Check Employment Status for Tax (CEST) tool – What you need to know

Check Employment Status for Tax (CEST) tool – What you need to know


In our article last month, we explained the upcoming changes from 6th April 2023 regarding associate dentists’ tax status, and the requirement for dental practices and associate dentists to check the associate dentists employment status using the CEST tool.

To help explain the CEST tool, Client Manager, Matt Norton has worked his way through the CEST questions and applied them to the standard working practices and contracts we see for an associate dentist.

Over to Matt…

The CEST tool has seen much criticism by contractors since it was rolled out in 2017. Various issues have been found where the tool was giving incorrect tax status results, and the tool has been revised various times in the interim period.

The CEST tool can be used by either the worker (the associate dentist) or the hirer (the dental practice), and can also be used to determine whether the worker is an employee or self-employed, or a worker operating through a limited company, and if they fall under the off-payroll working (IR35) rules or not.

The CEST tool is split into different sections. We have gone through each section below with the questions that the tool asks, and have given what we feel the conservative answer is for the average associate dentist contractual arrangement.

These are just a guide to the answers and your own working arrangements may differ to what we have stated below.

About you and the work

The first section of the CEST tool asks if you are looking at whether IR35 applies (a contract with an associate dentist operating through a limited company), or whether you are looking at if the work will be classed as self-employment. The answer to this will depend on how the associate is being engaged.

We will be looking at this from the point of view of the hirer/dental practice and where the associate dentist is already working at the dental practice.

Worker’s duties

The CEST tool asks whether the associate dentist will be an office holder. An office holder is a company secretary or company director of the dental practice if the dental practice is trading as a limited company. The answer for this will be no.

Substitutes and helpers

If you have previously been looking at the CEST tool and articles surrounding this, you may have read that this section is important for determining whether the associate dentist will be self-employed. This part asks whether the associate has ever engaged a substitute to carry out the work, whether the dental practice has the right to reject the substitute and whether the associate dentist has ever paid another person to carry out the work for them.

The answers to this will differ greatly for many dental practices but as we are looking at a conservative approach to this, we have seen many contracts where the dental practice can reject the substitute/locum, and so we would answer that the dental practice can reject the substitute, even if this is unlikely. If the associate dentist has previously engaged a locum to carry out their work, for example if they were off work with illness or on parental leave, the test will then ask who actually paid the locum.

It is important that the questions are answered according to the actual working practices and not the contract. If the contract states the associate dentist will need to engage the locum, but the dental practice found the locum and paid them, then the question should be answered in accordance with the actual working practice.

Working arrangements

This section looks at the control the dental practice has over the associate dentist. The questions in this section include:

  • Does your organisation have the right to move the worker from the task they originally agreed to do?
  • Does your organisation have the right to decide how the work is done?
  • Does your organisation have the right to decide the worker’s working hours?
  • Does your organisation have the right to decide where the worker does the work?

The associate dentist is engaged to carry out dental services on the dental practice’s patients. The dentist would not be moved from this task to carry out other tasks, such as reception duties, and the first question isn’t a particular concern for the ordinary working arrangement.

The associate dentist is a highly skilled professional and the principal dentist will not decide how the associate treats their patients and so we would answer the second question stating the worker is highly skilled.

It is likely that the dental practice will determine the working hours, as the dental practice will be open on certain days of the week with standard opening hours. The place of work will also be the dental practice building, and so there is only one place for the associate dentist to work in.

Workers financial risk

This section is arguably the most important section to determine self-employment.

The questions are as follows:

  • Will the worker have to buy equipment before your organisation pays them?
  • Will the worker have to fund any vehicle costs before your organisation pays them?
  • Will the worker have to buy materials before your organisation pays them?
  • Will the worker have to fund any other costs before your organisation pays them?
  • How will the worker be paid for this work?
  • If your organisation was not happy with the work, would the worker have to put it right?

Associate dentists will have their own loupes that they have purchased to enable them to carry out dental treatment and may have other equipment they use that is not funded by the dental practice. Without these, the associate dentist would not be able to carry out treatment and so would not be paid.

Vehicle costs are not relevant for the majority of associate dentist engagements.

For the materials question, HMRC state this includes items that form a lasting part of the work and is most relevant to the construction industry. We have seen the argument that laboratory work could be relevant here but this question doesn’t have a huge weighting to the decision made by CEST.

The associate dentist will need to fund other costs – these include professional indemnity insurance, GDC subscription and other costs.

Most associate dentists are paid a percentage of the sales they generate and this is an important answer to result in a decision of self-employment. If the dental practice is paying the associate a fixed hourly rate, which would be in a small minority of cases, we would suggest that this is changed as it could affect the final decision.

The final question can be looked at in the scenario of a patient being unhappy with the treatment they have received. In most contracts, the associate dentist will need to fix the problem with no additional fee being paid by the patient and so the associate dentist will effectively generate no income during that treatment time. The associate dentist may also incur additional laboratory costs that may not be shared by the dental practice depending on the terms in the contract.

Workers involvement

This section looks at what benefits the practice provides to the associate, whether they have management responsibilities and how they introduce themselves to patients.

HMRC describe management responsibilities as giving appraisals to employees, hiring and firing employees and helping decide on how much to pay someone. It is unlikely an associate dentist will have management responsibilities at most dental practices and as a self-employed individual, the associate dentist should not have management responsibilities.

The CEST tool asks how the associate dentist introduces themselves to consumers/suppliers and can be answered as working for you, an independent worker acting on your behalf, work for their own business or this would not happen. An associate dentist is working for their own business in the dental practice premises, but it is unlikely a patient is aware of the working arrangement. From our tests, the answer to this isn’t important in determining tax status.

Workers contracts

This final section looks at the contract, whether there are any ownership rights in the contract or restrictions of trade and previous and future contracts. Most contracts we see are open-ended with some restrictions on the associate being able to work within a certain radius of the dental practice.

The answers to some of these questions will depend on the contract in place and whether the associate dentist is also working at more than one dental practice.


Once the questions are answered, the CEST tool will ask you to check your answers and then give you a result of either employment, self-employment or cannot determine the status.

From our tests, the workers financial risks section is the most important section in determining whether the engagement is self-employed. If the associate is paid a percentage of sales generated, funds some of their own costs, or funds some of their own equipment costs, the result will generally be that of self-employment. If the answers to these questions are amended, then the CEST tool may change the result to unable to make a determination.

HMRC have stated that where the questions are answered truthfully and accurately then they will accept the determination that arises.

The dental practice should keep a copy of the results with the contract for the associate and if the CEST tool is updated, the working arrangement should again be tested on CEST.

We’re here to help

At DJH Mitten Clarke (previously Morris & Co), we are much more than just your run-of-the-mill accountancy firm. If you’re an associate dentist looking for advice about your tax and employment status or a practice owner looking for advice on associates working for your practice, you can speak to one of our specialist team members by calling 0151 348 8400.

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