It is a ‘national scandal’ that GPs are having to work less or leave their jobs altogether due to NHS pension rules, the House of Commons Health and Social Care Committee has said.
The committee of MPs has recommended a number of urgent actions the Government should take to prevent the ‘haemorrhage’ of staff.
To avoid losing GPs, NHS England should ‘develop a national NHS “retire and return” policy to replace ad hoc local schemes’, it concluded.
The report on workforce in health and social care, published today, said that the NHS ‘cannot afford to lose staff who are willing and able to work’.
The report recommended a ‘swift’ reform of the NHS pension scheme, as ‘clearly, the Government’s changes to tax regulations have not gone far enough to remedy this crisis’.
It said: ‘It is a national scandal that senior doctors are being forced to reduce their working contribution to the NHS or to leave it entirely because of NHS pension arrangements.’
The report added: ‘With mounting waiting lists and ever-increasing demands, the NHS cannot afford to lose staff who are willing and able to work, and urgent action is needed to reform NHS pensions and prevent the haemorrhage of senior staff.
‘The Government must act swiftly to reform the NHS pension scheme to prevent senior staff from reducing their hours and retiring early from the NHS.’
The MPs also recommended:
- An ‘overhaul of flexible working’ to encourage staff to stay in permanent NHS roles. The report said the NHS ‘should commit that within 12 months, all regular NHS staff should be able to opt for similar flexibilities to those enjoyed by locum or agency staff.’
- No newly qualified doctor should do any full-time locum work ‘for two years after their qualification’ and ‘incentives’ should be used to slow the number of postgraduate doctors opting straight into locum work.
- A ‘national menopause strategy’ looking at retaining staff who might leave due to a lack of menopause support.
- The General Medical Council should start a ‘green list’ of countries where doctors are given ‘an automatic right to practise in the UK following the minimum necessary checks’.
- There should also be ‘default visa extension for six months after the international medical graduate’s expected GP training completion date, to give them time to find an appropriate employer’.
Health and Social Care Committee chair Jeremy Hunt said: ‘Persistent understaffing in the NHS poses a serious risk to staff and patient safety, a situation compounded by the absence of a long term plan by the government to tackle it.
‘We now face the greatest workforce crisis in history in the NHS and in social care with still no idea of the number of additional doctors, nurses and other professionals we actually need.
‘NHS professionals know there is no silver bullet to solve this problem but we should at least be giving them comfort that a plan is in place.
‘This must be a top priority for the new Prime Minister,’ he said.
Why pensions are pushing GPs into early retirement
Under the current NHS pension scheme, the highest-earning GPs pay at least 14.5% in contributions, but a tapered annual allowance limits the amount of money that can go into the pension pot each year without facing significant tax penalties.
The Health and Social Care committee’s report said the target to solve the issue with doctors’ pension taper problem has ‘broadly been met’.
It said: ‘In the Department’s response to our request for evidence on the taper problem, it stated that from 6 of April 2020 the taper threshold was increased, which removed 96% of GPs and 98% of consultants from the scope of the taper.’
The pensions taxation rules, in particular around annual and lifetime allowances, push GPs to reduce their hours or retire early to avoid large tax bills.
In evidence by the BMA submitted to the workforce inquiry, Dr Vish Sharma explained that the key issue is the way the NHS pension interacts with taxation policy, and how as a result, a GP can be ‘financially worse off’ for working ‘for longer or by not reducing hours worked’, which creates a situation where GPs ‘are in effect prevented from contributing further or continuing to remain within the healthcare sector’.
Back in March 2021, the Government froze the lifetime allowance for GP pensions at £1,073,100 until at least 2025/26.
The lifetime allowance is the maximum amount you can put into a pension pot without triggering an extra tax charge. If a pension pot exceeds the allowance, it is then taxed heavily when you retire.
GP pension experts recently warned that an average GP could be hit by a ‘nightmare’ £33k tax bill due to the ‘unfair’ way inflation is applied to their pension.
But a Government minister said it would be ‘hard to justify’ another GP pensions tax compensation scheme like the one implemented in 2019/20.
And a Pulse survey which revealed that half of the existing GP workforce plans to retire at or before the age of 60 saw doctors quote problems around pensions as a significant reason.
Meanwhile, the BMA announced it has been granted a judicial review into the Government’s ‘unlawful’ handling of NHS pensions.
Dr Vishal Sharma, BMA pensions committee chair, said: ‘The Health and Social Care Select Committee findings are correct – it is indeed a “national scandal” that senior doctors are being driven to reduce their hours or retire early, just when the NHS is facing the ‘biggest workforce crisis in its history’. What is most scandalous is that this is a mess entirely the Government’s own doing through its absurd and unfair pension taxation policy – and it is entirely within its gift to solve, quickly.
‘It’s good to see the Committee taking heed of the BMA’s warnings, and fully recognise that despite the changes to the taper in 2020, there remains an urgent and pressing need for Government to solve this issue in order to prevent a further exodus of doctors. It is also vital that there is reform of pension taxation rules so that doctors can maximise the amount of care they can provide to their patients.
‘For those doctors who are left with no choice but to leave the pension scheme, the Committee highlights the necessity for employers to be mandated to “recycle” the full value of pension contributions back to the employee in their wages, a measure backed by the BMA and most recently the review body for doctors’ pay, the DDRB – as well as the outgoing Secretary of State for Health and Social Care.
‘At the BMA we still believe that the long-term solution is a tax unregistered scheme, similar to the one implemented for judges to solve the retention crisis in the judiciary. Such a scheme would remove the disincentives from providing more care for patients and enable doctors to work for longer. It would also ensure that doctors paid the correct amount of tax on their pension savings and therefore is a fair solution for the taxpayer.
‘Whilst the Government argued that the situation for the judiciary was different as judges could not return to private practice, the BMA rejects this argument as the vast majority of doctors do not do private practice, and the BMA wants a solution that will retain doctors within the NHS. We also firmly believe that the introduction of ‘pension flexibility’ would not solve the problem and indeed this has been consulted on twice previously and rejected by both scheme members and the Government.’