The current situation – the doctorsWhen someone is employed, their employer applies employer national insurance to their pay packet. So, for example, if a hospital has £118k to pay its doctors, about £16k comes out immediately as employer national insurance. The doctor only ever sees the remaining £100k – and of course pays income tax and employee national insurance on it. Someone earning (say) £6m would pay £414k more tax if employer national insurance applied to their pay. This becomes quite hard to fix unless employer national insurance (or something equivalent) is applied to all the self-employed (and see further below).
