Intended for healthcare professionals


Locums withdrawing work in wake of tax change must consider impact on patients, GMC says

BMJ 2017; 357 doi: (Published 07 April 2017) Cite this as: BMJ 2017;357:j1785
  1. Abi Rimmer
  1. BMJ Careers
  1. arimmer{at}

Locum doctors who wish to withdraw their services from NHS trusts following tax changes should consider the impact of such action on patient safety, the General Medical Council has said.

Susan Goldsmith, deputy chief executive and registrar of the GMC, said, “We are aware that some locum doctors have told hospitals that they may withdraw services after new tax rules come into effect. While matters of pay and contracts are for individual trusts to resolve with those staff, our chief concern is patient safety.”

Goldsmith said that health services were under severe pressure and providers and doctors were working hard to cope with demand. “Any unreasonable withdrawal of staff may exacerbate that pressure, and we would expect doctors planning to withdraw their services to give sufficient notice in line with their contractual agreements,” she said.

On 6 April, IR35 legislation, which affects how people work through limited companies, was changed. The change means that locum doctors working through an intermediary, such as their own limited company, may have to pay more in tax.1 For public sector body engagements, it will become the responsibility of the organisation engaging the worker or the agency that they are working for to assess the tax and national insurance deductions that should be applied to the worker, and this will be done at source.

Goldsmith said that, to minimise disruption and reduce the risk to patient safety, doctors should adhere to the GMC’s Good Medical Practice guidance. She said, “That states: ‘Patient safety may be affected if there is not enough medical cover. So you must take up any post you have formally accepted, and work your contractual notice period before leaving a job, unless the employer has reasonable time to make other arrangements.’”

A spokesman for NHS Improvement said, “It is right and fair that NHS clinical staff doing the same job should be paying the same tax.

“These tax rule changes wouldn’t affect an individual if they were already paying the right amount of tax and it is unacceptable for anyone to hold the NHS to ransom or risk patient safety by refusing to work in an effort to pay less tax.”

He added, “We are also offering trusts support and advice with this, including help with workforce planning, rota management, and securing support for shifts from elsewhere in the local area. Some locums and agencies are working with us and medical directors to make sure that the locum market works well for staff and patients, tackling the culture that’s behind locums charging high rates. Our priority is to ensure services for patients continue as normal and we will review what support is needed on an ongoing basis.”

Danny Mortimer, chief executive of NHS Employers, said, ‘‘Employers are clear that they cannot absorb extra charges as a result of this change.”