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Dentists in the UK fall into 5 categories:
Principals are practice owners. They work either as contractors to the NHS or privately or both (this is called mixed practice). If they are contractors to the NHS they have their own contract number.
Associates have a financial arrangement with a principal. Like principals, they can contract (with their own contract number) to the NHS or work privately.
Assistants (Performers) are employees of another dentist. Any NHS work done by an assistant is done under his own contract number.
Vocational Trainees.Vocational training lasts one year and takes place in approved practices. The position is salaried and after completing the year the dentist is awarding a vocational training number. A dentist needs a vocational training number to be an associate or a principal.
Employee in the hospital or community services. These dentists are employees of the hospital or community service.
Associateships
To become an associate, you need to have a VT number; if you are an EEA dentist you are exempt. This is awarded after a dentist has completed a year of Vocational Training in an approved practice. The Vocational Training position is salaried. The number of Vocational Training positions available in any one year, are limited.
An associate relationship is a financial arrangement between two dentists of equal professional responsibility.
There are a variety of agreements made between associates and principals but usually the owner provides the associate with patients, surgery premises, equipment and materials, staff and facilities. The associate pays for these services (usually by means of a proportion of gross fees at the end of the month) commonly; the practice owner will split lab bills, hygienist costs and sometimes bad debts, at the end of the month.
The contract can usually be terminated by either party giving three months notice.
Sometimes, there may be a 'binding out' clause in the associate contract, if so; the associate may be bound out of practicing again within a designated geographical radius for a period of time.
The associate has full clinical responsibility for their own work. They have their own contract with the local PCT to provide NHS treatment and, like all dentists, are registered with the GDC they are therefore personally accountable to complaints made to the PCT or to the GDC.
There are a variety of ways of dividing the 'gross fees'. Some arrangements have a fixed percentage, others a set monthly fee and some a sliding scale.
The gross fees are usually paid directly to the practice owner under a system called fee assignment. The practice owner must then calculate all expenses, divide the fees and pay the associate.
Advantage of this arrangement to practice owner is that he is not responsible for the associate's patient care or clinical competence. He is also does not have employment law responsibility to the associate.
The associate benefits from the tax benefits of being self-employed but has a long period of notice (3 months) to the patients and the PCT. He is also not protected under employment law and does not receive sick or holiday pay.
The associate is responsible for hiring a locum if one is required and must personally bear any agency fees.
Assistants
What is an Assistant? An assistant dentist is employed by the practice owner to treat patients registered to the practice. The assistant has no contract with the Primary Healthcare Trust and therefore any complaints, which are directed to the PCT, have to be answered by the practice owner rather than the assistant. However, the assistant is registered with the GDC and is personally responsible for complaints made to the GDC.
The assistant has certain protection under employment law but is not self-employed as so must pay PAYE income tax.
The assistant must be given a written statement of terms and conditions of employment within the two months of work. Most dentists are paid monthly and each month the performer should receive an itemized pay-slip which shows how much tax and class I national insurance contributions have been deducted from their earnings. The income tax, which has to be paid, is deducted from the assistant dentist's pay before he/she receives it.
Becoming a successful associate / assistant and interview technique
Practice Owners want associates/assistant who is::
- Hard working.
- Reliable: i.e. arrive for work on time and do not take too many days off sick.
- Work to good clinical standards.
- Have good communication skills: and so are able to communicate well with patients and work in a team with other staff members.
- Interested in the practice and want to contribute to the success of the practice.
- Want to stay: high dentist turnover provides poor continuity of care and, in general, patients do not like change.
Some questions a practice owner may ask:
Where and when did you qualify?
Where will you career have taken you in five years time?
Are you looking for a NHS, private or mixed list?
How much money did you make per month in your previous practice?
Which continuing education subjects interest you most and why?
What kinds of patients did you treat, in your previous practice, and which do you find most/least satisfying?
Are you interested in running your own practice or becoming a partner?
Are you part of any local dental interest groups?
Name the three most important characteristics in a good dentist?
Name the three most important characteristics in a good nurse?
Will you sign a contract?
Some questions you should you ask:
Will I always have a dental nurse to help me?
What are the practice working hours?
Is there a full list of patients for me to take over or will I be building a list? Are the patients on the list NHS or private?
How many new patients register with the practice each month and are they private/NHS?
Why did the previous dentist leave?
Where is the emergency kit and oxygen kept?
What is your cross infection policy?
Who decides which materials to order and which labs to use?
How is emergency cover organised?
How are the fees divided and how does the dentist get paid? How are lab fees and bad debts divided?
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