Autumn Budget 2026: What Changed for a Private Clinic

Nothing in the Budget of 28 October 2026 changes what a private clinic pays before April 2027. The measure being sold as help for small business does raise the Small Business Rate Relief threshold from £12,000 to £18,000, but only for retail, hospitality and leisure property in England, and the regulations that define that category name physiotherapy, osteopathy and chiropractic among the excluded uses. A clinic stays on £12,000, its multiplier rises from 43.2p to 44.7p on 1 April 2027, and the 1p supplement that helps fund the retail freeze runs two years longer. The National Living Wage goes to £13.21 on 1 April 2027. The only date inside the next month is 5 November 2026, and it has nothing to do with any of that.

Most Budget coverage written for small business is written for shops and cafés, because that is where the measures point. Reading it as a clinic owner produces a false impression of relief. This piece separates what reaches a clinic from what does not, and puts a date on each thing that does.

Figures below come from the Budget document itself, from Annex A of the Overview of Tax Legislation and Rates, and from the business rates letter the housing department sent to billing authorities. Where something was announced but not yet legislated, it says so. This is general information about commercial and tax changes, not advice on your own position.

The dates that matter

Nine of those ten dates are more than five months away. That is the honest shape of this Budget for a clinic: a calendar, not an emergency.

Business rates: the relief a clinic cannot claim

The Chancellor raised the Small Business Rate Relief threshold from £12,000 to £18,000 for full relief, and the tapered band from £15,000 to £21,000. Both changes apply from 1 April 2027, and both are restricted to qualifying retail, hospitality and leisure property in England. Budget paragraph 4.6 puts it in six words: "for qualifying RHL properties in England".

This is not a grey area a council can be talked round. The regulations that define a qualifying property list the uses that fall outside it, and physiotherapy, osteopathy and chiropractic appear on that list by name, alongside dentistry and acupuncture. A clinic is excluded by definition rather than by assessment. Counselling is not named, but the list is introduced as examples rather than as a closed set, so a counselling practice should not assume it falls the other way.

So a clinic stays on the existing thresholds: full relief at a rateable value of £12,000 or less, tapering away to nothing at £15,000. Our guide to business rates on a clinic covers how that relief works and the second-property rule that quietly removes it.

Meanwhile the multipliers a clinic actually pays both rise on 1 April 2027:

That is a rise of about 3.5 per cent, and it is uncapped, because the two-year real-terms freeze announced in the same Budget applies to retail, hospitality and leisure property only. Note also that the published multipliers exclude the 1p Transitional Relief Supplement, so a clinic actually paying a bill is charged on 45.7p before reliefs are applied. If your bill is already nil under Small Business Rate Relief, none of this costs you anything.

The part worth knowing

The 1p supplement was due to end. It has been extended for two further years, and the Budget is explicit that it helps fund the retail, hospitality and leisure freeze. It falls on ratepayers whose bills did not rise sharply at the revaluation, which describes a great many clinics.

A clinic therefore sits on the paying side of a relief it is defined out of. That is not a complaint about fairness, and there is nothing to appeal. It is a planning fact: if you are modelling premises costs for 2027/28, do not import any of the high-street relief into your figures, and do add 3.5 per cent to the multiplier.

One genuine win

The Budget abolishes the £150 and £300 fees the Valuation Tribunal in England charges for business rates appeals, and paragraph 7.17 says this "will enable fees already paid for appeals on the 2026 list to be refunded". That applies to the 2026 rating list and later lists, so an appeal you lodged and paid for this year is in scope.

There is no commencement date and no refund process yet. The practical step is to keep the receipt and watch for the fee regulations, not to chase a refund today.

If you let a treatment room to another practitioner

This is the measure most likely to cost a reader real money, and it is not being reported as a healthcare story at all.

From 6 April 2027 property income is taxed at its own rates: 24 per cent at basic rate, 44 per cent at higher rate and 49 per cent at additional rate. Savings income moves to the same figures.

Two things about that are easy to get wrong.

The rise is four percentage points from today, not two. The Budget adds two points, but two points were already legislated last year for the same tax year. Compared with what you pay now, property income is up four.

Room rent is property income. The policy paper does not mention room sharing, so the answer comes from the definition it points to, which puts payments for a licence to occupy or use land inside property income. A practitioner who lets a room to a colleague is in scope.

There is an election that can pull the rent back into your trade and out of the new rates, for accommodation that is temporarily surplus to your business: broadly, space you used for the practice within the last three years, intend to use again, and are letting for no more than three years, where the receipts are relatively small. Covering a colleague's sabbatical looks like that. A standing arrangement that has run for years does not. There is no published figure for "relatively small", so this is a conversation with your accountant rather than something to decide from an article.

One asymmetry is worth seeing plainly. The trading allowance triples to £3,000 on 6 April 2027. The property allowance stays at £1,000. From that date, treatment income gets three times the tax-free band that room rent does, and the rent above it is taxed harder. If you are choosing between seeing more patients yourself and letting the room out, the tax code has quietly moved against letting.

Our guide to the VAT position on renting out a treatment room deals with the other half of that decision.

If you drive to patients

The mileage change has been widely misreported, so here is the shape of it.

The 55p is not new money. It arrived in April 2026 and the Budget confirmed it will stay. The new money is entirely above 10,000 miles, which is the opposite of the last change and matters for a busy domiciliary round. Our domiciliary podiatry pricing guide works through what a mileage rate is actually worth once routing is accounted for.

The rates cover employees claiming mileage allowance and the self-employed using simplified expenses. The 35p is announced rather than legislated, with the instrument still to follow.

Fuel duty is the one to diarise. The 5p cut now runs to 30 June 2027, and the main rate reverts on 1 July 2027 from 52.95p to 60.59p a litre. That is a 7.64p jump in one day, because the cut unwinds and an inflation rise arrives on the same day.

If you employ anyone

All wage bands rise 3.9 per cent on 1 April 2027.

For one full-time receptionist on the National Living Wage, 50p an hour is about £910 a year.

Widely quoted figures add employer National Insurance on top, taking it to roughly £1,047. For most clinics that overstates it. Employer National Insurance is unchanged at 15 per cent above a secondary threshold frozen at £96 a week, and the Employment Allowance stays at £10,500. A practice with two or three part-time reception staff has a total employer National Insurance bill well under £10,500, so the allowance absorbs all of it and the marginal cost of the pay rise is the £910. Check your own position before budgeting the larger number, and note that the allowance is not available where a sole director is the only employee.

Our comparison of an associate against an employed second practitioner covers the wider cost picture.

The one thing to do this month

Payrolling benefits in kind becomes mandatory on 6 April 2027. This Budget delayed it by a year, which is good news, but employer-provided medical benefits are in the first wave along with cars, vans and fuel. If your clinic pays for a practitioner's private medical cover, that benefit has to run through payroll from April 2027.

Voluntary registration reopens on 5 November 2026. Registering early lets you run it for a year before it is compulsory. The P11D does not disappear, and HMRC expects employers to operate both for a period, so there is a real argument for getting the payroll routine working while mistakes are cheap: there is a one-year easement for non-deliberate errors.

Professional subscriptions and indemnity are not named either way in the published scope. Where the clinic pays an approved professional fee direct, that is already outside benefit reporting altogether, which is usually the more useful answer.

If you are thinking of selling

The Business Asset Disposal Relief lifetime limit halves from £1 million to £500,000 for disposals on or after 6 April 2027. The relief rate itself does not change.

Read the arithmetic before reading the headline. Business Asset Disposal Relief charges 18 per cent where the main higher rate is 24 per cent, so the relief is worth six percentage points. Removing £500,000 of lifetime limit therefore costs at most £30,000, and only to someone whose qualifying gains exceed £500,000. For the great majority of independent practices, where the whole gain sits below that, the change costs nothing at all.

What it does create is a dated window. A disposal completing on or before 5 April 2027 uses the £1 million limit.

Do not read that as an invitation to sign something now and complete later. The measure comes with anti-forestalling rules: a contract entered into before 6 April 2027 but completed after it is still capped at £500,000 unless the parties can show they did not contract in order to get the earlier date, and where the parties are connected, that the timing was for wholly commercial reasons. A statement is required where the gain exceeds £100,000. If a sale is genuinely in progress, the date to discuss with your adviser is completion. If it is not, the window is not a reason to start one.

A new Founders' Relief was also announced, charging 10 per cent on up to £10 million of lifetime gains for disposals from 6 April 2027. An independent clinic will not qualify, and this is worth knowing now rather than hoping otherwise. The company has to have turnover of at least £10 million and at least 15 qualifying full-time equivalent employees, and then meet two of three growth tests built on the same scale or on £1.5 million of research and development spending. HMRC expects around 600 individuals a year to use it across the whole UK. The restriction is scale and growth, not newness, so there is no structuring that gets a three-room practice into it.

The technical consultation on those conditions closes on 30 November 2026. Note that the consultation is on Founders' Relief only. The Business Asset Disposal Relief cut is not out for consultation, so nobody has a say on that one.

What you can safely ignore

E-invoicing. From 1 April 2029 VAT invoices must be issued electronically, and the mandate applies where a VAT-registered business invoices a VAT-registered customer. HMRC's roadmap excludes consumer invoices, invoices for transactions not subject to VAT, and invoices from businesses that are not VAT registered. A clinic invoicing a patient is outside it on up to three separate grounds. HMRC says directly that there is "no need to begin implementing e-invoicing before the detailed requirements are published". Expect to be told otherwise by people selling e-invoicing.

Two honest exceptions. A VAT-registered clinic will need to be able to receive an e-invoice by 2029, which is a job for whoever supplies your accounting software. And a VAT invoice you issue to a business customer, for corporate occupational health work or room hire, would be in scope.

The locum VAT story. The Budget removes the VAT exemption for supplying a deputy for a person on the register of medical practitioners, from 1 May 2027. That register is the General Medical Council's. Treatment by registered allied health professionals sits in a different part of the same exemption and is untouched. Coverage that says "the Budget removes the VAT exemption for locums" without the word doctors is wrong, and there will be a lot of it.

Frozen thresholds. The personal allowance stays at £12,570 and the higher-rate threshold at £50,270, frozen to April 2031. That freeze was legislated at the 2025 Budget. It is not news from this one, whatever the summaries say.

Capital allowances. The main writing-down allowance falls from 14 to 12 per cent and the main first-year allowance rises from 40 to 50 per cent. For a clinic buying a couch, a shockwave machine or laptops, neither matters, and HMRC says so in its own impact note: for many businesses "main rate writing-down allowances are not relevant to future expenditure as this will be covered by the annual investment allowance and full expensing". The Annual Investment Allowance stays at £1 million and still relieves the whole cost in year one. Cars are the real exception, because they cannot use it.

What is not in this Budget at all

Worth saying, because absence is hard to verify from coverage and several of these were widely expected.

• No change to the VAT registration threshold. It stays at £90,000, deregistration at £88,000. There is also no announcement freezing it, so do not write it into a plan as frozen.
• Nothing on employment status, agency rules or off-payroll working. Fee-split associate arrangements are untouched by this Budget.
• No health and work measure. No tax incentive for employers to fund staff treatment, nothing on occupational health, nothing on musculoskeletal or mental health services. The words do not appear in the document.
• No corporation tax or dividend change. 25 per cent and 19 per cent with the £50,000 and £250,000 thresholds, dividend rates and the £500 dividend allowance all flat. If you are weighing incorporation, sole trader or limited company still reads the same after this Budget as before it.
• No change to Making Tax Digital thresholds. £30,000 of qualifying income from 6 April 2027 and £20,000 from 6 April 2028, as already published. The Budget added a twelve-month penalty easement for the April 2027 cohort, which does not remove the obligation to file. Our Making Tax Digital guide has the quarterly routine.
• The energy help is domestic. The £50 off the price cap and the electricity VAT cut apply to household supply. A clinic on a commercial electricity contract does not get it. Whether a very small practice on a domestic-rate supply benefits is genuinely unclear from the wording, so ask your supplier rather than assuming either way.

The overseas software measure, and who it actually reaches

From 1 April 2027 the reverse charge for services bought from abroad is restricted to VAT-registered customers. The effect is that an overseas supplier must charge UK VAT to a UK business customer that is not VAT registered.

If your practice is VAT registered, nothing changes. The reverse charge continues exactly as now, and that is true of a partly exempt practice too. Read the rest of this section only if you are not registered.

For an unregistered clinic the position today is unusual, and it is the reason this measure exists. Buying a service from overseas produces no VAT at all, because the reverse charge only bites on a registered recipient. Buying the same service from a UK supplier costs 20 per cent more. HMRC describes the change as removing an inconsistency that let unregistered businesses "gain a tax advantage by using an overseas supplier". So the honest framing is a saving being withdrawn, not a new tax being imposed.

That saving is worth something because an exempt clinic cannot recover VAT on anything. Registering voluntarily does not help, because input tax is only creditable against taxable supplies and exempt treatment income produces none.

Two things keep this from being "every clinic's software bill rises 20 per cent on 1 April 2027".

You may be paying it already. HMRC's own note says suppliers currently have to weigh evidence about whether a customer is a business, and will in future simply check for a VAT number. A clinic with no VAT number to give is exactly the customer an overseas supplier may already be treating as a consumer and charging accordingly. Whether your suppliers do that today is not something any official source records.

Prepaid annual licences are unresolved. Nothing published says whether a licence paid for before 1 April 2027 that runs past it is caught. Treat that as an open question rather than assuming either answer.

The useful action is not to budget a 20 per cent rise. It is to pull out the most recent invoice from each overseas supplier you use and look at whether UK VAT is already on it. If it is, this measure costs you nothing. If it is not, and you are not VAT registered, that line is likely to grow by a fifth from April 2027.

One footnote on where the advantage really sits. A UK supplier only has to charge VAT once it passes the £90,000 threshold, while an overseas supplier gets no threshold at all. After the change, then, a small UK supplier below the threshold still charges nothing where an overseas supplier of any size must charge 20 per cent.

Where this does not apply

Business rates are devolved. Everything above about thresholds, multipliers and the supplement is England only. Scotland, Wales and Northern Ireland received funding through the Barnett formula and set their own policy, so none of the English figures can be read across.

Income tax rates on earnings are devolved in Scotland. Scottish rates and bands for 2027/28 were not published at the Budget. The new property rates apply in England, Wales and Northern Ireland, with Scotland and Wales given the power to set their own.

Several items are announced, not law. The wage rates, the 35p mileage rate, the multiplier change and the business rates threshold changes all require instruments that did not exist on the day of the Budget. The figures are published and reliable enough to plan with. The commencement detail is not final.

Questions clinic owners are asking

Does my clinic get the £18,000 business rates threshold? No, if you are in England and your property is used for physiotherapy, osteopathy, chiropractic, dentistry or acupuncture. Those uses are named outside the qualifying retail, hospitality and leisure category. You stay on £12,000 for full relief, tapering to £15,000.

Do I need to do anything before April 2027? One thing, and only if you provide staff benefits: voluntary registration for payrolling benefits in kind reopens on 5 November 2026, and medical benefits become mandatory to payroll from 6 April 2027. Otherwise nothing in this Budget requires action in the next five months.

I am selling my practice next year. Am I caught by the Business Asset Disposal Relief cut? Only if the disposal happens on or after 6 April 2027, and only if your qualifying gains are above £500,000. Below that figure the change costs nothing. Above it, the relief is worth six percentage points, so the most the cut can cost is £30,000. Completion is the date that counts, and signing a contract before April 2027 to complete after it does not preserve the old limit by itself, because there are anti-forestalling rules.

I rent a room to another therapist. What changes? From 6 April 2027 that rent is taxed at 24, 44 or 49 per cent depending on your other income, which is four percentage points above today. There is an election for temporarily surplus accommodation that may let you treat the rent as trading income instead, and it is worth asking your accountant whether your arrangement fits the conditions before the tax year starts.

Should I be worried about e-invoicing? Not if you invoice patients. The 2029 requirement applies between VAT-registered businesses, and HMRC's own roadmap says consumer invoices and invoices from non-registered businesses are outside it.

Set three reminders and close the tab: 5 November for payrolling registration if you provide benefits, 1 April 2027 for the wage rise and the new multiplier, and 6 April 2027 if you let a room or drive more than 10,000 business miles. Everything else in this Budget happens to someone else.

Sources: Budget 2026 document paragraphs 4.6, 7.13 and 7.17 · Overview of Tax Legislation and Rates and Annex A · Income Tax: changes to tax rates for property and savings income · Income Tax: increasing the trading allowance · Capital Gains Tax: reduction in the Business Asset Disposal Relief lifetime limit · Changes to reporting of benefits in kind from April 2027 · VAT: removal of the exemption for a deputy for a medical practitioner · E-invoicing implementation roadmap · National Minimum Wage rates · MHCLG business rates information letter 8/2026