When Silence Becomes Expensive: Understanding Self-Employment in Dentistry
“A problem can only be present in the absence of a truth-full conversation.”
For many in dentistry, the words self-employed associate have been used so often they’ve become accepted as fact. But what happens when that assumption is wrong?
A Costly Lesson
Mark was a well-liked associate dentist who had worked in the same practice for seven years. He was described as self-employed, produced his own income, and paid his taxes each year. His principal, Sarah, was equally confident that their arrangement was above board.
Neither of them, however, had ever checked the finer details of what “self-employed” really meant in the eyes of HMRC. They trusted that because “everyone else does it this way”, they were safe.
They were not.
When HMRC reviewed Mark’s tax position, they found that his day-to-day working arrangements looked far more like employment than self-employment. He couldn’t decide when to work, his days were fixed and time off when another clinician was off was denied. The practice provided all his equipment, he had not even bought his own loupes because he thought they were expensive. Sarah had a previous associate who persistently reduced fees so the ability for Mark to alter fees was withdrawn and he had no control over fees. Even though the expectation to engage a locum was in his agreement, Mark went on a five week holiday, he refused to engage a locum and to keep the peace, Sarah funded it. Mark though it was unfair that he did not get paid for FTA, PNB and LC appointments and to keep the peace Sarah renumerated him anyway.
He failed the self-employment tests — and so did Sarah.
The result? HMRC reclaimed seven years of unpaid tax in full, with no allowance for what had already been paid. Both were left shocked, anxious, and financially strained. Sarah faced unexpected liabilities, and Mark’s savings were wiped out.
All because neither of them had a truth-full conversation about what self-employment really meant.
The Reality of Being Self-Employed
Being self-employed means that you are running a business, whether you are an associate, hygienist, therapist, increasingly a nurse, or a practice principal.
According to HMRC, you’re probably running a business if you:
(From HMRC – Working for Yourself)
- take responsibility for its success or failure
- have several customers at the same time
- can decide how, where and when you do your work
- can hire other people at your own expense to help you or to do the work for you
- provide the main items of equipment to do your work
- are responsible for finishing any unsatisfactory work in your own time
- charge an agreed fixed price for your work
- sell goods or services to make a profit
Checking Employment Rights
(From HMRC – Self-employed and Contractor)
If someone is self-employed, they do not have the rights and responsibilities of an employee or worker.
Someone is probably self-employed if they’re self-employed for tax purposes and most of the following are true:
- they put in bids or give quotes to get work
- they’re not under direct supervision when working
- they submit invoices for the work they’ve done
- they’re responsible for paying their own National Insurance and tax
- they do not get holiday or sick pay when they’re not working
- they operate under a contract (sometimes known as a ‘contract for services’ or ‘consultancy agreement’) that uses terms like ‘self-employed’, ‘consultant’ or ‘independent contractor’
Employment law does not cover self-employed people in most cases because they are their own boss.
If a person is self-employed, they have:
- protection of their health and safety
- protection of their rights against discrimination (in some cases)
- the rights and responsibilities set out by the terms of the contract they have with their client
Employment
Someone who works for a business is probably an employee if most of the following are true:
- they’re required to work regularly unless on leave
- they have set hours and are paid for that time
- a manager supervises their workload
- they cannot send someone else to do the work
- they get paid holiday
- they’re entitled to sick and maternity pay
- they can join the business’s pension scheme
- disciplinary and grievance procedures apply to them
- they work on the business premises
- the business provides materials and tools
- they only work for that business
- their contract uses terms like ‘employer’ and ‘employee’
There are many experts in dental employment and tax law who suggest that the most appropriate status for associates may, in some cases, be as a self-employed worker rather than a pure contractor.
A person is generally classed as a worker if:
- they have a contract or arrangement to do work or services personally for a reward
- their reward is money or a benefit in kind
- they can only subcontract in limited ways
- their employer must have work for them while the contract lasts
- they are not operating through their own limited company
Workers are entitled to certain employment rights, including:
- National Minimum Wage
- protection against unlawful deductions
- paid holiday and rest breaks
- maximum 48-hour average working week (or opt-out)
- protection against discrimination
- protection for whistleblowers
- protection against less favourable treatment if part-time
They may also be entitled to:
- Statutory Sick, Maternity, Paternity, Adoption, Shared Parental, Parental Bereavement, or Neonatal Care Pay
Workers usually are not entitled to:
- minimum notice periods
- protection against unfair dismissal
- the right to request flexible working
- time off for emergencies
- statutory redundancy pay
What Matters Most: What Happens Day to Day
There are no clear-cut rules. Each case is judged on the overall picture — and what happens day to day matters more than what’s written in the contract.
For example, if your agreement says you must find and fund a locum for holidays, but you agree with your principal that you’ll simply take five weeks off without doing so, you’re no longer operating as a self-employed contractor.
You can check your status here:
HMRC – Check Employment Status for Tax
Could You Justify Your Own Status?
As you read through the different employment scenarios described by HMRC, take a moment to reflect — whether you are a clinician or a principal. Could you confidently defend your self-employed arrangements if they were challenged? For the clinician, this means ensuring you truly operate as an independent business: e.g generating your own income, raising your own invoices, managing your own time, taking responsibility for the outcomes of your work., fully funding remakes, and putting right unsatisfactory work, not being remunerated for white spaces, buying equipment and materials, engaging locums to work on your behalf etc.
For the principal, it means structuring relationships and systems that genuinely support self-employment — not simply labelling them as such.
The safest approach is to align what happens day-to-day with what is written in the agreement. Review your contracts, invoices, and locum cover arrangements, and make sure your working practices demonstrate autonomy, not assumption. Both parties share the responsibility for getting this right — and for protecting each other from the consequences of getting it wrong.
How Employment Status Affects Life Beyond the Surgery
Your employment status doesn’t just influence your tax return — it can ripple through many other areas of your life. For dentists early in their career, being classed as self-employed can make it harder to secure a mortgage or loan, particularly without three years of accounts to demonstrate stable income. Pension contributions also differ; employees benefit from automatic enrolment and employer contributions, while self-employed clinicians must take full responsibility for setting up and funding their own retirement plans. Even accessing financial protection, such as income or sickness insurance, can be more complex. Understanding your true status — and planning accordingly — protects not just your professional life, but your long-term financial wellbeing too.
A Call to Conversation
Before taking on a new position or recruiting a clinician, make sure you understand the distinctions, rights, responsibilities, risks, and benefits. Just because everyone else is working as self-employed does not mean they are doing so correctly — and if you are the only one swimming against the tide, it doesn’t mean you are wrong.
Whichever status you hold, it’s your responsibility to ensure that you can justify it if challenged.
As a profession, we need to talk about these things openly. It’s time to move beyond hoping for the best and start having those truth-full conversations — the ones that prevent stress, confusion, and costly mistakes.
