“I’m self-employed!” – The five words that can derail a dental practice
Client Question:
"Please can we have some verbals to explain to clinicians that although they may be self-employed they still need to conform to practice policies etc on booking patients and seeing patients.
We all know that the self employed status is very tenuous when working as an associate. Allowing a clinician to flex their status as "self employed" is fraught for the existence of any practice."
As soon as I read this message, I decided in my head that the answer had to be a blog post - because so many Owners are thinking the same question.
Coach Answer:
Thank you for raising this because I think it's one of the most important conversations we need to have with associates in modern dental practice.
My starting point would be this:
Self-employment provides professional and commercial independence. It does not provide exemption from the agreed systems, standards and responsibilities of the practice in which you choose to work.
However, we have to be careful about how we communicate this because, as you rightly point out, the employment status of dental associates is an increasingly sensitive issue.
I would suggest approaching the conversation from the perspective of patient experience, professional responsibility, teamwork and mutual commercial benefit, rather than employer control.
Here are some suggested verbals.
1. The team meeting verbal
This is how I would address all clinicians at a team meeting.
"I want to clarify something about the relationship between our clinicians and the practice.
We absolutely recognise and respect that our associates are self-employed professionals.You have your own clinical responsibilities, your own professional judgement and your own businesses.
We respect that independence, and we have no intention of interfering with your clinical autonomy.
However, there's an important distinction between clinical independence and working within an organised dental business.
When a patient contacts this practice, they don't see a collection of independent businesses operating under one roof.
They see one dental practice. They expect one consistent standard of service, communication, appointment management and patient care.
That's why we have agreed systems for booking appointments, managing diaries, communicating with patients, handling cancellations, arranging follow-up appointments and working with the wider team.
These systems aren't designed to tell you how to practise dentistry.
They're designed to ensure that patients receive a consistent experience and that everyone working within the practice can operate effectively.
We welcome your input into improving those systems.But we cannot have a situation where every clinician independently decides which agreed operational procedures they will or won't follow.That simply doesn't work for our patients, our colleagues or the sustainability of the business.
Clinical independence is something we respect.
Operational cooperation is something we expect.
Our objective is a relationship in which everybody benefits: the patients, the clinicians, the team and the practice."
2. When an associate says: "But I'm self-employed"
I would respond calmly:
"Absolutely, and we respect that.
Your self-employed status gives you genuine independence within the terms of our agreement.
However, self-employment doesn't mean that you operate without regard to the shared systems and agreed arrangements of the practice.
We provide the premises, equipment, clinical support, reception, administration, patient enquiries and infrastructure that enable you to deliver your dentistry.
In return, we need everyone using those facilities to cooperate with the agreed operational arrangements.
You retain your independent professional judgement about your patients' treatment.
But we also need agreed ways of managing appointments, communicating with patients and coordinating the work of the team.
That's not about controlling your dentistry.It's about making our commercial relationship work for both parties."
An important qualification: this wording assumes the relevant requirements are reasonable, consistent with the associate agreement and do not undermine genuine self-employment.
3. When a clinician refuses to follow the booking system
This is where I would become more specific.
"I completely understand that you have preferences about how your diary operates.
We want to accommodate those preferences wherever reasonably possible.
However, we also have to consider the needs of patients, the availability of our support team and the effective operation of the practice.
Our appointment booking system is intended to balance those requirements.
If there's something about the system that isn't working for you, let's discuss it and agree an appropriate solution.
What we can't have is a situation where reception receives conflicting instructions from different clinicians and patients experience an inconsistent service.We need a mutually agreed approach that respects your clinical judgement and enables the team to manage appointments effectively."
I would also distinguish between clinical and administrative decisions.
The clinician should determine the clinically appropriate treatment, appointment duration and timing where these affect patient care.
The practice should coordinate the booking process, administrative communication and use of shared resources within the agreed contractual framework.
That's an important boundary.
4. When an associate repeatedly ignores agreed procedures
For a private conversation, I would use:
"I wanted to have a conversation about something that's becoming difficult for the wider team.
We've agreed certain operational arrangements for how patients are booked and how our reception and nursing teams support your clinical sessions.
We've noticed that those arrangements aren't consistently being followed.
I want to understand whether there's a genuine problem with the system or whether we have different expectations about how we work together.
We're very happy to review systems that aren't working.
However, once we've mutually agreed an arrangement, we do need both parties to honour it.
This is a professional commercial relationship, and it depends on cooperation, communication and mutual respect.
If we cannot agree on how that relationship should operate, we will need to review whether our existing arrangements remain suitable for both parties."
Notice that I haven't referred to insubordination, disciplinary action or management instructions.
Those are employment concepts that I would avoid when discussing a genuinely self-employed associate relationship.
5. My preferred approach: The win-win agreement
I've always advocated establishing what I call a win-win relationship between the practice and its clinicians.
Rather than simply issuing rules, I would create a written agreement around two questions.
What will the practice do to support the clinician?
Provide appropriate clinical facilities, trained nursing and reception support, effective patient enquiry handling, reliable administrative systems, agreed diary availability and opportunities for professional development.
What will the clinician do to support the practice?
Cooperate with agreed booking arrangements, communicate diary requirements in advance, participate in appropriate team discussions, follow applicable safety and compliance procedures, support continuity of patient care and treat colleagues with professional respect.
This creates a relationship based on reciprocal commitments rather than one party controlling the other.
I would include an agreed process for changing appointment arrangements and resolving differences.
Importantly, any such document should be reviewed alongside the existing associate contract rather than used to impose new obligations unilaterally.
6. A word of caution about employment status
I agree with your concern, but there is an important legal distinction.
The British Dental Association's guidance, updated in March 2026, recognises that self-employed associates work within practice policies and systems. However, its employment-status guidance also highlights the importance of genuine independence, particularly regarding how clinicians work and exercise professional judgement. British Dental Association
The GDC also expects dental teams to understand relevant policies, work effectively together and cooperate in delivering safe patient care. General Dental Council
So I would differentiate between three things:
Area | Appropriate approach |
Patient safety, infection control and regulatory compliance | Mandatory professional and legal requirements apply regardless of employment status. |
Booking procedures, diary coordination and patient communication | Establish reasonable, clearly documented arrangements agreed within the associate relationship. |
Clinical decisions, treatment planning and professional judgement | Preserve the clinician's professional autonomy and responsibilities. |
The difficulty arises when an owner attempts to exercise the same level of day-to-day direction over an associate as they would over an employee.
Employment status depends on the reality of the working relationship, not simply what the contract says.
For that reason, I would recommend having your associate agreements and operational policies reviewed by a dental specialist solicitor, particularly if you are introducing new restrictions or requirements.
7. The one sentence I would want every clinician to remember
If I were delivering this message at your practice, I would finish with:
"Being self-employed means you are running your own professional business. It doesn't mean you are running the whole practice. We respect your independence, and in return we expect you to respect the agreed systems that allow all of us to work successfully together."
I think that strikes the right balance.
It respects the clinician's status without allowing self-employment to become an excuse for poor teamwork or disregard for agreed responsibilities.
My final thought
The strongest associate relationships aren't built around arguments about who has authority over whom.
They're built around a shared understanding that:
The practice provides the environment in which clinicians can succeed, and clinicians contribute to the environment in which the practice can succeed.
Neither party can operate successfully without the other.
That's why I would always begin with a win-win agreement, supported by a clear associate contract, rather than a list of instructions.
Well done if you stayed with me this far - attached is a summary sheet.
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