Article Text
Abstract
Background The Annual Allowance (AA) taper caused many doctors to pay to work though receiving tax bills on their pension.
Aim To explore how receiving a tax bill due to the AA taper of the NHS Pension Scheme affected surgeons’ perceptions of working in the NHS.
Methods In 2020, 12 qualitative, semi-structured, one-to-one interviews were conducted with surgeons from six NHS trusts. Thematic analysis.
Findings Before a bill, most participants were content working in the NHS as they had financial equilibrium, job satisfaction, and promised pension remuneration. However, receiving a bill was unaffordable and stressful. As working risked triggering future bills, participants became risk averse to working in the NHS and so reduced their NHS work. Many felt guilty withholding patient care but several were frustrated with the government and felt that the government was taking advantage of doctors. All believed that it was the governments’ responsibility to resolve problems caused by the taper in the NHS but many distrusted the government and felt voiceless. The NHS Pension was viewed as remuneration for high work done at low pay, and a reward for loyalty and commitment to the NHS. A pensions tax bill broke this expectation, leaving participants demoralised and with reduced incentive to keep contributing.
Conclusions Receiving a tax bill disrupted the financial equilibrium, job satisfaction, and pension remuneration that participants expected of working in the NHS. Some found it a final straw so were considering retiring early and reported reduced engagement. Others experienced less disruption but still felt undervalued, mistreated, and demoralised which contributed to increased frustrations with working in the NHS. Although the 2020 Budget gave a financial solution to the taper, it may not resolve perceptions that some doctors now have of working in the NHS. Future grievances may exacerbate these perceptions, causing a greater loss of workforce engagement.