Multiple Roles in Healthcare: Understanding Your Tax Position

Many healthcare professionals have a combination of employment, self-employment and partnership income. While this can increase earnings and lead to a more varied job role, it can also make your tax position more complex and lead to unexpected tax liabilities. The key to this is understanding how tax codes operate and how PAYE interacts with Self-Assessment.

One Personal Allowance

You are entitled to one Personal Allowance each tax year, currently £12,570, regardless of how many jobs or income sources you have. HMRC will usually allocate this allowance to your main employment, with any additional employments taxed without an allowance.

The Personal Allowance begins to reduce once adjusted net income exceeds £100,000 and is completely withdrawn at £125,140.

Tax Codes and Multiple Employments

Each employment will have its own tax code. Common examples include:

• 1257L for your main employment where your Personal Allowance is allocated
• BR where all income is taxed at 20%
• D0 where all income is taxed at 40%
• D1 where all income is taxed at 45%

Where HMRC expects your basic rate band to be fully utilised elsewhere, higher-rate tax codes may be applied to other employments.

Why Tax Underpayments Occur

Employers operate PAYE independently and do not have visibility of your wider income position. As a result, tax is calculated on each employment separately.

This can lead to:

• Underpayments where your combined income falls into higher or additional rate tax bands
• Overpayments where allowances are not fully utilised
• Tax code adjustments that do not accurately reflect changes in income during the year

If you are not required to complete a Self-Assessment tax return, HMRC will usually review your position after the end of the tax year and issue a reconciliation where necessary.

Starting Additional Roles: Payroll Considerations

Issues often arise when new roles begin.

If you already have an existing job:

• You will not receive a P45
• You must complete a new starter checklist
• It is important to confirm you have another job

Incorrect information can result in an emergency or incorrect tax code being applied, leading to under or overpayments of tax.

Adding Self-Employment or Partnership Income

For many healthcare professionals, employment income is only part of the picture. Once self-employment or partnership income is introduced, the tax position generally moves beyond PAYE and into Self-Assessment.

Your tax return brings together all sources of income and calculates your overall tax liability after taking account of tax already paid through PAYE.

Payments on Account

Where you have tax to pay through Self-Assessment, you may also be required to make payments on account towards the following tax year.

These are payable:

• 31 January – balancing payment plus first payment on account
• 31 July – second payment on account

These should be planned for in advance.

Why Underpayments Are Common

PAYE does not take account of your full income position where you have multiple employments and additional income streams.

For example:

• Secondary roles may be taxed entirely at 20%
• Your main job may only partially reflect higher rate tax
• Additional partnership or self -employment income increases your overall taxable income

When everything is combined:

• A greater proportion of your income may fall into higher rate or additional rate bands
• This often creates a balancing payment through Self-Assessment

Practical Steps

To help avoid surprises:

• Review your tax codes regularly
• Complete starter checklists accurately when beginning a new role
• Monitor your total income across all sources
• Set aside funds for tax on non-PAYE income
• Plan for payments on account
• Seek advice when your income mix changes

Many of our clients find it helpful to obtain a tax estimate during the year, providing visibility of future liabilities and helping identify any issues early. If you would like support reviewing your tax position across multiple roles and income streams, please get in touch here.