Supporting nhs consultant doctors industrial action

[Lapland123]

I hope this has public support. Consultants have seen the largest pay erosion in public services- now 35 % pay erosion since 2010.

Add the pension debacle, where we are asked for real money now for a theoretical glitch in how pensions are calculated. The ‘real money ‘ bill now can be 6+ months of your take home pay annually. Yes, really.

Vacancies exist in multiple specialties and the day to day job is more and more difficult in the context of vacancies throughout the nhs

I hope we have support for industrial action due to this government’s disgraceful erosion of our pay though we are working harder than ever

@Jazz12 I assume you don’t work in the nhs? Most nhs consultants do not also have private practices. The ones that do have worked themselves into the ground to build it up. For my (junior doctor) and most of my colleagues there is no private work in the majority of specialties.

Limited or no private practice in specialties such as emergency medicine, palliative medicine, endocrinology, geriatrics, neurosurgery, etc etc.

I’ve had one boss in the last couple of years who had a substantial private practice. Only one. The other consultants worked wholly in the nhs including a massive deal of unpaid overtime and time spent teaching junior doctors and students.

If you want the best and brightest 18 year olds to train to be your future consultants then make the job a more appealing prospect than it currently is. They’re not martyrs and we’re haemorrhaging doctors of all grades/level of experience. It’s terrifying.

No support from me I'm afraid.

People who state “thriving private practices” need to clarify if they work in the nhs or they’ve made an assumption about a consultant who has treated them.

That’s ridiculous, that obviously needs sorting out.

The pension issue is the biggie. Full time NHS doctors, not motivated solely by money at all, are being saddled with sudden huge tax bills because of growth in a pension. Something they are unaware of, usually don’t understand, and are not even able to access now. So many are reducing sessions or taking early retirement. It’s utter madness.

I heard a comment on the World at One about the Nadhim Zahawi affair saying that it may not have been a fair tax because he hadn’t received the money or something, and I immediately thought of our pension growth- it’s generally out of our control, we may not even reach pension age and suddenly we need to pay out 6 months wages in tax- for money we’ve never seen!
and I can’t remember the details but I think High Court judges have been made exempt from the scheme as there was a worry too many would leave, seemingly doctors are less important.
i need to see an accountant about it but I’m too scared!!

Well ALL NHS employees need a pay rise. Perhaps the doctors and nurses should stand together on this one. More degrees and post grad qualifications walking hospital corridors than any other employer.
But yes we should reward the level of training.

Sorry, no I cannot support any strikes by essential personnel where striking literally means excess & entirely preventable deaths. Doesn’t matter how high up the food chain you are, if ‘industrial action’ aka striking is what you want support for as a doctor in the NHS, you will never get it from me.

Everyone has the right to petition for higher pay, but no one has a right to sacrifice the lives of other human beings to make this point to the government. It’s no different imho from taking people hostage and threatening to blow them up if you aren’t delivered suitcases of cash.

salaries are shit in general here, no idea what the solution is.

Start with buying homes they can afford perhaps.

Well that's one of the huge issues. Housing is too disproportionate vs wages.

My husband is a consultant surgeon, the last few years I have seen the pressure and stress he’s under . He’s on call this week and I was really upset to see him almost dropping with tiredness last night, if he could find a way to retire now he would . The pay is awful for the amount of hours, years of training and responsibility required.

I think if you take the pension part out of it, consultants are paid well. However, you cannot take the pension part out of it and so it is grossly unfair. The tax charges are huge. A relatively small pay rise can result in a tax charge many times that amount. I believe it is possible to come out of the pension scheme to avoid this, but why should they have to? Why should they have dedicated years of their life on pitiful money as a junior doctor to end up in that position? Consultants are well paid but certainly no less than they deserve. Get rid of the ridiculous pension tax charges, give our doctors a reason to stay, and recoup the money from the tax dodging billionaires.

Do you not read the papers? There are excessve deaths every single day due to the current state of the NHS

People are dying everyday due to staff shortages. Sure it's not the only issue in the NHS but it's a big one. During strike action critical services and care is still provided. It's fine of course to be against strikes, but it's important to acknowledge people are dying now from this issue.

I guess the issue could be easily fixed by moving consultants onto a DC pension scheme, like the private sector have. Problem solved.

Yes will support it. DH is a consultant and is fed up. We consider moving abroad on a monthly basis. We have no real family ties here but would be further away from the family we do have if we up sticks and moved to Canada or Australia...its definitely not as it was when we qualified several years ago.

100% back them. Consultants are who get the hospital moving, patients discharged (freeing up beds for sick patients). Make hard risk based decisions. They are required for difficult diagnoses and treatment. They train and examine junior docs. We need more of them!

Personally I don't think they are paid enough. TBH - most of the UK workforce isn't paid enough. This government has been intent on keeping wages low - which was bearable when inflation was low.

I know it's been said before - but I'll say it again. It isn't a race to the bottom. For the work they do (the training/skill/time) they deserve to be paid more. I wouldn't want the stress if their job for the wage they get.

Jeremy Hunt was pushing hard for it to be sorted from the back benches. Current chancellor doesn't agree, I forget his name......🙄

I have yet to see a poor consultant.

Is this really the bar you want to set? Some of the highest skilled professionals in the country who are responsible for people’s health are not poor?

@edwinbear there are two separate pension issues.
The most pressing is the annual allowance not the lifetime allowance (the you can have a million pounds in your pension pit one)
The annual allowance has been capped at £40000 contribution to prevent extra high earners putting in extra pension to their defined contribution pension and getting extra tax relief too.
In the NHS the pension is defined contribution. I have to contribute 13% - this does not come anywhere near £40000. But annual allowance tax is paid on an amount that my pension is calculated to have grown. This is impossible to predict in advance as it is influenced by inflation and a multiplying factor too. A pay rise of £2000 could potentially produce a tax bill of £10000!
If they want people to do extra work to tackle waiting lists then the government really need to address this.
I work slightly less than full time to accommodate caring responsibilities. I will not be moving back to full time anytime soon as the tax bill for doing so could be huge!

Agreed. I appreciate all the points made here but it is still a great pension scheme with a big employer contribution of 14%!

Where is all the money for all the pay raises coming from?

Typo the NHS is defined benefit 🙄

Unless you believe that nobody deserves to earn over £100k for any reason, the pension taxation system is genuinely unfair to senior NHS consultants, and actually to anyone else who is in that salary range or above and

1. is in a defined benefit pension in the UK, and
2. makes substantial contributions to that pension out of their own salary, and
3. is not given the flexibility to reduce those contributions.

Defined benefit (DB) pensions can get punitively taxed in the UK, especially for NHS consultants, because

1. the annual allowance limit of £40k is applied more harshly to DB pension plan members than DC plan members. A defined contribution (DC) pension plan member earning below £200k (net of pension contributions) can enjoy tax relief on up to £40k of new cash going into their DC pension pot, and they also do not face any tax for growth in value of that pension pot.
   In contrast, for a DB pension plan member, which includes NHS consultants, any growth above inflation in the actuarial value of their DB pension pot gets treated as an additional cash contribution, with that figure compared against the £40k annual allowance. That means that a DB pension plan member does not enjoy tax-free growth in the value of their pre-existing pension pot the same way a DC pension plan member does. Instead, a DB pension plan member who sees an actuarial growth of more than £40000 from the combination of new contributions and growth in the value of historical contributions will see that excess amount taxed at their highest marginal tax rate, which for many NHS consultants will be 45%. So if the computer spits out £60k, then wham! They have to pay 45% of £20k, or £9k, in cash. This is not only unfair, it is also complicated to understand and can lead to unpredicted tax liabilities.

2. NHS consultants face substantial upfront deductions from their headline pay in exchange for their DB pensions. Pension contributions plus income tax will, together, often or always be above 50 percent of gross salary. So an NHS consultant on £100k is taking home £50k, and if they then get a year to which the computer says there was a £60k actuarial pension value increase, they have to pay £9k (45% of the £20k overage) in taxes. Unlike the £60k, an actuarial number that may never get paid out to them and whose true value will fluctuate with any policy or interest rate change, the £9k is in real money, due now.

3. An employee in a private company with a DB plan (not many of those left!) can remedy this if the pension trustees give flexibility to receive more take-home pay and less of a pension contribution, so they can avoid this punitive treatment. NHS consultants, however, do not have any flexibility to reduce those pension contributions, except by working less.

It is also important to remember two other things:

1. when an NHS consultant retires, everything they get from their pension will get taxed as ordinary income, just as with any other pension in the UK. So a consultant forced to pay a tax penalty for exceeding the allowance will first have faced large and involuntary contributions to their pension, next a tax penalty in the year of contribution for making too large of a contribution, and then finally ordinary income tax after retirement as they get their earned pension benefits, even though the tax penalty had the effect of also taxing their money as it went in. So they effectively get taxed twice

2. On top of this, it is also important to remember that many NHS consultants will be in the £100-125k band of taxable income so their ordinary taxable pay is in effect already facing a marginal tax rate of 60%, and that is even before dealing with any of these pension tax chargers.

The obvious fix in the short-term would be to give NHS employees the flexibility to reduce their pension contributions, together with a lot of robust assistance working out whether they should do that. That could at least let people out of the annual allowance tax trap, although many would instead end up in the 60% marginal tax rate band, which is less bad but still pretty bad.

A longer-term fix might involve changing the tax treatment of DB pensions to make it less onerous, for instance by allowing some of the annual actuarial growth in pension value to be tax-free (since it will anyway get taxed as income if and when it gets paid out), and perhaps paying for that in the udget by increasing the tax rates on capital and earnings from capital. It makes no sense at all to me that people who get their money from capital without working pay a much lower tax rate than people who get their money by working and being of service to others.