Specialist Accountants for Portfolio Doctors & Multi-Income Clinicians
Modern medical careers are rarely one job. A single tax year can contain an NHS salary, a partnership profit share, locum sessions, out-of-hours shifts, private clinics, medico-legal reports, teaching, appraisal work, a company directorship and rental income from the flat you never got round to selling. Each is taxed differently, each affects your pension allowance, and HMRC expects them all in one return. Bringing that together correctly is exactly what we do.
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We act for clinicians whose income arrives from several directions at once. The more sources you have, the more there is to get wrong and the more there is to plan.
A PAYE salary alongside locum, private or medico-legal income, with tax codes reconciled and payments on account forecast so January never surprises you.
Partnership profit share plus teaching, appraisal, ICB or CCG roles, medico-legal work and directorships, coordinated into a single tax and pension position.
Salary, dividends, partnership profits and employment income modelled together so allowances, thresholds and the personal allowance taper are managed deliberately.
Rental profits, furnished holiday lets, dividends and capital gains brought into the plan, including the effect on adjusted net income and pension tapering.
When income comes from six places, the value of an accountant is in the coordination. Every service below is designed to bring the pieces together.
One return covering employment, self employment, partnership, dividend, property and foreign income, fully reconciled to every P60, remittance and statement.
Multiple employments checked for duplicated allowances and emergency codes, overpayments reclaimed and HMRC asked to correct coding for the following year.
Annual Allowance, carry forward and tapering calculated across NHS growth and any private pension contributions, using your full income picture.
Deciding which income belongs in a company, which stays personal, and how to sequence drawings so you are not paying tax at 60 per cent unnecessarily.
A single reserve calculation covering every stream, with quarterly updates, so the money for January and July is always already there.
Portfolio careers create tax problems that would never arise from a single job. These are the ones we see and fix:
Duplicated personal allowances across two or more employments
Income streams forgotten entirely until HMRC asks
Personal allowance withdrawn and a 60 per cent effective rate
Annual Allowance tapering triggered by combined income
Payments on account calculated on an unrepresentative year
Expenses claimed against the wrong income stream
No single view of what is actually owed until January
Complexity is where good accountancy earns its fee. Our team handles multi-source medical income every week. Here is what you get:
Every income stream in one place, reconciled and reported, so you finally know your real total income and real total tax.
Multiple employments checked and refunds reclaimed, with HMRC coding fixed so the same mistake does not repeat every year.
Annual Allowance, tapering and income tax modelled as one calculation rather than treated as separate problems by separate advisers.
Deliberate management of the personal allowance taper, child benefit charge and higher rate thresholds using pension, gift aid and timing.
A single, quarterly-updated tax reserve figure covering everything, so January is a transfer rather than a crisis.
One agreed fee covering all your income streams, quoted up front, with unlimited telephone and email support.
The more income streams you have, the more time a good system saves you. Our three-step process gets you set up quickly and keeps you informed all year:
We begin by getting to know your practice and understanding your unique needs. This step ensures we have a clear picture of your operations and your goals.
Based on our initial discussion, we create a personalised plan designed specifically for you. The aim is to keep everything organised and easy to follow. You can rest assured that your numbers are being handled with expert precision.
From there, we take care of the ongoing work and keep you updated with reports. You’ll always know what’s happening, and we’re always here to answer your questions, ensuring you have a clear picture of your financial health at all times.
Chartered, experienced and genuinely specialised in healthcare. Here is what working with us looks like in practice:
We use Xero, Quickbooks, Sage & many other online software.
Meet, call or email the same qualified accountant who knows your practice and your pension position.
Free telephone & email support
throughout the year.
Our team have over 100 years of combined experienced.
Never Miss any deadline with our automated email reminders.
We’re an ICAEW, ACCA & AAT accredited Firm.
Take a back seat and let our specialist healthcare accountants handle everything. Switching part way through the year is straightforward and you never need to speak to your old accountant:
Reach out to us, and we’ll discuss your needs and how we can help your healthcare practice thrive.
We’ll send over a simple letter to formalise our partnership and get everything in motion.
If you're switching, we’ll take care of contacting your previous accountants to make the transition smooth.
From there, sit back and relax. We’ll manage your accounts, taxes, and everything in between, keeping your practice running smoothly.
Yes. Employment, self employment, partnership profits, dividends, property, savings interest above the allowance, foreign income and capital gains all have to be reported where they exceed the relevant limits. Small amounts of casual teaching or report income are the most commonly forgotten, and they are exactly what HMRC data matching picks up.
HMRC allocates your personal allowance to one employment and usually applies a basic or higher rate code to the other. If your income changes, or a third source appears, the codes rarely keep up. The final position is only corrected through self assessment, which is why the return matters even for mainly employed doctors.
It depends on how the payer treats you. Some pay through payroll, which means PAYE has been applied. Others pay gross, in which case the income is self-employed and must be declared. We check each payment source rather than assuming, because the two are handled very differently on the return.
No. Expenses must be matched to the income they relate to, and the rules differ between employment and self employment. Employment expenses face a stricter wholly, exclusively and necessarily test. Allocating costs to the right stream is one of the most common corrections we make for new clients.
Adjusted income for the tapered Annual Allowance includes all your taxable income plus your pension growth. Doctors with several income sources therefore reach the taper far sooner than colleagues on a single salary, often without any warning from the scheme.
Between the point where the personal allowance begins to be withdrawn and the point where it is fully lost, each extra pound of income costs you both higher rate tax and part of your allowance, producing an effective rate of around 60 per cent. Pension contributions and gift aid are the usual tools for managing income within that band.
Sometimes. Medico-legal work, private clinics or consultancy can suit a company, while NHS employment cannot go through one at all and locum work may fall inside IR35. The decision should be made across your whole income picture, including the NHS pension effect, not stream by stream.
One business bank account for self-employed work, cloud bookkeeping with receipt capture on your phone, and a habit of forwarding every remittance and statement to a single folder. We set this up during onboarding, and it usually takes clients under ten minutes a month afterwards.
Making Tax Digital for Income Tax applies to self-employed and property income above set thresholds, with phased start dates. Doctors with self-employed private, locum or rental income are likely to be brought in, which means quarterly digital updates. We move affected clients onto compliant software well ahead of their start date.
We calculate a single percentage across all your non-PAYE income, allowing for payments on account, any Annual Allowance charge and the child benefit charge. It is reviewed quarterly, because a strong private or locum year changes the figure significantly.
We quote a fixed fee based on the number and complexity of your income streams. It is agreed before we start and includes unlimited telephone and email support through the year, so an extra question never means an extra invoice.
Yes. We request professional clearance and handover information directly, review the previous returns for anything that should be amended, and take over from that point without you having to make an awkward call.
Please double-check the figures before you act. The tax, NHS pension and accounting information on this page is general guidance for UK doctors and healthcare professionals, not personal advice. Tax rates, allowances, thresholds and NHS pension rules change regularly, including at each Budget and at the start of every tax year on 6 April. Trading and property allowances, payments on account and the thresholds at which extra reporting is triggered change regularly. Always cross-check any rates or figures against HMRC, the NHS Business Services Authority and the latest Budget announcements, or speak to one of our qualified accountants before acting. CruseBurke cannot accept liability for decisions made solely on the basis of this page. Last reviewed: August 2026.
