The government provides various types of financial support to families with children, including direct payments (Child Benefit) and support with childcare (free childcare hours and Tax-Free Childcare).
Parents are not eligible for this support if they earn over certain thresholds of income. For example, if either parent or legal guardian have qualifying income over £100,000, they cannot access additional free childcare hours. If either parent or legal guardian have a qualifying income over £60,000, Child Benefit starts to be withdrawn.
For some doctors, this can mean they are financially penalised for progressing in their career, and it may impact the amount of hours they are able to work.
Are you a doctor affected by the threshold for childcare support? Has it led to you changing the number of hours you work? Use our child support portal to tell us about your experiences.
Support for childcare
Free childcare hours
In all nations of the UK, the government provides financial assistance with childcare for children under school age. The amount you are entitled to varies between nations and the age of your child and is summarised in the table below.
| Nation | Offer |
|---|---|
| England | 1,140 hours a year (30 hours a week during term time or 22 hours spread across the year) free childcare for 3 and 4 year olds for eligible working parents. If either parent does not work, you get half that - 15 hours a week for 38 weeks for 3 to 4 year olds. |
| Scotland | 1,140 hours a year (30 hours a week during term time or 22 hours spread across the year) free childcare for 3 and 4 year olds, regardless of parent’s working status. |
| Wales | 1,140 hours a year (30 hours a week during term time or 22 hours spread across the year) free childcare for 3 and 4 year olds for eligible working parents. If either parent does not work, you are able to access 10 hours a week for 38 weeks for 3 to 4 year olds, or 12.5 hours a week in specific Flying Start areas. |
| Northern Ireland | Funded pre-school education place for 3 and 4 year olds in their immediate pre-school year. This amounts to at least 12.5 hours per week (some areas offer 22.5 hours per week) during term time. |
Tax free childcare
You can also get up to £2,000 per child per year (up to £500 every 3 months) towards the costs of childcare, if your child is 11 or younger. This can be up to £4,000 if your child is disabled. You must set up a Tax-Free Childcare account and for every 80p you put in, the state will add 20p. It essentially gives you basic-rate tax back on your bill, hence the name. This is available in all nations.
£100,000 eligibility threshold
However, if you or your partner’s adjusted net income is above £100,000, you are not eligible for tax-free childcare. And in England and Wales, you are only able to access 15 hours per week of childcare for 3 to 4 year olds, not 30. Your adjusted net income means income less certain reliefs such as pension contributions or charity contributions.
This is a particular concern for doctors, as other workers on defined contribution pension schemes have more flexibility and can invest more in their pension to ensure adjusted net income remains below the threshold; doctors cannot do this due to the way their pensions are structured. (They can however potentially invest into a private pension or give money to charity).
This threshold of £100,000 has not changed since its introduction in 2017. If it had been adjusted by inflation, it would be £130,567.40 from April 2024. It is also based on an individual’s income, not the combined income of parents or guardians.
In addition, once earning over £100,000, your personal tax allowance starts to be withdrawn. This means In our representations to the Treasury in the 2023 Autumn Statement and the 2024 Spring Budget, we called for these thresholds to be raised.
NHS Induction and Refresher Scheme
Qualified GPs who are interested in returning to work or doctors joining from overseas can join the Induction and Refresher Scheme. If family responsibilities are a barrier to joining the scheme, applicants with children aged 11 and under are able to claim a total of £2,000 towards the cost of childcare for each child whilst on the scheme. More information can be found on the NHS England website.
Doctors can lose money from progression
Due to the £100,000 eligibility threshold for free childcare hours and tax free childcare, some doctors may actually be financially worse off from progressing in their career, depending on the age of their children and where they are in their career.
For example, Dr A is 41 years old and has a 3-year-old child and a 5-year-old child. They are currently on threshold 2b of the consultant pay scale in England, with basic pay of £108,390. After adjusting for their pension contributions, their adjusted income is £93,575.35. Therefore, they are able to claim a up to £2,000 tax-free childcare annually per child and 15 hours additional free childcare for their child, worth approximately £4,200 (based on estimates of average childcare costs in England by the Family and Childcare Trust). This means they are able to access over £8,000 worth financial support. The value of their take home pay, after tax and pension deductions, and including the value of child support they are eligible for, is £72,878.
However, if they progress to threshold 3 of the payscale they will have a basic pay of £118,884. After adjusting for pension this gives a net income of £102,834,66 - so they can no longer access support tax-free childcare or 15 hours additional free childcare, worth over £8,000. Their take home pay including child support, ie. after tax and including the value of child support they are eligible for, is £69,314 - £3,564 lower than if they remained at threshold 2b – because they are no longer able to access child support. They are actually financially worse off due to progressing in their career.
Child benefit
In all nations of the UK, you get child benefit if you’re responsible for bringing up a child under 16 (or under 20 if they stay in approved education or training). It’s currently worth around £1,200 per year for your first child and £800 for each additional child.
Until April 2024, if you (or your child’s other parent or guardian) earn above £50,000 you are subject to the High Income Child Benefit Charge. This tapers away the amount of Child Benefit you receive. For every £100 of income over £50,000, 1% of the value of your child benefit is withdrawn, meaning that once your income is over £60,000 it is fully withdrawn.
The level of income from which the High Income Child Benefit Charge starts to apply had not been raised since its introduction in January 2013. If it had increased in line with inflation each year, it would now be £68,460.87 from April 2024.
Recognising that this threshold means that many doctors who are parents miss out on support, the BMA and many others lobbied the government to increase the threshold, and in the Spring Budget 2024, the Chancellor announced that the initial threshold would be raised to £60,000 from April 2024, and would not be fully tapered away until you earn over £80,000, meaning a new taper of 0.5%.
The High Income Child Benefit Charge is based on an individual’s income, not the combined income of parents or guardians. However, the Chancellor announced that there would be a consultation on whether and how to change this in the coming years.
What next?
The BMA will continue to campaign for better support for doctors looking after children and for thresholds of financial support to be raised.
Tell us about your experiences with child support here – having case studies and examples may help us with the campaign.
A lack of access to government financial support is not the only issue doctors with children face. BMA research has found that doctors with caring responsibilities are less likely to be supported in career progression opportunities and are discouraged from entering specialities which are seen as incompatible with caring responsibilities. There are also factors based on the working patterns and career pathways of medicine that make accessing childcare more challenging and costly. Whilst childcare responsibilities are disproportionately allocated to women, these challenges are going to impact them more. In fact, the gender pay gap in medicine only emerges at the average age that doctors have children. More information on the impact of childcare on the gender pay gap can be found here.
The BMA’s Joint Pledge on Ending Sexism in Medicine continues to grow, sexism is a key reason for the lack of childcare support. One of the ten goals of the pledge is to remove the detrimental impact that having children and other caring responsibilities have on career progression. You can find out here if your employer or medical school has made this commitment here.