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98% of A&E consultants believe patient safety at risk as a result of staff pension tax arrangements

Royal College of Emergency Medicine

12 min read Member content

Emergency Medicine consultants overwhelmingly believe that the safety of patients will be compromised as a result of the recent changes to taxation rules and pensions.  

A survey of members of the Royal College of Emergency Medicine about the current pension situation found that 98% of respondents believed that the rules would have a detrimental effect on patient safety due to reductions in consultant presence. 
The survey also found:  
• Nine out of 10 believed that the rules would result in rota gaps at senior decision maker level (89%) • Over three quarters were considering reducing their clinical care commitments (77%)
• Three quarters believed that patient flow is being adversely affected due to the impact the taxation rules were having on staffing
• Just 2% of respondents found the current pension tax arrangements easy to understand
• Four out of five respondents said that they did not feel knowledgeable enough to be able to answer the Department of Health’s pension consultation questions
• Just over half of respondents said that they had been directly affected by the pension taxation rules (51%)
• Respondents were unsure whether they would bring their retirement plans forward, with 48% saying they would but 52% saying they would not. Dr Katherine Henderson, President of the Royal College of Emergency Medicine said: “Our frontline Emergency Department staff overwhelmingly believe that the recent changes will impact patient care. 
“The number of doctors who have told us that they have or are considering reducing their hours is really worrying for the NHS and our patients; particularly going into what will likely be another tough winter.  
“Even though there have been suggestions of more flexibility in future, this does not address the immediate issues we face this winter. Given the sheer complexity of the scheme, and confusion around what this additional flexibility means, we fear that many consultants will ‘play it safe’ and continue to reduce their clinical commitments to avoid any financial risks this taxation issue brings. 
“This means that rota gaps will worsen as winter arrives, patient safety will be compromised, and patient flow will worsen. These rules leave very few levers for the Department of Health and Social Care to pull, meaning that we could yet again see a new nadir in terms of performance this winter.  
“Rota gaps due to understaffing should not be an issue in the first place, but to then expect others to cover these shifts when they fear being punished financially by doing so, is not right and is further demoralising an already overstretched workforce.  
“As such we would ask the Treasury to urgently find a viable solution to this problem for the sake of our patients’ safety this winter. We would strongly recommend the suspension of the taper, so that doctors can be reassured that taking on extra shifts will not end up costing them financially. 
“We would also encourage greater clarity; our survey also showed that just 2% of staff understood the rules. Many had consulted financial advisors, who themselves struggled to understand the arrangements. Better communication may help to ease this issue.”  
Commentary from Doctors 
 Survey participants were asked to share their thoughts and suggestions about the current arrangements. The comments show a mixture of confusion, disappointment and concern for the long-term viability of Emergency Medicine.  
The overriding concern was the impact that staff reducing extra work, due to the risk of being financially penalised, would have on patient care:  
• “Patient care has already [been affected] as Consultants in few hospitals have stopped doing extra work due to future pension issues.”
• “Cannot fill rotas at the minute as a direct response to this. Also, senior cover on wards reduced both directly affecting patient safety.”
• “Am in a position where there are so many gaps in the senior rota that reducing my workload and hence income to avoid the taper, would mean patient safety would be compromised.”
• “The Government will see the effects of this in next few years indirectly. I am certain this will compromise patient care and quality of care NHS provides.”
• “Our biggest hit affecting running a service which is having an immediate impact on patient care is Locum consultant shifts we created to bolster the rota which we can no longer fill. This has meant a loss of an equivalent of 108PAs of consultant time in the last six months. In addition, there has been a failure to internally cover long term sickness. This is a time period where we have seen the worst four-hour performance in the history of our department.” Many expressed that they have reduced or would be reducing the number of additional shifts they cover:   
• “Unless the pension tax trap is removed, I see no other option than to reduce hours/clinical commitments.”
• “I have reduced my hours in case I have problems with tax and pensions. This has meant less overtime at weekends so less consultant cover. My consultant colleagues have had to do the same. As we are a small department this has had a significant impact on senior staffing levels.” • “The tax situation is daylight robbery and people will naturally lead to people reducing their tax exposure by working less. The NHS is currently propped up by good will and people “going the extra mile” and doing extra work. Being financially penalised for going the extra mile will lead to people not doing the extra work. This will have large adverse effects. I myself have been forced to withdraw from providing extra voluntary 
weekend shifts (these keep our on call weekends manageable and safe as opposed to unmanageable and unsafe) I also intend to get out ASAP (I am 53 currently and have many years of potential work left in me).” Respondents acknowledged that this is affecting staffing levels:  
• “Internal locum shifts are not being filled. This affects senior cover as our demand overstretches current consultant availability in standard job plans.”
• “I can’t staff my department at weekends without additional consultant shifts. Now no one is picking them up.” • “My dept is getting hammered as no one wants to do extra shifts.” 
• “It's a stupid system designed to punish senior clinicians. In my department we cannot cover OOH shifts as lots of people cannot work for free. It's bonkers.”
• “To avoid either pension or income tax penalty it is easier to reduce sessions. Many consultants work more than full time. This will mean a large deficit in senior staff during an NHS winter.” Others highlighted the damage done to morale: 
• “This issue is affecting many of my previous colleagues who are very despondent, especially those under 50. It is certainly affecting NHS productivity. Long term this will destroy NHS morale.” • “One of the worst aspects of this is the message it sends to an already understaffed, overworked workforce. It really is insult to injury and the final straw for many.
• “It feels like a kick in the teeth - completely disincentivized.” • “I feel that respect has been lost for our field and a lack of appreciation for what we do and what we are meant to be doing is quite paramount.”
• “There is nothing like adding a hefty tax bill to an already pressured consultant workforce to really demoralise them further. If the NHS want us to work harder for longer, then it has to be worth it financially given that any altruism and good will have already been exhausted.” Many wondered about the long-term impact this would have on Emergency Medicine: 
• “EM staff depend on NHS income. Unlike other specialties who can do private work. It feels like the expected retirement age of 65+ and heavy taxation will lead to be the wrong choice for any well-informed junior doctors. EM will end up as a speciality unwanted unloved and under siege.”  • “With increasing pressure for consultant delivered care, junior rota gaps and trainees that are less able to manage the department, there is often pressure on consultants to do additional hours to maintain a safe environment. but to expect us to do additional hours on top of what is an extremely arduous job is exploitative and would not be considered for a second in another profession.”
• “This is a disaster and a ticking time bomb that a lot of consultants believe won’t affect them. They will all realise very soon it does and there will be a very rapid reduction in hours as a result. This is a huge problem for EM as we are already under-filled nationally at senior level and will only serve to cut extra sessions and extra cover such as TTL shifts in Major Trauma centres. This will have a direct impact on clinical care. It’s also terrible for morale and is nonsensically punitive to public sector workers. Can only serve to increase the consultant brain drain we are already seeing on the ground to the Middle East and Australia.” 
Frustration was evident about the toll it was taking on personal lives: 
• “We struggle hard enough to become doctors, Specialist Consultants sacrificing our family and personal lives to an extent expecting that there would be a better future. Current proposed pension plan would make our future worse.”
• “I have worked out that I have paid a nominal rate of tax around 95% for every extra shift done. I have had to stop all extra shifts to keep dept afloat due to this.”
• “I love emergency medicine but as I grow older I am uncomfortably aware that I have not had a holiday in 5 years, lost touch with friends & family & have only just settled down in our own home ( instead of leading a nomadic existence living like students into middle age) that there are other aspects of life that have been neglected & crying out for attention. I would not encourage my children to study medicine. This will have an effect on sheer numbers of senior doctors.”
• “This is a disgraceful tax on hard work and commitment to patient care. Cutting down my clinical work has enabled me to see more of my family and do things I enjoy. I will not increase or take on extra work to the detriment of my family life at significant financial penalty. I will look to decrease my NHS work further.” Several respondents said that the current arrangements may see them leave the country or the NHS altogether:  
• “Colleagues are considering going overseas as these taxation rules prohibit colleagues from taking on further work/duties/educational roles/governance roles. The DoH needs to take swift action.”
• “On top of the current demands placed on us due to an under resources system, this is the final insult. I am actively looking at emigrating purely based on this issue.”
• “I am considering leaving the NHS and working as a long-term locum/moving abroad.” There was much confusion around the actual pension taxation guidance:  
• “Pension tax rules need to be simplified and easy statements sent out to senior doctors, combining the two pension schemes with pay to ensure we know how we can manage our pension without having to pay for a financial advisor.”
• “My main issue is I do not have any understanding of how this will affect me and finding it hard to know what information i need to work it out.”
• “The lack of information/expert advice is laughable. Accountants, financial or pensions advisors do not understand this - so, HOW CAN WE? What a farce. It is in the national interest for us to be financially independent when we are retired- so, why is there this crazy, impenetrable, perverse scheme to scupper that and reduce the amount we work whilst still in employment. I’ll get my coat.”
• “If there was clarity on how much you could work before incurring pension tax bills rather than the current nightmare after the fact situation things would be much better.” Many were frank in their assessment of what needed to be done:  
• “Any solution should not involve doctors having to employ an accountant because the system is so opaque. At the point of having to decide whether to undertake extra work a doctor needs to know the entire financial implications of the decision immediately.” 
• “Considering the shortage for A&E doctors specially, taxation /pension rules should be softer as it will attract more A&E doctors to work, hence it will automatically reduce the shortage.”
• “Scrap the taper and the £110,000 limit for tax. I am four years into my consultant life and am already thinking about significantly reducing my sessions in order to try and protect myself and my family from significant financial 'penalties'”
• “50:50 is just a further erosion of our terms and conditions. It is not an acceptable solution. I will drop further PAs to avoid the tapering of the annual allowance rather than voluntarily reduce my pension accrual rate and lose the employer contributions. Taper needs to be scrapped. Annual allowance and tapered threshold if they remain need to be increased in line with inflation from when they were introduced.” 


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