There is a clear and compelling need to implement a solution to address the issues created by annual allowance taxation for clinicians, and we welcome government and the national bodies' efforts to address the gap in clinical capacity created by this issue, particularly given the substantial impact on frontline care.

The findings of this survey suggest that the current solutions available do not have the full confidence of clinicians, and that trust boards do not expect them to restore capacity in frontline services. As such, we believe there is a need to restore the incentive for doctors to work extra shifts, but also to present a fair offer for all staff affected by what can be viewed as a punitive tax. This has to include both a change to the taper and address the impact of annual allowance for all staff moving into senior roles or through pay increments. A lasting solution to the pension problem must also include a commitment to review flexibilities for lower paid staff who can struggle to afford high contribution rates.

The sustainability of trust leadership is essential to the quality of care provided by the NHS, yet large numbers of respondents to our survey say they are considering leaving the NHS, and a dwindling supply of more junior staff are prepared to take up the mantle of challenging executive roles, given the added risk of unpredictable pension taxation.

In our view, it is counterproductive to the culture of equity in the NHS to make the artificial distinction between the value of clinical and non-clinical staff to patient care. In a pressured working environment, these survey results suggest that the current pensions arrangements risk damaging morale and goodwill.  There is however an opportunity now to intervene and strengthen the resilience of the workforce through measures to address workload, burnout and wellbeing, and ensure staff feel valued and motivated.