The NHS problem is very complicated, but revolves round allowance tapering. In the worst case when a doctor takes on a set of shifts that boosts their income from 110000 to 111000 (and total package above £150k), the extra £1000 is taxed at 45%, loses £500 of personal allowance and £500 of pension allowance. In certain circumstances this means they are paying to work.
https://www.royallondon.com/siteassets/ ... -final.pdf explains all
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