The accountants who cause the most damage to doctors and dentists are rarely incompetent. They’re 100% qualified and insured, running perfectly good practices for builders, marketing agencies, and family-run restaurants, and they approach a GP partner with the same reasoning they’d bring to any other self-employed client with decent profits.
That reasoning holds for eighty per cent of the work; the remaining twenty per cent is where the lack of specific industry know-how comes in, and it tends not to surface for several years, usually in the form of a tax charge that nobody warned the client about or a pension record with gaps.
The NHS Pension Doesn’t Behave Like a Pension
The 1995, 2008 and 2015 schemes are defined benefit, which means the annual allowance test has nothing to do with what the member paid in. It measures the growth in promised benefit across the year, multiplied by sixteen, adjusted for inflation, and the number it produces bears no relation to what appears on a payslip.
A consultant who picks up a national clinical impact award or moves up a pay threshold can generate a five-figure annual allowance charge in a year where their contributions went up by a few hundred pounds. They find out about it long afterwards, and the accountant who filed the return without asking for a pension savings statement never saw it coming because nothing in general practice trains them to ask.
Type 1, Type 2 and the Certificate Nobody Files on Time
GPs are classified by working arrangement, and that classification determines which form is filed and how tiered contributions are calculated. Partners and salaried GPs sit in separate categories. Locums file SOLO forms or locum A and B forms depending on the engagement, often late, often incompletely, and PCSE processes the lot.
PCSE loses things. Contributions are allocated to the wrong scheme year or the wrong practice code, and the discrepancy goes unnoticed until someone requests a total reward statement and finds six months of 2021 missing.
An accountant who understands the estimate of pensionable profit knows to revisit it when practice profits climb, because leaving it at a figure set four years ago results in an underpayment that is collected in a lump at reconciliation.
Practice Accounts Run on Income Nobody Else Receives
A GP partnership’s funds arrive via the Statement of Financial Entitlements. Global sum weighted by Carr-Hill, QOF paid partly on account and reconciled after year-end, enhanced services commissioned locally, PCN income routed through ARRS with reimbursement rules that changed again recently.
Reading a set of practice accounts means knowing which of those figures are estimates awaiting adjustment and which are settled, and a generalist will treat the lot as turnover.
Premises are where it gets genuinely messy. Notional rent, cost rent on older builds, reimbursed rates, and quite often a surgery owned by two partners out of five, while the others hold no interest in the property at all. Partners retire and join at different points, capital accounts move, and someone has to work out what the incoming partner buys into and at what valuation.
Firms doing accounting for healthcare professionals as a specialism see the same structures repeated across hundreds of practices, which is why they can read a set of accounts in ten minutes and spot the wrong QOF accrual at a glance.
Dentistry Has a Separate Set of Obstacles
UDA delivery against contract value, clawback where the practice falls short of the threshold, and the rebasing conversation that follows. Associate agreements need to hold up as genuinely self-employed engagements now that the old BDA-approved template no longer offers protection, and HMRC has been paying attention to this for a while. Superannuation comes off at source on the NHS side, printed on a schedule that a specialist checks and a generalist accepts.
Those schedules are wrong often enough that checking them is worth the time, particularly where a practice runs mixed NHS and private work through the same surgery.
Where It Rears Its Head
Doctors are busy, and they trust whoever files their return. The failures don’t announce themselves at the time; they turn up as an unexpected charge, a pension record with holes in it, or a retirement figure that comes back lower than the one the client had been planning around for a decade, at which point the options for fixing it are limited to none.
