 weeks. Read more →
SMP is the government-funded statutory minimum, paid for up to 39 weeks. It requires 26 weeks of continuous service with the same employer by the qualifying week. Rotational trainees have additional protections. Read more →
Your official due date is confirmed at your 12-week scan and determines your qualifying week and all key pay dates. Even a few days' difference can shift important deadlines. Read more →
Not necessarily. Trainee protections mean your current employer may be required to pay the SMP equivalent even if you changed trust during training. Check your lead employer arrangement early. Read more →
You may still be entitled to Maternity Allowance, a government benefit paid through HMRC. Unlike SMP, it is non-taxable, and it is available even with a limited employment history. Read more →
OMP eligibility is assessed at week 29 of pregnancy; SMP eligibility at week 25. Your SMP pay rate is based on earnings in the 8-week window ending around week 25. Read more →
Yes, in many cases. Gaps of up to 3 months, approved career breaks, overseas training, and previous parental leave can all preserve continuity. The rules are broader than most doctors realise. Read more →
Under section 15.23 of the NHS Terms and Conditions, your SMP should be calculated on your notional full sick pay for that period, not on reduced earnings. Raise this with HR if it applies to you. Read more →
Yes. Both payslips and any annual leave payments from your previous trust should be included in your SMP calculation. Flag this explicitly with HR at your new trust. Read more →
If you have already triggered maternity entitlement while employed, your contract is normally extended for maternity purposes. The BMA also confirms that if the contract would have ended regardless of pregnancy, OMP repayment provisions do not apply. Read more →
Chapter 5 covers everything: notifying on time, locum strategy, salary sacrifice, suspending MDO and GMC fees, and KIT day timing. All designed to help you keep as much as possible. Read more →
Save them for the nil-pay period, months 9 to 12. A KIT day during the paid period adds very little; a KIT day in the unpaid period adds a full day's income when you need it most. Read more →
Yes. Use the interactive calculator in Chapter 5 to estimate your qualifying dates, pay periods, and accrued annual leave based on your own details. Read more →
Use the Table of Contents to browse by chapter, or contact the BMA's employment advisers for personalised guidance at bma.org.uk
Written by a resident doctor who lived this, for every doctor who doesn't want to piece it together alone.
This guide is for informational purposes only. Always verify entitlements with your HR department, deanery, and the BMA. Information correct at time of writing; check NHS Employers for current figures.
© Dr. Naomi Cave-Browne-Cave 2026 | All rights reserved