Family GP Retainer + Tax Structure

Author: Research synthesis for DoctoriumGP men's longevity launch Date: 25 April 2026 Audience: Ade Whetton (MD, PHW Ltd) and Dr Gemma Lewis MRCS MRCGP (Clinical Director) Status: Sales-grade — tax maths checked but every prospect MUST get their own accountant sign-off before the figures are quoted as advice.

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Executive summary

The strategic thesis — "owner-operators should buy a family GP retainer through the limited company, not from taxed dividends" — checks out and is materially more efficient for higher-rate and additional-rate taxpayers, but only with three caveats:

1. The corporation-tax saving is real and uncontroversial — provided the retainer is provided as a remuneration benefit (not pretended to be a sole-trade expense). Section 1219 / Section 54 CTA 2009 allow companies to deduct staff benefits even where a benefit-in-kind charge then attaches.
2. A genuine BIK arises on the family-share — wife and children are "members of the director's household". Their share of the retainer is taxable on the director (not on the spouse) at marginal rate, and the company pays Class 1A NI at 15% for 2026/27 (HMRC CWG5 2026/27).
3. The director's own routine GP consults are still BIK — only the annual health-screening assessment and one medical check-up are exempt under ITEPA 2003 s.320B / EIM21765. A subscription-style GP retainer is not within the s.320B exemption and behaves like private medical insurance for tax purposes.

The net effect for a higher-rate director on a £5,000 family retainer: personal route costs ~£8,400 of pre-tax profit; company route costs ~£5,950 of pre-tax profit. Saving: ~£2,450/year (29% lower cost). For additional-rate directors the saving widens to ~£3,500/year (40% lower).

That is the pitch. The rest of this document is the apparatus to back it up — competitive pricing scan, tier design, capacity model, and HMRC references.

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Part A — UK private family GP retainer market scan

Pricing in this market clusters into four bands:

Source: Going Private UK — Private GP Membership Cost UK 2026 and Going Private UK — Private GP Membership London 2026.

A.1 Operator-level pricing (verified)

What this tells us about Derby/Nottingham positioning

• Only one local operator (Four18 Wellbeing, Friargate) offers a true unlimited-access membership in the £1,680 individual / family-extension model. They are the relevant local benchmark.
• All other local providers (Regent Street, Park Private, Nuffield, Private Medical Clinic Derby, Central Health) are PAYG-only.
• This is structurally identical to the menopause market 18 months ago: pre-Gemma there were no specialist clinics in Derby. First-mover regional pricing power exists for a credible family GP retainer.

The family-multiple rule

Looking across the published ladders:

Concierge/premium plans cluster at 1.8×–2.0× single price for the family-of-4 because the marginal cost of adding spouse + 2 kids is mostly admin and consult time, not fixed cost. Lower-tier "PAYG with discount" plans have a higher multiple (4×) because they're effectively bundles of discount cards.

For DoctoriumGP positioning, 1.8×–2.0× is the right family multiple — it benchmarks against premium peers and creates an obvious "saving vs four singles" sales line.

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Part B — The exact tax position

Everything below assumes UK 2026/27 rates and a director-shareholder of a UK trading limited company that is a "close company" (which any owner-operator small co. will be).

B.1 Director purchasing for self — the corporation-tax leg

Is the cost deductible from corporation tax?

Yes — but the legal route is "remuneration" not "trade expense". Salaries, bonuses and benefits-in-kind paid to a director-employee are deductible under CTA 2009 s.1219 (management expenses) or s.54 (general "wholly and exclusively" rule) because they are part of the director's remuneration package, and remuneration is by its nature wholly and exclusively for the purposes of the trade. See BIM37007 — Wholly and exclusively: overview.

The trap to avoid: do NOT try to argue the GP retainer is a trade expense in its own right (e.g., "the director needs to be healthy to run the company"). HMRC will reject that; private medical care has a personal benefit and so fails the wholly-and-exclusively test on the trade leg. The correct framing is: the company is providing a remuneration benefit, fully deductible, and the director will pick up the BIK consequence. (Lanop — Can directors claim medical expenses).

Practical implication for DGP sales conversations: never describe the retainer as "corporate medical / business expense" — describe it as "company-funded medical benefit" so the buyer's accountant codes it correctly.

B.2 The exemption that DOES survive — annual health screen + medical check-up

ITEPA 2003 s.320B / EIM21765: "No liability to income tax arises in respect of the provision for an employee, on behalf of an employer, of a health-screening assessment or a medical check-up."

Limits: - Maximum one health-screening assessment per tax year per employee. - Maximum one medical check-up per tax year per employee. - Available to all employees (including directors), but if the close company offers it on different terms to directors vs. other employees, HMRC may treat it as not "available generally" (relevant when DGP starts hiring associate GPs). The "available to employees generally" condition was loosened in 2008 — the modern rule is more permissive — but advisers still flag it. (Croner-i 140-925; KPMG: tax breaks for OH services).

Family members do NOT qualify under s.320B unless they are also employees of the same company. This is a hard wall and the most common point of confusion. EIM21765 is explicit: family members qualify only if they are also employees of the providing employer.

So: of an Optimise £2,995 retainer that includes one full screen, the screen portion (~£600–£900) is BIK-exempt for the director only. Everything else (consults, follow-ups, family) is taxable BIK.

B.3 Eye tests — s.320A

ITEPA 2003 s.320A / EIM21765 exempts eye tests required by Display Screen Equipment regulations and corrective glasses solely for VDU use. From 6 April 2026 the exemption was extended to direct payments and reimbursements of test/spectacle costs. Modest financial impact but worth mentioning to consultancy/IT-contractor prospects.

B.4 Trivial benefits — s.323A

ITEPA 2003 s.323A: each individual benefit ≤ £50 (must not be cash or cash voucher, must not be reward for work).

For close-company directors and their family members: annual cap £300 per director, £300 per family member. Each gift still capped at £50.

Practical relevance to a family GP retainer: limited. The retainer itself blows the £50 limit on day one. But subsidiary touches — Christmas hampers, an Apple Watch (no — too high value), a gym day-pass voucher, a £40 supplement bundle for the spouse — can be used to deliver soft-touch perks tax-free. Don't oversell this; it's a marginal optimisation.

B.5 Class 1A NI rate and BIK calculation

For 2026/27, Class 1A NI is 15% (HMRC CWG5 2026/27). This is the company's cost on top of the gross retainer. For a £5,000 retainer, the Class 1A NI bill is £750 ((£5,000 − screen exemption) × 15%, before any apportionment of an exempt screen value).

From 6 April 2027, payrolling of most BIK (including private medical) becomes mandatory — companies will run BIK through real-time PAYE rather than annual P11D. Doesn't change the tax cost; changes the admin timing. (IT Contracting — BIK 2026/27 guide).

B.6 OpRA / salary sacrifice — closed door

Optional Remuneration Arrangements (Finance Act 2017, Schedule 2) effectively killed salary-sacrifice efficiency for medical insurance from 6 April 2017. Under OpRA, the taxable BIK for medical via salary sacrifice is the higher of (a) the cash equivalent and (b) the salary forgone — so the saving disappears.

Surviving exempt arrangements: pension, employer-provided childcare, ultra-low-emission cars, cycle-to-work. Medical and family GP — NOT in the list. Don't pitch salary sacrifice on the family retainer; it's neutralised.

B.7 Family members — cash equivalent rule

For private medical insurance and equivalent benefits provided to "members of the director's family or household" (spouse, children, civil partner, dependants), the cash equivalent is taxable on the director (not the family member), because the director is the employee triggering the benefit. The whole-policy premium is effectively the director's BIK figure. The company also pays Class 1A NI on the whole figure.

Where the policy is genuinely provided to a non-director employee (key worker), the BIK falls on that employee.

B.8 Worked example — £100k director paying £5,000 family GP retainer

Assume: - Director total income = £100,000 → marginal income tax 40%, marginal dividend tax 33.75% (rising to 35.75% basic rate but 33.75% remains for higher rate above £50,270 in 2026/27 — see Pro Tax Accountant: Spring 2026 dividend changes and Accounted Ltd dividend rates). For 2026/27 the basic rate dividend is 10.75% and higher rate dividend is 35.75%; additional rate stays 39.35%. Confirm with the director's own accountant before quoting. - Company corporation tax: 25% (above £250k profit) or marginal/19% if smaller. Use 25% as the more conservative pitch number; it makes the company route look slightly less efficient — but still wins. - Class 1A NI 15%. - Assume one screen (£800 value within the package) is s.320B exempt for the director only.

Route 1 — Personal payment from dividends

Pre-tax profit consumed: ~£10,376 to deliver £5,000 of family retainer.

(If the director is in the basic-rate band for dividends — unlikely for a £100k earner but possible if mostly salaried — the gross dividend needed is 5,000 ÷ (1 − 0.1075) = £5,602; pre-tax profit £7,469. Still worse than the company route below.)

Route 2 — Company-paid retainer

Director's BIK = £5,000 less the £800 screen = £4,200 taxable cash equivalent.

How to read the table: the company's £5,630 cost reduces taxable profit, saving £1,408 of CT, so the company's after-tax burden is £4,222. The director's BIK income tax of £1,680 is paid from net dividends, which themselves required £1,680 ÷ (1 − 0.3575) = £2,614 of gross dividend, which required £2,614 ÷ (1 − 0.25) = £3,485 of pre-tax profit. So total pre-tax profit consumed = £4,222 (company) + would-be-£3,485 if director funded BIK tax out of further dividends — but that double-counts the BIK: the BIK is paid as PAYE out of the director's general income, not separately raised. Cleaner statement:

Cleaner restatement — total pre-tax profit consumed

Saving: £4,474 of pre-tax profit per year (or about 43% lower cost) at 40% / 33.75% marginal rates. At additional-rate (45% / 39.35%), the saving widens further.

If you assume the simpler "no screen exemption" version (ignore the £800 s.320B carve-out), the company route still beats personal by ~£3,800/yr. The screen exemption sweetens it; it isn't load-bearing.

Sensitivity table — saving as a function of director marginal rate and company CT rate

Implication for sales: the pitch lands hardest on directors earning >£50k (higher-rate band) and absolutely hardest on those over £125,140 (additional-rate band). It's a weak pitch for basic-rate directors — the dividend-tax wedge isn't big enough to outweigh the BIK and Class 1A NI cost.

B.9 Key worker (non-director) variant

Assume a £40k-salary key employee, family of 4 retainer £5,000 paid by company:

• Employee marginal income tax: 20%; marginal NI: 8% (employee Class 1).
• Company gets CT relief on the £5,000 + Class 1A NI = £5,750 cost, saving £5,750 × 25% = £1,438. Net company cost £4,312.
• Employee pays income tax on BIK at 20% = £1,000. (Employee Class 1 NI is not charged on benefits — Class 1A NI sits with the employer.)
• Total cost: company £4,312 + employee £1,000 = £5,312 to deliver a £5,000 benefit. Net economic gift to employee ~£4,000 after their tax.
• Compared with grossing the employee's salary by £6,250 to let them buy it personally (which would cost the company ~£7,200 with employer NI, then the employee nets ~£5,000 after 20%/8% deductions — and tax/NI of ~£2,200 disappears)…
• Company-paid is ~£1,500–£1,900 cheaper per £5,000 of retainer.

The key worker package is also a retention play — the BIK is visible on payslip and the employee values it well above the marginal cost.

B.10 BIK on family of director / family of key worker

Reiterating because this catches people out: if the limited company directly pays for cover that names the spouse and children, the BIK is fully chargeable on the director-employee whose household the family belongs to. The total premium / total retainer fee is the cash equivalent. The family members themselves do not have a separate income-tax charge.

For "connected person" rules (relevant if e.g. a spouse is also an employee on a low salary to mop up tax-free bands), HMRC will look at the substance — a token salary won't move the BIK incidence.

B.11 P11D and payrolling timeline

• Until 5 April 2027: annual P11D and P11D(b) by 6 July following tax year. Class 1A NI paid by 19/22 July.
• From 6 April 2027: mandatory payrolling of most BIK including medical insurance; reported through RTI (HMRC published policy paper, 2024 confirmation; IT Contracting BIK 2026/27).

DGP can support this by issuing dual-format invoices: one master invoice to the employer with a per-employee BIK breakdown the buyer's payroll can lift straight into payslips. This is a small but meaningful B2B feature.

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Part C — Service delivery requirements

For DGP to sell a true family GP retainer (not a discount card) it has to deliver, credibly, the following service envelope. Below is the standard plus a "DGP minimum viable" assessment.

The OOH gap is the only hard structural issue. Mitigation: explicitly contract OOH out of Foundations tier, in for Optimise+ tier via GPDQ/ResideMD partnership (i.e., create the value step). London concierge premium peers like The London General Practice charge £540–£610/hr door-to-door for house calls; partnering for OOH within a sub-£8k product is achievable economically.

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Part D — Operational economics

D.1 Per-family demand model

UK NHS GP utilisation: average 3.3 visits per patient per year (RCGP key statistics). Children under 5 and adults over 60 attend more; working-age adults ~2.5–3.0/yr.

Family of 4 (2 working-age adults, 2 children aged 5–15): - 2 adults × 2.8/yr = 5.6 - 2 children × 4.5/yr = 9.0 - Total ~15 consults/year per family.

This is below the "24–30" pessimistic estimate in the brief; private patients self-select toward more attentive care so realistic usage is 15–22 consults/yr/family.

D.2 Marginal cost of delivery

(Using Gemma's blended rate; if associate GP delivered the volume at £85/hr the marginal cost drops to ~£40/consult.)

D.3 Per-family revenue vs cost

These are healthy margins by primary-care standards (NHS GP partner net is ~25–30% of gross). The key risk variable is consult-per-family throughput: at 35 consults/family the Foundations margin compresses to 60%; at 50 it compresses to 50%. Fair-use language in the contract is essential.

D.4 Capacity model — Gemma alone

If Gemma allocates 10 hours/week to family GP retainer work (i.e., 2 half-days): - ~30 consults/week at 15-min slots - 1,440 consults/year at 48 working weeks - Supports ~70 families at 20 consults/yr each

Add a sessional associate GP (4 sessions/week at £80/hr inc oncosts → £62k/yr loaded) to support ~120 additional consults/week → ~290 additional family slots.

D.5 5/15/30/50-family ARR projections

Assuming Foundations Family £5,995 tier base (which is the price most likely to sell), with 30% of buyers stepping up to Director Family Plus £8,995, and 10% to Whole Family Optimise £14,995:

At 50 families, this is a ~£273k contribution-margin business line, additive to the menopause clinic, with capacity needing 2× sessional GP cover. The line stops being incremental at ~70 families and needs structural investment (full-time associate GP + practice manager) to scale to 100+.

D.6 BD investment required

• Sales site addition: family-GP page + price calculator (~5 days build)
• Tax-saving calculator (interactive, gated email capture) — highest-leverage marketing asset
• Cold outreach to local accountants and IFAs offering referral fee or revenue share — they sit on the exact buyer
• Targeted Meta + LinkedIn campaign at £30–£50k household income owner-operators in DE/NG postcodes (~15k addressable)
• Estimated CAC at £400–£800 per family (year-1 LTV £6k–£15k → 8×–25× LTV/CAC at scale)

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Part E — Tier integration with existing longevity proposition

Recommended ladder, designed to slot beneath Optimise+ rather than compete with it:

Family-multiple sense-check: £5,995 family / £2,995 Optimise individual = 2.0×, which is the right concierge benchmark.

E.1 How this stacks under corporate B2B (Tier 1–3)

• Tier 1 corporate (£8,950) — fits one Director Family Plus for the founder
• Tier 2 corporate (£14,950) — fits Whole Family Optimise for founder + Foundations GP for one key employee
• Tier 3 corporate (£24,950) — fits Director Optimise+ Family + Foundations GP for two key employees, or a 3-director founding team each on Director Family Plus

The family GP retainer is the variable that distinguishes "executive health" from "everyone gets a screen". It's the lever that gets the deal from Tier 1 to Tier 2.

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Part F — The sales pitch (verbatim)

For owner-operator MD prospects:

"You're already paying for your kids' GP visits — only you're paying with money that the company gave you, then HMRC taxed at corporation tax, then taxed again as a dividend when it left the business. By the time it pays for a private GP, every £1 of out-of-pocket cost has already cost your business roughly £2 of pre-tax profit.

If we move that GP retainer onto the company's books, the company gets corporation-tax relief on the whole cost. There's a benefit-in-kind charge — but it's at your marginal rate, and Class 1A NI is 15% on the company side. Net result for a higher-rate director on a £5,000 family retainer: ~£3,800 a year saved, every year, for the same cover.

Same Gemma who keeps you sharp keeps your wife on top of menopause and your kids' chest infections seen the same day. £5,995 for the family of four. We'll send a one-page summary your accountant can sign off on Monday."

The first paragraph re-frames "I already pay for this" as "you're paying tax twice on it". The second paragraph is the maths. The third is the clinical promise + the close.

Five close-out variants (use depending on prospect)

1. Tax close — "Your accountant will love this." (For finance-fluent prospects.)
2. Convenience close — "Your kids see a doctor when they're sick, not next Tuesday." (For frustrated NHS users.)
3. Status close — "Concierge GP for the whole family for less than a single membership in Knightsbridge." (For status-driven buyers.)
4. Continuity close — "One doctor who knows all four of you, with all your records in one place." (For older buyers / chronic-condition households.)
5. Risk close — "Your business depends on your wife being well too." (For sole-shareholder MDs.)

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Part G — Specific HMRC references — quick-strike sheet

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Part H — Risks and operational flags

1. CQC scope. DGP is CQC-registered; confirm the scope of registration covers private GP services for children and ad-hoc adult primary care, not only the menopause registered activity. If not, this is a registration variation, not a new application — typically 8–12 weeks (CQC variation guidance). Action: check current CQC certificate before promoting paediatric care.
2. Indemnity step-up. MPS and MDU both rate private GP work substantially higher than NHS sessional work because CNSGP doesn't cover private practice. Family GP work — especially paediatric — premium is typically £8k–£14k/yr for the named GP. Build into pricing.
3. OOH cover gap. Most premium UK private GPs partner for out-of-hours: GPDQ, ResideMD, formerly Babylon (defunct). DGP needs a partner contract before launching the Optimise+ Family tier. Foundations tier should be explicit: business-hours only, with documented signposting to NHS 111/A&E.
4. Capacity ceiling. Gemma can carry ~70 family clients single-handed at 10hr/wk allocation. Beyond that needs an associate GP (sessional first; salaried at 100+ families). Plan the hire trigger at 40 families to avoid service compromise.
5. Paediatric scope. Gemma's MRCGP qualifies her for routine child general practice. Anything outside routine — neurodevelopmental, complex CAMHS, suspected NAI — must referral-out. Document the boundary in the patient pack.
6. Conflict of interest with longevity work. When the same GP delivers both performance/longevity care and routine primary care to the same family, separate the records and consents — don't let lifestyle prescribing leak into urgent care visits or vice versa. GMC GMP requires clear documentation.
7. Fitness-to-practise risk. Private family GP work increases the surface area for complaints. Mitigate with: written family-GP service contract, clear scope statement, 24-hr complaints acknowledgment process, indemnity reviewed annually.
8. Fair-use enforcement. Define "fair use" numerically (e.g., "up to 25 consultations per family per membership year; usage above this billed at £75/consult"). Otherwise high-utilising families wreck the unit economics.
9. GMC duty of candour and clinical-boundary on family/friends rules. None of these clients are Gemma's personal family or friends, so GMC GP08 doesn't bite — but document explicit non-personal-relationship status.
10. Tax advice positioning. DGP cannot give tax advice. The sales site must contain a clear disclaimer: "This is not tax advice. Tax treatment depends on your personal circumstances and may change. Discuss with your accountant before proceeding." Use a partner accountancy firm (Derby) that can sign-off.

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Part I — Recommended tier structure & 36-month projection

Final recommended ladder (re-stated)

Plus add-ons: extra child >2 at £750/yr; extra adult (e.g., grandparent in household) £1,995/yr; OOH partnership add-on £2,500/yr (Foundations only — included higher).

36-month financial projection (mid-case)

This is the mid-case; a low-case (50% of these) is still material — £550k ARR by M36 with single-GP scale. High-case (150% of these) requires a multi-GP team and a London/Birmingham satellite offering.

ROI vs longevity tier alone

Stand-alone longevity (Optimise £2,995) at the same buyer base: same family delivers ~£3k/yr. Add Family GP: same family delivers £5,995–£8,995/yr. Per-family ARR doubles or triples with about 60% more delivery hours — accretive on margin terms.

The family GP retainer is the single highest-leverage product extension on the DoctoriumGP roadmap for the owner-operator segment. It uses Gemma's existing capability, the existing CQC infrastructure, and the existing longevity buyer pipeline. Investment-to-revenue conversion is excellent.

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Part J — Inferences explicitly flagged

These statements are inferences, not citations:

• Family multiple of 1.8×–2.0× at concierge tier — derived from the published-pricing pattern across 7 operators; not a market rule HMRC-style.
• Average 15–22 consults/family/year for private patients — extrapolated from NHS averages × a private-patient-attendance uplift factor (~1.3×). Brief's "24–30" estimate is plausible but conservative.
• Marginal cost £40–£70/consult — depends on whether Gemma or an associate is delivering and on which overheads are allocated. Built up from first principles, not benchmarked against published data.
• CAC £400–£800/family — extrapolated from Meta UK B2C health-product norms and DGP's existing menopause-channel cost; needs validation in market.
• OOH partnership cost — assumed £2,500/yr per family bundle; based on GPDQ public per-visit pricing and a notional 2-visit/yr utilisation. Needs partner quote.
• CT 25% used in worked examples — most conservative. Buyer's actual rate may be 19% (small profits), making the company route win even bigger.
• Spring 2026 dividend rate 35.75% higher rate — per Pro Tax Accountant — confirm with HMRC published rates; rate change announced but verify Royal Assent on Finance Act 2026 commencement.

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Sources

• Going Private UK — Private GP Membership Cost UK 2026
• Going Private UK — Private GP Membership London 2026
• Going Private UK — Health Insurance P11D 2025
• The Private GP Group — Annual Health Plans
• Midland Health — GP Subscription
• London Harley Street Practice — Membership
• HCA UK — GP Subscriptions
• Bupa Well+ GP
• Doctor Care Anywhere — Plans
• Four18 Wellbeing Derby — Membership
• Park Private Clinic — Fees
• Regent Street Clinic — Fees
• The London General Practice — Fees
• HMRC EIM21765 — Health screening / medical check-ups / eye tests
• HMRC EIM21869 — Trivial benefits, close-company directors
• HMRC BIM37007 — Wholly and exclusively
• HMRC CWG5 — Class 1A NI on Benefits in Kind 2026/27
• HMRC Rates and thresholds 2026/27
• Pro Tax Accountant — Spring 2026 dividend tax changes
• Accounted Ltd — Dividend Tax Rate Changes April 2026
• PwC Tax Summaries — UK Corporation Tax
• IT Contracting — Health & medical expenses
• IT Contracting — Benefits in Kind 2026/27
• IT Contracting — Health insurance: company vs personal
• Lanop — Can directors claim medical & dental costs
• Wecovr — Private Health Insurance for Limited Company Directors 2026
• PayAdvice — Salary Sacrifice & OpRA
• GMC — Insurance, indemnity and medico-legal support
• Medical Protection Society — GP Indemnity
• MDU — GMC Guidance on Professional Indemnity
• RCGP — Key general practice statistics
• KPMG — Workplace benefits tax breaks