Healthcare accountants for London clinicians. Pension, IR35, partnership.
NHS GP partner navigating the annual allowance taper? Locum doctor with multiple agency contracts and an IR35 question? Private dentist incorporating to optimise tax? GP or dental practice running a partnership return? We work with the full spread of clinical professionals — and we know the pension, IR35 and partnership rules that hit healthcare hardest.
Clinical tax has its own rules. Generalist firms miss the big saves.
NHS pension annual allowance taper. IR35 for locums. VAT exemption (not zero-rating) and what that means for cosmetic mix. Capital allowances on six-figure equipment outlays. Partnership accounting. Four problems below show up in every onboarding from a clinician who has been with a generalist firm.
"I'm getting a £15K pension tax charge and nobody warned me."
The pension annual allowance for 2026 is £60,000 but it tapers to £10,000 for adjusted income above £260,000. NHS pension growth (the year's accrual value) counts towards the allowance — high-earning clinicians breach it routinely. The charge is at marginal rate (often 45%+). Carry-forward from prior three years and scheme pays elections both help, but you have to model it before year-end. Generalist firms rarely run the calculation.
"My locum agency assignment looks like IR35 and I have no defence ready."
NHS bodies have been the most active IR35 enforcers in the country. If your assignment fails the CEST tests — agency dictates hours, you wear NHS-issued ID, you cannot send a substitute, you sit in the rota — the income is taxed as employment with no salary/dividend benefit. We review every significant contract against CEST, draft amendments, and document working practices so you have a paper trail.
"I bought a £40K dental chair and my accountant just put it on depreciation."
Medical and dental equipment qualifies for the Annual Investment Allowance — up to £1M of immediate 100% deduction against trading profits. A £40K chair correctly claimed saves £18K of tax in year one for a 45% taxpayer. Generalist firms often miss the AIA election or default to slow depreciation, which spreads the relief over years and costs you the time-value.
"My private practice mixes cosmetic work and NHS — I have no idea about VAT."
Therapeutic medical and dental services are VAT EXEMPT (not zero-rated) — no VAT on fees, no VAT recovery on expenses. Cosmetic / aesthetic procedures and expert witness work are standard-rated at 20%. If your standard-rated income exceeds £90,000 you must register for VAT and apply partial recovery rules to overheads. Most generalists don't even realise the distinction.
NHS pension annual allowance taper. The £15K surprise nobody warns you about.
If you earn above £260,000 of adjusted income — and many GP partners, consultants and senior dentists do — your pension annual allowance tapers down to as little as £10,000. NHS pension accrual counts. Here's what to do about it.
Pension growth above the allowance is taxed at your marginal rate — often 45% or more.
Most clinicians don't realise their NHS pension benefit is "taxed" at all because the contribution is made by the employer (via the NHS scheme). But HMRC measures the annual growth in pension value — the present value of the new accrual added in the tax year — and counts that against your annual allowance.
For a senior GP partner or consultant approaching retirement, that growth figure is often £30,000–£60,000 per year. With the taper down to £10,000, the excess generates a tax charge that lands on your personal Self Assessment. Bills of £10,000–£25,000 are common.
Three things help: (1) using carry-forward of unused allowance from the previous three tax years, (2) electing for the NHS scheme to pay the charge from your future pension via "scheme pays" (no out-of-pocket cash), or (3) opting out of further accrual once the marginal economics tip negative. We model your specific numbers annually for £495.
Everything a clinician needs. Specialist, not generalist.
Click any service to read the dedicated page. All services delivered in-house by chartered accountants who specialise in clinical tax.
High-Earner Self Assessment
Tier 3 SA covers multiple income, NHS + private mix, capital gains, foreign income. £1,300/year.
View service →Limited Co Accounts
Locum or private practice Ltd Co accounts and corporation tax. Tier 1-3 from £1,200/year.
View service →Tax Planning Workshop
Bespoke £1,200 strategy — pension taper, capital allowances, structure, R&D for medical SaaS.
View service →MTD for Income Tax
Mandatory from April 2026 for sole-trader locums above £50K. £150/quarter quarterly service.
View service →Limited Company Formation
Locum or practice incorporation, share structure, IR35-aware setup. From £400 one-off.
View service →Business Mentor
Free for every client. Practice growth, contract negotiation, partnership transitions.
View service →Find your clinical service mix and fee. Five questions, one minute.
Answer five quick questions about your practice, income and structure. We'll show you the right service mix, an estimated fee, and flag any pension, IR35 or MTD issues to address.
Your healthcare position
Based on your answers, here's the right setup.
The fees a clinician actually pays. Standard, transparent.
Below is the typical service mix and standard fee. Quotes are issued in writing within 24 hours of the call — request one to see what discounts and seasonal offers are available in the current period.
Healthcare service fees
All prices exclude VAT. From the master service-fee schedule.
| Service | Description | Fee |
|---|---|---|
| Self Assessment — Tier 3 (Complex / Multi-Source) High-earner clinicians, NHS + private mix, multiple income |
Multi-income, capital gains, foreign income, pension allowance review | from £1,300/year |
| Limited Co — Tier 2 (Locum / Practitioner) Most popular structure for locums and private practitioners |
Annual accounts, CT600, director SA, payroll setup | from £2,200/year |
| Limited Co — Tier 3 (Multi-entity) Larger private practices, multi-clinic groups |
Tier 2 plus second director SA, integrated tax planning | from £3,500/year |
| NHS Pension Annual Allowance Review Critical for high earners — taper, carry-forward, scheme pays |
Annual modelling, carry-forward optimisation, scheme pays election | £495/year |
| IR35 Contract Review For locum agency assignments at risk of inside-IR35 status |
CEST review, contract drafting, working practices documentation | from £395per contract |
| GP / Dental Partnership Tax Return Partnership SA800 plus all individual partner returns |
Profit allocation, capital and current account reconciliation, partner pension | from £2,500/year |
| Tax Planning Workshop Bespoke strategy for high-earner clinicians |
Pension, capital allowances, structure review, secure portal delivery | £1,200fixed |
| MTD for Income Tax — Quarterly Service Mandatory April 2026 for sole-trader locums above £50K |
4 quarterly digital submissions + year-end finalisation | £150/quarter (£600/yr) |
What our clinical clients actually got back. Real numbers.
Three recent examples from a GP partner, a locum doctor and a private dentist. Names changed, numbers real.
£11,400 pension tax charge mitigated via carry-forward and scheme pays
A GP partner at a busy north London practice came to us in January with a £14,200 annual allowance tax charge looming on her Self Assessment. Her previous accountant had not modelled pension growth at all. We pulled her Pension Savings Statements, identified £18,000 of unused allowance carried forward from the prior three years, and elected for £6,200 of the remaining charge to be paid by the NHS scheme via scheme pays. Net out-of-pocket exposure dropped from £14,200 to £2,800.
£8,200/yr saved by incorporating with IR35-clean contracts
A locum doctor doing £110K through a personal service company had been told by her agency that "all locum work is IR35 now". We reviewed her three main contracts via CEST, identified two as outside-IR35 with the right contract amendments and one as borderline. We renegotiated the contract wording (substitution clause, no rota control, project-based deliverables), documented working practices, and confirmed the outside-IR35 status. She continued operating through her Ltd Co with full salary/dividend optimisation, saving £8,200/year vs deemed employment.
£18K tax saving on a £40K dental chair via correct AIA election
A private dental practice acquired a new £40K dental chair plus £12K of associated equipment in their accounting year. Their previous accountant had applied 18% writing-down allowances by default, spreading relief over many years. We re-elected for the Annual Investment Allowance, claiming the full £52K immediately against trading profits. At the practice's 45% effective marginal rate, the year-one tax saving was £23,400 — versus only ~£4,200 under the previous depreciation approach.
Healthcare-specific quote, in writing within 24 hours.
Tell us your practice type, income, structure and pension status. We'll send a written fixed-fee quote covering exactly the services you need — and any current discounts or offers in the period.
Frequently asked questions.
If your question isn't here, message us on WhatsApp or book a free 15-minute call.
Healthcare accountants in King's Cross, London.
Our office sits at 39-41 North Road, London N7 9DP — five minutes from Caledonian Road tube and ten from King's Cross St Pancras. We work with clinicians across Islington, Camden, Hackney, Westminster, Tower Hamlets, the City of London, Marylebone, Harley Street and the wider London medical district, plus our secondary presence in Wickford / Basildon, Essex.
Most engagements are delivered remotely via video call, secure portal and our client area — particularly suited to busy clinicians. For practitioners who prefer to meet, the King's Cross office is open Monday to Saturday 10am to 7pm. No appointment fee, no travel charge.
London N7 9DP
10am to 7pm
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Book a free 15-minute call. We'll quote your engagement in writing within 24 hours including any current discounts or seasonal offers. If LOYALS isn't the right fit we'll tell you that too.
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