Dr Tony Goldstone Profile picture
Jul 17, 2022 26 tweets 11 min read Read on X
1/26 V Important 🧵 on this weeks debate in the House of Commons tabled by @DrDanPoulter

Highlights & my analysis. Pls read to end & share/RT👇. Vital we resolve this to fix *retention* & backlog

Part 1/2 - Dr Poulter (Pt 2/2 Minister response soon)
2/26 Really important points from @Dr_PhilippaW

1️⃣ vital issue needing 4 nation solutions @BMACymru @BMAScotland @BMA_NI
2️⃣AA is the wrong tax for the wrong group of people & its destroying the NHS
3/26 A further intervention from Northern Ireland's @JimShannonMP again pointing out the 4 nation problem and large rise in retirements in the NHS since April (my prediction - unless this fixed very urgently, retirements will increase +++ in 22/23)
4/26 Similarly Dame @NiaGriffithMP again pointing out that Wales too affected by the same retention issue. And @DrDanPoulter pointing out this isnt the same issue as previously discussed due to the unique position in the current tax year due to inflation
5/26 Crucial point from @DrDanPoulter on the "just use scheme pays" argument used by government
1️⃣ Eye Wateringly expensive currently as inflation+2.4% so >>10%
6/26 2️⃣ Unfair 22/23 as being billed thousands of pounds in tax for "pseudogrowth" in their pensions which never materializes

So whats the impact on the NHS
- Waiting lists continue to rise 6.48m waiting for treatment 📈 (and rising)
7/26 - care backlog for general practice, with 401,115 patients waiting for treatment
8/26 So on staffing...
-England needs additional 46,300 full-time doctors OECD EU average
- Over 100,000 posts in secondary care are vacant, >8,000 medical
- The NHS needs to keep the staff it has simply to keep the current level of service running.
9/26 - Pension tax > financially unviable stay in the NHS or work the number of hours they would like to.
- By tackling the NHS pension crisis through amending the Finance Act 2004 & introducing a tax unregistered scheme for those senior NHS workers
10/26 Without those changes to the pension rules, more staff will leave and the care backlog together with waiting times are likely to continue to rise.
11/26 Next Jonathan Edwards points out a similar issue with judges was solved with a tax unregistered scheme which "critically, breaks the link between working more hours and the additional tax bill, as well as ensuring that the right amount of tax is paid.". Poulter agrees
12/26 Now to LTA. 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.

That would surely be worse now as LTA rapidly falls with inflation
13/26 Next @AmyCallaghanSNP intervenes - >100 of her constituents contacted her re this issue. "This really significant issue needs to be noticed & action needs to be taken, but not like the action that was taken with the taper, which did not affect enough doctors. "
14/26 OK pay attention now. This is the technical bit - but essential nonetheless.

- AA "completely unsuited" to defined-benefit schemes such as that in the NHS
- should be scrapped in defined-benefit schemes. That view has been supported by Treasury advisers & @OTS_UK
15/26 Next Dr. Poulter turns to the 3 reasons inflation is crucifying retention

(1) Doesn’t pay to stay
16/26 (1) - Doesn’t pay to stay - my thoughts
17/26 (2) - CPI disconnect S235
18/26 (2) - Finance Act S234
19/26 (2) - Finance Act - My thoughts
20/26 (3) - The lifetime allowance & inflation
22/26 (1) - Solutions #FixTheFinanceAct #CPIdisconnect #FixNegativePIAs - My thoughts
23/26 (2) AA Compensation scheme
24/26 (3) #Taxunregistered - fair to taxpayers and doctors. Already delivered to judges.
25/26 AA charges arising from the defects in the Finance Act are *manifestly unfair*. It is clear to any reasonable person that the intention of the Act was to measure growth *above inflation*. It is doing nothing of the sort. Hence @TheBMA asks
26/26 The unintended consequences of rapidly increasing inflation could be dire for the NHS. Please fix this. It needs *urgent* action. @NHSMillion @TheBMA

Please share widely / watch the debate☝️ / RT

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More from @goldstone_tony

Oct 30
1/ Well after intense media speculation re: budget (speculation incl. reduction of tax free lump sum to £100k; flat rate relief at 30 or 20%; lifetime allowance re-introduction & pension "flexibility" [i.e. balance between pay & pension] .. speculation can now END....
Pls RT 🧵 Image
2/ Its now time for @RachelReevesMP to deliver her first budget ... I'll be live tweeting anything significant with a focus on #pensions and #pensiontax (if there is indeed anything!)

So keep following! Appologies for any typos/errors read to end for any corrections & docs Image
3/ So following #PMQs there is a statement that the contents of some of the budget has been made public before the budget and expresses dissapointment that this has happened Image
Read 27 tweets
Oct 17
1/ Longtime followers may remember this update from 4.5 years ago. Id met the then head of @nhs_pensions and the senior leadership team. They made lots of promises to improve things around Annual Allowance that BADLY needed improvement....

Pls read, share and RT
2/ Chief among those promises was to have an end to waiting till October for a PSS. Indeed no more brown envelopes. 85% of people would get their "digital brown envelope" by June (starting in 2020) 👇

3/ And furthermore for those that dont get automatic PSS (then around 85%), 15% would be able to see in this portal, from June 2020 why they DONT have a PSS i.e. you need manual calculations, or they cant issue one as they are awaiting info from employer

Read 14 tweets
Sep 7
1/ ICYMI Ive done a couple of videos 📹 on the tapered annual allowance - and why it could be hugely problematic for higher earners in the NHS *THIS* tax year (24/25)

Its crucial you have an understanding of chart 👇 if you are in affected groups.

Please share 👇/ RT & 👀📹 Image
2/ This was the first of two videos introducing the problem via a real case study

I discuss why its crucial that @wesstreeting @jamesmurray_ldn get an urgent grip of the dreadful tax policies they inherited affecting lower and higher earning consultants

3/ In second video I discuss a case in more detail & look at some strategies to try & mitigate this nightmare tax cliff.

None are desirable & tax needs changing to remove the huge discincentives to not to extra work, or worse still, reduce current

Read 4 tweets
Aug 20
THOUGHT FOR THE DAY: many senior doctors desperate to help waiting lists & would be willing to give up evenings/weekends to help out.

But current tax rules will mean some could end up #PayingToWork 👇

RT if you want @wesstreeting @jamesmurray_ldn to fix this ludicrous tax trap Image
2/ Per the chart with taxable income 242,400 after income tax, NI and AA post tax pay is around 95,056.40

However the same member earning 199,999 also gets 95,083.88 post income tax, NI, and AA

Why would this member do over £40k extra work, and PAY TO WORK?? Image
3/ Looking at it the other way the member earning 200,001 takes home 72,584.96

But the member earning 157,500 takes home essentially the same 72,559.40

*HOW IS THIS FAIR*

[CLUE: it isnt] Image
Read 6 tweets
Jun 29
1/ NEW & IMPORTANT: Quarterly NHS pay data updated 27/6/24 👇 In BREAKING NEWS NEW charts now show ALL SECTORS have reached #FullPayRestoration (though NOT, of course, the NHS)

We MUST fix pay/retention to fix #WaitingLists

Please read whole [long bumper] 🧵 & share widely/RT

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2/ You'll notice when ministers are in the media, they often talk about how hard "your viewers/listeners" have been hit by inflation. But what we need to do is separate fact from fiction (aka LIES), it was 👇excellent @jburnmurdoch @FT chart that really showed this well last year Image
@jburnmurdoch @FT 3/ But its not just government ministers gaslighting NHS workers that they have no right for their pay to keep up (like everyone else's), it was also so-called "independent" DDRB👇

Apparently doctors & dentists should not be protected when "its not taking place in other groups" Image
Read 33 tweets
Mar 29
1/ NEW & IMPORTANT: LOTS of new data this week incl new pay data 28/3/24 👇 NEW charts incl NHS satisfaction (SPOILER: Its grim #MindTheGap)

MUST fix pay/retention to fix #WaitingLists- next GE WILL be won/lost on NHS.

Please read whole [long bumper] 🐇🧵 & share widely/RT

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2/ You'll notice when ministers are in the media, they often talk about how hard "your viewers/listeners" have been hit by inflation. But what we need to do is separate fact from fiction (aka LIES), it was 👇excellent @jburnmurdoch @FT chart that really showed this well last year Image
@jburnmurdoch @FT 3/ But its not just government ministers gaslighting NHS workers that they have no right for their pay to keep up (like everyone else's), it was also so-called "independent" DDRB👇

Apparently doctors & dentists should not be protected when "its not taking place in other groups" Image
Read 35 tweets

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