Noise in quantum computing is countered with quantum error correction. Achieving optimal performance will require tailoring codes and decoding algorithms to account for features of realistic noise, such as the common situation where the noise is biased towards dephasing. Here we introduce an efficient high-threshold decoder for a noise-tailored surface code based on minimum-weight perfect matching. The decoder exploits the symmetries of its syndrome under the action of biased noise and generalises to the fault-tolerant regime where measurements are unreliable. Using this decoder, we obtain fault-tolerant thresholds in excess of $6%$ for a phenomenological noise model in the limit where dephasing dominates. These gains persist even for modest noise biases: we find a threshold of $sim 5%$ in an experimentally relevant regime where dephasing errors occur at a rate one hundred times greater than bit-flip errors.
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