Accountants for Healthcare & Medical Professionals —
Compliance, NHS Pension & Private Practice Tax
Specialist accountancy for UK healthcare professionals — GPs, dentists, consultants, locum doctors, nurses and private practice owners. NHS pension annual allowance checks, partnership accounts, CQC financial compliance, private practice income structuring and Making Tax Digital. ACCA qualified. Fixed fee.
Healthcare Accounting — The Unique Tax Landscape of UK Medicine
Healthcare professionals face a unique set of tax and financial complexities not encountered in other sectors — the NHS pension annual allowance charge, tapered annual allowance for high earners, partnership profit shares, the interaction of NHS and private income, CQC registration requirements, and for many doctors the recent decision between staying in the NHS pension scheme and building wealth through alternative structures.
NHS pension annual allowance is one of the most significant financial risks for senior NHS staff. The standard annual allowance is £60,000 (from 2023/24), but tapering reduces this to as little as £10,000 for the highest earners. Pension input above the annual allowance is taxed at marginal rates — for a consultant in excess of their annual allowance by £30,000, the annual allowance charge could be over £13,500. We check every healthcare professional client’s pension input annually and advise on Scheme Pays elections and carry forward utilisation.
GP partnerships have their own distinctive accounting requirements — NHS practice accounts, partner profit shares, item of service income, QOF payments, PCN income, enhanced services and the calculation of pensionable pay for each partner. We prepare full partnership accounts for GP surgeries, supporting both the practice manager and each individual partner’s Self Assessment.
Private practice income requires careful structuring — the interaction with NHS employment income, the VAT position of medical services (generally exempt but with complex exceptions for cosmetic procedures and non-diagnostic services), and the decision whether to practice privately as an individual or through a limited company. We model the optimal structure for each client’s specific NHS/private income mix.
✅ Services We Provide
- ✓ NHS annual allowance check (all grades)
- ✓ Tapered annual allowance calculation
- ✓ Scheme Pays election advice
- ✓ GP partnership accounts
- ✓ Partner Self Assessment returns
- ✓ Locum PAYE vs self-employed analysis
- ✓ Private practice income tax planning
- ✓ Medical Ltd company setup and management
- ✓ CQC financial compliance support
- ✓ VAT advice — medical services
- ✓ BMA and MDU subscription deductibility
- ✓ Expense claims — GMC, CPD, equipment
Our Approach — Sector-Focused, Results-Driven
Which Businesses We Serve — And How
GPs and GP Partners
GP practices and individual GP partners — partnership accounts, partner profit shares, NHS pension annual allowance checks and all individual partner Self Assessment returns.
Dentists and Dental Practices
NHS and private dental practices — practice accounts, dentist Self Assessment, associates’ earnings, specialist equipment capital allowances and dental VAT issues.
Consultants and Private Practice
NHS consultants with private practice income — income structuring, VAT position of private services, annual allowance for senior clinicians and private practice limited company options.
Locum Doctors and Agency Workers
Locum doctors working through agencies — PAYE vs self-employment analysis, IR35 assessment, expense claims and the tax treatment of agency fees.
4 Costly Mistakes in This Sector
Many healthcare professionals don’t check their annual allowance position until they receive a tax charge from HMRC — sometimes years later, with interest. We check every year as standard. Annual allowance checks are included in our healthcare package.
Healthcare professionals have above-average legitimate business expenses — GMC registration, medical defence subscriptions, BMA membership, CPD courses, professional journals, home office costs, specialist equipment and work-related travel. Many under-claim significantly.
Medical services provided for the diagnosis or treatment of medical conditions are generally VAT-exempt. However, cosmetic procedures, some health checks, medical reports for non-therapeutic purposes and certain services may be subject to VAT. Getting the VAT treatment wrong creates significant risk.
If you have an annual allowance charge, the Scheme Pays election (which allows the NHS pension fund to meet the charge instead of you personally) must be made by 31 July following the tax year. Missing this deadline means paying the charge from personal funds.
Healthcare & Medical — Your Questions Answered
The annual allowance limits the amount of tax-relievable pension saving in a year. For the NHS pension, the ‘input’ is calculated as the increase in the defined benefit value of your pension entitlement, multiplied by 16 (plus any additional voluntary contributions). Input above the annual allowance is taxed at your marginal rate. For senior clinicians with salary increases or significant career progression, annual allowance charges of £10,000-£50,000+ are not uncommon.
The tapered annual allowance reduces the standard £60,000 annual allowance for high earners. If your ‘adjusted income’ (broadly, income plus employer pension contributions) exceeds £260,000, the annual allowance is tapered at £1 for every £2 of income above that level, down to a minimum of £10,000. For NHS consultants and GPs earning above this threshold, the tapering significantly increases annual allowance charge risk.
It depends on the volume of private income, your NHS earnings and your plans for the income. A limited company can defer tax on retained profits (Corporation Tax at 19-25% versus personal income tax up to 45%) but has administrative overhead and potential issues with the NHS pension if practice income is ’employed’ rather than self-employed. We model both options for every private practice client.
Yes — locum doctors who are self-employed pay Class 2 NIC (voluntary from April 2024, but worth paying to protect State Pension entitlement) and Class 4 NIC on profits between the Lower Profits Limit and Upper Profits Limit. GP locums who work through agencies are sometimes treated as employees for PAYE purposes — the correct classification depends on the contractual arrangements.
Yes — GMC registration fees, BMA membership, medical defence union subscriptions (MDU, MPS), RCP/RCS/RCGP and other Royal College membership fees are all allowable professional subscriptions deductible against self-employment income. Continuing professional development (CPD) course fees directly related to your specialty are also deductible.
Fixed Fees — Agreed Upfront, No Surprises
Every fee fixed and agreed before we start. Book a free consultation for your exact quote.
Complete Your Accounting Package
Healthcare Accounting — NHS Pension, Private Practice & Full Tax Compliance
Book a free consultation. We’ll check your NHS annual allowance position, identify every available deduction and ensure your practice or self-employment tax affairs are fully optimised.