69% of consultant surgeons cut their hours because of NHS pensions ‘tax trap’, as waiting times rise

A YouGov survey¹ of surgeons commissioned by the Royal College of Surgeons of England in October, and published today, reports:

• 68% of consultant surgeons are considering early retirement because of the pensions tax situation.
• 64% of consultant surgeons have been advised to work fewer hours in the NHS following recent changes in pension taxation rules to avoid ‘crippling and unpredictable’ tax bills.
• 69% of consultant surgeons have reduced the amount of time they have spent working in the NHS as a direct result of changes to pension taxation rules.²

The RCS is urging Boris Johnson to follow through on a pledge he made last summer to resolve the NHS pensions ‘tax trap’, before winter arrives.  Amid record waiting times, the RCS warns that patients will face even longer waits this winter if the Government doesn’t take swift action. 

An unforeseen consequence of a ‘taper’ in the NHS pensions scheme has led to doctors receiving large and unpredictable tax bills for agreeing to work extra weekend shifts on waiting list initiatives.  Today’s survey findings show surgeons are reducing their hours as a direct result, while others are retiring early.  

Many have received financial or legal advice to work less, refrain from taking part in waiting list reduction initiatives, or retire early, because of the pensions tax situation:

• 61% of consultant surgeons have been advised to refrain from taking part in waiting list reduction initiatives.

• 31% of consultant surgeons have been advised to retire early.

The NHS waiting list in England stands at a record 4.41 million. In August 2019, more than 660,000 patients were waiting more than 18 weeks to start treatment, including surgery.  

Tackling the waiting list backlog has traditionally been achieved through ‘waiting list initiatives’, whereby surgical teams undertake extra work, often during weekends.

Among consultant surgeons who undertook extra operating sessions in the last year, to reduce surgical waiting lists, two thirds (66%) say they will not take on extra sessions this year.  

Commenting on the impact the pensions crisis is having on waits for surgery, Professor Derek Alderson, President of the Royal College of Surgeons of England said:

“As our survey findings emphasise, the impact of pension tax rule changes on waiting times for surgery are devastating. Surgeons who have previously done many hours of extra work to help reduce waits, are cutting back their hours. Many are considering early retirement.  

“Patients already face overly long waits for operations. Persisting with a tax system that punishes clinicians for taking on extra work, will undoubtedly lead to a further deterioration in waiting times.”

Royal College of Surgeons of England Council member Miss Stella Vig, who is a Clinical Director at Croydon University Hospital, added: 

“It’s only fair to know how much tax you will have to pay if you work extra shifts. The NHS pensions scheme has created a ‘tax trap’, where accepting an extra shift can lead to a large and entirely unpredictable tax bill landing in the post many months later.”

“The Government has published a consultation that looks set to last many more months, rather than taking decisive action.  We need them to sort this out before winter takes hold.”

The survey of RCS members also revealed worrying findings about surgeons’ future working intentions. More than three in five (64%) RCS members are considering retiring early because of changes to pension tax. This figure rises to 68% among the most senior surgeons (consultants).   

In addition, the survey revealed that three in five (61%) surgeons are considering reducing their non-clinical commitments because of the rule changes. These include educational and managerial roles. The RCS is concerned about what this might mean for the future training of surgeons. Professor Alderson commented;

“The number of senior surgeons considering retiring early or cutting back on their educational and managerial roles is incredibly worrying. Not only does the NHS risk losing their considerable experience, but it also stands to lose the very staff who are responsible for training the next generation of surgeons. 

“Surgical training is built on an apprenticeship model, with trainees learning their skills from more experienced, senior surgeons. If those surgeons leave the NHS early, who will train the surgeons of the future?”   

The YouGov/RCS survey also revealed that 94% of surgeons surveyed in Wales are concerned about the current tapered annual allowance and pension taxation rules. 


Case Study:  

Mr Richard Morgan
Consultant General Surgeon

Mr Morgan, 53, works as a consultant general surgeon at Glan Clwyd Hospital, north Wales.  He is expecting to receive a back-dated tax bill on his pension contributions to the tune of £40,000.  Mr Morgan said that since he realised that the pension tax would leave him with very little income from undertaking extra sessions for the ‘Waiting List Initiative’ (WLI), he has stopped doing them. He said that many of his colleagues have taken a similar stance, making it increasingly difficult for the department to meet its targets for long waiting elective surgical patients, unless it employs locum doctors, at a great cost. He believes the pension tax could have a significant financial impact on some trusts as they plug gaps in the service with locum doctors to maintain waiting list targets. 

However, he remains extremely concerned that patients are suffering and having to wait longer for treatment, as a result of the pension tax.  He says there is a detrimental effect on the endoscopy service, with waiting times increasing as vacant lists, resulting from annual and professional leave, etc., are no longer backfilled for WLI payments. This may result in the delayed diagnosis of gastrointestinal cancers and other serious diseases.

He has also turned down requests to take on leadership roles in the hospital and the wider region, because the extra payments involved would result in very little income, after the pension tax.  He believes he is therefore contributing less to the healthcare service (NHS Wales) than he would be if he did not have these concerns about the pension tax.


Surgeons’ comments from RCS/YouGov survey:

“This is not a story about pensions, it is a story about how long patients will have to wait for surgery. I am 42 and looking at an annual allowance bill every year until I retire. I have dropped from 11 to 10 programmed activities³ because it is the only thing I can do to mitigate it. In trauma and orthopaedics, the programmed activities (PAs) for those of us in trauma are set into the rota, so it is elective orthopaedics that is cut. By dropping 1 elective PA, my elective operating lists are reduced by one third. My waiting list went from 5 months to 9 months overnight. It is the biggest threat to the NHS at present, much greater than Brexit.”

*****

“As a junior consultant, to have to actively avoid doing any waiting list initiatives, and watch your waiting list grow, and see your patients suffering in pain or getting angry at the length of the waiting list is soul destroying. I have never seen morale so low and in a department of 25 consultants, to hear the dismay expressed by all senior colleagues at this complete fiasco is frankly depressing. All consultant meetings are now dominated by this and meanwhile, the real victims of this mess are the patients.”

*****

“The current pension arrangements mean to fulfil my commitment to patients with cancer, I undertake extra lists for free. That is not sustainable going forward, or other parts of my job will need to change.”

*****

“I’m a senior trainee with CCT⁴ in the next 8 months. The major impact to me will be the relative lack of senior colleagues for advice and support when I become a consultant as they are forced to reduce their hours or retire early.”

*****

“The NHS is under a massive pressure. It is very sad to see senior consultant colleagues retiring very early from the NHS and junior consultants, including myself, reducing their NHS work significantly. Unfortunately, those who will suffer are the patients that rely on the NHS for their treatment.”

Notes to editors

1. YouGov hosted an online survey of the Royal College of Surgeons of England’s membership. Fieldwork ran from 7 October 2019 – 14 October 2019. The full survey findings are available on request. The survey was completed by 1890 members of the Royal College of Surgeons of England. 

2. Over two thirds (69%) of consultant surgeons are expecting an increase in taxes this year specifically because of the tapered annual allowance and pension taxation rules. The annual allowance taper, introduced in April 2016, lowers the amount of pensions tax relief available to those with a threshold income over £110,000, reducing it from £40,000 to £10,000 over time. This has had a significant impact on senior clinicians in the NHS pension scheme, with some saying they are in effect ‘paying to work’ if they take on additional sessions. 

3. A full-time job plan for a consultant working in the NHS consists of 10 programmed activities (PAs), some for direct clinical care and others being ‘supporting professional activities’. Trusts may request medical staff to work more than 10 PAs per week or take on additional responsibilities.  A programmed activity is a 4-hour unit of time (one half day) done within the normal working week (Monday to Friday). 

4. Certificate of Completion of Training (CCT) confirms that a doctor has completed an approved training programme in the UK and is eligible for entry onto the GP Register or Specialist Register. 

5. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.

6. The government has launched a consultation with new proposals for NHS pensions, however, surgeons are concerned that any changes that may follow the consultation won’t come into force in time for the added pressure of the winter season.

7. For more information, please contact the RCS press office: telephone: 020 7869 6047; email: pressoffice@rcseng.ac.uk; out-of-hours media enquiries: 07966 486832.