What to know before you decide
Practices & businesses
Specialist accountants for Starting a Care Home · Fixed fees · Free first call
Starting a care home: costs, registration and tax
A new care home needs premises, staff and CQC registration before the first resident arrives, and income builds slowly as beds fill. The forecast must carry the home through that fill-up period.
What does it take to open a care home?
Suitable premises, a registered manager, staff, policies and CQC registration before you admit residents. Lenders want a business plan showing occupancy building over time, fee rates by funder and enough working capital to pay staff while beds fill.
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
- ICAEW & ACCA regulated
- 5,000+ clients served by ACCOTAX
- Specialist healthcare accountants
Reviewed by Waqas Sagar ACA FCCA FMAAT, Founder of ACCOTAX, 18+ years' experience · Last reviewed: 8 October 2026 · Updated for the 2026/27 tax year
Medical.Accountants by ACCOTAX, ICAEW/ACCA-regulated chartered accountants, London, serving clients across the UK. Over 5,000 clients served.
Key takeaways
- We set up the company, payroll and bookkeeping; we do not write your CQC or regulator application.
- Fixed fee for start-up work, agreed in writing before work starts.
- One named accountant from your first forecast to your first year-end.
Opening a care home step by step
- Choose structure and premises
- Build the business plan and finance
- Recruit a registered manager and apply to the CQC
- Set up payroll and bookkeeping
- Admit residents and track occupancy
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 work | What we check | Support to explore |
|---|---|---|
| Employed or umbrella (PAYE) | Tax codes, eligible employment expenses and whether a tax return is needed. | Healthcare tax refund support |
| Genuinely self-employed | Business income and expenses, Self Assessment and MTD eligibility. | Healthcare Self Assessment service |
| Your own limited company | Company accounts, Corporation Tax, director income and off-payroll status where relevant. | Healthcare limited company accounts |
| Partnership | Practice 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
Company set-up and structure
Sole trader or limited company, shareholders, bank account and registration for VAT, PAYE and Corporation Tax, done before your first client.
02
Business plan figures
Start-up costs, cash-flow forecast and break-even point prepared for your lender, landlord or regulator application.
03
Payroll and year one accounts
Payroll with pension auto-enrolment, bookkeeping set up on Xero or QuickBooks, and your first accounts and tax returns at a fixed fee.
Your questions answered
Can I claim capital allowances on a care home?
Often yes, on qualifying plant and fixtures such as lifts, heating and fire systems. The Annual Investment Allowance gives 100% relief on up to £1 million a year of qualifying spend.
Want us to check this for you? Get a free review →Should I own the property in a separate company?
Many owners hold the property separately from the trading company to protect it and plan for a future sale. It affects Stamp Duty Land Tax and reliefs, so model it before buying.
Want us to check this for you? Get a free review →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
Want us to check this for you? Get a free review →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
Want us to check this for you? Get a free review →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.
Want us to check this for you? Get a free review →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 care providers
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 care providers 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 packageMedical accountants for care providers: limited company 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 packagesPersonal tax return packages for care providers
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 packageEmployment 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 care providers
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
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 quoteHow it works
- 01
Free call
A 15-minute chat about your income, structure and deadlines.
- 02
Onboarding in 48 hours
We set up your records, software and HMRC agent access.
- 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.
Speak to a specialist today
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Book a free 15-min tax reviewRelated healthcare expertise
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 sources referred to on this page: CQC: Registration; GOV.UK: Annual Investment Allowance; CQC: Find and compare care services; Google Maps: care homes near me.