Medics Money podcast

Cyra is joined by Nina, a South African doctor, how medical training in South Africa works: a six-year degree followed by compulsory government placement of two internship years and one rural community service year before independent practice, while specialist registrar posts are government-only, scarce, and often require years of waiting. Nina shares why she entered medicine after a childhood spinal fusion and admiration for her surgeon, but felt increasingly disconnected from the work, wanted a life outside medicine, and struggled with a broken system, long hours, and unpaid overtime. She nearly quit before community service but finished to keep future options, then began traveling. Nina explains she started posting raw, honest videos about leaving medicine to provide representation, gaining rapid online support, while facing more in-person backlash from colleagues and family, and emphasizes that reassessing and quitting can be a valid choice.

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The hosts review Labour’s third budget of the Parliament (28 Oct 2026), the first under Prime Minister Andy Burnham and Chancellor John Healey, arguing it lacked big headlines but contained many detailed changes with potential impact for doctors. Core income tax thresholds remain frozen, continuing fiscal drag, while tax on rental and savings interest rises by 2% from April 2027 (dividend tax unchanged). The trading allowance increases from £1,000 to £3,000, and self-assessment payment timing is set to shift from 2029, affecting cash flow. From April 2028, the £2,500 employment-expense claim threshold requiring self-assessment is removed, and mileage rates are improved. ISA plans to cut cash ISA limits are scrapped; Lifetime ISAs are replaced in April 2029 with a first-time buyer ISA, with the >£450k withdrawal penalty abolished. CGT changes include cutting Business Asset Disposal Relief to £500k and introducing a limited founders relief. NHS measures are modest, with limited winter funding, robotics investment, and a productivity/AI review, amid ongoing pay tensions; cost-of-living steps include fuel duty and VAT cuts and an energy payment for bands A–D.

00:00 Budget Overview

02:22 Income Tax Changes

05:13 Self Assessment Shakeup

07:50 Claiming Work Expenses

10:17 ISA Rule Changes

12:32 Capital Gains Updates

15:50 NHS Funding Snapshot

18:00 Cost of Living Measures

20:04 Wrap Up and Takeaways

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In this episode Ed and Andy sit down to discuss the upcoming 28th of October Budget.

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Host Dr. Tommy Perkins is joined by Sarah Cook, a specialist medical solicitor from DR Solicitors, to unpack NHS England's recent consultation on the future of neighbourhood healthcare — a topic that could reshape how general practice is delivered.

Key topics covered:

1. The consultation at a glance — NHS England isn't asking whether neighbourhood healthcare is coming; it's asking who will deliver and control it. Two models are on the table: a Single Neighbourhood Provider (SNP) built on existing PCN footprints (~50,000 patients), and a Multi-Neighbourhood Provider (MNP) spanning multiple neighbourhoods (~250,000+ patients) that would coordinate a wide range of services across primary and community care.
2. Three SNP delivery routes — (1) Vary the existing PCN DES (already in regulations since May), (2) Have the PCN hold a single neighbourhood contract directly, or (3) Let an MNP sweep up services and subcontract them — the option GPs should most want to avoid.
3. Income & risk concerns — Dr. Perkins raises the fear that MNPs could strip away enhanced-service income (LESs, DESs) that practices rely on top of the frozen global sum. Sarah reassures that GMS/PMS contracts remain and PCN/ARRS funding is intended to be protected — but only if practices stay engaged and organised.
4. The legal entity question — Any SNP contract must be held by a legal entity. Since PCNs aren't legal entities, many are incorporating as limited companies to gain limited liability, cleaner governance, and the ability to hold contracts and employ staff (with NHS pension access confirmed).
5. Future of PCNs — PCNs are expected to evolve into neighbourhoods rather than disappear outright. A limited company structure gives practices future-proofing and flexibility for that transition.
6. What practices should do now — Assess your current organisational model, consider whether a limited company makes sense, read the consultation, and get both legal and accounting advice. DR Solicitors offers a free initial consultation and has a webinar on their website.

Bottom line: Neighbourhoods represent a potential growth opportunity for GP-led organisations — but only for practices that get structured and ready before contracts arrive. Those that disengage risk losing control and income to MNPs.

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Ed is joined by Cyra and Andy to tackle three financial topics for medics: the government's new "Your First Home" scheme and what first-time buyers need to know, HMRC's letters targeting doctors with consultancy income — what to do if you get one — and the surprisingly complex world of free childcare and funded hours. Plus, a little-known NICU parental leave entitlement most parents miss.

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Show notes:

Tommy interviews specialist medical accountant Steve Nichols (Nichols & Co, London) about how doctors can use limited companies for legitimate tax planning. Nichols explains the key advantage is flexibility over who gets paid, when, and how (dividends, salaries, director’s loans, liquidation, and pension contributions), and clarifies differences between shareholders, directors, and employees, including using alphabet shares to pay dividends to spouses or adult children. He notes limited companies aren’t always better due to costs and admin, especially for single high-earning sole traders who spend all income, and says suitability is bespoke. They discuss using companies and pensions to manage the £100,000 tax-free childcare cliff edge and the £200,000 pension taper threshold, “money box” companies using members’ voluntary liquidation to swap dividend income tax for capital gains tax, family investment companies (e.g., property), director’s loan accounts, and employing family members at commercial rates. Nichols also offers PDFs on allowable expenses, meals, and M&S vouchers, and shares contact details.

00:00 Tax Planning Teaser

01:01 Meet The Medical Accountant

02:24 Why Limited Companies Work

04:49 When It Is Not Worth It

08:37 Getting Paid From The Company

12:20 Shares Directors Employees

14:16 Setting Up The Company Right

16:57 Income Levels And Tradeoffs

18:41 Tax Free Childcare Cliff Edge

22:44 Private Only Doctors Strategy

26:53 Money Box Companies Explained

30:57 100k And 200k Cliff Edges

33:59 Family Investment Companies

39:06 Directors Loan Accounts

42:40 Employing Spouse And Kids

46:07 Perks PDFs And Wrap Up

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This week we welcome back GP partner Dr. Nabeel Arshad, founder of growyourlistsize.co.uk, to discuss urgent list-size losses from an “aggressive list clean” by PCSE, with the BMA estimating 300,000 patients removed and £40m in funding lost. Arshad explains FP69 flags and the three-month window to verify patients, noting many removals are erroneous and can drive staffing and profit pressures. He urges practices to run FP69 searches in EMIS/SystemOne, track list trends, and stop treating list size as passive. He outlines strategies to grow lists through marketing, optimizing estates capacity (his practice grew from 10,000 to 20,000 patients in the same building), attracting digitally literate demographics, managing out-of-area registrations without home visits, and reducing registration friction via fast online onboarding. He recommends using the site’s free growth report and describes exclusive-area working and a money-back guarantee.

00:00 Streamlining Patient Onboarding

01:08 List Cleansing Funding Shock

02:50 FP69 Flags Explained

05:50 Run the FP69 Search

07:15 Why List Size Is Active

09:37 Marketing to Grow Lists

11:44 Capacity and Estates Myths

14:24 Out of Area Patient Strategy

15:52 Digital Front Door Fixes

18:13 Free Growth Report Next Steps

20:34 Guarantee and Exclusivity

22:00 Wrap Up and Call to Action

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