Employment Status Issues for Associate Dentists, Hygienists and Therapists

HMRC have been and are continuing to conduct a review of the arrangements between Dental Principals and their self-employed Associates, Hygienists and Therapists. We are concerned that this may be an area that Practices are getting wrong, leaving a potential for the Principals to be left with an underpayment of Tax and National Insurance Contributions.

In addition, HMRC can recover liabilities for up to 6 years, so there is the possibility of a significant liability for the Principal to find.

Self Employed Status

The question of whether an Associate, Hygienist or Therapist is employed or self-employed can be quite complex and the intention of the parties is only a small consideration when it comes to reaching a conclusion. Far more importantly, the critical tests for self-employment would need to be considered.

These critical tests are;

  • Is there a commitment to provide a personal service?
  • Does the Associate agree to undertake the work themselves and not send a substitute?
  • Is there control over the Associate by the Principal?
  • Does the Associate have certain things to do, such as work certain hours or perform certain tasks?
  • Is there mutuality of obligation?

There needs to be an obligation for the Principal to provide the work and pay for it and for the Associate to perform that work.

So, it follows that where it can be demonstrated satisfactorily that any one of the above is not found or proven then there cannot be an employment relationship, the Associate is self-employed.

Arrangements to Support Self Employment

Examples of arrangements that might further help to protect self-employed status within the Dental sector would be charging the Associate/Hygienist/Therapist for the use of equipment, staff and back office support.

You should ensure that the Associates, Hygienists and Therapists are not paid for days when they are absent from the surgery and are not provided with paid holiday and training days. In addition, it would be beneficial if the workers are paid by the session or for each treatment and not an hourly or day rate.

Another very important aspect would be for the Associates, Hygienists and Therapists to hold appropriate medical defence insurances.


The importance of having a written contract cannot be underestimated. If you are engaging the services of self-employed workers without a written agreement or, an agreement that was signed some time ago, then we recommend that you act now to protect yourself from a potential HMRC challenge and a significant Tax and NIC liability.

A contract for services between parties can be obtained from the British Dental Association (BDA) website if you are a member. We are happy to offer a review of any existing agreements you may have and/or assist with the drafting of a new and more suitable agreement designed to provide your practice with a contract that both reflects the reality of the engagement and protects the practice from HMRC challenge.

If you wish to discuss any of the issues raised in this article, please contact Richard Clutterbuck Employment Taxes Director at Baldwins.