Medical.Accountants
Regulated by ICAEW
Regulated by ICAEW
Regulated & AML supervision
Regulated & AML supervision
AAT fellow member
AAT fellow member
Certified advisor
Certified advisor
Certified ProAdvisor
Certified ProAdvisor
100+ yearsCombined team experience
Fully insuredUp to £2m indemnity
4.9 out of 5321 Google reviews

Practices & businesses

Care home accountants for residential and nursing care

Care home accounting, payroll and management reporting for UK operators. Understand occupancy, staffing costs and cash flow alongside annual accounts and tax.

Fixed fees, specialist healthcare accountants, and every HMRC and NHS Pensions deadline handled.

  • Fixed monthly fee — no surprises
  • Specialist in NHS pension and healthcare tax
  • Onboarding within 48 hours
Get my fixed-fee quoteBook a free 15-min tax review
  • ICAEW & ACCA regulated
  • 5,000+ clients served by ACCOTAX
  • Specialist healthcare accountants

Reviewed by Waqas Sagar ACA FCCA FMAAT · Last reviewed: 8 October 2026 · Updated for the 2026/27 tax year

Key takeaways

  • Your actual working arrangements determine the tax treatment; choosing a package does not change your employment status.
  • Keep records for each income source and check the official guidance linked to the questions below.
  • Agree the accounts, returns and advisory work you need before accepting a written fixed-fee quote.

Which accountancy support fits your income?

Start with how you are paid. Different income sources can need different accounts, returns and expense checks.

How you workWhat we checkSupport to explore
Employed or umbrella (PAYE)Tax codes, eligible employment expenses and whether a tax return is needed.Healthcare tax refund support
Genuinely self-employedBusiness income and expenses, Self Assessment and MTD eligibility.Healthcare Self Assessment service
Your own limited companyCompany accounts, Corporation Tax, director income and off-payroll status where relevant.Healthcare limited company accounts
PartnershipPractice accounts, allocated profit and each partner’s personal tax position.Healthcare partnership accounts

Sound familiar?

Problems we fix for care providers

  • "National Living Wage and employer NIC rises are squeezing us."
  • "Travel time and sleep-in pay compliance worries me."
  • "I'm unsure about VAT on welfare services versus staff supply."
  • "Local authority payments are always late."
  • "CQC or Ofsted want financial viability evidence."

What it's costing you

Leaving it unfixed is rarely free

Overpaid tax
Unclaimed expenses and wrong tax codes mean paying more than you owe, year after year.
HMRC penalties and interest
Late returns attract automatic penalties, plus interest on tax paid late.
Lost evenings
Hours spent on forms, invoices and spreadsheets after a long shift.

General examples — your position depends on your own figures.

How we solve it

What we actually do for you

Care payroll

Payroll that handles travel time and sleep-ins correctly.

Cash-flow forecasting

Forecasts that plan around late local authority payments.

VAT review

A clear view of which services are exempt.

Viability statements

Financial evidence prepared for CQC or Ofsted.

How we help

01

Management accounts

Report occupancy, revenue, agency staffing, wage costs and operating margins with a consistent monthly view.

02

Care home payroll

Payroll for variable hours and shifts, with pension auto-enrolment and employer reporting included where agreed.

03

Annual accounts and tax

Company or partnership accounts, tax returns and a review of qualifying capital expenditure.

04

Financial planning

Budgets and cash-flow projections to support funding discussions and financial viability information.

What to know before you decide

Occupancy is only one part of the margin

A full home can still be under financial pressure if fee rates lag behind staffing, energy, food and agency costs. Separate resident income by funding source and monitor receipts as well as invoiced revenue. Monthly reporting should show operating costs, debt servicing and planned maintenance, so decisions are based on cash and sustainable margins rather than occupancy alone.

Accounting support is not CQC certification

Financial records and forecasts may support a provider’s registration or financial viability evidence, but an accountant does not grant CQC registration or guarantee regulatory compliance. Care-related VAT exemption also depends on the provider and qualifying supplies. We keep accounting and tax support distinct from specialist clinical and regulatory advice.

Payroll & Pensions for Doctors & Healthcare Professionals

Your questions answered

What is RTI?

Real Time Information (RTI) requires employers to report payroll data to HMRC on or before every payday. This process ensures tax and National Insurance calculations remain accurate throughout the year. You must submit a Full Payment Submission for each pay period. Our team manages these digital filings for medical practices to ensure compliance.

Help with this question: Payroll & Pensions for Doctors & Healthcare Professionals

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What is the National Minimum Wage rule for my staff?

Employers must pay staff at least the statutory minimum rate based on their age and apprenticeship status. These rates typically increase every April. You must maintain accurate records of hours worked to prove compliance. Failure to pay the correct rate can result in significant penalties and public naming by the government.

Help with this question: Payroll & Pensions for Doctors & Healthcare Professionals

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What year-end forms do employers send?

Employers must submit a final payroll report and provide employees with a P60 by 31 May. You may also need to file P11D forms for taxable benefits by 6 July. These documents summarise total pay and deductions for the tax year. Medical.Accountants handles these filings as part of our payroll service.

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Quick quote

See what you could save — get a fixed fee in one working day

Three fields. No obligation. A specialist replies, not a sales team.

Packages for your working life

Accountancy packages for nurses

Self-employed income, a limited company, PAYE or a mixture: start with the support that matches how you actually work. We check your status and agree the scope and fee before starting.

Self-employed accountants for nurses packages

For genuine sole-trader income. We prepare your business accounts and Self Assessment, review allowable expenses and explain payments on account.

  • Sole-trader accounts and personal tax return
  • Allowable business expenses reviewed
  • Tax reserve and payment deadline guidance
  • MTD support scoped separately where required

Fixed fee quoted after a review

Discuss this package

Limited company accountants for nurses packages

For clinicians working through their own company. Choose Essential/Compliance, Core/Complete or Growth according to your accounts, bookkeeping and payroll needs.

  • Statutory accounts and Corporation Tax return
  • One director return for salary and dividends from the same company
  • Confirmation statement support; filing fee extra
  • Bookkeeping, VAT and payroll according to your chosen plan

Company packages from £45.83 + VAT / month

Compare company packages

Personal tax return packages for nurses

For employed clinicians, partners and people with mixed income who need a return. We check whether Self Assessment is required and reconcile the relevant income, expenses and pension tax information.

  • Self Assessment requirement checked
  • PAYE and other income reconciled
  • Eligible employment expenses reviewed
  • Pension tax work agreed separately where needed

Fixed fee quoted after a review

Discuss this package

Employment status is determined by the facts, not the package you choose. PAYE, umbrella and partnership arrangements may also apply. A limited company does not override IR35 or off-payroll rules, and not every employed clinician needs a tax return.

Overpaid tax?

Tax refund support for nurses

We review tax codes, eligible professional expenses and overpaid tax, then prepare a claim where you qualify. A refund is not guaranteed; HMRC decides the claim.

£249 + VAT

For refunds up to £5,000, our fee is £249 plus VAT. For refunds above £5,000, add 5% of only the amount above £5,000 to the £249 fee. VAT applies to the total professional fee.

Example: a £6,000 refund means £249 + £50 = £299 plus VAT.

Professional fee, excluding VAT

£249

Ask about a tax refund

This illustrates the fee only, not whether you qualify or how much HMRC will refund. We agree the claim scope and payment terms before work starts.

What's included

Limited company packages — compare what's included

Essential/Compliance

For locums, salaried GPs and dentists with a limited company

from £45.83 + VAT /month

  • FRS 105 or FRS 102 1A statutory accounts
  • Corporation tax return (CT600) and tax computation
  • Confirmation statement preparation and filing support
  • One director Self Assessment return
  • Deadline reminders ahead of every filing date

Core/Complete

For private practice, consultants and associate dentists

from £62.50 + VAT /month

  • Everything in Essential/Compliance
  • Monthly bookkeeping and bank reconciliation
  • Quarterly Making Tax Digital VAT returns
  • Director payroll with RTI filing and pension submissions
  • Quarterly review call on numbers and tax position

Growth

For clinics, dental practices and growing medical teams

from £75.00 + VAT /month

  • Everything in Core/Complete
  • Payroll for up to five employees

Prices exclude VAT. Making Tax Digital quarterly updates available as an add-on. Compare fees

Why clinicians trust us

Chartered accountants who know the NHS

  • ACCOTAX has served over 5,000 clients.
  • Regulated chartered accountants (ICAEW and ACCA).
  • Founded by Waqas Sagar ACA FCCA FMAAT, with 18+ years' experience.

Reviewed by Waqas Sagar ACA FCCA FMAAT

Chartered accountant and founder of ACCOTAX. Last reviewed October 2026.

Get my fixed-fee quote

How it works

  1. 01

    Free call

    A 15-minute chat about your income, structure and deadlines.

  2. 02

    Onboarding in 48 hours

    We set up your records, software and HMRC agent access.

  3. 03

    We handle the rest

    HMRC, NHS Pensions and every deadline, with reminders before each one.

Free resource

Get the care provider cash-flow template free

Tell us where to send it and we'll email it to you.

Your questions, answered

Can you outsource our care home payroll?
Yes, subject to an agreed payroll scope, deadlines and complete approved hours. Holiday pay and variable shifts need accurate source records.
Are care homes VAT exempt?
Qualifying welfare services may be exempt, but provider status and the nature of each supply matter. Exemption can restrict input VAT recovery.
Do you guarantee CQC compliance?
No. We provide agreed financial and accounting support; regulatory approval and operational compliance remain separate.

Speak to a specialist today

Leave your details and we'll call you back, or book a free review straight away.

Book a free 15-min tax review

Related healthcare expertise

Payroll & Pensions for Doctors & Healthcare ProfessionalsHealthcare VAT, payroll and bookkeeping servicesAccountants for private clinics and independent hospitalsFixed-fee online accountants for medical professionals
Accountants for healthcare professionalsHealthcare tax questions answered

General information for the 2026/27 tax year, prepared from the official guidance linked below. It is not personalised tax or regulated financial advice. Rules and circumstances can change; confirm your position before acting.

Official guidance

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