Thread by @goldstone_tony

1/32 An important🧵 summing up some new worrying information & terrifying predictions, & how to reverse these concerning trends -gvmnt needs to finally take head out of the sand regarding pensions taxation (& and how *you* can help). Pls read to end & share/RT.

2/32 So contrary to the Conservative manifesto pledge of 6,000 more
family doctors by 2024, @thetimes reported yesterday now 27,627 fully qualified full-time GPs in England, down from >28,000 this time last year & almost 2,000 fewer than in 2015.

thetimes.co.uk/article/doctor….

3/32 But what the Times article fails to do is dive into the reasons WHY GP numbers are dropping (probably because they are too focussed on obsessing on drop in %age of face to face appointments). But very clear fewer GPs on ground delivering highest activity EVER.

4/32 Clearly numbers of GPs depends on numbers going in (increasing +) vs numbers going out (increasing +++ faster) which is one of the reasons that RETENTION should be front & centre of strategies to increase doctor numbers & reducing waiting lists.

5/32 Obviously the reasons for people leaving are complex & there is not single factor (i.e. burnout, workload, media bashing to name a few) but there is no doubt that pension taxation is also a key driver to both session reduction & early retirement.

6/32 So what is the evidence for this?

Lets look at two drivers and whats happening to them. Lifetime allowance (LTA) and Annual Allowance (AA).

7/32 We have known for a while that proportions of doctors taking early retirement (before NPA of 60) has been increasing over a decade. In fact its more than tripled in that time for GPs and is now around 60% of retirements (red line)

8/32 Look at the correlation with the fall in the real terms value of the LTA. Back in 2008, corrected for inflation, you could have an NHS pension over £95k and be under LTA (very few did!), but that has decreased massively to 50% of that level, but flattened since 2016-21.

9/32 But here is the worrying bit. Government froze the LTA in
2021. Back then inflation was 0.4%, with 2% long term prediction. A survey of 8000 Gps/con. 72% said LTA freeze⬆️likely retire early; 61% ⬆️ likely work fewer hours.

https://twitter.com/goldstone_tony/status/1365947865625944064?s=20&t=pFH6Iob3KbMAdm2ATBeo2g

10/32 So deeply worrying policy with inflation at 1-2% - but now inflation is 9.1% & @bankofengland say will exceed 11%. That means- by failing to increase with CPI as it did, LTA will decrease in real terms by 11% (over £100k). What will happen to early retirements??👇

11/32 So what about Annual Allowance? I wont cover this again in detail - suffice to say 22/23 is going to be a *terrible* year, especially for GPs but for consultants too.

https://twitter.com/goldstone_tony/status/1530483691960541191?s=20&t=8401Lgzf1bKupHW1ZPmtPQ

12/32 Important to dismiss the government spin that the AA reflects the "generosity of the scheme". Thats nonsense - almost all the AA charges this year is due to a flaw in the finance act which means its not correctly measuring growth above inflation👇

https://twitter.com/goldstone_tony/status/1530483767013523458?s=20&t=e9jnSRZWSKfeOlDz-mxHDQ

13/32 So we've talked about the situation up to now, but what does the future hold. Last week I did a thread on bleak projections for waiting lists, which could exceed 14.6m by 2030. But on Thursday there was widespread media coverage of a @HealthFdn report 👇

14/32 But lets take a bit of a deep dive into that report. Their key finding is their "pessimistic" scenario predicted that up to 1/4 of GP posts could be vacant by 2030 👇

Thats a very worrying statistic, but how realistic is it @NikkiKF @BMA_GP

15/32 This shortfall was based on these assumptions. Though @HealthFdn did acknowledge the rates of retirement between early retirement ns NPA, they failed to mention the elephant in the room & one of the key drivers of this - pension taxation.

16/32 The assumptions are that optimistically VER will increase by 1% from now 2030, 5% in the pessimistic scenarios.

You read that right - the *pessimistic* scenario is that VER rates increase by only 5% to 2030

17/32 I would suggest 5% increase in VER may be SIGNIFICANT underestimate. With LTA dropping by 11% this yr (see correlation graphs abv) & AA bills being "off the scale" this year - w/o govmnt intervention, wouldnt be at all suprised to see those VER rates in next 1-2 years.

18/32 So what can you do about it? There have been some green shoots over the past 3 weeks in government (both side of the political fence) that the penny may be starting to drop. For example (1) @wesstreeting (shadow health)

https://twitter.com/goldstone_tony/status/1539264973641326592?s=20&t=GE2ibnFjnypHrFjaTilZtA

19/32 (2) @sajidjavid gives central support for recycling ♻️ ("make it clear that it is something that we, at the centre, are happy with"), & some superb questioning by GP/MP @drlukeevans

https://twitter.com/goldstone_tony/status/1538128900051591169?s=20&t=8401Lgzf1bKupHW1ZPmtPQ

20/32 (3) Some excellent questions about pension taxation from multiple MPs (less sure about some of the answers!) incl. Dr. Dan Poulter (cons) & @FeryalClark (labour shdow health) asking the Minister about rising CPI inflation & impact on AA/LTA

https://twitter.com/goldstone_tony/status/1541352725203623937?s=20&t=NbMeu5K8VNz7jV0wgCKFzQ

21/32 So how can you help? We've already had over 1000 docs contact their MP asking them to attend a roundtable event at Westminster hosted by Dr. Dan Poulter MP & @bma_pensions

22/32 If you havent already *please* contact *your* MP👇, email preferable (see twt 7) so you can explain circumstances & why they *must* fix this pension tax car crash. Please take a couple of minutes and do it now!

https://twitter.com/goldstone_tony/status/1542100700989120513?s=20&t=GE2ibnFjnypHrFjaTilZtA

23/32 I'm afraid the meeting is for MPs only (& @bma_pensions officer team) but please read the brief so you can see what we are discussing & the solutions we are putting forward.

24/32 When you write, you might get responses such as 👇 as some MPs have been brainwashed that the only problem was the taper, and tweaking it 2020 removed the problem from 96-98% of doctors. It *really* didn't so write back asking them to actually read the brief!

25/32 In various threads I have put my (& @BMA_Pensions) thoughts on solutions. I wish it could be distilled into 1 or even two simple asks, but I'm afraid I dont believe it can. Instead I think there are urgent actions & more medium/long term aims.

26/32 Here are solutions @thebma are urgently asking that we think could turn this round (but action is needed *right now*)

27/32 1️⃣ ALTER THE FINANCE ACT, VERY URGENTLY
The finance act doesnt work & isnt fair.There will be dreadful unintended consequences of not fixing this & thanks again @AISMANewsline for highlighting this & to @hmtreasury @DHSCgovuk to listening to @bma_pensions views on this

28/32 2️⃣ Another part of the finance act re "negative PIAs", and its interaction with scheme regulations needs fixing immediately as well. Neither can wait to avoid terrible consequences. They *both* *must* be fixed

29/32 3️⃣ An AA compensation scheme - carbon copy of 19/20 scheme

Another emergency mitigation could be a carbon copy of 19/20 scheme. To be effective it would need announcing *really* quickly (but in all 4 nations)

30/32 4️⃣ Full mandated recycling, centrally, in all 4 nations
As mentioned @sajidjavid recycling ♻️ is something "centre are happy with" & "where that is happening, it is certainly helping". So lets end the postcode lottery, and mandate full 20.6% - empl NI, in all 4 nations.

31/32 5️⃣ Lastly & perhaps MOST importantly, government must understand its not do 1-4 & 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. Need #taxunregistered

32/32 With record waiting lists, the only way to make a dent in the short and medium terms is to improve RETENTION - these solutions would make a SERIOUS difference to that @Jeremy_Hunt @sajidjavid @RishiSunak @CommonsHealth @NHSMillion

Pls share / RT