For each academic or fiscal year, which begins on July 1, you receive a contractual increase.  When you are promoted to the next post-graduate year of training, you receive a promotional increase which recognizes your increased responsibility and value to the organization.  Typically, these happen simultaneously.  However, sometimes they do not.  Even though the graphic depicts steps moving down, your pay is going up! For those that reach the HO9 level, there is no higher level, so your increase is strictly based on the contractual yearly increase.  

If you've taken a leave of absence or have an off-cycle appointment, your promotional increase will be delayed until you meet the requirements of your current House Officer level.  Your contractual increase is awarded yearly on July 1, so you will always receive that increase in your July 30 pay.

Your Lump Sum is 10 % of your yearly salary and is in addition to your salary and bargained to encourage savings, in lieu of a structured retirement fund.