08th August 2019 Written by Dean Royles

PensionThe Government has launched another consultation on NHS Pensions. In any normal circumstances, that first sentence may’ve won an award for the “most boring start ever to a topical blog”, but NHS Pensions are topical again – very topical.

The media is full of reports that, due to the tax implications on annual pension allowances and the pension tax taper, doctors are refusing to undertake additional work and, in some cases, trying to reduce hours because the punitive pension tax rules mean they potentially face huge tax bills. Therefore, essentially they would be working for nothing, or in some cases, potentially paying to work.

The implications on NHS services are obvious, fewer operations, fewer clinics, fewer hours worked – longer waits for patients and the concomitant impact on morale and motivation. It is a mess.

So, although HM Treasurer has said it has listened to the concern and indicated it will review the review, in the absence of a more obvious solution of making urgent changes to pension tax rules, a consultation on pension flexibility is very welcome. But…and it’s an enormous but…the flexibility would only apply to senior clinicians and only where there is an impact on service delivery (effectively suggesting that flexibility will only apply to medical consultants and GPs). The flexibility on pension contributions would not apply to all the other NHS staff that make up the healthcare team. This is bound to create problems.

Now, it’s clear that it’s medical staff who are most affected, in particular consultant medical staff, due to higher salaries. But there are a significant number of non-medical staff also effected.

The consultation permits more flexibility on pensions contributions for doctors to help alleviate some of the tax implications. The irony of government department introducing a consultation to ameliorate the implications of the governments own tax rules is not lost on many.

However, there are also thousands of lower paid NHS staff that are not in the NHS scheme because their circumstances mean they can’t afford the full monthly contribution.

In an organisation like the NHS, known and respected for its egalitarian approach to terms and conditions of employment, it’s bizarre that we can have a consultation that gives flexibility to senior doctors but not to a dedicated healthcare support worker earning 5 times less. It seems to me also divisive and potentially discriminatory to treat clinical staff and non-clinical staff differently in respect of pension provision.

It’s right to resolve the urgent issues with medical staff but failing to explore flexibility to all NHS staff will have implications on morale, motivation and the discretionary effort of staff that the NHS so desperately needs for years to come.

It’s not too late to extend the consultation to all staff.


Dean is strategic Advisor at Skills for Health and Co-author of “An Introduction to Human Resource Management”, by Oxford University Press.

Dean always welcomes feedback. Please get in touch with him on Twitter @NHS_Dean, or email him directly: This email address is being protected from spambots. You need JavaScript enabled to view it.