Thread by @goldstone_tony

1/46 If you are a doctor this may have landed on your mat. Some more info for GPs, consultants & some crucial new info following @CommonsHealth this week. Sorry its long read🧵 Pls read all carefully/share. Needs fixing, by government NOW. What will, & importantly WONT work.

2/46 The full online @bmj_latest @ingridtorjesen
article is here 👇which has more important info. I would suggest reading the full version

bmj.com/content/377/bm…

3/46 The full article contained a subtle but important error (caused by the editing process of a long & complex subject, but removal of two crucial words completely changed the meaning!) so please read alongside this rapid response which I thought needed urgent correction

4/46 The article covered the release of a new @TheBMA tool. I covered this detail in last week, so if you missed it come back to this one later in this long read🧵 👇. There is a link to the tool in that thread

https://twitter.com/goldstone_tony/status/1527949232107360256?s=20&t=zvx6-ixI4HA-bz92UCYAGw

5/46 So why is this article about "GPs". Thats principally because the tool is specifically for GPs, but also because the particular (highly complex) issue is *worse* for GPs, but will also affect other high earners in the NHS including @BMA_Consultants & snr mgrs @Jon_Restell

6/46 Worth adding @BMA_Pensions currently writing urgent guidance with a small team for
@BMA_Consultants so they can rapidly work out their own position as well as @BMA_GP @CNagpaul @rpodolak

7/46 I cant tell you what CPI @ Sept 22 (its already 9%, I predict it will be 10% or more in Sept 22) nor what pay award is coming but you can model impact as a consultant using existing tool👇 in the factors tab. @TheBMA
Goldstone pension modeller modelyourpension.com

8/46 We had agreed with our actuaries who signed off the tool future CPI 2% and pay growth 1%. I dont have a crystal ball but these are the values I'm using as a best guess. It is of course all complicated (massive understatement) by McCloud

9/46 I cant emphasize enough how much McCloud will muddy the water (which is already muddy). I'm mid 40s. If nothing changes I wouldn't have found out about my likely MASSIVE AA charge for this year for 16 years, IF retire at 60 (looking less likely now 😔). Ridiculous situation

10/46 Firstly why am I (& lots of other people who speak out to protect patients) are doing this.

11/46 Ive been speaking out about this for a long time now, here in @FT in 2019 before my time at @TheBMA

12/46 The fact that we are still here having the same conversations over 3 years later is a national disgrace in my opinion.

13/46 I could bore you with maths, that incredibly few people I have met can actually fathom, and if you are like me a detail person the latest crisis we find ourself in is because of this👇. And I appologise to anyone offended by the strong strong words/direct style.

14/46 But now lets very briefly analyze govmnt response in that article.

15/46 The same well oiled terms like "The generosity of the NHS Pension Scheme" and "some senior doctors exceed their allowances for tax free pension saving" but its just not correct (as explained in last weeks thread).

16/46 The higher tax relief was an illusion, already removed entirely by the design of the scheme (steep tiering).

17/46 And then this bit "GPs who pay into the scheme benefit from their pension pot being automatically increased in value at the end of each scheme year, to help maintain its purchasing power over time.”

18/46 Thats not correct either becuase the problem with this year, its the pace of change of inflation, & flawed design of the finance act/scheme reg which means "maintain its purchasing power over time" - *far* from it

19/46 The other reason to speak out, is that essentially all GPs have accountants. Look at the difference between early retirement in GPs vs consultants. A *key* driver of that is expert information / financial advice.

20/46 If government really want to improve retention, and I'm sure they need to, they need to make it pay to stay longer. These are fantastically complex & difficult messages to get across. But people cant reasonably be expected to #paytostay. Simply NOT fair.

21/46 The other reason to raise the alarm urgently (noting as above all GPs use accountants) is that's others will have inevitably done the same and bravo to @AISMANewsline for sounding the alarm to @hmtreasury independently.

22/46 What will their professional advisers tell them (ps look at the early retirement data for a DECADE & consider the unintended consequences of things like making the lifetime allowance even lower by freezing it, after saying you would sort it).

23/46 So 20 odd tweets in, its time for you take a break & watch superb questioning @CommonsHealth including by @drlukeevans @Jeremy_Hunt @rosie4westlancs

24/46 I hope other influential doctors like @AWMurrison
@drcarolinej
@LiamFox
@DrDanPoulter
@drlukeevans
@DrRosena
@Dr_PhilippaW
Also watch it

25/46 ALL doctors NEED to watch this (but promise to come back to this thread to talk about solutions that will/won't work)

bbc.co.uk/iplayer/episod…

particularly from 1:48:21

26/46 So to summarise the excellent questioning by @drlukeevans basically boils down to this - why were we still here 3 years later (that picture in @bmj_latest article above was from 2019 #ARM).

27/46 You watched the video, and you have been told that there is an answer to this problem - and that answer is "flexibility".

28/46 Im no expert on government consultations @drlukeevans but is it common place to have to withraw a consultation (in 2019, on flexibility)?

29/46 That consultation was re-run in 2019

gov.uk/government/con…

30/46 Goverment's own response concluded "The majority of consultation responses argued that tax reform would be the simplest way of solving the issue of senior clinicians limiting their NHS work for fear of large unexpected annual allowance charges"

31/46 Government have consulted twice on flexibility and it was rejected. Here is a nonconventional offer, but we have a serious crisis brewing - send me the details of what is proposed (DMs open) & I'll confidentially tell you <24hrs if I think they will solve the problem.

32/46 Please dont delay having a 3rd flexibility consultation, that will come to the same conclusion. Flexibility in any event became MUCH more difficult due to increased complexity from the current inflationary environment. It won't work

33/46 Go back to @drlukeevans underlying question - why has this been going on for 3 years? The real answer, in my opinion at least, is that some in government haven't been listening to people that *really* understand this.

34/46 They had to use an emergency fix in 19/20 in 3/4 Uk nations (AA compensation scheme Enlgand & Wales, Recycling Scotland). They had to urgently amend the rules in 20/21 with the taper.

35/46 @TheBMA told government then it wouldn’t fix the issues, now in 22/23 scrambling for another urgent fix.

An urgent fix is needed *right now* to stop not-sleep walking into a crisis.

36/46 To be fair to government, noone could have predicted the particular CPI issue but @RishiSunak has made other immediate fixes available this week to sort out these unprecedented problems.

So enough on what wont work (subject to offer above), lets talk about what will work.

37/46 1) The finance act doesnt work and isnt fair. There will be dreadful unintended consequences in my opinion of not fixing this & thanks again @AISMANewsline for highlighting this

38/46 2) Another part of the finance act, and its interaction with scheme regulations needs fixing immediately as well. Neither can wait to avoid terrible consequences. They *both* *must* be fixed

39/46 Learn from past mistakes. You made changes to the operation of the taper ("the taper tweak"), yet here we again in 2022 and its still not fixed.

40/46 3) Another emergency mitigation could be a carbon copy of 19/20 scheme. To be effective it would need announcing *really* quickly

41/46 Whatever happens you need to fix the above, and quickly. But be warned, that doesnt fix all your problems.

42/46 4) Lastly & perhaps MOST importantly, government must understand its not do 1-3 & the problem goes away. Far from it. The mistake gov. made before- thinking a problem was fixed, & then not listening when it didn't work.

43/46 Its about speaking with the right experts 👇#taxunregistered

44/46 I'd like to also apologize to my family. These threads take a huge amount of time & effort at weekends. There are also necessarily long, but its incredibly nuanced & complex so I hope its helps you understand the problem🙏

45/46 Morale is at all time low. Slides like this have been in fellow @BMA_Pensions @Vish_Sharm @Krishanx slide decks for a while. Fix it. Please. Let all move on from this car crash of pension taxation. If these are "unintended consequences" & I hope they are, fix them. Properly

46/46 This graph shows what you already know @Jeremy_Hunt @sajidjavid @RishiSunak @CommonsHealth

Please start listening, and fix this properly for the sake of patients everywhere.😢

Pls share / RT

47/46 (Addendum) Apologies in the crucial trade off between urgency/timeliness/accuracy/typos etc I missed this @TheIFS graph which should have correctly been in tweet 46