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Practice
Management
GP Forum – 28 February 2013
Luke Bennett & Stuart Cowen
www.francisclark.co.uk
Programme
11.30 Profit maximisation in times of income constraint
12.30 Lunch
1.30 The NHS Pension Scheme – impact of current changes on
GPs and practice staff
2.30 Tax planning to minimise liability under new higher tax rates
and reduced allowances
www.francisclark.co.uk
Speakers
Luke Bennett – Truro office
Stuart Cowen – Plymouth office
www.francisclark.co.uk
Profit Maximisation in Times of
Income Constraint
• Changes in funding 2013/14
• Controlling expenses
• Profit forecasting
• Managing drawings and cash flow
www.francisclark.co.uk
“Times of Income Constraint”
- A Crystal Ball
• Backdrop of “austerity measures”
• Public and government reactions to bankers’ bonuses
• Support for restricting public sector final salary schemes – the
Hutton Report
• Health and Social Care Act has firmly pushed the NHS back in the
political spotlight
www.francisclark.co.uk
The Squeeze is on
• Income is rising slower than costs
• QoF income being reduced
• Any uplift in April 2013 to cover rising costs?
• CPI January 2013 – 2.7%
• Result = profit erosion
• Compounded by higher tax / NI / pension
• Lower net income whilst domestic costs rise too
www.francisclark.co.uk
Inflationary effect
Illustrative GMS practice 2010/11
Gross income (100%) £238k
Costs (58%) £138k
Profit (42%) £100k
Take home pay after tax and superannuation £62k
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Effect on take home pay by 2013/14
Illustrative GMS practice
Income + 1% per annum £245k
Costs + 3% per annum £151k
Profit (38%) £94k
Take home pay after tax and superannuation £55k
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Overall effect
• Reduction in take home pay over 3 years
o £7k which is 11% of £62k
Reduction 11%
Inflation say 9% cumulative
Erosion in spending power 20%
Excludes effects of higher rate taxes, excess over annual
allowances, withdrawal of child benefit
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Changes from 1 April 2013
1. Quality and Outcomes Framework (QOF)
2. Directed Enhanced Services
3. Local Enhanced Services
4. Uprating of investment to GMS contractors
5. Employer superannuation contributions for locums
6. Employee superannuation contribution rates
www.francisclark.co.uk
Changes from 1 April 2013
QOF points changes
Points per domain 2012/13
Domain Points
Clinical 669
Organisational 254
Patient experience 33
Additional services 44
Total 1,000
Points per domain 2013/14
Domain Points
Clinical 610
Quality and Productivity 100
Patient experience 33
Public health 157
Total 900
100 points worth about £15,000
37 points shifted to new clinical areas worth about £5,000
Raising of thresholds expected to cost £11,000
Hence loss to average practice £31,000
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Changes from 1 April 2013
QOF threshold changes – 2011/12 example
• Contractor index 1.214
• Achievement 250 out of 289 = 86.5%
• Thresholds in 2011/12 40% to 71%
• Points scored out of 17 17
• Disease prevalence 1.209
• Value of points 1.214 x 17 x 1.209 x £130.51 = £3,256.66
CHD6 The percentage of patients with coronary heart disease in whom the blood pressure reading
(measured in the previous 15 months) is 150/90 or less.
www.francisclark.co.uk
Changes from 1 April 2013
QOF threshold changes – 2013/14 exampleCHD6 The percentage of patients with coronary heart disease in whom the blood pressure
reading (measured in the previous 12 months) is 150/90 or less.
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Changes from 1 April 2013
• Directed enhanced services up to £15,000
• Risk profiling and care management for frail older and high risk patients
• Dementia case finding scheme
• Improving on-line patient access to services
• Remote care monitoring for patients with long-term conditions
• Local enhanced services ???
• Kernow Clinical Commissioning Group
• Uprating of investment for GMS contractors 1% ?
• Employer superannuation contribution for locums ???
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Changes from 1 April 2013
Luke’s guess at impact on average practice
£
Changes to QOF
Loss of 100 points (15,000)
New clinical indicators (1,000)
Rising thresholds (6,000)
(22,000)
Earned from new DES 10,000
General pay rise 6,000
Reduction in income for average practice £ (6,000)
www.francisclark.co.uk
Changes from 1 April 2013
Luke’s guess at impact on average full-time GP
£
Reduction in income per GP (2,000)
Tax, NI and superannuation saved 1,091
Increased employee superannuation (2,400)
Tax relief on increased superannuation 960
Reduction in take-home pay £ (2,349)
www.francisclark.co.uk
Maximising profits
• Manage your business: Discipline / planning / control
• Before each year:
Identify controllable items: e.g. QOF, enhanced services, wages costs
Identify factors that drive income or expense
Use these to set targets – probably not financial targets in the first instance
www.francisclark.co.uk
Maximising profits
• Identify who is responsible for ensuring targets are achieved, and
when / how they will report to partner group
• SMART targets
• Pre-arranged partners’ meetings – chaired, with targets on agenda
www.francisclark.co.uk
Maximising income
• Assume you are doing the “givens” – e.g. maximising QOF points
• QOF typically about 15% of gross income
• 2011/12 average QOF points 969 = 3.1% lost
• Pay particular attention to disease prevalence indicators
• Exception reporting will become more important in 2013/14
www.francisclark.co.uk
Maximising income
• Use your weekday space effectively – if a GP is not in for 10
sessions per week consider if his / her room has an alternative use
• Rearrange rooms to make minor surgery clinics viable
• Weekend minor surgery / other clinics
• Rent space to alternative health providers (but beware PCT
clawbacks)
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Maximising income
• List size per GP is major determinant
• Use your Friends and Patient Participation Group
• “Market” in the community
Articles about local health issues
Profiles on GPs and staff
Do your patients realise you would like more patients, or do you give the
impression of being too busy?
www.francisclark.co.uk
Maximising income
• NHS fees are largely fixed so maximise revenue from non-NHS
work: letters, insurance reports, etc.
• Your reception staff may fail to apply charges unless they can fall
back on a pre-printed tariff (“£X / letter”)
www.francisclark.co.uk
Maximising income
• Understand the criteria for each enhanced service: select those
cost-effective to chase
• Identify one GP specifically to maximise the enhanced services
identified
• Identify likely crunch points (e.g. X date for Y% of childhood
immunisations) and identify nominated GP or PM to report before
then on achievement / any action required.
www.francisclark.co.uk
Controlling expenses
Typical surgery cost profile:
Staff wages / on-costs 41%
Salaried GPs, locums, drugs, consumables 23%
Other costs mostly fixed 26%
100%
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Controlling expenses
• “Other costs mostly fixed” cannot be ignored
• Sourcing effective cleaning, telephone charges, heat and light etc.
are all important
• But not at expense of ignoring largest costs:
People
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Controlling expenses - staff
• Pay reviews
• Benchmarking
• Flexible working – T.O.I.L. not overtime
• Multi-tasking e.g. reception
• “Squeezing” hours e.g. some staff may prefer 35 hours per week
• Budget and monitor
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Controlling expenses –
Salaried GPs and locums
• Budget / monitor
• Set budget before financial year – GP partners’ holidays = locum
requirements
• Monthly report to partners, current + cumulative
www.francisclark.co.uk
Management accounts
• Historically limited uptake in GP practices
• Understandably so for smaller practices
• Just as useful to monitor and report on “controllables” – QOF,
enhanced services, staff and salaried GP / locum costs – the profits
and cash will follow
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Profit forecasts, drawings and cash flow
• In theory, profit forecast prepared each year for superannuation
payments on account
• But simplistic since retro-corrected
• Financial pressures now mean drawings and cash flows deserve
more attention
• For many practices drawings will need to reduce – not least
because of increased superannuation contributions
www.francisclark.co.uk
Practice financing
• Loans v Overdrafts
Rates including arrangement fees
Flexibility
Sustainablility
Personal loans v practice loans
Rates
One size (doesn’t?) fit all
Fixed v Variable rates
www.francisclark.co.uk
Profit maximisation
• Profits and drawings under pressure
• Set targets and monitor
• Clear responsibilities: SMART
• Concentrate on controllables
• Targets may be non-financial, but must be regularly and formally
monitored
www.francisclark.co.uk
Lunch
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NHS Pension Scheme –
Impact of Changes
• 1995 v 2008 sections
• Annual allowance
• Lifetime allowance
• Increasing contribution rates
• Hutton report
• National Employment Savings Trust
www.francisclark.co.uk
www.francisclark.co.uk
NHS Pension Choice
1995 Section 2008 Section
Normal retirement age 60 65
Benefits 1.4% earnings plus lump
sum
1.87% earnings minus
lump sum
Survivor pension 50% 37.5%
www.francisclark.co.uk
NHS Pension Choice
1995 Section 2008 Section
Lump sum Normally 3 x pension Minimum 4.2% of earnings
up to 31/03/2008
Maximum 5.36 x pension Maximum 4.28 x pension
Added years contributions Continue Cease but benefit to date
transferred
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Restriction of Tax Relief –
Annual Allowance
• £50,000 maximum
• Reducing to £40,000 from 2004/05
• Special rules for defined benefit schemes
• Measured against growth in benefits
• 16 x growth in pension + growth in lump sum
www.francisclark.co.uk
Restriction of Tax Relief –
Annual Allowance
Simplified example (member of 1995 Section)
Career earnings at 31 March 2011 £2,000,000
“Regulation 72 fraction”
Years in NHS pension scheme 20 1.250
Years as a GP 16
Pension = 1.4% of career earnings x Reg 72 fraction
1.4% x £2,000,000 x 1.250 £35,000
Increase by CPI (September 2010) 3.1% £36,085
Establish position at 31 March 2011
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Restriction of Tax Relief –
Annual Allowance
Simplified example (member of 1995 Section)
Career earnings at 31 March 2011 £2,000,000
Dynamisation factor for 2012 (CPI to Sep 11: 5.2% + 1.5%) 6.7% £134,000
Pensionable earnings in 2011/12 £110,000
Career earnings at 31 March 2012 £2,244,000
“Regulation 72 fraction”
Years in NHS pension scheme 21 1.235
Years as a GP 17
Pension = 1.4% of career earnings x Reg 72 fraction
1.4% x £2,244,000 x 1.235 £38,808
Establish position at 31 March 2012
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Restriction of Tax Relief –
Annual Allowance
Simplified example (member of 1995 Section)
Value of pension at 31 March 2012 £38,808
Value of pension at 31 March 2011 (after allowance for inflation) £36,085
Growth in pension in year £2,723
Growth in lump sum in year (3 x pension) £8,169
Annual pension input = 16 x pension growth + lump sum growth
16 x £2,723 + £8,169 £51,737
Excess over annual allowance taxed at marginal rate
£1,737 x 40%? £695
Annual pension input (growth in benefits)
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Restriction of Tax Relief –
Annual Allowance
• Unused relief from previous three years can be carried forward
• Added years contracts complicate calculations and increase
pension growth
• Private pension contributions to be factored in
• NHS Pensions required to calculate figures for 2011/12 and
2012/13 by October 2013
• Self assessment tax return for 2011/12 was due January 2013!
www.francisclark.co.uk
Restriction of Tax Relief –
Annual Allowance
Likelihood of being affected when annual allowance £50,000
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Restriction of tax relief –
Lifetime allowance
• Lifetime pension savings limit reduced from £1.8 million to £1.5
million on 6 April 2012
• Further reduction to £1.25 million planned for 6 April 2014
• Calculation based on 20 x pension + lump sum (+ value of any
private pension funds)
• Option to elect for fixed protection
Maintains lifetime allowance at £1.5 million
No contributions after 5 April 2014
Election must be made by 5 April 2014
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Restriction of tax relief –
Lifetime allowance
Example for member of 1995 Section £
Career earnings at retirement £4.7 million
Pension: 1.4% of career earnings £65,800
Multiply by factor of 20 1,316,000
Lump sum (3 x pension) 197,400
Value of pension 1,513,400
For retirement between 6 April 2012
and 5 April 2014 charge on excess
over £1.5 million
£13,400 x 25% £3,350
Pension reduced by 1/20th of lifetime allowance charge
Pension therefore reduced from £65,800 to £65,632
www.francisclark.co.uk
Restriction of tax relief –
Lifetime allowance
Benefit of extra year’s membership If lifetime
allowance
not exceeded
If lifetime
allowance
exceeded
£ £
Pensionable pay 100,000 100,000
Employer’s and employee’s contributions 27,500 27,500
Tax relief (40%) (11,000) (11,000)
Increased lump sum (4,200) (4,200)
Net cost 12,300 12,300
Annual pension 1,400 1,400
Lifetime allowance charge - (403)
Tax (40%) (560) (399)
Net benefit 840 598
Effective annuity rate 6.83% 4.86%
www.francisclark.co.uk
Increasing employee contribution rates
2011/12 2012/13 2013/14 2014/15 (possible)
Up to £15k 5.0% 5.0% 5.0% 5.0%
£15k to £21k 6.5% 5.0% 5.3% 5.3%
£21k to £27k 6.5% 6.5% 6.8% 6.8%
£27k to £49k 6.5% 8.0% 9.0% 9.75%
£49k to £70k 6.5% 8.9% 11.3% 12.5%
£70k to £110k 7.5% 9.9% 12.3% 13.5%
£110k and over 8.5% 10.9% 13.3% 14.5%
www.francisclark.co.uk
Reduced monthly drawings from
April 2013?
Pensionable profit Before tax After tax
£60,000 £120 £72
£80,000 £160 £96
£100,000 £200 £120
£120,000 £240 £144
£140,000 £280 £168
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Hutton Report
• Link normal pension age to state pension age
• Final salary schemes replaced by career average earnings
schemes
• Implement changes by 2015
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Government offer
• New scheme from 1 April 2015
• Those within 10 years of retirement at 1 April 2012 stay in existing
scheme
• Date of joining new scheme delayed for those between 10 and 13.5
years of retirement at 1 April 2012
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Protection
Age at 1 April 2012
(if member of 1995
scheme)
Switch to new
scheme
<46.5 1 April 2015
47 1 April 2016
47.5 1 April 2017
48 1 April 2018
48.5 1 April 2019
49 1 April 2020
49.5 1 April 2021
50 N/A
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New NHS Pension Scheme
• Career earnings for all members (GPs already on career earnings)
• Dynamisation continues at inflation + 1.5%
Inflation equals CPI?
Normal pension age linked to state pension age
State pension age = 67 or 68?
www.francisclark.co.uk
Protection for accrued benefits
82%
84%
86%
88%
90%
92%
94%
96%
98%
100%
45 46 47 48 49 50
Age at 1 April 2012
Value of new scheme compared with 1995 Section
Assumes member joined scheme at 25 and retires at 60
www.francisclark.co.uk
Accountancy/Tax advice IFA advice
Annual allowance calculation Stop paying into NHS Scheme?
Lifetime allowance calculation Take early retirement?
Prediction of NHS pension Elect for fixed protection?
www.francisclark.co.uk
National Employment Savings Trust
• All employers compelled to offer either a Qualifying Workplace
Pension Scheme (e.g. NHS) or NEST
• Will affect non-NHS employing bodies
• Employer contribution 3% to 4%
• Employee contribution 3% to 4%
• Opt-out option for employee
• Phased introduction up to 2017
www.francisclark.co.uk
NHS Pension
(average earnings £100,000 per annum)
Lifetime
contributions
Retirement
age
Pension Lump sum
£ £ £
1995 Section 752,500 60 45,573 188,125
2008 Section 860,000 65 56,883 215,000
New scheme? 1,182,500 68 55,775 295,625
www.francisclark.co.uk
NHS Pension Personal Pension
(average earnings £100,000 per annum)
Lifetime
contributions
Retirement
age
Pension Lump sum
£ £ £
1995 Section 752,500 60 45,573 188,125
14,742
2008 Section 860,000 65 56,883 215,000
20,711
New scheme? 1,182,500 68 55,775 295,625
32,086
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Tax Planning
• Impact of tax / NIC thresholds
• Incorporation
• Income shifting
• Capital allowances
• Tax efficient investments
• CGT planning
www.francisclark.co.uk
Tax / NIC thresholds for the
self-employed
• 2013/14 thresholds for tax and NIC largely aligned
Income from
/ to
Tax rate NIC Combined
£9,205 0% 0% 0%
£41,450 20% 9% 29%
£100,000 40% 2% 42%
£118,410 60%* 2% 62%
£150,000 40% 2% 42%
£150,000 + 45% 2% 47%
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Income tax rates 2013/14
0%
10%
20%
30%
40%
50%
60%
70%
£9,205 £41,450 £100,000 £118,410 £150,000 £200,000
Effective marginal tax rate (%)
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Tax rates
• The tax / NIC at 62% is not an “official rate”
• It is the effect of withdrawing £1 personal allowance for every £2
earned over £100k
• Given GP average earnings, it sits in a real problem bracket
• And at a level where pension planning can become more restricted
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Net retained earnings 2014/15
• £100 additional gross
• Assume marginal NIC 2%
• Superannuation 27.5%
• Assume marginal tax rate 40%
• Net retained earnings £43.53
• At the 60% marginal rate the net is £28.35
• BUT Superannuation is “invested” not lost
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Incorporation
• For some non-GPs, incorporation offers potential to convert some
income into CGT (effective rate 10% or less); and the rest taxable
under Corporation Tax at 20% - 30%
• Sale of NHS goodwill illegal so CGT advantage – for NHS work –
disappears
• But leaves potential CGT savings on non-NHS work and income
tax savings on all
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Incorporation
• Key to potential savings are:
Whether higher rate taxpayer needs to draw the company’s profits
Or can allow a fellow lower-rate taxed shareholder to take
dividends
Whilst ensuring the costs of setting up and running the company do
not outweigh the benefits
With an eye on superannuation
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Incorporation
• For main GP practice
GMS contracts cannot involve limited company
PMS / APMS can in certain circumstances – but cannot just
introduce
Introducing may mean PCT has to retender contract
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Incorporation
• For certain areas of work incorporation can still be worthwhile – but
individual circumstances
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Income shifting
• HMRC has attempted to legislate against “income shifting”
• At its simplest, creating structures enabling income of one
individual to be taxed on another
• Such as limited company with GP and lower earning spouse
• HMRC unsuccessful so far
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Capital Allowances
Tax allowances in respect of (e.g)
Equipment (BP monitors, computers)
Vehicles (GPs’ cars)
“Integral features”
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Capital Allowances
• In accounts, buy equipment and write down (“depreciate”) over
useful lives
• In tax return, HMRC rules may allow faster or slower claim back
against tax
• One of reasons why accounts profit figure differs from tax returns
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Annual Investment Allowance “AIA”
• Currently capped at £250k p.a.
• But 95% of UK businesses invest less than £250k p.a.
• Enables all tax relief to be gained “up front”
• Excludes cars
• Note effect on GP partners joining/leaving
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Writing Down Allowance 2013/14 - cars
• All following rates multiplied by % business use
• Note effect on Vehicle Excise Duty too
Emission (grams/km) Allowance rate Example
<95 100% Fiat 500C
>95, <130 18% Ford Focus 2.0TDCi
>130 8% BMW 325D
www.francisclark.co.uk
Integral features
• Electrical wiring
• Cold water systems
• Heating/air conditioning
• Lifts
Not all of these previously qualified – so scope to re-open purchase of
surgery and retrospectively identify/claim back tax
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Tax efficient investments
• Restrictions on pensions relief for some higher earners /
contributors
• ISAs – income not taxed in receipt but no relief on investment itself
• EISs
• VCTs
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Individual Savings Accounts “ISAs”
• Income not taxed in receipt* but no relief on investment itself
• No CGT on sale
• 2012/13 limit £11,280 of which up to half can be in cash ISA
* Except 10% dividend tax credit not reclaimed
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Venture Capital Trusts “VCTs”
• Government encouraging investment in fledgling businesses
• Hence higher risk
• Though many “planned exit” VCTs that concentrate on the tax
returns rather than the trade itself
• 30% tax relief going in
• No income tax, no CGT
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Enterprise Investment Schemes “EISs”
• Higher risk, illiquid
• Need to stay invested in trading EIS for 3 years to get benefits
below
• Can use to defer CGT on earlier gain
• 30% income tax relief, no CGT
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Seed Enterprise Investment Schemes
“SEISs”
• Smaller companies (assets < £200k, employees < 25)
• Full CGT reinvestment relief in 2012/13
• New qualifying trade – not investment or property
• 50% income tax relief (max £100k investment)
• CGT exempt if held for 3 years
www.francisclark.co.uk
CGT planning
• CGT annual allowance 2012/13 £10,600
• Transfers between spouses up to / including year of separation
CGT free
• So approx. £22k gains p.a. tax free
• Capital Gains form “top slice” and CGT payable at 18% for basic
rate income tax payers, 28% for higher rate
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Entrepreneurs relief
• Reduces CGT payable to 10% effective rate (still get annual
allowances)
• Available against gains in assets used in proprietor’s business
(most commonly for GPs – surgery premises)
• Also for shares: shareholder with at least 5% of equity, employed
or company officer at least one year
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CGT on sale of share in premises
• CGT payable on excess of sale proceeds over costs
• Costs may represent an amalgamation over years of various
tranches bought / sold
• Relief for any costs of sale – legal, valuation
• No allowance for “indexation” (i.e. general increase in prices since
purchased)
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CGT on sale of share in property
• Payable in Jan following tax year of sale
• If sale can be split, can use more than one annual allowance
• Normally no Entrepreneurs Relief if rent has been received for use
of building
• HMRC not taken point re notional rent
• ER – need to sell within 3 years associated with material disposal
of business interests
www.francisclark.co.uk
Summary – tax planning
• Pensions relief useful for higher rate earners but care needed re
AA / LTA
• Penal rates of tax / NIC for earnings £100k to £118k
• Incorporation can work – but individual circumstances
• ISAs, VCTs, EISs
• CGT on property ownership
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