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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

Disclaimer:

The information provided in this content is for educational and informational purposes only and does not constitute financial advice. You should not rely on this content as a substitute for professional advice tailored to your specific financial situation. The value of your investments can go down as well as up. Past performance is not indicative of future results.

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Find out if you can claim tax relief with this list: https://www.gov.uk/government/publications/professional-bodies-approved-for-tax-relief-list-3

Sanay (incoming F1) and Cyra (doctor and chartered accountant) explain how doctors can get money back via HMRC tax relief and NHS reimbursements. Cyra advises tracking professional expenses in a spreadsheet across the tax year (6 April–5 April) and applying online at year-end, noting HMRC may adjust your tax code. Eligible tax-relief items include GMC, Royal College and BMA fees (including exams but not revision courses), some recognized memberships, subsequent stethoscopes, plus a flat £80 NHS doctor work expense; question banks aren’t eligible. They contrast this with employer-funded study budgets (e.g., ALS), which generally aren’t tax-relievable. They also outline relocation expenses up to £10,000 across training, common caps, the need for pre-approval and evidence, tips on comparable mover quotes, and the importance of understanding excess mileage policies.

00:00 Welcome and Series Intro

00:51 Episode Focus Reimbursements

01:31 Meet Saira the Expert

02:10 Tax Relief Basics HMRC

04:00 What You Can Claim

05:16 Evidence and Flat Rate

06:12 Study Budget vs Tax Relief

07:42 Memberships from Med School

08:40 Relocation Expenses Explained

11:08 Relocation Application Pitfalls

13:06 Mover Quotes Pro Tip

14:25 Excess Mileage and Final Takeaways

15:59 Wrap Up and Next Episode

This episode is sponsored by InvestEngine:

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A Medic's Money MDT episode with Tommy Perkins, Dr Cyra Asher, Andy Pow, and Ed. The team breaks down three live financial stories affecting doctors right now: the £100,000 tax trap, the huge amount of cash sitting in low interest accounts, and the NHS pension scheme's reported surplus. It is practical, opinionated, and focused on what these headlines mean for clinicians in real life.

• In this episode, Ed explains how the £100,000 tax trap works and why income above that level can effectively face a 60% tax rate in England, or 67.5% in Scotland, because of the tapering personal allowance.
• The team discusses how frozen thresholds have pulled far more people into the trap over time, with the threshold now affecting a much larger share of earners than when it was introduced.
• Cyra and Andy talk through the knock on effects for doctors, including tax free childcare, childcare hours in England, and child benefit, all of which can disappear at different income points.
• Practical mitigation ideas are covered, including monitoring annual earnings, additional pension contributions, gift aid, and claiming professional expenses properly.
• Ed and Andy emphasize that many doctors still have not claimed expenses back, despite a Medics Money guide being widely downloaded and potentially saving substantial tax overall.
• The discussion moves to working less as a legitimate strategy, with Cyra noting that reducing hours does not always reduce take home pay as much as people fear.
• Tommy raises the option of private work and limited companies outside the NHS, while Andy cautions that company structures need proper advice and compliance.
• The second topic looks at the £1.1 trillion held in cash and easy access savings, where average returns are far below inflation, meaning real value is being eroded.
• Tommy argues that keeping large sums in cash feels safe but often loses value over time, and he contrasts that with the long term growth potential of broad market investing.
• Cyra adds the millennial perspective, explaining how financial crisis, recession, and pandemic experiences make many younger savers deeply risk averse.
• The final discussion focuses on the NHS pension scheme's reported £7.38 billion surplus and the planned reduction in employer contribution rates in England and Wales from 23.7% to 15.5%.
• The team debates what should happen with that surplus, from improving NHS pay and services to reducing employee contributions or fixing pension administration.
• Tommy strongly pushes for a better pensions portal and clearer statements, arguing that the current NHS pension admin and forecasting tools are far too opaque.
• Andy explains that projected pension figures need caution because pay, hours, inflation, and retirement timing can all shift substantially before benefits are taken.
• The episode ends with a wider critique of annual allowance tax charges, with the group arguing that the current system is overly complex and punitive.

00:00 - Welcome back to the MDT style podcast and today's three live money stories

02:07 - How the £100,000 tax trap works and why it keeps growing

03:31 - Frozen thresholds and why more earners are getting caught

04:21 - Childcare cliff edges, child benefit, and other hidden losses

05:21 - Why marginal tax plus student loans

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In this episode, Cyra sits down with Shivali, a senior private client lawyer at Talbots specialising in wills, estates, trusts, and tax, for a deep dive into inheritance tax (IHT). They cover the basics — how IHT is calculated and the 40% rate — then move into practical strategies: lifetime gifts (exempt gifts, annual exemptions, gifts out of income), chargeable lifetime transfers, and potentially exempt transfers (the seven-year rule). Shivali also breaks down available reliefs like the nil rate band and residence nil rate band, explains how trusts work and when they make sense, clears up common misconceptions about IHT and control over trust assets, and shares why getting a lasting power of attorney sorted early is so important. A practical, must-listen guide for anyone thinking about protecting their estate and loved ones.

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In this episode, Ed GP, chartered accountant and tax advisor) and Andy Pow (specialist medical accountant with 30+ years advising doctors) break down everything employed NHS doctors need to know about claiming tax relief on their work expenses — including the latest changes following the BMA–government agreement.

What's covered:

• Which expenses qualify for tax relief: GMC fees, BMA membership, medical defence/indemnity, Royal College fees, NHS pension contributions, and eligible travel
• The HMRC "wholly, exclusively and necessarily" test — and why it rules out CPD, conferences, and courses like ALS/ATLS
• How much you could get back: up to 40% of qualifying expenses if you're a higher-rate taxpayer
• Claiming for up to 4 previous tax years — you can go back to April 2022
• New for English resident doctors: Exam fees reimbursed from April 2026; Royal College membership and portfolio fees from April 2027 — and what this means for your tax claim
• How to make a claim via your HMRC Personal Tax Account (and the new step you can't miss to actually receive your refund)
• When you need to file a Self Assessment return instead

Download the Medics' Money Doctor's Tax Rebate Guide (30,000+ downloads) — link above.

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Disclaimer:

The information provided in this content is for educational and informational purposes only and does not constitute financial advice. You should not rely on this content as a substitute for professional advice tailored to your specific financial situation. The value of your investments can go down as well as up. Past performance is not indicative of future results.

Mentioned in this episode:

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