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Feature Pensions

Cuts to pension tax relief deepen retention crisis for senior doctors

BMJ 2019; 364 doi: (Published 17 January 2019) Cite this as: BMJ 2019;364:l206

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  1. Stephen Armstrong, freelance journalist, London, UK
  1. stephen.armstrong{at}

Pensions feature prominently in the decision to retire early for many doctors, a new BMA survey has shown. Stephen Armstrong explains the problem

A survey published last week by the British Medical Association shows that six out of 10 consultant doctors (2446 out of 4089 respondents) are intending to retire from the NHS before or at the age of 60. The second biggest factor for this decision, after work-life balance, is current pension legislation. The survey also found that more than a third (36%) of consultants were expecting to reduce the number of days they work in the NHS by up to half (fig 1). More than 40% said they have or will stop taking part in initiatives to reduce waiting lists.1

Fig 1

Consultants’ responses to BMA survey, based on 4089 replies1

“There aren’t enough doctors in any specialism as it is,” argues Rob Harwood, chair of the BMA consultants committee and a consultant anaesthetist. “We expect that in 15 years’ time we’ll have 25% too few anaesthetists, and having spoken to other colleges I think that’s about average [for all specialties]—no one is saying they have enough people. Consultants are the most experienced members of a team—the most experienced, most efficient, and most cost effective.”

Huge tax bills

The new pension pressure on senior doctors identified by the BMA has been caused by a recent change to pension regulations that means many consultants are receiving huge tax bills and that these increase significantly if they work harder.

“Pension legislation has been changing—and deteriorating—for higher earners for years,” explains Andrea Sproates, head of Chase de Vere Medical, one of the UK’s largest independent financial advisers. “Previously only a doctor’s NHS pensionable income mattered. Now we have to look at every piece of taxable income—NHS work, private work, dividends, rental income, …

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