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Cuts to pension tax relief deepen retention crisis for senior doctors

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l206 (Published 17 January 2019) Cite this as: BMJ 2019;364:l206

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Re: Cuts to pension tax relief deepen retention crisis for senior doctors

Notification of change of private anaesthetic fees.

Recent tax changes have meant that doctors in a certain income band/bracket are subject to an effective tax rate of 94% on any extra income that they earn (https://twitter.com/BMANWRCC/status/1052112637721542657?s=09).

This means that for a private case - say lasting 2 hours, for which they might charge £500, £470 goes to the taxman. Thus for a 2 hour case, this means the profit is £30 or £15 per hour - around twice the minimum wage. This might explain why MPs like David Davis are charging £60,000 for 20 hours work per year or £3,000 an hour ( https://www.independent.co.uk/news/uk/politics/david-davis-jcb-brexit-jo... ) - as they will be taking home £180 per hour unless they have some accountant who has made clever arrangements to allow him to take home more. Given that David Davis resigned as Brexit secretary and still commands such a fee, it would be reasonable for senior experienced anaesthetic doctors to charge a similar rate when they are capable of delivering a more tangible result - an alive patient at the end of an operation. I am therefore notifying you that from April 6th 2019 my minimum call out private fee to deliver any anaesthetic will be £3000 (multiply by 1.5 for revision knee and revison hip surgery).

Any one spluttering over their cornflakes at the thought of this increase in charges should take a moment to reflect on how they will benefit the country by paying this higher fee. People can bask in the patriotic knowledge that the bulk of their fees - around £2,820 - will contribute to the filling of government coffers and help pay for the NHS, social care and other vital public services, and will also help to pay for bailing out the banks and pay for HS 2.

Competing interests: Over the years I have attended meetings and had lunches/dinners sponsored by a range of pharmaceutical firms and equipment manufacturers.

10 February 2019
Varun K Jaitly
Consultant Anaesthetist with an interest in Chronic Pain
Wrightington Wigan and Leigh NHS Foundation Trust
Department of Anaesthesia, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 1NN