As an ST4, you are likely paying for GMC, BMA, medical indemnity, your college and maybe a portfolio or exam.
A typical ST4 pays £1,367 to £2,142 a year on these, depending on specialty. £522 to £1,273 of it can come back from your trust and HMRC, if you keep the receipts.
Estimates from published fees for a typical full-time ST4 passing first time. Yours might differ. Fees checked on against each body’s own fee page.
ST4 take-home pay after tax and NHS Pension ›ST4 tax rebate on fees, back four years ›
What you pay, receipt by receipt
Three fees come with every ST4, whatever the specialty. The GMC charges an annual fee to keep you registered. The BMA charges for membership. Medical indemnity is an estimate, because the MDU, MPS and MDDUS each quote individually.
That is £1,200 a year before any college, portfolio or exam. All three count for tax back: HMRC returns the income tax you paid on that money, once you claim it.
GMCreceipt.pdf
GMC annual fee
With a licence to practise
Total£481.00
✓ HMRC tax back
BMAcard statement
BMA membership
Annual subscription
Tax back on 85% of the fee
£34.92 a month
Total£419.00
✓ HMRC tax back
Then your college and exam, by pathway
What comes next depends on your specialty. These five are shown: medicine, surgery, anaesthetics, obstetrics and gynaecology, and paediatrics. Each adds a college fee, and surgery adds a portfolio fee; both count for tax back. Anaesthetics and obstetrics and gynaecology also add an exam, which your trust pays back for the first two attempts.
Medicine, surgery and paediatrics have no exam in a typical ST4 year, so the trust pays back nothing there. The last slip in each row adds it all up, with the three fees above.
Medicine one more receipt
ST4 · Medicinea typical year, with the three costs above
You pay in total£1,367
HMRC, 40%£522
Surgery two more receipts
RCS Englandforwarded email
Membership
Standard member rate
Total£336.00
✓ HMRC tax back
ST4 · Surgerya typical year, with the three costs above
You pay in total£1,806
HMRC, 40%£697
Anaesthetics two more receipts
RCoAreceipt.pdf
Membership
Anaesthetist in training
Total£207.00
✓ HMRC tax backFinal FRCA SOEbooking email
Exam fee
First two attempts
Jun 2027 sitting
Total£735.00
✓ Your trust pays backST4 · Anaestheticsa typical year, with the three costs above
You pay in total£2,142
Your trust£735
HMRC, 40%£538
Obstetrics and gynaecology two more receipts
MRCOG Part 3booking email
Exam fee
First two attempts
May 2027 sitting
Total£645.00
✓ Your trust pays backST4 · Obstetrics and gynaecologya typical year, with the three costs above
You pay in total£2,007
Your trust£645
HMRC, 40%£520
Paediatrics one more receipt
RCPCHreceipt.pdf
Membership
Ordinary member in training
Total£388.00
✓ HMRC tax backST4 · Paediatricsa typical year, with the three costs above
You pay in total£1,588
HMRC, 40%£610
Logos belong to their owners and show where each fee goes. Reimbsr is not affiliated with these bodies.
Who pays you back
Two places pay you back, and neither does it unless you ask. Your trust pays back an exam once you send a claim, if your pathway has one this year. HMRC gives tax back on the other fees once you ask.
The exam, where there is one
This covers the first two attempts, for sittings from 1 April 2026. You pay the College as usual, then claim it back from your employer with the College receipt showing the fee and the sitting date.
From April 2027 your trust pays back royal college membership and portfolio fees too. Until then, they count for tax back instead.
GMC, BMA, medical indemnity, college and portfolio
On fees you pay yourself, HMRC gives back tax at your income tax rate. The estimate uses 40% for an ST4. For the BMA, it counts 85% of the subscription.
You claim on the P87, HMRC's form for claiming tax back on work costs you pay yourself (like GMC and BMA fees). It covers this tax year and the last four. Over £2,500 in a year, you use Self Assessment instead.
Claiming is easy. Proving it, a year later, is not.
On top of the GMC, BMA and medical indemnity come a college fee and perhaps an exam, each to a different body on a different date. Where there is an exam, your trust wants the College receipt with the fee and the sitting date, and if you wait until you rotate, its claim window can close first. In a year with no exam, it is easy to forget the rest still counts for tax back.
- The exam receipt is in an old email, or on a booking site you no longer log in to.
- You cannot say which attempt it was, and your trust pays for the first two.
- In a year with no exam, nothing reminds you to keep the college receipt.
- The P87 means finding a year of statements in one sitting.
Keep each receipt the day it arrives, and the claim is ready when you are.
Reimbsr keeps the proof from the day you pay
If your pathway has an exam, the College receipt and sitting date are already there, and Reimbsr nudges you before the claim window closes. At the end of the tax year, your GMC, BMA, medical indemnity, college and portfolio fees are ready for your tax back.
- Snap it or forward itSnap the receipt, forward the email to your own Reimbsr address, or add a drive. It reads the amount, date and claim deadline for you.
- See who pays you backEach expense is sorted into what your trust pays back and what HMRC gives tax back on, with the rule behind it. Not sure? Ask Reimbsr. It answers from published NHS and HMRC guidance, with sources, and in a grey area writes the question for you to send to medical staffing.
- Check it, then send itReimbsr builds one PDF with every line and receipt, and drafts the email to whoever approves your expenses. You check it and send it from your own email.
- Get your tax backIt fills in your P87 at the end of the tax year, on Free and Pro, so you get tax back on the fees your trust does not pay.
Doctors like you (ST4) are typically eligible for up to £735 reimbursed and £520 to £697 back as tax relief a year.It will be free to try; you may never need to upgrade. Pro is £49.99 a year (£0.96 a week), only if it saves you more than it costs. See pricing ›
Free to start. Upgrade only if it pays.
In keeping with making financially savvy decisions, Reimbsr will be free to try. Only upgrade to the Pro version (£0.96 a week) if you think the app can help you save more money than it costs.