The Chancellor’s Prescription for the NHS, Taxes, and First-Time Buyers

What the OnCall community need to know about the new budget

Politics may not top your list of thrilling reads, but the Chancellor’s budget release is a page-turner for anyone in healthcare. This year’s budget brings a financial boost for the NHS and education, funded, as the Chancellor puts it, through some "difficult decisions". Here are some OnCall thoughts we want our community to know:

The NHS… The health sector took the spotlight this year with a £22 billion injection into front-line services and £3 billion more for equipment and infrastructure. To put this into perspective, the overall health budget for this year alone was around £190 billion—This represents a 3.8% real-terms uplift (after accounting for inflation). A chunk of this will likely cover recent pay rises for resident doctors.

A "Not-a-Tax-Rise" Tax Rise… One standout point that has been missed when discussing the budget is a stealthy tax increase… cleverly not called a tax increase. So, on the surface, the headlines will say that income tax, employee national insurance rates and VAT rates remain unchanged. But there’s a catch. Income tax thresholds (i.e. the threshold at which you begin to pay or will have to pay more tax) will be frozen until 2028, a decision from the prior government the Chancellor simply "extended."

What’s the problem? This freeze is what’s known as fiscal drag. As wages climb with inflation, many will drift into higher tax brackets without actually boosting their spending power—a sneaky hit to our OnCall community, especially after our recent resolution to the pay dispute.

ISA ISA Baby… For the many in our community holding Individual Savings Accounts (ISAs)—from stocks and shares ISAs to lifetime accounts—no changes were announced. The annual contribution limits remain steady. These government-backed accounts are designed to encourage and incentivise saving, and there’s no better time to take advantage of that than now.

Stamp Duty: First-Time Buyers Beware… Amid buzz about stamp duty for second homes, less attention has been paid to how the changes affect first-time buyers. Previously, those buying their first home didn’t pay stamp duty on properties up to £450,000. Now, that threshold has dropped to £300,000. In most of England, this won’t impact first-time buyers since average prices remain below that threshold.

However, in London, where the average first home costs around £461,450, the stamp duty on that price will rise from £1,822 to a painful £8,072. For those in the Southeast, the stamp duty on average first-time buyer house prices will go from £0 to £405. Elsewhere in the country, though, it’s still a smooth, stamp duty-free purchase for the average first-time buyer.

To Bleep or Not to Bleep

The bleep—the trusty pager that’s been part of the NHS toolkit for decades. While the world races ahead with smartphones, the NHS holds onto nearly 10% of the 1.3 million pagers still beeping away worldwide, costing £6.6 million per year. Patients often stare at them in surprise, wondering what era we are living in.

But there’s a reason pagers endure. They’re reliable in emergencies, running on independent networks, and are essentially indestructible—the Nokia 3310 of medical comms. Drop it or step on it, and that bleep will live to see another day.

On the flip side, they’re not exactly the most informative devices. Beyond crash bleeps, the unspoken rule often goes, “If it’s truly urgent, I’ll get a second bleep.” This approach, however, can backfire. When it’s time to call back, our most junior resident doctors find the line busy 39% of the time, SHOs 55%, and consultants 47%. It’s a maddening game of phone tag that leaves us asking: can we keep the pros of pagers without the endless callback roulette?

Beyond Buzzwords: When SBA Questions Miss the Mark

Is it time we started questioning the very questions themselves?

There is a wide reliance on single best answer (SBA) questions in undergraduate and postgraduate medical examinations. A selling point unique to the SBA style is that they remove the subjective element of marking and therefore are an ideal format for computerised marking.

But surely these are secondary considerations and the question we need to ask is whether they are an accurate way to assess what they intend to measure. There is evidence to suggest that SBA’s are inferior to other question formats and can give a false impression of a student’s competence. So is it time we started questioning the very questions themselves?

It's important to recognise that while some SBAs are well-crafted and effectively test clinical reasoning, many rely too heavily on buzzwords, leading students to memorise answers rather than truly understand the material. This poses a risk in real-world applications, where such cues are absent, leaving doctors and students struggling to recall necessary information.

So perhaps it isn’t the SBA format that is the issue, but how well those questions are written. How many times have you attempted to answer a multiple choice question, narrowed the options down to two possibilities, and picked the wrong one just to see the explanation that says ‘option 2 is less likely as there is no evidence of X symptom’. Yet it would be an improbable assumption for anyone to make, without the question explicitly stating ‘there is no evidence of X symptom’ in the vignette, which is often not the case. 

We know that every assessment type will come with its flaws and to a certain extent, trade offs need to be made. The old fashioned Viva may allow a thorough testing of knowledge and higher cognitive function, but its subjectiveness and the time needed has led to its abandonment. SBA’s can work, but there are still far too many that leave doctors no better off in the real world when the options are removed. 

Today, we dedicate the board round to the Rads - our beloved friends working behind the scenes and ask for the worst radiology requests:

How’s this for a CT request: “Patient has had abdominal surgery in the past. She can’t remember what this was. CT to find out what surgery she had”

“Neck US Request: Bilateral neck lumps ?Carotids”

“Chest pain, Pussy Wound Site. Requesting CXR ?lungs”

“Lady post Hartmann’s procedure - get a phone call from surgical reg saying that they have also requested a CT abdomen pelvis - just to make sure everything is okay in there”

Email us to share what’s on your mind in our next issue!

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Attention, future doctor-homeowners! The Lifetime ISA (LISA) could be your best friend for saving up that first home deposit. Here’s the deal: save up to £4,000 a year, and the government tops it up with a 25% bonus—meaning an extra £1,000 annually for your efforts. Plus, the interest it gains is tax-free as it’s an ISA!

You just need to be between 18 and 39 to start, and you can use your LISA savings for a first home up to £450,000. If you end up not using it for a house - you can let it grow until retirement at 60 and then withdraw with no penalties. Just be sure to use it for one of those two, or there will be penalties for withdrawing the cash. Popular option? Check out the Moneybox LISA that gets the Oncall seal of approval! Start saving and soon that doctor-owned home could be yours!