Pensions, tax and the anaesthetist: significant implications for workforce planning

Abstract

SummaryThis paper shows how recent tax changes to pensions (i.e. new lifetime and annual allowance contribution limits) mean that NHS consultants will need to adopt one of four rational strategies to work and financial planning. Two of those strategies (termed 'Earn Fast, Drop Out' and 'Never Enter') involve a break between work and pensions. The logical consequence of this break is that consultants may exercise options to maximise their total income, which in turn will result in less work within the NHS and more work in alternative higher paying (e.g. private) sectors. A third strategy ('Go Slow, Stay Low') also involves less-than-full-time NHS work. Only one option ('Do Nothing' as a result of the tax changes) has no effect. In short, the tax changes will predictably lead to future senior consultants devoting proportionately much less of their time to NHS work than before. The article discusses the important implications of this conclusion for NHS workforce planning.

A national survey of out‐of‐hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland

“…These data indicate that additional work done by the current workforce is essential to maintain services. Recent tax regulations mean that there may be little financial incentive to work these extra hours . This may cause consultants to cease much of this extra work, but it is not known whether the effect of individuals recognising this reality can mitigate fatigue.…”

Is it worth treating patients with COVID‐19 in intensive care? Utility, choice, costs and value

“…These human frailties are exploited widely in advertising [ 8 ], and even closer to home, by taxation systems [ 9 ]. People would often choose to work harder/longer to earn higher gross incomes, even if that entails equal or even lower net income despite their hard work [ 10 ]. Therefore, the utility of choice methods like standard gamble or time trade‐off methods accurately to assess HQoLs has been questioned, because people do not always express rational choices [ 11 ].…”

Staff: our most valuable asset

“…To make matters worse, changes in pensions and tax rules means that an increasing number of existing consultants opt to either reduce their service commitment, retire early or abandon their posts for more inviting positions elsewhere [17][18][19]. This will serve to hasten the diminishing pool of experts delivering peri-operative care in the UK in the coming years.…”