There is an increasing demand for the services of health and care professionals across the whole spectrum of rehabilitation and wellbeing services. Physiotherapists, chiropractors, osteopaths, occupational therapists, massage therapists, podiatrists, psychotherapists and counsellors and holistic therapists, to name but a few.

Many private multi-disciplinary clinics are emerging to satisfy the growing need to treat and manage a variety of minor to severe disabling conditions. At Duncan & Toplis we have been working with health and care professionals for many years and understand the challenges of running a profitable and efficient practice, while caring for the health needs of your clients.

Business structures

Deciding on the best business structure is not always easy. A limited company can reduce exposure to personal financial risk while sheltering profits from higher rates of personal tax to enable higher levels of investment back into the business. Often a company will present a more reputable business structure for obtaining lucrative NHS or Local Authority contract work. A start-up business may benefit from running as an unincorporated business until it is established in order to take advantage of tax losses against earlier year’s earnings. At Duncan & Toplis we can guide you through the various options to devise the best solution for you.


Understanding the complexities of the tax system is essential in order to plan effectively and stay on the right side of the taxman. Some healthcare supplies are exempt from VAT and some are charged at the standard rate (20%). If you offer a range of services and your income is over the VAT registration threshold, it is important to understand which services are exempt and which are taxable as this determines how much you need to charge for your services as well as how much VAT you can reclaim on business expenditure. Our VAT team are well versed in the complexities of partially exempt businesses and will be able to assist in reviewing and advising on your VAT affairs.

Cash flow

Since the economic downturn and restrictions on government funding, maintaining and winning new contracts within the public sector arena as well as providing services to the private client has become more difficult. NHS England and the various NHS trusts and Local Authorities are required to obtain the best value for money when tendering for healthcare services from both public and private providers. Private practice needs to ensure a consistency in the quality of service, but remain prudent with their resources. D&T can provide specialist advice on maximising use of working capital, cash flow forecasts and strategic planning to ensure practices are able to operate with minimised impact on business finances.

Off-payroll working and the “Gig” economy

Many practices engage workers on an as required/locum basis. While this provides flexibility in the workforce, care must be taken to comply with the rules relating to payroll operation. HM Revenue and Customs have increased their focus on the status of workers within a business to determine whether they should be paid through the payroll with the additional obligations that places on the “employer” in relation to tax and NIC as well as pension, annual leave entitlement and other employment related rights and obligations. We are able to offer advice in this area in line with recent changes in legislation and the growing body of case law. We also offer a full payroll service which can save you time and money as well as relieving the headache of administering this function.

Tax relief and capital allowances

If you are building or purchasing your own premises then don’t overlook the costs within the building that can be claimed in the form of capital allowances. Meticulous tax planning will ensure you maximise your income and practice profitability.

Our services to you

We are able to offer a comprehensive accounting solution to the healthcare sector to include tax compliance and advisory services, cash flow management, budgeting and forecasting, acquisitions and disposals and private client services.

For more information, please email

Profile photo Christine Newitt

Key contact

Christine Newitt

t. 01205 310250