To qualify for and retain MHO status, you must be in the 1995 pension section and spend substantially the whole of your time (at least 80%) in the direct treatment or care of patients suffering from mental disorders.

This status was removed for new entrants in England and Wales from 6 March 1995 and in Scotland and Northern Ireland from 1 April 1995.

You must have had the status before the relevant date of abolition in order to be able to reacquire or retain it now.

The McCloud ruling on age discrimination means that all members who transitioned to the 2015 scheme on or after 1 April 2015 will be reverted to their legacy sections.

MHO status will be reinstated, where appropriate, and doubling will resume (where 20 years of MHO service was achieved) on reverting to the 1995 section for the remedy period from 1 April 2015 to 31 March 2022.

As from 1 April 2022 all members, regardless of age, will move to the 2015 scheme and the guidance below will refer to the time after this transition.

The 2015 scheme calculates benefits for all members in the same way. When you join the 2015 scheme, MHO status has no bearing on your prospective accrual. Doubling of service ceases on moving to the 2015 scheme.

However, you may be able to access your accrued 1995 section benefits from age 55 onwards. A 'better of' calculation known as uniform accrual will be undertaken in relation to your accrued benefits.

As you no longer qualify for prospective MHO status your accrued 1995 section benefits will be based on the better of:

Basic pensionable service (1995 section service ignoring any doubling achieved) calculated against your prospective final pay (unless you have had a break in service of 5 years or more).

Or

Basic service/potential basic service x potential service. Basic service = basic pensionable service (1995 section service ignoring any doubling).

Potential basic service = potential basic pensionable service (1995 section service) up to age 55.

Potential service = potential doubled service to age 55 calculated against final pay when you last held an MHO qualifying post (unless you had a break of five years).

This 'better of' uniform accrual calculation can result in an enhanced service which is applied against the best of the last three years pensionable pay up to when you last worked in what would have been a MHO post were you still in the 1995 section.

That is, unless you have had a break in pensionable service of five years or more. Then your pay will be based on the best of the last three years pensionable pay up to when you last worked in a post with MHO status before the break.

If you are a member of the NHS pension scheme 2008 section you are not eligible for MHO status.

If you transferred to the 2008 section from the 1995 section through the Choice exercise, your MHO status was lost. Any doubled service accrued prior to transferring no longer applies as only the actual accrued service was transferred.

If you left your MHO post you can regain MHO status at any time in the future providing that you have not left the NHS pension scheme.

If you have left the scheme, with a deferred pension, you must return within five years in order to remain eligible for MHO status.

If you carried out MHO type work outside of the NHS, this can be used to count towards the 20 year period required to trigger doubling of service, known as qualifying MHO service. However, it cannot be used in the calculation of your NHS pension.

The NHS pensions agencies require written evidence of your duties during this non-NHS work, detailing the proportion of work carried out in the direct treatment or care of patients suffering from mental disorders.

They will then determine if the work qualifies to count towards doubling or not. The BMA pensions department can assist you with these enquiries.

If you are credited with service of this type, the earliest your doubling can begin is age 50, once 20 calendar years’ of qualifying MHO service has been achieved.

If you undertook any of the following work you can apply for this service to be treated as qualifying MHO service. This will count towards the 20 calendar years’ required to trigger doubling.

However, you need to have been in NHS service in a MHO qualifying role from before the abolition of the status on 6 March 1995 (England and Wales) or 1 April 1995 (Scotland and Northern Ireland) to have the following service taken into account:

• Work that satisfies the MHO criteria where duties are performed in UK based non NHS institutions.
• Work that satisfies the MHO criteria where duties are performed overseas.
• NHS work that satisfies the MHO criteria where pensionable service has been refunded or transferred out.
• NHS work that satisfies the MHO criteria where you did not contribute to the pension scheme.

Your overall maximum service, as for any other member of the 1995 section, is 45 years’ of service, (inclusive of doubled service and added years).

However, at age 55 the maximum service allowed, inclusive of doubled service and added years, is restricted to 40 years’ of service.

At age 60 the maximum service allowed, inclusive of doubled service and added years, is restricted to 45 years’ of service.

Should you have achieved 45 years’ of service before age 60, you are required to continue to contribute to the scheme until age 60 (unless you retire or opt-out of scheme membership before then).

You must stop paying in, however, at age 65 even if 45 years’ of service has not been reached.

Any service you achieve at ages 55, 60 and 65 in excess of the relevant pension scheme limits, described above, is excluded for pension purposes. When these service limits are reached at ages 55 and 60 your doubling date resets to your birthday, prospectively.

The day after you have completed 20 calendar years’ in a MHO post is known as your ‘doubling date’. Thereafter, every complete year of service you work in a MHO post will be doubled for pension purposes.

The effect of doubling differs depending on whether you work full-time or part time. For example, where two MHOs have worked for 21 calendar years in a MHO capacity, one full-time and one part-time (five PAs for example), the service on which their benefits will be calculated as below.

20 years full-time MHO plus one MHO doubled year = 22 years

20 years part-time MHO (five PAs) = 10 scaled years, plus

One year at 5/10 commitment doubled = one scaled year (365 x 5/10 = 183 (doubled = 365)

Total scaled service for the part-time MHO including doubling = 11 years

Because of the impact of doubling, it is possible for MHOs to achieve maximum service limits earlier than other doctors. Any service accrued in excess of the service limits is excluded for pension purposes.

Added years and any enhancement paid for tier 2 ill health retirement is not doubled.

Only complete years of service are doubled. Please note that doubled service is only achieved on the anniversary of your doubling date.

For example, working for eight months after your doubling date will not result in an additional period of doubled service in respect of the eight month period.

If you work beyond the maximum of 45 years’ pensionable service, the pension is calculated using whichever of the following two options produces the better result.

1. Pensionable salary up to the date 45 years’ service is achieved (or age 60 if later), combined with service up to that point including doubled years. The resulting pension and lump sum are then increased in line with inflation up to the last day of service, when they are put into payment.
2. Pensionable salary up to the last day of service, combined with service up to that date excluding doubled years. This will be limited to the earlier of when 45 years’ of service is achieved, age 65 reached or the member dies.

The NHS pensions agencies will automatically pay the most beneficial package.

It may be that you are not eligible for MHO status (see above).

On the other hand, it may just be an error and the BMA can assist you in rectifying this. If necessary we may require evidence of the amount of time spent in the direct care of patients suffering from mental disorders. Job plans, contracts and CVs can assist in establishing whether MHO status should apply.

Please note that MHO status was abolished for new joiners to the scheme from 6 March 1995 (England and Wales) or 1 April 1995 (Scotland and Northern Ireland) onwards and anyone who did not hold an MHO qualifying role in the NHS prior to this date cannot acquire it now.

The McCloud age discrimination remedy will mean that your pension growth during the remedy period of 1 April 2015 to 31 March 2022 will be reassessed. Any doubling due may result in an increased exposure to breaching the annual allowance limits.

As a 2015 scheme member with accrued 1995 section benefits, you will need to undertake two calculations to check whether the growth in your NHS benefits have exceeded the annual allowance threshold.

The first will be in relation to your 1995 section MHO benefits which will continue to grow as they will be linked to your current pay (so long as you have not had a break in pensionable service of five years or more).

Benefits may be linked to the pay you had when you last worked in a MHO qualifying post (the better of which will be used as per the uniform accrual rules).

The second will be in relation to your ongoing 2015 scheme accrual. The chances of exceeding the annual allowance are greater if you are buying added years or additional pension, or have recently received a significant pay rise or additional pensionable award, eg a pensionable a clinical excellence award.

You will be covered for death in service benefits if:

• you are under age 60 and have yet to retire, even if you have achieved scheme maximum service
• you are over age 60 and have withdrawn from contributing to the scheme but have yet to retire
• you are still actively contributing up to age 65.

If you have opted out of the scheme you will not be covered for death in service benefits.

It is only possible to access unreduced benefits from age 55 onwards if retiring from NHS pensionable service, whilst in a MHO qualifying post and after having attained at least 20 calendar years’ of MHO service.

If you have transitioned to the 2015 scheme after 1 April 2022 you will still need to be in a role which would have qualified for MHO status in order to access benefits from the 1995 section from age 55 without reduction.

A member with over 20 years’ MHO service who leaves the scheme before age 55, and does not return, can claim their preserved benefits in full at age 60. The benefits will be based on a comparison between a normal non-MHO pension calculation and one which takes account of potential service they could have had had they remained a MHO until age 55. This is known as uniform accrual.

If benefits are accessed before age 60 without rejoining the NHS in a MHO qualifying post, they will be actuarially reduced.

A member with over 20 years’ MHO service who leaves the scheme after age 55, and does not return, can claim their preserved benefits in full at age 60. The benefits will take account of any doubling that had been achieved by the time of leaving the scheme.

If benefits are accessed before age 60 without rejoining the NHS in a MHO qualifying post they will be actuarially reduced.

However, when an MHO has 20 years’ or more MHO service and returns to a MHO qualifying post within five years of leaving, even for just one day, they can access their benefits in full from age 55 if the retirement application is submitted on the day(s) when pensionable work is undertaken.

If you transitioned to the 2015 scheme, you can access your benefits accrued in the 2015 scheme from age 55 onwards with an actuarial reduction or defer the payment until you reach your state pension age.

If you transfer service out to another pension scheme, the transfer value is increased, using the uniform accrual method, to reflect the fact that doubled years could have been achieved through continued service in the NHS pension scheme.

Care should be taken when transferring to other public sector pension schemes as schemes are often described as ‘similar’ or with reciprocal arrangements, but MHO benefits can be lost if transferred out and then back into the NHS pension scheme.

If you retire under tier 2 ill health retirement the enhancement you are awarded will not be doubled.

If you are made redundant and defer taking your benefits, you will retain a normal pension age of 55 (provided that you have had more than 20 years’ service as an MHO). You will be able to access your accrued benefits in full from this age onwards.

If you’re in the 1995 section

Subject to employer agreement, you may return to work after retiring and claiming your NHS pension. No further access to the NHS pension scheme is allowed except in the following circumstances.

• Where retirement was on health grounds and you have rejoined the scheme before age 50 (tier 1) or age 49 (tier 2).
• Where you claim the pension from a redundant post and remain a member of the NHS scheme while continuing in a concurrent post.

If you are unable to rejoin the scheme, it is possible to contribute to a personal pension or stakeholder pension.

Your NHS MHO pension may be abated on a return to NHS employment if you return before age 60.

If you transitioned to the 2015 scheme

Subject to employer agreement, you may return to work after retiring and claiming your NHS pension.

No further access to the 2015 scheme is allowed except where you have had a break in pensionable service of five years or more which has resulted in the loss of your final salary linking.

If you are unable to rejoin the scheme, it is possible to contribute to a personal pension or stakeholder pension.

It should be noted that your employer may be required to enrol you into a pension scheme. If you are not eligible to join the NHS pension scheme you may be admitted to an alternative arrangement.

Read more in our guidance on returning to work and your pension.

If you return to NHS employment before age 60 with a MHO pension including doubling, your pension may be reduced pound for pound if your earnings on re-employment in the NHS, when added to your NHS MHO pension, exceed your previous level of NHS earnings.

This rule has been suspended during the COVID-19 pandemic but will be reinstated thereafter.

Abatement ceases to apply to MHOs from age 60 onwards.

If you wish to return to work after retirement it is necessary totake a break in service of 24 hours (unless you have had a break in pensionable service of more than 5 years)

If you do not take the required break then your pension will be suspended and only paid from when the required break has been taken.  Benefits not paid due to being suspended will not be paid back to you.

If you return to NHS work before age 60 then your pension may be subject to abatement. 

If you have left the 2015 scheme, with a deferred pension, you must return within five years in order to remain eligible for MHO status in relation to your accrued 1995 section benefits.