Running a medical practice in the UK, whether NHS, private, or a mix of both, involves financial and regulatory complexities that go far beyond typical business scenarios. Doctors, dentists, locums, and consultants often face unique challenges that require the expertise of specialist medical accountants. From managing NHS pensions and navigating HMRC compliance to ensuring efficient tax planning and helping practices scale sustainably, a dedicated healthcare accountant is indispensable.

FSL Accountancy Ltd specialises in working with doctors and healthcare providers, helping you save time, reduce risk, and improve profitability through tailored accounting services.

Common Accounting Challenges Faced by Medical Professionals

Complex Income Streams and Tax Structures

Most medical professionals earn from various sources: NHS salaries, private practice income, hospital locum work, or even medico-legal reports. This fragmented income structure can make tax calculations and filings highly complex.

FSL Accountancy Luton based medical accountants helps you:

• Categorise income sources accurately
• Optimise income structures between salary, dividends, and self-employment
• Handle IR35 compliance for locums
• Claim all allowable expenses related to your practice

NHS Pension Scheme Complications

The NHS pension scheme presents one of the most intricate aspects of medical accounting. Issues around Annual Allowance and Lifetime Allowance (especially pre-abolition changes in 2023) can lead to unexpected tax bills.

FSL Accountancy provides:

• Annual Allowance pension growth calculations
• Guidance on Scheme Pays elections
• Collaboration with IFAs to develop long-term strategies

Locum and Consultant-Specific Issues

Locums often face tax complications under off-payroll working rules (IR35). Similarly, consultants managing a mix of NHS and private patients must navigate VAT, self-assessment, and sometimes company incorporation.

At FSL Accountancy, we support:

• IR35 reviews and risk mitigation
• Business structure advice (sole trader vs. limited company)
• Cash flow planning and working capital management

Key Areas Where Healthcare Accounting Makes a Difference

Accurate Expense Management

Medical professionals are eligible for various deductible expenses, but many miss out due to lack of awareness. Common allowable costs include:

• Professional indemnity insurance
• GMC/GDC fees
• CPD and training costs
• Equipment and uniforms
• Travel between sites (excluding home to permanent workplace)

FSL ensures full compliance while maximising your deductible claims.

VAT in Healthcare

VAT can be a grey area in medical services. While most medical services are exempt, cosmetic and medico-legal work often isn’t. The wrong classification can lead to severe penalties or lost refunds.

FSL Accountancy:

• Evaluates whether your services are exempt, standard, or zero-rated
• Advises on VAT registration thresholds and planning
• Manages VAT returns and MTD compliance

Practice Partnerships and Profit Sharing

For GP partnerships, dental surgeries, or clinics, agreeing how profits are split and recorded is essential. Each partner’s capital account, drawings, and tax position must be accurately maintained.

We offer:

• Partnership agreement reviews
• Quarterly or monthly profit-sharing analysis
• Automated bookkeeping and real-time dashboards for partners

Private Practice Financial Management

Running a private practice is akin to running a small business. You need clear profit/loss data, expense tracking, and growth forecasting to remain sustainable.

FSL provides:

• Cloud-based bookkeeping with Xero or QuickBooks
• Customised reports to monitor margins and costs
• Budgeting and forecasting tools