The expertise of thousands of the NHS’s most senior doctors has potentially been lost over the last year due to consultants and GPs reducing work over fears about pension taxation, according to a survey¹ by the BMA.

The survey of more than 5,000 doctors found that significant proportions of senior doctors have reduced their work commitments by such an amount that, if replicated across the wider workforce, would be equivalent to the loss of around 5,400 full-time consultants. That is almost 10% of capacity that could be offered to the NHS in England to tackle waiting lists this year. For GP partners, the reduction in hours represents a potential loss of around 4 million appointments².

The problem largely centres on the tapered annual allowance (AA)³. The standard annual allowance is the amount by which doctors’ pensions can be deemed to grow before being subject to additional tax charges. The taper is a mechanism whereby this allowance decreases when doctors’ earnings exceed certain thresholds. This taper can be triggered by taking on extra work, such as initiatives to clear waiting lists, creating a “cliff-edge” where earning as little as £1 more can result in an additional tax bill of £22,500, which would mean the doctor would be literally paying to work. Almost all of this extra work is non-pensionable, meaning it also does not result in increased pension benefits on retirement.

For consultants responding to the survey⁴:

• 1 in 5 (21%) said they had reduced their “regular overtime” this year due to the tapered AA, with reductions averaging 1.4 sessions (or programmed activities, PAs) a week. Additionally, almost 1 in 6 (16%) consultant respondents have gone part time this year due to the tapered AA, with reductions averaging 1.9 sessions (or PAs). A full-time consultant works 10 sessions per week. Combined, these regular hours reductions represent potential lost capacity equivalent to around 3,500 consultants in England this year alone.  
• Almost 1 in 4 (24%) reduced their “ad hoc” overtime sessions to clear waiting lists (‘waiting list initiatives’, or WLI) due to the tapered AA, with reductions averaging 5.1 hours a week. This implies a potential loss of around 3.2 million hours of WLI work that would have been offered to the NHS in England this year alone, equivalent to around 1,900 full-time equivalent consultants’ worth of work.
• Combined there has already been a potential loss of capacity of around 5,400 consultants' worth of activity – i.e. 9.3% of the total consultant workforce in England this year alone.

For GP partners⁵:

• Almost 1 in 4 (23%) reduced their regular workload this year due to the tapered AA, with reductions averaging 1.7 sessions per week.  This implies a potential loss of around 4 million GP partner appointments in England this year alone.

In June 2024, a snap survey of BMA members showed 71% of all respondents indicated that if there were no reforms to the tapered AA, this would prevent or limit their ability to take on additional overtime. The new results show that this has sadly come to fruition.

Ahead of the Spring Statement this week, the BMA has written⁶ to the Government urging it to address the absurd situation where doctors are being prevented from taking on additional work or reducing the hours they do, especially in the face of a waiting list of 7.4 million in secondary care in England alone, and a workforce and workload crisis in general practice.

BMA pensions committee chair Dr Vishal Sharma said:

“It is an absurd situation when the Government is promising to bring down near-record waiting lists, yet doctors are being forced by complex and unfair pension tax rules to turn down or reduce extra work.  Doctors want to do more to help patients and do as much as they are able to, but no one should be expected to pay to work, which is the bizarre scenario that this cliff edge can create.

“These survey results, from more than 5,000 doctors in the UK, show that this a real, not hypothetical, issue affecting the capacity in hospitals and GP practices right now.

“We’re urging the Government, ahead of next week’s Spring Statement, to urgently address this head on, by removing the annual allowance taper. This would be one of the quickest and most cost-effective ways of increasing NHS capacity whilst still ensuring fairness for the taxpayer as higher earners would still have limits on tax relief via the standard annual allowance.

“It would maximise the amount of work doctors can do, particularly at a time when patient demand is outstripping the number of doctors available to treat them, and be a huge step forward in the Government’s attempt to bring down waiting lists.”

Ends

Notes to editors

1. The survey was open to BMA members currently working in the UK as consultants, SAS doctors and GPs. The survey ran from Tuesday, 18th February to Wednesday, 26th February at noon. 5,172 doctors responded. 76% of respondents (3,914) were consultants. 18% (907) were GPs, with 13% (668) being GP contractors (partners). 7% (351) were SAS doctors.
2. Calculations based on NHS England data as at November 2024 for consultants and as at January 2025 for GP contractors (partners). Assuming a full-time consultant works 10 programmed activities or 40 hours per week, adjusted for paid leave, and GP contractors (partners) deliver 12 appointments, 15 minutes in length, per half-day session, in line with BMA safe working in general practice in England guidance.
3. The AA is a threshold which, in defined benefits pensions schemes such as the NHS Pension Scheme, restricts the amount of tax-free pension growth allowed each year. When this threshold is breached, a tax charge on the amount of pension growth exceeding the threshold is payable at one’s marginal rate of income tax (e.g. 45% for additional rate taxpayers in England). The standard AA is currently £60,000. Since April 2016, some individuals have instead been subject to a lower tapered AA. The taper only applies currently when both threshold income (taxable income) exceeds £200,000 and adjusted income (taxable income plus pension growth) exceeds £260,000. With both conditions met, for every £2 that adjusted income exceeds £260,000, an individual loses £1 of their annual allowance until a minimum is reached. The minimum reduced (or fully tapered) AA is currently £10,000. 
4. Consultant responses (n = 3,638) 
   How, if at all, has the tapered AA influenced your decisions about working any of the following this year (2024/25)? 
   -    Additional/Extra Programmed Activities (APA’s/EPA’s, i.e. any PA’s above 10)
   o    I have added these due to tapered AA – 1% (38)
   o    I have reduced these due to tapered AA – 21% (763)
   o    I have declined to increase these due to tapered AA – 35% (1,278)
   o    Tapered AA has had no influence on my decisions – 28% (1,022)
   o    Not applicable to my role – 15% (537)
   -    Contractual Programmed Activities (i.e. PA’s up to 10) 
   o    I have added these due to tapered AA – 1% (32)
   o    I have reduced these due to tapered AA – 16% (593)
   o    I have declined to increase these due to tapered AA – 26% (959)
   o    Tapered AA has had no influence on my decisions – 41% (1,495)
   o    Not applicable to my role – 15% (559)
   -    Waiting List Initiative (WLI) work 
   o    I have added these due to tapered AA – 1% (30)
   o    I have reduced these due to tapered AA – 24% (882)
   o    I have declined to increase these due to tapered AA – 31% (1,116)
   o    Tapered AA has had no influence on my decisions – 17% (623)
   o    Not applicable to my role – 27% (987)
   -    Roles with additional remuneration (e.g. Clinical Director) 
   o    I have added these due to tapered AA – 1% (28)
   o    I have reduced these due to tapered AA – 14% (519)
   o    I have declined to increase these due to tapered AA – 30% (1,108)
   o    Tapered AA has had no influence on my decisions – 24% (886)
   o    Not applicable to my role – 30% (1,097)
   Consultant respondents that indicated having reduced APA/EPAs, Contractual Programmed Activities, and/or WLI work, were asked to quantify this as below: 
   -    You indicated that you have reduced APA/EPA’s during 2024/25 due to tapered AA. How many APA/EPA’s per week have you reduced? NB: APA/EPA’s meaning any PA’s above 10. – mean response 1.4 APA/EPA’s
   -    You indicated that you have reduced contractual PA’s during 2024/25 due to tapered AA. How many PA’s per week have you reduced? NB: Contractual PA’s meaning any PA’s above 10. – mean response 1.9 PA’s
   -    You indicated that you have reduced WLI work during 2024/25 due to tapered AA. Approximately how many HOURS per week on average have you reduced? NB: We have asked about hours because WLI shift length varies. – mean response: 5.1 hours
5. GP contractor (partner) responses (n = 594)
   How, if at all, has the tapered AA influenced your decisions about working any of the following this year (2024/25)? 
   -    Sessions at my normal place(s) of work
   o    I have added these due to tapered AA – <1% (<7)
   o    I have reduced these due to tapered AA – 23% (135)
   o    I have declined to increase these due to tapered AA – 31% (184)
   o    Tapered AA has had no influence on my decisions – 30% (177)
   o    Not applicable to my role – 16% (97)
   -    Additional cover sessions (i.e. for holiday and sickness cover internally)
   o    I have added these due to tapered AA – 1% (<7)
   o    I have reduced these due to tapered AA – 18% (104)
   o    I have declined to increase these due to tapered AA – 32% (188)
   o    Tapered AA has had no influence on my decisions – 26% (154)
   o    Not applicable to my role – 24% (144)
   -    Other remunerated work (e.g. OOH work, PCN Director, Clinical Lead Role)
   o    I have added these due to tapered AA – 1% (<7)
   o    I have reduced these due to tapered AA – 21% (127)
   o    I have declined to increase these due to tapered AA – 28% (168)
   o    Tapered AA has had no influence on my decisions – 23% (134)
   o    Not applicable to my role – 27% (160)
   -    Offering additional funded services at my practice
   o    I have added these due to tapered AA – <1% (<7)
   o    I have reduced these due to tapered AA – 16% (95)
   o    I have declined to increase these due to tapered AA – 30% (180)
   o    Tapered AA has had no influence on my decisions – 30% (177)
   o    Not applicable to my role – 24% (140)
   Respondents that indicated having reduced sessions were asked to quantify this as below: 
   -    You indicated that you have reduced sessions during 2024/25 due to tapered AA. How many sessions per week have you reduced? – mean response 1.7 sessions
6. Read the letter to Chief Secretary to the Treasury Darren Jones MP.
7. Read the BMA briefing “The impact of punitive pensions taxation on the NHS”.

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