Doctors' leaders have warned repeatedly that punitive tax charges on pensions are severely damaging an already-depleted NHS workforce, threatening a 'massive loss of capacity within the NHS' that places its future sustainability at risk.
In the latest evidence of how the tax charges will affect the NHS workforce, a YouGov poll commissioned by the Royal College of Surgeons (RCS) found that 69% of consultant surgeons have reduced the amount of time they work in the NHS 'as a direct result of changes to pension taxation rules.'
GP leaders say the reduction in the surgical workforce - with pension tax penalties forcing many surgeons to drop out of hospital 'waiting time initiative' schemes that aim to reduce delays for operations - threatens to have a major knock-on impact on general practice.
NHS winter crisis
Two winters ago the NHS was forced to halt all elective procedures throughout January as many hospitals were full to capacity. BMA polling following that winter - the worst on record for the health service at the time - found GPs were the most likely medical specialty to report increased workload pressure, as patients sought reassurance and follow-up appointments over delayed hospital treatment - on top of the expected seasonal rise in appointments.
BMA GP committee chair Dr Richard Vautrey told GPonline: 'This survey reflects the kind of dilemma doctors of all specialties - including GPs - are increasingly facing, being penalised for doing extra work.
'In terms of waiting lists for surgery, we know delays in one part of the NHS can have knock-on effects on the rest of the system - and ultimately patients will suffer. Longer waits mean GPs will struggle further to help their patients get the timely care they need, and this is likely to impact practice workload.
'As winter approaches, of course this is a huge concern for GPs, and it’s why the government must urgently take action by scrapping these absurd tax rules.'
The RCS poll found that 68% of consultant surgeons were considering early retirement over pension tax charges, and that 64% had been advised by financial experts to reduce their workload to avoid 'crippling and unpredictable' tax bills.
At a time when a record 4.41m patients are on the NHS waiting list, including around 650,000 waiting more than 18 months, more than six in 10 consultant surgeons have been advised specifically not to take part in waiting list initiatives because extra income from this work will be wiped out by tax penalties.
The RCS has called for Boris Johnson to scrap the pension 'tax trap' before winter to avoid a further spike in waiting lists.
RCS president Professor Derek Alderson said: 'As our survey findings emphasise, the impact of pension tax rule changes on waiting times for surgery are devastating. Surgeons who have previously done many hours of extra work to help reduce waits, are cutting back their hours. Many are considering early retirement.
'Patients already face overly-long waits for operations. Persisting with a tax system that punishes clinicians for taking on extra work, will undoubtedly lead to a further deterioration in waiting times.'
BMA polling earlier this year showed that in some parts of England nearly all GPs have either reduced or plan to reduce their working hours over pension tax concerns - suggesting that capacity in primary care to cope with the knock-on effects of a reduction in the hospital workforce is extremely limited.
The government is consulting on plans that health and social care secretary Matt Hancock has said will create the 'most flexible NHS pensions ever', but doctors' leaders have warned the measures will not solve the workforce crisis triggered by pension tax rules.
Government advisors set out proposals for the removal of the annual allowance for defined benefit schemes such as NHS pensions earlier this month. Mr Hancock has said planned 'flexibiltiies' could be dropped if the Treasury backs this move.