Specialist Accountants for NHS Hospital Doctors, Registrars & Consultants
Hospital medicine produces one of the most awkward tax positions in the country. You are taxed at source, yet you rotate between trusts, pick up bank and waiting list initiative shifts, sit exams, pay for courses out of your own pocket and watch an NHS pension quietly build an Annual Allowance charge you were never warned about. Our accountants for hospital doctors reconcile every payslip, claim every relief you are owed and make sure the pension tax never arrives as a surprise.
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We act for hospital doctors from foundation year through to substantive consultant posts across NHS trusts and the private sector. Your pay structure, pension growth and tax risks change at every grade.
Multiple trusts and tax codes in one year, exam and course costs, relocation expenses, student loan repayments and reclaiming overpaid tax from emergency coding.
Rotations across trusts, banding and enhanced pay reconciliation, less than full time working, and the first real Annual Allowance checks as pension growth accelerates.
Clinical excellence awards, waiting list initiative payments, private practice alongside the NHS contract, tapering checks and incorporation reviews for private income.
Expert witness fees, insurance reports, private clinics and consultancy income handled through the right structure, with VAT reviewed where the work is not exempt.
Every service below is built around the way hospital doctors are actually paid — trust payslips, bank shifts, WLI sessions and private fees — not around a generic small business template.
Every P60, P45, bank shift and private invoice reconciled into one accurate return, filed on time, with payments on account forecast well before January.
Pension input amount calculations, carry forward reviews, tapering checks once private income is included and Scheme Pays elections handled before the deadline.
GMC and indemnity fees, royal college subscriptions, exams, courses, conferences, clinical equipment and qualifying travel, including backdated claims for earlier years.
Sole trader versus limited company modelling for private and medico-legal income, profit extraction planning and the pension consequences of each route explained.
Simple systems for doctors with private income, receipts captured from your phone, and quarterly reporting so you always know what tax is coming.
Hospital doctors meet tax problems most employees never see: rotations that break your tax code, allowances nobody explains and a pension that can generate a charge larger than your take-home pay rise. These are the issues we fix:
Rotating between trusts and losing track of tax codes
Emergency tax codes on new posts and unclaimed refunds
Annual Allowance and tapering charges nobody explained
Exams, courses and indemnity fees never claimed
Bank, locum and WLI shifts declared incorrectly
Private practice run through the wrong structure
High Income Child Benefit Charge and lost allowances
Hospital doctor finances take specialist knowledge. Our team already understands trust payslips, pay protection, pension input amounts and where the line falls between NHS and private work. Here is what you get:
We calculate your pension input amount, apply carry forward, check tapering and advise on Scheme Pays before a charge becomes a problem.
GMC and indemnity fees, college subscriptions, exams, courses and equipment, including backdated claims for up to four earlier tax years.
Banding, enhanced rates, on-call supplements, WLI sessions and bank shifts reconciled properly instead of guessed at.
An honest comparison of sole trader and limited company for your private and medico-legal work, with the pension impact set out clearly.
Returns, accounts and elections filed on time, with reminders well in advance so penalties and interest never happen.
One agreed fee, quoted up front, with unlimited telephone and email support included all year.
Nobody trains for a decade to spend their nights on tax admin. 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.
Not always, but most do at some point. A return is needed if you have private or medico-legal income, an Annual Allowance charge to declare, income over the High Income Child Benefit Charge threshold, rental income, or if HMRC has issued a notice to file. Many doctors also file voluntarily to reclaim relief on professional fees.
GMC registration, medical indemnity and royal college subscriptions are generally allowable. Training courses and exams are more nuanced: HMRC accepts costs that maintain or update existing skills more readily than those that acquire a new qualification. We assess each claim on its facts and can backdate up to four tax years.
In the NHS defined benefit scheme, the value of your pension growth in a year can far exceed your contributions, particularly after a pay rise, a change of grade or the accrual of a clinical excellence award. If that growth exceeds your allowance and you have no carry forward, a tax charge follows. We calculate it and check whether Scheme Pays is worthwhile.
Once your total income including private practice exceeds the threshold, your Annual Allowance is gradually reduced. Because private income is often variable, the taper position can only be confirmed after the year end, so we build in a review each year rather than waiting for a statement to arrive.
Possibly. A limited company can help if you retain profits, employ a spouse legitimately or invest in equipment, but it adds administration and the income is not NHS pensionable. We compare the take-home position under both structures before you commit.
Almost certainly the coding will be, at least temporarily. Emergency codes and duplicated personal allowances are extremely common on rotation. We reconcile all your P45s and P60s and reclaim any overpayment, then get your code corrected.
Travel from home to a permanent workplace is never allowable, but travel between sites during the working day, and travel to a genuinely temporary workplace, often is. Rotational training posts raise particular questions and we look at each placement individually.
If you or your partner receive child benefit and the higher earner has adjusted net income above the threshold, some or all of the benefit is clawed back through self assessment. Pension contributions and certain other deductions reduce adjusted net income, so there is often planning available.
Yes. We act as your agent, handle correspondence, respond to enquiries, sort out coding notices and arrange time to pay where necessary, so you are not on hold to HMRC between theatre lists.
A straightforward employed doctor’s return is a modest fixed annual fee. Private practice, a limited company or detailed pension work costs more. You always get the fixed quote before we start any work.
Yes. We obtain professional clearance and the handover information directly from them, so you never have to make the awkward call.
Yes. We are based in Morden, South London and act for doctors across the UK using secure cloud accounting, video meetings and electronic signatures.
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. Consultant and grade pay scales, clinical excellence awards and pension contribution tiers are reviewed annually. 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.
