Hygienists & therapists: employment status done right

Why status matters

Whether a hygienist or therapist is employed or genuinely self-employed isn't a label you choose — it's a conclusion the facts support or don't. Get it wrong and the practice (not the clinician) carries the exposure: back PAYE and National Insurance, employer NIC, holiday pay claims, pension auto-enrolment duties, plus interest and penalties. Years of a comfortable arrangement can unwind expensively in one review.

What the status tests actually look at

• Control — who sets the hours, the diary, the pricing, the protocols? The more the practice controls, the more it looks like employment.
• Substitution — can the clinician genuinely send a suitably qualified substitute, and has it ever actually happened? A theoretical right no one uses is weak evidence.
• Financial risk — do they carry any? Own equipment or materials, payment tied to fees generated rather than a guaranteed day rate, gaps unpaid?
• Integration — uniform, staff meetings, appraisals, practice email: each one alone is minor; together they paint an employment picture.

A day rate, a practice-controlled diary, practice equipment and no real substitution is — in substance — employment, whatever the contract's title page says.

Structuring it cleanly

Both models work when done honestly. Employment buys control and integration: you set the diary, own the patient relationships and simply price the role properly (salary, employer NIC, pension, holiday — the full cost, which is why this belongs in your staff-cost ratio). Genuine self-employment needs the facts to match: fee-share or per-patient pay rather than a flat guaranteed day rate, meaningful control over diary and methods, a real substitution clause, their own indemnity and registration, and a contract that reflects what actually happens day to day.