A worked example
The clinic employs all ten: eight practitioners on an average of £38,000 (an illustration, not a Budget figure) and two full-time receptionists on the National Living Wage, 37.5 hours a week for 52 weeks. It pays the minimum auto-enrolment pension and claims the Employment Allowance. Its treatments are given by registered physiotherapists, so they are exempt from VAT. The premises are not retail, hospitality or leisure property, and get neither transitional relief nor supporting small business relief, so the 1p supplement applies. Cliniko itself does not change any figure.
| A year | Before the Budget | After the Budget, from April 2027 | Difference |
|---|---|---|---|
| Receptionists' pay: 2 × 1,950 hours at £12.71, then £13.21 | £49,569.00 | £51,519.00 | +£1,950.00 |
| Employer's National Insurance, practitioners: 8 × (£38,000 − £5,000) × 15% | £39,600.00 | £39,600.00 | |
| Employer's National Insurance, receptionists | £5,935.35 | £6,227.85 | +£292.50 |
| Less the Employment Allowance | −£10,500.00 | −£10,500.00 | |
| Employer's National Insurance | £35,035.35 | £35,327.85 | +£292.50 |
| Minimum pension (practitioners £7,622.40 in both) | £8,735.07 | £8,793.57 | +£58.50 |
| Business rates: £24,000 × 43.2p, then 44.7p | £10,368.00 | £10,728.00 | +£360.00 |
| Business rates with the 1p supplement | £10,608.00 | £10,968.00 | +£360.00 |
| VAT on treatments | £0 (exempt) | £0 (exempt) | £0.00 |
| Pay, National Insurance, pension and rates together | £103,947.42 | £106,608.42 | +£2,661.00 |
The practitioners' pay and National Insurance do not change: the Budget left employer's National Insurance at 15% above £5,000 and the Employment Allowance at £10,500. The before column uses this year's wage floor and business rates multiplier, because the April 2027 rates were set at the Budget.
One VAT change may matter to a clinic that is not VAT-registered: from April 2027 an overseas business supplying it with services must charge UK VAT, because the reverse charge will apply only to VAT-registered businesses. Whether it touches the clinic's software or other subscriptions depends on where each supplier is based and how it bills today.
When it takes effect
- The National Living Wage of £13.21: 1 April 2027.
- The 2027/28 business rates multipliers: 1 April 2027, with the 1p supplement extended to 31 March 2029.
- The VAT reverse charge change: April 2027.
Who it doesn't affect
A clinic whose staff are all paid at least £13.21 an hour sees no change in pay costs from the Budget, and a clinic outside England is not affected by England's business rates multipliers. The exemption from VAT for treatments by registered health professionals is unchanged.
Where this comes from
- Budget 2026 (HM Treasury), policy decisions, "Young people and labour markets": the National Living Wage of £13.21 from 1 April 2027
- Budget 2026: Overview of Tax Legislation and Rates (HMRC), Annex A, Business rates: the England small business multiplier of 43.2p for 2026/27 and 44.7p for 2027/28
- Budget 2026 (HM Treasury), policy decisions, "Business rates": the 1p Transitional Relief Supplement extended for two years from 1 April 2027
- Budget 2026 OOTLAR, Annex A, National Insurance contributions: employer's rate 15% above the secondary threshold and the £10,500 Employment Allowance for 2027/28
- Budget 2026 OOTLAR, Annex A, VAT: the rates for 2027/28, unchanged
- Budget 2026: Overview of Tax Legislation and Rates (HMRC), section 1.59: from April 2027 the reverse charge on services from overseas applies only to VAT-registered businesses, so overseas suppliers must charge UK VAT to UK businesses that are not registered
- National Minimum Wage and National Living Wage rates (GOV.UK): £12.71 from April 2026
- Rates and thresholds for employers 2026 to 2027 (HMRC): the £5,000 secondary threshold a year
- Workplace pensions: what you, your employer and the government pay (GOV.UK): the employer minimum of 3% of earnings between £6,240 and £50,270
- VAT Notice 701/57: health professionals and pharmaceutical products (HMRC): exempt medical services by registered health professionals, physiotherapists among them
Every figure on this page comes from the Budget documents published on GOV.UK on , and was checked by Lewis Back ACA. Last updated . It is general information, not advice on your own position.