The expertise of thousands of the NHS’s most senior doctors has potentially been lost over the last year due to consultants and GPs reducing work over fears about pension taxation, according to a survey by the BMA.
The survey of more than 5,000 doctors found that significant proportions of senior doctors have reduced their work commitments by such an amount that, if replicated across the wider workforce, would be equivalent to the loss of around 5,400 full-time consultants. That is almost 10% of capacity that could be offered to the NHS in England to tackle waiting lists this year. For GP partners, the reduction in hours represents a potential loss of around 4 million appointments.
The problem largely centres on the tapered annual allowance (AA). The standard annual allowance is the amount by which doctors’ pensions can be deemed to grow before being subject to additional tax charges. The taper is a mechanism whereby this allowance decreases when doctors’ earnings exceed certain thresholds. This taper can be triggered by taking on extra work, such as initiatives to clear waiting lists, creating a 'cliff-edge' where earning as little as £1 more can result in an additional tax bill of £22,500, which would mean the doctor would be literally paying to work. Almost all of this extra work is non-pensionable, meaning it also does not result in increased pension benefits on retirement.
For consultants responding to the survey, 1 in 5 (21%) said they had reduced their 'regular overtime' this year due to the tapered AA, with reductions averaging 1.4 sessions or programmed activities a week. Additionally, almost 1 in 6 (16%) consultant respondents have gone part time this year due to the tapered AA, with reductions averaging 1.9 sessions. A full-time consultant works 10 sessions per week. Combined, these regular hours reductions represent potential lost capacity equivalent to around 3,500 consultants in England this year alone.
Almost 1 in 4 (24%) reduced their ad hoc overtime sessions to clear waiting lists due to the tapered AA, with reductions averaging 5.1 hours a week. This implies a potential loss of around 3.2 million hours of work that would have been offered to the NHS in England this year alone, equivalent to around 1,900 full-time equivalent consultants’ worth of work.
Combined there has already been a potential loss of capacity of around 5,400 consultants' worth of activity – i.e. 9.3% of the total consultant workforce in England this year alone.
Almost 1 in 4 (23%) reduced their regular workload this year due to the tapered AA, with reductions averaging 1.7 sessions per week. This implies a potential loss of around 4 million GP partner appointments in England this year alone.
In June 2024, a snap survey of BMA members showed 71% of all respondents indicated that if there were no reforms to the tapered AA, this would prevent or limit their ability to take on additional overtime. The new results show that this has come to fruition.
BMA pensions committee chair, Dr Vishal Sharma, said: “It is an absurd situation when the Government is promising to bring down near-record waiting lists, yet doctors are being forced by complex and unfair pension tax rules to turn down or reduce extra work. Doctors want to do more to help patients and do as much as they are able to, but no one should be expected to pay to work, which is the bizarre scenario that this cliff edge can create.
“These survey results, from more than 5,000 doctors in the UK, show that this a real, not hypothetical, issue affecting the capacity in hospitals and GP practices right now.
“We’re urging the Government, ahead of next week’s Spring Statement, to urgently address this head on, by removing the annual allowance taper. This would be one of the quickest and most cost-effective ways of increasing NHS capacity whilst still ensuring fairness for the taxpayer as higher earners would still have limits on tax relief via the standard annual allowance.
“It would maximise the amount of work doctors can do, particularly at a time when patient demand is outstripping the number of doctors available to treat them, and be a huge step forward in the Government’s attempt to bring down waiting lists.”
