Why aren’t associate dentists classed as employed, Michael Watson questions.

Last week’s blog by Alun Rees on this site discussed ‘the evolving status of associates’ with HMRC.

He rightly said: ‘Observing work patterns of many NHS associates, I struggle to justify their status as truly self-employed’ and I agree with him.

Employed or self employed?

During my career I have worked as employed – the Army, as self-employed – a practice owner, and again employed – working for the BDA.

My experiences tell me that the difference between being employed and self-employed is far more than a classification by the tax authorities, vitally important though that is.

Being employed is a different ethos – a different way of working, not just a different way of being paid.

Self-employment in the UK has increased significantly in recent years, rising from 3.3 million people (12.0% of the labour force) in 2001 to 4.8 million (15.1%) in 2017 according to www.ons.gov.uk.

But still, the overwhelming majority of the workforce are employed, so why not dentists?

Why should two people (dentist and nurse) both working on the same patient be paid in a different way?

One self-employed by the UDA and the other employed by the hour.

Dental contract

There were historical reasons for this, when prior to 1994, the dental budget was determined by the number of dentists working in the NHS.

Until 2006, associates brought money into the practice, now however only the contract holder brings NHS funding into the practice and the associate is, in reality, an expense, not an income generator.

There is no reason why an associate should be paid according to the number of UDAs ‘performed’, any more than I was paid in the Army for the number of fillings I did, or the number of meetings I attended at the BDA.

As a higher-paid employee you are expected to work flexibly both in relation to hours of work and where you work (in a multi-practice corporate say).

You would also be expected to help with the running and clinical governance of the practice.

You would thus be paid according to your experience and the responsibilities you were given.

In return you have the protection of a contract outlining your pay and terms of service.

Your employer takes on some responsibility for your continuing professional development, in both the Army and the BDA I was sent on courses and given training at my employers, not my expense.

Above all you have the protection of the organisation for which you work in relation to your professional duties.

I recall that, when BDA News editor, I was threatened with legal proceedings for libel and it was the BDA’s lawyers, not me, that kicked the (unwarranted) claim into touch.

Translate that into a complaint from a patient against an employed associate and ask who becomes responsible for dealing with it, the practice I would think.

The debate on self-employment or employed status needs to be broadened from the narrow question of how much income tax or national insurance is paid.


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