⚠️Lots of threads/posts on tapering, threshold, adjusted etc. Now we have March payslips can I tell you how I would approach it
1️⃣ Get your March 25 payslip. Note your YEAR TO DATE TAXABLE Pay. *IGNORE* gross pay and for now IGNORE pensionable pay. Dont use gross income and deduct pension contributions - the "taxable pay" already has them deducted so dont deduct it again.
2️⃣Do *NOT* add back in salary sacrifice for things likes cars and childcare. You are required to add in "relevant salary sacrifice arrangements made after 8 July 2015" - the key word here is relevant defined as "the individual gives up the right to receive general earnings or specific employment income in return for the making of relevant pension provision," - so DONT add cars etc back in.
3️⃣So you now have your NHS taxable income for the year. Now you need to add any other taxable income - think other PAYE, private practice, property, BIK, dividends, interest etc. Basically anything else that is subject to income tax. Less employment related Income Tax Reliefs claimed via tax return i.e. GMC, BMA, MDU etc
4️⃣Do NOT take off gift aid for normal charitable donations which is another common mistake Ive seen experts make. Note you can do this for the ridiculous £100k cliff calculation, but not threshold/adjusted
5️⃣So your NHS taxable income plus all other taxable income, less any other NON NHS pension contributions i.e. a SIPP, is THRESHOLD INCOME.
If this is below £200k you are not tapered and have the full £60k allowance and any carry forward (use the HMRC carry forward calculator to work out if you have carry forward - you will have needed both your RPSS to the 22/23 tax year and 23/24 PSS to work this out, latter obviously also delayed in England & Wales - you can estimate 23/24 using the tool below).
6️⃣If threshold income above £200k you need to work out ADJUSTED INCOME. You wont find out your PIAs for 24/25 until October 2025 but can estimate them using the link to the free tool and video below. If you are in 2008 its a bit more involved, and I wouldnt advise the NHS Employers modeller for this as for 2008 it ignores reckonable pay so is wildly innacurate. Adjusted income is THRESHOLD plus deemed PIA pension growth accross both schemes plus any other pension growth or SIPP contributions etc. The free tool below will help you calculate this.
7️⃣The free tool below will help you estimate your threshold and adjusted income, so see if you can expect a liability for 24/25 (due Jan 26, scheme pays Jul 26)
WHY IS THIS SO IMPORTANT in 24/25
Because of the 23/24 pay award paid in 24/25 and DDRB 24/25 many people will have VERY LARGE PIAs - Im year 14 (just) and my PIA is over £150k. That means if you go over THRESHOLD income, when you add in the PIA, tapering can be BRUTAL and reduce your allowance from £60k down to £10k - that might increase your AA tax charge by £22,500 (45% x £50k reduction).
So if your THRESHOLD income is CLOSE to £200k you can still DURING THE TAX YEAR ONLY i.e. the next 9 days or so make a SIPP payment to reduce it below threshold income to avoid tapering. Say your THRESHOLD income (step 5 above) is £210k you could make a £11k GROSS SIPP payment which would reduce your threshold income to £199k which could reduce your AA liability by £22.5k making the SIPP free.
See the worked examples in the video below
Free tool and video to work all this out is below
Free Tool: https://t.co/rVC2FzNF84
Self help video: https://t.co/UB9dqIyke5
As a cardiologist, here is what I tell my patients
To help them lose weight and maintain muscle mass using nutrition.
Because most people have this all wrong.
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1/ NEW & IMPORTANT: So we need to talk about NHS pay. NEW shocking [post DDRB] data just in 4/1/24 👇 (SPOILER: Not "fair & reasonable")
We need to fix pay/retention to fix waiting lists- increasingly clear next GE will won/lost on NHS
Please read whole 🧵 & share widely/RT
Thanks Dr Poulter👇@Conservatives
"If gvmnt has any hope of reducing waiting times any time soon & fulfilling PM’s pledge, needs to put ideology aside & work constructively to recognise legitimate pay concerns of doctors & end this dispute by getting our doctors back to work" RT
HF guidelines have utilized a EF based classification system
In the 2013 ACC/AHA HF guidelines we first put forth a 3 component categorization
HFrEF, EF<=40%
HFbEF, EF 41-49%
HFpEF, EF >=50%
This was controversial and vigorously debated
https://t.co/JUe58YqqDT
1/ #ContinuumCase!!
A 50 yo man presented to the ED with acute onset aphasia. He is not able to report a history, but BP Is 215/95.
Non-contrast HCT reveals this bleed…
What do you want to see next?
I'm a consultant interventionalist, but was a trainee just 18mo ago. I am an educational supervisor (to doctors) and have mentored ANPs & pharmacists to expand their skills. I am clinical lead for my department, so all too aware of the pressures on trusts. Here are my thoughts. https://t.co/NTtasXQiam
Hey #medicine residents !!
Time to talk about EOSINOPHILS today. Not as common a consult as thrombocytopenia and anemia but important nonetheless.
A short 🧵 to touch upon all things eosinophilia 👇🏻
#MedTwitter
An older man comes to the ED with abrupt onset nausea, & diarrhea
He is joined by her daughter whom he is visiting from abroad
Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter#liverstory#MedTwitter
The celestial entrance known as 'Heaven's Gate' located within the breathtaking Tianmen Mountain in China.
Situated approximately 5,000 feet above sea level, Tianmen Cave in China stands as the world's highest naturally formed arch.
Accessing this remarkable landmark involves ascending 999 steps referred to as the "stairway to heaven," where the number nine holds significant meaning in Chinese numerology, symbolizing good fortune and eternity.
Alternatively, visitors can opt for a bus ride along a narrow roadway. With dimensions reaching about 430 feet in height and 190 feet in width, the cave was once an ordinary cavern. However, in 263 A.D., a section of the mountain's cliff collapsed, giving rise to the captivating appearance of a "portal to heaven" that mesmerizes observers to this day.
Normal B12 levels DOES NOT rule out B12 def anemia. Period.
Many of my colleagues justify doing a bone marrow when the whole clinical picture is of ⬇️B12 only bcoz of normal B12 levels!😓
Anti-IF AB- many times gives Falsely ⏫ levels in B12 CB luminescence assay! #MedTwitter