Orthodontic therapists – employed versus self employed?

self employment Chair for the Orthodontic Nation Group, Sally Dye gives us the benefits and drawbacks of both options.

Employment presents in various guises – and with this comes benefits and drawbacks. Within a working environment there are principally three categories of employment. The fully employed status, a worker and a self-employed person (www.breathehr.com).

An employed individual has entitlement to full statutory work rights while at the opposing end of the employment field. A self-employed person accrues almost no rights. In short, the biggest differences are ‘pay’ and ‘rights’.


An employed worker is seen as a permanent member of staff. They have a signed contract with no time frame. This means no end date (after an initial previously agreed probation period). Further indications of employment include specific statements of what work is, together with when it is required to take place. Also, where exactly it will take place and how to complete their job.

In addition, all equipment and tools specific to the required tasks are provided by the employer. The maintenance of these is also the responsibility of the employer. The employee directly receives their salary (net payment). With all contributions (pension and taxes) previously being deducted from the gross amount.

Other benefits may also be available to the employee after a minimum length of continuous employment. This comprises of statutory sick pay and maternity and paternity pay, pension scheme, redundancy pay. Also, the right to request flexible working hours and protection against unfair dismissal.


A worker may be employed from an external company such as an agency or bank staff to work alongside the existing team. This individual will have a zero hours contract and can choose whether or not to take the hours of work offered. The agency or bank will deduct national insurance and tax from gross wages or salary. The worker is also entitled to holiday pay and rest breaks and employment rights such as national minimum wage. Again, tools and equipment specific to the tasks will be provided.


Self-employed workers work for themselves or for their own business. Despite being their own boss, they will not be paid through PAYE (pay as you earn). Employment law doesn’t cover them. Other factors that indicate the self-employment status: fixed term contracts, responsible for own health and safety, responsible for the provision of all equipment, does not require any direction or supervision from others, can refuse work or subcontract and is responsible for one’s own tax payments and national insurance contributions. You must inform the HMRC of any works that have the self-employed status.

Within a clinical environment such as orthodontics in primary or secondary care, certain checks are expected to be collated. This would include: GDC certificate, indemnity insurance, the Disclosing and Barring Service (DBS) work visa (where appropriate) and Hepatitis B status. It is highly likely that some evidence of continuing professional development will also need to be presented.


Regardless of the employment status an individual has the right to be safe at work and free from all discrimination harassment and bullying. All employment status must also be compliant with GDPR (General Data Protection Regulation).

An employed orthodontic therapist (OT) can work in a specialist or general practice or in hospital under the direct supervision of a dentist or orthodontist. He or she will carry out aspects of orthodontic treatment whilst working within the guidelines of supervision for OTs and observing the GDC standards and scope of practice at all times.(2) This employed individual will be entitled to all the benefits that employed status offers.

A self-employed orthodontic therapist (OT) will work in the same environments as that of their employed colleagues and assume the same clinical responsibilities, but can find themselves in a somewhat unofficial ‘grey area’ of employment if effects are not managed correctly.

Some of the self-employed prestige can simply not be accomplished due to the pure nature of the clinical work. For example it is simply not appropriate to subcontract work or work on one’s own direction, or to arrive at work at a time that suits the individual, or to take constant rest breaks. The self-employed OT is working within an employed structure and as such does not have the ‘freedom’ that self-employment can command.

The main drawbacks centre around the absence of sick and annual leave pay. As well as being unable to claim travel to and from work, together with the lack of pension contributions. Although all tools and equipment to include PPE are provided, tunics or scrubs may well have to be purchased at the OT’s own expense.


This may make the self-employed status for an OT less attractive. Although it must be remembered that the delivery of work, the provision of care to the patient and the supervision of the orthodontist are unchanged. If you have a passion for the speciality and a true desire to improve a person’s well-being, continue to observe the GDC Scope of practice and the Supervision Guidelines for OTs.

With some tactical negotiation for an agreeable hourly rate to address the potential shortfalls that full employment status accrues and the employment of a knowledgeable accountant, the election to be self-employed or employed becomes principally a lifestyle choice.


1. Types of employment status – Breathe

2. British Orthodontic Society – What is an orthodontic therapist?

Useful links

Employment status www.gov.uk/employment-status/worker

Personal tax www.gov.uk/topic/personal-tax/income-tax

Health and Safety at work Act www.hse.gov.uk/legislation/hswa.htm

This article first appeared in Orthodontic Practice magazine. You can read the latest issue here. 

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