If you have a PAYE job with an NHS trust, a care home or a home care company, those wages don't count towards the Making Tax Digital threshold. HMRC only adds up your self-employed income and any rent from a property, before expenses. So the job on your payslip never puts you into MTD by itself. The extra shifts that are paid gross, with nothing taken off, are the ones that can.

Do my NHS wages count towards the £30,000?

No. Wages taxed through PAYE aren't qualifying income for MTD. That's the same whether the PAYE comes from the trust, the care home or an agency that runs its own payroll, and pay through an umbrella company counts as employment too. Your pension, savings interest and dividends are left out as well.

What does count is your self-employed turnover. That's everything the shifts brought in, before you take off your registration fee or the petrol between visits.

The line is £30,000 from 6 April 2027, and it drops to £20,000 from 6 April 2028. (People over £50,000 started in April 2026.) HMRC decides using your tax return from two years before, so your 2025/26 return sets April 2027 and your 2026/27 return sets April 2028. You have to be over the line. Exactly £30,000 doesn't put you in.

Which of my shifts are self-employed?

Look at what lands in your account after the shift. If it comes with a payslip and tax and National Insurance already taken off, you're paid as an employee for that work. If the app that pinged you at 10pm with a Saturday shift pays you the full amount, with nothing deducted, you're usually being treated as self-employed.

Two agencies can pay the same kind of shift in two different ways. So go by your own paperwork. What a colleague on the ward was told doesn't settle it for you.

The payslip is a good place to start. It doesn't decide your legal status on its own, though, because your contract and who controls how the work is done matter too. If you're unsure, HMRC's free Check employment status for tax tool walks you through the questions. And you're allowed to be employed and self-employed at the same time. HMRC says so on its Working for yourself page.

Three examples

These are made-up figures to show the sum, not anyone's real situation.

A care worker earns £28,000 on PAYE at a care home and picks up £12,000 of gross shifts through an app. Qualifying income is £12,000, not £40,000. That's under the £30,000 line for 2027 and under the £20,000 line for 2028. Not in MTD, unless the extra shifts grow.

A nurse who left the trust and did £35,000 of self-employed shifts in 2025/26 is over £30,000, so MTD starts on 6 April 2027. A PAYE job on top wouldn't change anything, because the PAYE side isn't in the sum.

The one to watch is in between. Say your 2026/27 tax return shows £16,000 of PAYE and £22,000 of self-employed shifts. If 2025/26 looked about the same, you're clear of the 2027 start. But £22,000 is over the £20,000 line, so MTD starts for you in April 2028. It doesn't take much to get there. Two twelve-hour shifts a week at £20 an hour comes to about £23,000 over 48 weeks.

What happens to my PAYE job if I'm in?

Nothing changes on the job side. Your employer keeps running PAYE as before. The quarterly updates only cover the self-employed shifts and any rent.

At the end of the year you still send a final declaration, and that's where the PAYE wages go in, next to your self-employed profit. HMRC works out the tax on all of it together. Keep your P60 from the trust or the care home, because you'll need the figures on it. We've written separately about how PAYE and locum work fit together for tax.

If you've got payslips from one job and app payments from another and can't tell which pile is which, tell us roughly how much came in each way last tax year. Alex or Anca will tell you whether MTD looks likely and when it would start. There's more on how we work with healthcare workers and on the Making Tax Digital page, or you can get in touch.

Sources: HMRC, Work out your qualifying income for Making Tax Digital for Income Tax, Find out if and when you need to use Making Tax Digital for Income Tax, Check employment status for tax, Working for yourself and Use Making Tax Digital for Income Tax. Correct as at November 2026.