BDA advice

Associate contracts for NHS and mixed practices

in England and Wales

Date: May 2016

 Contents
The essential nature of associateships
– a licence 3

Self-employed status 3

Practicalities of associateships 5

Financial arrangements 10

Associates and NHS general dental

practice in England and Wales 12

Choosing carefully 15

Putting it in writing 17

BDA code of practice for associates

and practice owners 17

© BDA May 2016 Associate contracts for England and Wales Page 2
 Associates are self-employed dentists who work in practices owned by other Security of tenure
dentists or by dental com-panies. This advice sheet provides advice for both as- The practice owner, by selling a licence rather than a lease, avoids giving the
sociates and practice owners and contains model contracts for NHS and mixed associate any rights in land law to exclusive possession of the surgery or security
practice in England and Wales. Separate advice sheets cover associates in purely of tenure.
private practice, NHS and mixed practice in Scotland and Northern Ireland and
employed dentists in general dental practice. Associates are not recognised within NHS regulations
Associates working under the NHS in England and Wales are defined as dental
Checklist – which associate contract should I use? performers under the General Dental Services (GDS) or the Personal Dental
Services (PDS) regulations. The GDS and PDS regulations distinguish between
• Are you based in England or Wales and some, no matter how few, of your NHS contract holders (who are called ‘providers’ in the GDS and PDS regulations)
patients are seen under the NHS? If so, you should use the model associate and ‘performers’.
contract (NHS) - England and Wales.
• Are all of your patients seen privately, either on a fee per item basis or through Performers are the dentists actually treating the patients under the NHS. In
a private capitation or insurance scheme? If so, you should use the model as- many practices the NHS contract holder (the provider) will be the practice owner,
sociate contract (private). although in some situations associates may hold their own NHS contract or bid
• Are you based in Scotland or Northern Ireland and some, no matter how few, for an NHS contract.
of your patients are seen under the NHS? If so, you should use the model as-
sociate contract (NHS) - Northern Ireland or Scotland. Self-employed status
The essential nature of associateships – a licence A major feature of being an associate is being self-employed. The associate
makes independent professional judgements and takes full clinical responsibility
Working as an associate is the most common way for dentists to work in general for their work. The practice owner may control the facilities offered but should
dental practice (unless, of course, they are the practice owner). not control the associate’s day-to-day work.

In an associateship: the practice owner provides services to the associate, Establishing self-employed status
including surgery facilities and staff; the associate pays the practice owner for Self-employed status cannot be taken for granted. To an outside observer,
the use of the facilities. It is a business relationship between two dentists - the perhaps a tax inspector, the arrangement may look like that of employer and
associate being self-employed, not the employee of the practice owner. Although employee. Therefore it is vital to have a written agreement defining the self-
it involves the associate hiring the surgery, the associate is a lodger, not a tenant. employed nature of the associateship so that it cannot be mistaken for a
The legal definition of this type of arrangement is that the associate has the contract of employment.
practice owner’s licence (permission) to use the facilities.
The contract should state that the associate is self-employed and is paying the
The practice owner also provides the associate with patients, equipment, practice owner for the use of the facilities. It is not enough for an agreement
materials and staff assistance. The associate normally pays for the use of the simply to declare that the associate is not an employee, however. In the event of
facilities monthly, the amount generally based on a proportion of fees earned. a legal dispute, a court or employment tribunal would decide whether or not the
associate was an employee by looking at the extent to which the practice owner
Whilst associateships may be popular across the profession with both practice exercised control over the associate’s work or working practices. Both parties
owners and associates, the nature of the arrangement has some basic pitfalls. need to be stringent in observing the day-to-day aspects of self-employed status.
It is important that dentists do all they can to minimise the effects of these by Just because the taxman accepts it for income tax purposes does not rule out the
having a written contract which is as sound as possible. Associates in particular possibility that an employment tribunal may find that someone is an employee
are advised to be very wary of any agreements which are not based on the BDA’s for employment law purposes, or vice versa.
model and to check that those which appear at first sight to be based on our
model do not lack vital safeguards.

© BDA May 2016 Associate contracts for England and Wales Page 3
 The contract needs to provide clinical freedom for the associate. The associate If a practice owner terminates a contract for a reason connected with pregnancy,
should also be able to offer private care and choose which laboratory to use. They for example, the associate will be able to go to an employment tribunal for
should be obliged to make full use of the facilities, including sending in a locum if compensation or reinstatement. Women are also able to seek to return to
they are ill, and be obliged to promote the interests of the practice - which could work under different hours than before their maternity leave - working fewer
mean complying with the practice’s NHS contract or private fee scale. hours, for example - provided that the adjustments the practice has to make to
accommodate this are not unreasonable. Further information is available in
Self-employed status could be compromised if the contract or daily working BDA advice Dentists’ parental leave and pay).
practices are too prescriptive. Associates should not be told which treatments to
provide, which materials to use or which laboratory to use. Assigning associateships
Associateships are personal to the parties to the agreement and cannot be
Implications of self-employed status assigned. So if a practice is sold the agreement would normally come to an end.
For an associate, the main advantage of being self-employed is that income tax A new owner would have to enter into a new contract with existing associates
is paid differently. It is not deducted at source but is paid later under income if they want the associates to continue. This contrasts with the situation of
tax ‘Schedule D’ and it is possible to claim tax allowances for certain legitimate employees, whose contracts automatically transfer to a new owner when a
expenses. New associates must remember to save up for their tax liabilities and business is sold.
to complete their tax return accurately. Even with the relatively simple tax affairs
of an associate, it is advisable to employ an accountant to ensure that they are Clinical freedom and responsibility
in order. (Incidentally, some tax inspectors increasingly question self-employed A key aspect of self-employed status is the associate’s clinical freedom in treating
status, especially if an associate remains in the practice where he or she was a patients. Subject to the normal rules of ethical practice, associates should be free
vocational dental practitioner). to decide upon the treatment they offer to patients. Nevertheless, the practice
owner may exert a strong influence on the way dental care is provided at the
There is also a tax saving for the practice owner as they will not be liable for practice: the associate may well be limited by practice standards and policies
employer’s National Insurance contributions. relating to equipment, materials, use of laboratories, collection of fees, and
staffing. So it is important for an associate, before taking a job, to look very
In employment law, the practice owner avoids most employer responsibilities, carefully at the practice and talk in detail to the owner so that a full picture of
though the associate is equally denied statutory employee protections. Rules on the job can be gained and to be sure that the practice will provide the facilities
protection from unfair dismissal, which provide job security to employees, do and framework for the quality of dentistry to which they aspire.
not apply to associates. A practice can decide at any time to dispense with an
associate, whether or not a replacement is found, and the only obligation it has On the other hand, associates are directly responsible for the clinical work
is to follow the agreed notice period. If there is no contract, it can be very difficult that they provide. There can also be problems for practice owners where the
to enforce any notice period at all and associates can find themselves suddenly associate’s clinical standards cause concern for the goodwill of the practice. It
out of a job. is not an easy situation to resolve and may ultimately end in the termination
of the associateship. Where patients complain, the associate should comply
Nor is there any right to Statutory Sick Pay. Associates should take out appropriate with the practice’s complaints procedure (see section on Failed treatment). In
sickness and accident insurance to cover themselves if they are unable to work. other instances practice owners should initially raise concerns through practice
procedures, such as the practice’s underperformance policy. Associates should
Equalities and discrimination legislation be open to accept constructive comments about their performance as it is in
Discrimination laws, however, do apply to associates as these cover all workers. A everybody’s interest to solve any problems at the earliest opportunity.
practice owner must not treat an associate less favourably on grounds of gender,
marital status, sexuality, race, nationality, religion, or age. Whilst associates do
not have security of tenure under employment law, they do have protection
under the Equalities Act 2010. One practical effect of this is that associates are
entitled to maternity, paternity or adoption leave.

© BDA May 2016 Associate contracts for England and Wales Page 4
 Furthering the interests of the practice If there is no specific agreement about goodwill, then the associate may be
Associateships are about working co-operatively. The associate is being provided able to vie for patients of their former practice after the termination of an
with the facilities and patients. The practice owner will want the associate to associateship. This can still be fraught; the associate would in effect be starting
make a positive contribution to their practice. The associate also has an interest openly to compete against the practice owner. Patient records should not be
in ensuring a steady flow of patients. Associate contracts often contain a general misused to solicit patients. It is likely that personal details such as addresses
clause on promoting the interests of the practice. would be covered by the Data Protection Act.

The associate should deal with patients professionally and politely, complying Practicalities of associateships
with the practice owner’s business plan. The associate should not harm the
practice’s business, nor criticise the practice or care provided in the practice Facilities
(genuine concerns about a colleague’s performance should be brought up Equipment
through the proper procedures). Generally, unless there is a clinical need, the Associates are, in effect, paying for the use of the practice’s equipment and
patient should not refer patients outside the practice or promote products or facilities - similar to paying rent for a furnished flat or house. Since associates
payment schemes not adopted by the practice as a whole. are hiring their surgery from the practice owner, they need to know what they are
getting for their money, for example what equipment is provided in the surgery.
Ownership of goodwill
Goodwill is the reputation of a business and the tendency of its customers to use When entering into an agreement, the associate should be provided with a full
it again and recommend it. It represents the potential of a business. So although inventory of the equipment and facilities that they are entitled to use during their
not tangible, in general dental practice it is an important asset of the practice associateship and should double check the inventory and the current condition
owner. A practitioner can own and sell on to a new owner the goodwill relating to of each piece of equipment.
a group of patients, so associate contracts generally have clauses to protect the
practice owner’s goodwill. Many customers will be patients of the associate, but The standard of an associate’s surgery, quality of support from dental care
the contract will usually state that all goodwill belongs to the practice owner. A professionals and the general clinical environment may be reflected in the
clause protecting a practice owner’s goodwill would cover: financial arrangements. A practice owner providing excellent facilities could
charge a higher percentage of gross fees.
• A statement that the practice owner owns the goodwill of the practice.
• Conditions on what an outgoing associate can tell patients about their new Responsibility for servicing and repairs
practice, limiting the extent to which an associate gives patients information Associates pay to use the facilities at the practice so they can expect them to be
about a new practice location, while taking care not to mislead patients in reasonable working order. Where appropriate, equipment should be regularly
• A requirement that on departure an outgoing associate agrees with the serviced. If any equipment breaks down or requires repair, the practice should
practice owner the arrangements for completion of treatment attend to it. The BDA model contract obliges the practice owner to arrange for
• A restriction on where the associate can work once they leave. These repairs promptly. It gives some leeway for the time to arrange for an engineer to
‘binding-out’ clauses or ‘restrictive covenants’ must be reasonable – they visit or obtain spares. But the practice owner should indemnify the associate if a
must be limited to a defined area (usually a given radius from the practice) repair or replacement is not arranged within a reasonable time.
and limited to a defined period of time (usually no more than a few years).
Practice owners may find that unreasonable or excessive restrictions are not Conversely the associate should use the equipment properly. They should follow
legally binding upon former associates. Guidance on a reasonable restriction manufacturers’ instructions. Any damage caused by the associate’s negligence
is difficult to provide as it depends on the particular practice, its location and or neglect would be their responsibility.
patient base.

© BDA May 2016 Associate contracts for England and Wales Page 5
 Practice staff Supervising practice staff
Issues relating to the nature of the associate’s relationship with practice staff The associate is not the employer of staff members, yet heads up a team and
are generally twofold. First, what staff should a practice owner provide for an is frequently responsible for the day-to-day supervision and allocation of work,
associate? The other issue can arise because, while the associate is clearly not particularly in the case of the dental nurse. This can be a complex relationship.
the employer of these members of staff, he or she is often involved in their day-
to-day supervision. This prompts the question of what role an associate should The associate needs to treat team members fairly and equally. Respect
adopt in relation to practice staff. and courtesy should be shown to all employees regardless of experience or
background. The associate should provide guidance and support to employees
The dental team and be ready to answer any queries that may arise. In return, the associate
Who does an associate need to work with, in the practice? This should be is entitled to expect dedicated service from their colleagues. The associate
relatively straightforward, though, for clarity, practice staff should be covered is paying the practice owner for the service of practice staff (part of the fee
by the associate agreement. Essentially, associates should expect a practice apportionment each month covers staff costs) and so the practice owner has
owner to supply enough staff support to enable them to work effectively - as a contractual obligation to ensure as well as they can that staff do their job
a minimum you may expect a dental nurse to support them in surgery and a properly.
receptionist to help with appointments and administrative work.
So what happens if the associate has a problem with an employee? If the
Chairside assistance from a dental nurse employed by the practice is almost associate tries to improve the employee’s performance without the support of
universal (the BDA has come across a handful of cases where specialist peripatetic the employer, the employee might perceive that the shortcoming is unimportant
associates directly employ their own specialist dental nurse). Dental nurses and feel that the correction is unjustified or even a form of bullying and
should either be registered with the General Dental Council (GDC) or enrolled in harassment. The employee could well bring a grievance against the associate.
training. Will the associate be working with a trainee and, if so, will this require If an associate’s actions are bullying, the practice owner has an obligation to
additional supervision by the associate? If the associate considers that working resolve their employee’s grievance. The associate may even find themselves in
with a trainee nurse may be a problem, this should be discussed with the practice breach of the associate contract, jeopardising not only their working relationship
owner prior to commencing work. It is possible for the associate agreement to with the dental nurse, but also their position at the surgery.
specify that the associate will be provided with a qualified dental nurse.
Where concerns cannot be resolved easily, the associate should approach the
General dental practice throws up a lot of administrative work. Someone needs practice owner with details of the issues. As the employer, the practice owner is
to deal with the associate’s appointments, greeting patients and collecting the correct person to put in place a strategy designed to help the dental nurse
payments. The same person may deal with these tasks for all dentists within a improve. The associate is not the employer and so is not in a position to hold
practice but the individual associate needs to know who is responsible for these formal appraisals or indeed take any disciplinary action. Moreover, the practice
tasks. owner should have a contractual obligation to deal with staff in cases where the
associate has genuine concerns.
The associate may also be able to utilise the services of other staff, perhaps a
dental hygienist or a practice manager. If so these, also, should be listed in the Nevertheless, as a leading member of the team, the associate must keep a sense
associate agreement. of perspective. Many issues can and should be resolved directly between the
associate and employee. However, both parties need to be confident that the
practice owner will handle legitimate concerns about the other appropriately
and promptly.

© BDA May 2016 Associate contracts for England and Wales Page 6
 Hours Associates should give adequate notice of taking leave as patients may be
Both parties need to know when the associate will be working. By providing booked in for some weeks ahead. In small businesses it may also be necessary
facilities to an associate, a practice owner gets the services an extra dentist to coordinate leave. Holiday notification requirements can vary from a few days
- making full use of surgery facilities and enabling the practice to see a wider to several weeks. The contract may allow more leeway for taking off a single day
patient base. Although the associate will be a self-employed dentist working in at the last minute, but for a long summer vacation notice should be given to the
business on their own account, they are not purely their own boss. If the associate practice well in advance.
takes time off there are repercussions for the practice owner. The practice will
be employing a dental nurse to work with the associate and booking in patient Similarly, it is usual to ask the practice owner to notify the associate of their
appointments, for example. Payments to the practice owner are often based on holiday and staff holiday. If the practice owner is away, this can affect day-
patients seen and fees earned by the associate. The contract should normally to-day issues, such as ordering supplies or dealing with staff problems, so the
define which sessions the associate will work on each day of the week. associate should be given reasonable notice. If the associate´s dental nurse
is going to be away then the associate should be provided with a substitute.
Flexible working Again they should be given notice of this in advance and the substitute should
Flexible part-time working - where sessions may vary from week to week - is have equivalent skills and experience. In many instances practices may wish an
a valuable option for general dental practices. Where an associate is working associate and their dental nurse to take leave at the same time. This resolves
flexibly this needs to be adequately covered in the written agreement, however. the practical issue of having one away and the other not being able to work
This cannot, of course, stipulate the actual sessions that will be worked from effectively as a result. But how should the dates be agreed between practice
week to week because this would defeat the point of flexible working. But the owner, associate and dental nurse? The contract should set a framework and all
contract can give the parameters within which the associate will work. involved should be aware of the expectation to co-ordinate holidays beforehand.

Clauses can be written to give a wide degree of flexibility. It may be that the Holiday pay
practice can offer a surgery to an associate for, say, 21 hours a week, but the As self-employed contractors, associates do not receive paid holiday; their
actual days to be worked may vary from week to week. earnings are based on fees generated as a result of their work. Working time
rules might apply to self-employed associates, so some of their earnings should
Nevertheless, both the practice and associate should be clear about when and be designated as holiday pay.
how the days to be worked will be agreed: a month in advance, for example. Also,
it should be clear who in the practice has the authority to agree the sessions with The BDA model contract covers this. It states that associates are not entitled to
the associate. Perhaps the practice manager and associate could meet on the additional pay for holiday over and above their general earnings and also that
first working day of each month to agree the times for the month ahead. If so, a proportion of their earnings (10.77 per cent) accounts for holiday pay. This
this should all be written in the contract. percentage is equal to right of employees to a minimum of 5.6 working weeks’
holiday each year (10.77 is 5.6 divided by 52, expressed as a percentage). These
The contract can also give a maximum because the associate may have other provisions are included to maintain and protect the commercial arrangement
commitments or the practice may have another use for the surgery on other between associates and practice owners, without affecting the amount earned
days. Associate contracts, therefore, do not have to bind both parties in rigidly. by the associate or retained by the practice owner. The statement also provides
There is room for flexibility. the practice owner with a possible defence against a claim by an associate for
paid holiday under the working time rules.
Holidays and time off
Associates need clear arrangements for taking leave. The maximum amount Associates and sickness absence
of leave an associate can take each year and the arrangements for taking it Any absence caused by sickness or injury creates problems for the business, but
must also be stated in the contract. Working time rules for staff allow for 5.6 this is unforeseeable. Therefore it is vital that the associate agreement has clear
working weeks leave a year, which works out as 28 days, including bank holidays arrangements about the associate’s responsibilities where time off work has to
for someone working a full five-day week, but this is only the legal minimum. be taken in these circumstances. The associate and the practice owner have to
Additionally, associates will need to think about time off for study leave to fulfil consider how to deal with notifying the practice about absence and dealing with
continuing professional development (CPD) requirements. the associate’s workload.
© BDA May 2016 Associate contracts for England and Wales Page 7
 When notifying the practice about illness or injury absence initial contact by Associate contracts usually include a term that the associate is required to
telephone is vital. The associate should speak directly to the practice owner appoint a temporary performer if they are absent from the practice for more
rather than leaving a message with the receptionist so that you can make than a specified period. As a general guideline, the BDA advises that a period of
an assessment on the telephone in order to decide how to ensure minimum seven to ten working days is reasonable, after which the associate is required to
disruption to the practice and most importantly to the patients. The associate appoint a temporary performer. The obligation to do so applies to any absence,
should understand that they need to call as early as possible allowing the practice including holiday, sickness or maternity or paternity leave.
to cancel the first patient.
In practice, however, the owner commonly arranges cover. Both practice owner
Keep the communications open. The associate may not know how long they are and associate are generally happy for the former to do so. It is in the practice
going to be absent or may not recover as soon as they would have hoped. They
must contact the practice on a regular basis, initially probably daily, unless it is owner’s interest to ensure that the locum is acceptable and to maintain control
certain that they will be absent for a prolonged period. Even then the associate over the terms on which they do so, whilst the associate is saved the job of
must keep the practice owner up to date – estimate when it is likely the associate finding and managing the locum. Indeed, if the associate is ill they not able to
will be able to return to work, tell the practice owner about progress, medical take a lead in co-ordinating all the arrangements.
advice received and if the expected date of return to work changes.
The choice of who assumes responsibility has ramifications for payments and the
For short term absences (an absence of, say, up to two weeks) the associate’s liability if something goes wrong. For instance, where the associate does so, the
workload can probably be absorbed by the practice. The practice owner or other temporary performer is the agent of the associate. The associate remains liable
associates can see urgent cases, whilst the associate can make up cancelled to the practice owner for any breach of contractual duties. There is a contractual
appointments on their return chain as the practice owner has recourse against the associate; and, in turn, the
associate has recourse against the temporary performer.
to work. In any case the rigmarole of finding and appointing a locum for such a
short period may not be appropriate. Generally, written agreements should say The associate needs to agree a written contract with the temporary performer,
that there is no obligation to employ a locum unless the associate is likely to be setting out their obligations, which should mirror those of the associate under
away for more than a fortnight. their contract with the owner. The owner continues to pay fees to the associate
as normal, which the associate uses to pay the locum.
To provide cover for long-term absences it is likely that the self-employed
associate will have to engage a locum. Where the practice owner takes responsibility for arranging cover, the associate
will not be liable in the event of any breach of their contractual duties. If the
Locums owner appoints a locum they pay them directly out of the fees that they would
Being self-employed, associates are ultimately responsible for arranging cover if otherwise have paid to the associate. The practice owner agrees a written
they are absent from the practice. (Most dentists refer to such cover as a locum contract with the temporary performer and so has recourse against them directly
but this is no longer a recognised term under NHS regulations and so is often not if they underperform or otherwise fail to carry out their duties.
understood by primary care organisations). One of the essential elements of self-
employed status is the responsibility to find your own cover when absent. Whilst In either case, ensure that the locum has a written agreement. In effect they
employees undertake to provide their services personally and their employer is are either an employee or associate engaged on a short-term basis. Further
responsible for arranging cover in their absence, independent contractors agree information is available in BDA advice Locums).
to get the job done, whether personally or through an agent.
Failed treatment
During the course of the associateship, the associate should comply with the
practice procedures, including the patient complaints policy, when handling
any replacement work. Generally, the associate is responsible for the care and
treatment provided and so should bear the full cost of any necessary repairs or
replacements.
© BDA May 2016 Associate contracts for England and Wales Page 8
 Certain NHS treatment must be replaced free of charge to the patient and the An associate holding their own GDS contract must give three months’ notice
repair and replacement qualify for UDA credit. If relevant NHS treatment fails, of termination to the PCO as well as notice to the practice owner. When the
it should be replaced by the associate personally, unless the patient does not associate leaves, their contract value is likely to return to the PCO for tendering.
agree. If the patient wishes another dentist at the practice to undertake the The practice owner could, however, seek to add the associate’s contract value to
work, the dentist providing the treatment would have those UDAs credited to the practice contract value or the associate could seek to take the contract to
their target and the patient charge element should be paid to the practice owner their new practice; the PCO would not be obliged to agree in either case.
by the associate.
Minimum duration contracts
For the situation after leaving the practice see the section on Handling failed Beware of contracts which state that they will run for a minimum period. Practice
treatment after leaving the practice. owners may be concerned about a high turnover of associates, which can cause
patient care to suffer. But it is not reasonable to force an associate to remain at
Leaving a practice a practice for a fixed period, such as one or two years. If the parties sign up to
Notice periods a clause of this type, it will be binding and compensation is payable if one party
Associate agreements should have a reasonable period of notice to the practice terminates it before the term expires. Nevertheless, it is not possible to know
for terminating the contract. Both the practice owner and the associate should whether the arrangement will work out for both parties, either in business or
have to give notice if they want to end the associateship. The length of notice is personal terms. Associates should not be expected to commit themselves to a
a matter for decision by both parties, though the common period of notice both fixed term, especially if they find that the practice is unsuitable for any reason.
reflecting the professional nature of the contract and for completing patient
treatments is around three months. The notice period must be defined in the Restriction clauses
contract and notice should be in writing. Restrictive covenants or binding-out clauses restrict the associate who agrees, on
leaving the practice, not to work within a given area for a given period of time or
In situations where no notice period has been specified, the courts have implied to treat patients of the former practice. These restrictions protect the goodwill
a reasonable notice period. Therefore, written notice should be given even in of the practice by stopping the associate from setting up in direct competition.
these circumstances. Restrictive covenants are, however, only legally binding on associate if the
practice owner can prove that they are reasonable and proportionate.
Occasionally the working relationship between the parties has broken down to
such a degree that one wishes to end the agreement immediately. This can be In order to be reasonable and proportionate, the restriction must be limited. It
done if it can be shown that the other party has committed a serious breach of should only apply within a defined radius or a particular geographical area. And
contract. Even then they should be given the opportunity to rectify the matter it should only apply for a limited amount of time. It is very difficult to advise on
and independent advice should be sought before the contract is ended. The what time and distance terms would be considered reasonable and local legal
contract can also make provision for the agreement to end immediately in advice should be taken on individual circumstances.
certain circumstances, such as one party being suspended from the GDC Dentists
Register or being declared bankrupt. In general terms, it is unlikely that more than a few miles and few years would
be upheld by the courts. In urban areas a shorter distance is appropriate. Be
An associate working under a practice owner’s GDS or PDS contract will not be aware that if the courts do not uphold the clause, they will simply determine that
required to give notice to the NHS if they wish to leave. NHS patients will not it is unreasonable - they will not substitute acceptable terms. Also, restrictions
need to be notified or transferred from the associate’s list, but the practice owner cannot be imposed where there is no written clause in the contract.
will need to notify the PCO that the associate has left and will probably be asked
how the UDA target will continue to be met. Of course practice owners should
nevertheless notify patients of practice changes, to maintain goodwill.

© BDA May 2016 Associate contracts for England and Wales Page 9
 Handling failed treatment after leaving the practice Bad debts
After the associateship has ended some former patients of the associate will Clear agreement is needed on the treatment of bad debts. The cost of bad debts
return to the practice needing replacement work. The associate remains liable is frequently shared between associates and practice owners as both parties
for treatment provided and any reasonable repair or replacement costs. It is have some responsibility – the associate treats the patients and explains the fee
suggested that the parties agree a reasonable sum for the practice owner to to the patient, the practice collects the payment and should monitor and chase
retain to cover the costs of this work. This figure should be based on the actual late payments.
value of replacement work carried out in the previous year. The practice owner
should provide the former associate with details of all replacement work carried Bad debts will automatically be carried over if the practice bases its monthly
out and repay any surplus at the end of an agreed period, say six or twelve accounts on fees actually collected. Therefore in terms of monthly income, bad
months. debts are dealt with immediately but will be added back into patient revenue if
they are collected in a subsequent month.
Financial arrangements
Laboratory bills
The associate pays the practice owner for the use of the facilities. The actual Where fees are collected by the practice owner, the practice owner should
arrangements can be complex so both parties need to follow very carefully settle the associate’s laboratory bills when they are due. As the associate is
what is going on. Both parties must take great care to ensure the contract and self-employed, the bills should be addressed to the asso-ciate but it will be the
schedule provide a clear and unambiguous method of calculating what sums are practice owner who has the cash-flow to pay the bills on the associate’s behalf.
payable by whom to whom and in what circumstances. Associates should check that their laboratory bills are being paid on a regular
basis as they may find themselves liable for unpaid bills.
Fee collection
In most practices all patient revenue, whether from patient payments, the NHS In accounting for laboratory bills it is recommended that, since they are a direct
or private capitation schemes will be collected by the practice. Indeed, this is part expense incurred by the associate in the course of treating their patients (that is,
of the reception and administrative services that the practice owner provides for treatment-specific), they should be met in full by the associate, with the practice
the associate. An everyday example of this is the fees collected directly from the owner being reimbursed from the fees collected. This should be done before any
patient over the counter at the reception. subsequent fee apportionment. Mathematically (though crucially not legally)
the laboratory bill is paid from the associate’s gross earnings thereby reducing
Fee assignments the total sum that is subsequently apportioned between the associate and
In most practices the associate formally assigns their NHS or private payments practice owner. To see how this works in practice please see the section A model
to the practice owner. Fee assignments need formal documentation which statement for associate’s monthly accounts.
associates would be required to sign. Often, if there is a disagreement and the
associate wishes to cancel the assignment, the NHS or the private capitation Hygienist payments
or insurance company will freeze the payments. They will be paid neither to Where patients of an associate are referred to and treated by a practice hygienist
practice owner nor the associate until the company has been informed by both the associate should only receive a fee for the examination and the work they
parties that the dispute has been resolved. carry out; the fee for the work done by the hygienist is to cover the hygienist’s
earnings and costs. However, sometimes practices have paid a referral fee to the
In the GDS and PDS in England and Wales, where the contract is practicebased, associate if they refer their patients for treatment by the hygienist – but this sort
NHS payments will in any case be paid directly to the practice owner as the of arrangement could breach paragraph 1.7.6 of the GDC’s standards for the
contract holder. There is no need for a fee assignment. But associates who hold dental team: “When you are referring patients to another member of the dental
the GDS or PDS contract personally are still likely to be required by the practice team, you must make sure that the referral is made in the patients’ best interests
owner to assign the fees to the practice. rather than for your own, or another team member’s, financial gain or benefit”.
Associates should not accept a fee from the practice for hygienist referrals.

© BDA May 2016 Associate contracts for England and Wales Page 10
 Despite not receiving a direct financial reward when referring patients to a Fee apportionments are generally based on final schedules and monthly receipts.
hygienist the associate nevertheless would make a time saving by referring When a new associate joins a practice it may be helpful to agree some interim
the patient on rather than doing the hygiene work themselves. Associates can day-book arrangements with the practice owner to tide him or her over until
benefit from this time saving by seeing other patients with more profitable work. there is a proper flow of completed treatment on schedules. But there should
Therefore, the associate has a choice as to whether to do the hygiene work be a change-over to payment on schedules at the earliest opportunity, with
themselves, or to subcontract that work to the practice hygienist. adjustment to take account of any interim payments made.

A possible alternative situation might be if the associate, rather than the Date of payment and monthly statement
practice, sub-contracts the treatment to the hygienist. In that case you might be The associate agreement should provide for a payment date on an agreed day
justified in dealing with hygienist fees in a similar way to laboratory bills. The fee per month. This is the day on which the practice owner should give the associate
for hygienist treatment would be included in the associate’s gross earnings but all fees collected on the associate’s behalf less all deductions (including the
the associate would then be billed for the hygienist’s time, materials and other licence fee and laboratory bills). Late payment can be a problem, so it is vital that
overheads. In this way: the associate commissions the practice’s hygienist to a set date is given in the contract, such as the fifth of each month, five working
carry out work on their patients; and the associate makes a specific contribution days after the receipt of NHS schedules or the first Friday of each month.
to the practice for hygienist’s costs. Such an arrangement would have to be
covered in the associate contract. The practice owner should also provide the associate with a written statement
detailing all fees collected, all deductions and their calculations (see the section
Whatever the arrangement, it is essential for all parties to have a clear A model statement for associate’s monthly accounts).
understanding from the start.
Pensions and superannuation contributions
Paying the licence fee NHS superannuation contributions should be calculated from based on figures
Associates generally pay practice owners for the licence through an apportionment provided to the PCO by the contractor. At the start of each contract year, estimated
of their fees. Where, for practical purposes, NHS and private payments are made to pensionable earnings must be provided for each performer. After the end of the
the practice, the practice owner deducts expenses such as laboratory charges and contract year (or mid-way through if a performer leaves) the contractor should
splits the income in the agreed manner. The practice owner will pay the associate confirm the actual pensionable earnings for each performer. Since these figures
the amount due to them (less any personal expenses such as superannuation) affect pension entitlements, and the level of NHS sickness, maternity, paternity
retaining the payment due to the practice for the licence. This can appear as if or adoption leave payments, associates must ensure that their practice owner is
the practice owner is paying the associate rather than remitting to the associate both supplying these figures and doing so accurately. Both parties should note
the money that the practice has collected on the associate’s behalf. Therefore, that the agreed gross UDA value in the associate contract affects the calculation
both parties must check that the arrangements for this are clear. of net pensionable earnings. See also UDA values and NHS sickness, maternity,
paternity or adoption leave payments, below. For further details on the NHS
Fee apportionments pension scheme, see BDA advice Pensions in the GDS.
The associate’s earnings may be apportioned with the practice owner by either:
NHS superannuation contributions are deducted from NHS gross earnings
• Splitting the gross earnings according to an agreed percentage. There is at source but are a personal payment by the associate for their pension fund.
no set percentage rate for apportioning an associate’s earnings as this is a Practice owners should include the superannuation contribution within the
business decision for both parties to consider. You should have regard to the associate’s gross earnings but should then deduct the contribution from the
patient base, practice costs and the local market conditions in deciding this associate’s net NHS earnings.
figure, or
• A fixed monthly sum being retained by the practice owner. This enables the Associates’ private pension arrangements will be directly paid by them and will
practice owner to receive a flat rate that should take account of practice not be of concern to the practice.
costs, desired profit margins and the associate’s ability to meet, and indeed
exceed, this figure from the practice’s patient base.

© BDA May 2016 Associate contracts for England and Wales Page 11
 Model statement for associate’s monthly accounts Associates and NHS general dental practice in England
A statement may summarise a practitioner’s monthly payments as follows: and Wales
Under the GDS and PDS regulations primary care organisations (PCOs; that
NHS Payments Amount
is Primary Care Trusts in England and Local Health Boards in Wales) contract
Associate’s monthly NHS Performer Fee 4,000 with dentists and dental practices. PCOs commission a fixed annual amount
(at £25 per UDA for 160 UDAs) of dentistry, measured in Units of Dental Activity (UDAs), in return for a fixed
annual amount of money. Full details are included in the BDA advice GDS and
Less NHS laboratory costs 800 PDS in England and Wales. (Please note the government proposals in the White
Paper, Equity and excellence: Liberating the NHS, July 2010, set out the vision
Less bad debts for uncollected NHS patient fees 400 for the future management of the NHS in England and how contracting and
commissioning arrangements will work - it is envisaged that changes will be
Plus previous NHS bad debts that have since been collected 200 implemented from 2013 or 2014).

Sub-total for NHS work 3,000 NHS earnings are fixed and, as practice owners need to meet UDA commitments,
they have to set performance targets for associates, who will also be required to
Less Licence Fee payable to Practice Owner at rate of 50 per 1,500 comply with the terms of the GDS contract or PDS agreement under which they
cent of the Sub-total are working.

Less Associate’s NHS superannuation contributions 100 Associates with their own GDS contract or PDS agreement
Some associates may hold their own GDS contract or PDS agreement. Generally,
Total amount payable to Associate in respect of NHS work 1,400 however, PCOs prefer to contract with a practice as a whole and so, where
individual associates hold a personal contract, this will largely be for reasons
Private Payments connected to the change-over to the current system in April 2006.

Associate’s private fees 6,000 Associates with a personal contract will have to pay the practice a share of the
monthly contract amount for the use of practice facilities (see section Financial
Less private laboratory costs 2,100 arrangements). This should be paid promptly to the practice, say within five
working days of the associate being paid. In many practices the associate will
Less bad debts for uncollected private fees 200 probably be asked to assign their contract payments to the practice owner (see
section Fee assignments). This is not essential. It defeats the benefits of the
Plus previous private bad debts that have since been collected 300 associate having their own contract from a self-employed point of view, since it
is the associate’s contract, and they are responsible for the completion of targets.
Sub-total for private work 4,000

Less Licence Fee payable to Practice Owner at rate of 55 per 2,200

cent (45:55 split)

Total amount payable to Associate in respect of private work 1,800

OVERALL TOTAL PAYABLE TO ASSOCIATE FOR NHS AND PRI- 3,200

VATE WORK

© BDA May 2016 Associate contracts for England and Wales Page 12
 Associates working under the practice owner’s GDS contract or PDS Performer fee with UDA target and withholdings for non-performance
agreement The method of a flat fee with a fixed UDA target and withholdings for non-
With practice-based contracts, the practice owner sub-contracts the performance, performance reflects the practice owner’s agreement with the PCO. The practice
or part of the performance, of their UDA target to the associate (as noted above, must work within a fixed target and PCOs expect that the UDAs are spread
under the GDS and PDS regulations associates are known as performers). There across the course of a full year. There needs to be some flexibility in the number
are alternative ways that self-employed associates can be paid in an NHS of UDAs the associate performs each month because of the varying length of
practice: months, holidays, bank holidays and weekends. Calculate a daily target. Each
associate’s monthly UDA target should be based on their annual target divided
• Payment per UDA by their number of working days per year and the number of working days in a
• A fixed performer fee with a UDA target and withholdings for incomplete particular month. A daily target automatically takes into account and does not
performance. penalise the associate for perceived shortfalls when, for example, they take their
annual holiday.
Whichever method is used it is essential that practices and associates make
arrangements to monitor each performer’s UDAs closely. Associates should be The associate receives a fixed gross performer fee each month. This is based on
given the information they need to assess their own performance. one-twelfth of their annual UDA target. The associate then pays the practice a
licence fee for the use of the facilities (see section Fee apportionments). Failure
Payment per UDA to meet the UDA target (taking holidays into account) would, however, result in
A system based on a fixed payment per UDA means that the associate is paid a proportional withholding of part of the performer fee, but, once the associate
for work done and provides an incentive for the associate to fulfil the required has made up any shortfall, the withholding must be repaid. The practice owner
numbers. The associate could receive an agreed payment per UDA provided in and associate must monitor UDA performance on at least a weekly basis and
the previous month, up to a monthly maximum. The monthly maximum helps reconcile their records of UDAs completed at least monthly. Where targets are
ensure that the associate does not exceed the UDA target. There must be a not being achieved, both parties need to understand the reasons why. Targets
maximum annual number of UDAs payable per performer which reflects the should be reviewed at the end of every quarter.
practice’s UDA total. This ensures that the practice stays within its NHS budget
and UDA target. If the associate performs more UDAs than the maximum, the If an associate leaves part way through the contract year the associate’s final
excess could be carried forward against future shortfalls. payment should take account of their pro-rata UDA target for the year to date.
Any shortfall should be deducted from their final pay. If they have not achieved
As self-employed performers, associates should be paid a gross amount per UDA the pro-rata required number of UDAs, another dentist will have to undertake
and pay an agreed proportion back to the practice for the use of the facilities them and will expect payment.
(see section Fee apportionments). The associate and contractor negotiate a
mutually-acceptable UDA rate, though it is suggested that, unless there is a UDA values
good business reason otherwise, this should reflect the practice’s average gross Many practice owners do not pass on the full UDA value and percentage uplifts
UDA value. to associates. Practice owners and associates are, of course, free to negotiate a
UDA rate for the work done by the associate and there is no rule that says that
practice owners must pass the full UDA rate to associates. It is a question of the
level of practice expenses, the relative value of the associateship, market forces
and supply and demand. The more good people applying for an associateship,
the less a practice owner might offer and vice versa.

© BDA May 2016 Associate contracts for England and Wales Page 13
 NHS benefits are calculated based on gross earnings and so the amount of gross (a) Under the pre-2006 GDS system, the practice owner would receive half of
payments an associate receives can have a significant effect on benefits such as the amount of money an associate brought in. If an associate brought in
superannuation, sickness and maternity pay. Because of the effect on benefits, less money, the practice owner would receive less money from the associate’s
the BDA recommends that practice owners give the full UDA rate to associates, work. Why should it be different now? Surely the clawback should be split
but if necessary pay a smaller percentage. For example: a practice owner may between the parties as it would have been under the old system?
receive £22.22 per UDA and give only £20 gross to an associate with a 50 per (b) Why should the practice owner suffer if the associate does not work as hard
cent licence fee (resulting in net £10 per UDA for the associate); alternatively as they agreed to work? The practice owner still has the same costs regardless
the practice owner could pay the associate £22.22 gross per UDA with a 55:45 of how many UDAs an associate performs as well as contractual obligations
per cent split (also resulting in net £10 per UDA). With the higher gross income, to the PCO. Surely the associate should bear the full cost of their failure to
the associate will benefit from higher pension provisions and greater long-term perform their allotted UDAs?
sickness, maternity and paternity pay. The extra money an associate could get
from these changes could be considerable, especially for the associate’s eventual The BDA suggests that, to a large extent, the associate should bear the cost of
pension. Passing on the full UDA value may also help demonstrate the associate’s clawback for non-completed UDAs. But that position is conditional. The principle,
self-employed status. we believe, is that risk should follow control. If the associate controls how many
UDAs they do, they should take the full financial risk. But if the practice owner
Passing on DDRB uplifts has some control over how many UDAs the associates can do, then the practice
Each year so far, contract values are increased, with the increase earmarked to owner should also take some of the financial risk by sharing the cost of any
cover increased practice costs, as a specific boost to dentists’ net earnings or a clawback.
mixture of both.
For example, if the practice owner does nothing to introduce sufficient patients,
Practice owners and associates should review their agreed UDA value and if the equipment keeps breaking down, if the practice does not call patients the
percentage split. If the contract value uplift is based partly on providing dentists day before to remind them of appointments, or if the associate’s nurse is not
with an increase in net income, it would make sense to pass that increase on properly managed and takes a lot of time off, then there is an argument that the
to associates. Both parties must consider practice costs and the effect of the practice owner should share the costs of clawback.
associate’s performance on the finances of the practice.
If either practice owner or associate can see that the associate is not going to
Failure to meet UDA targets reach their target, they should discuss the issue as soon as possible with the
Prevention is much better than the cure. Practice owners should carefully other party with a view to reaching agreement on whether some UDAs can be
monitor the number of UDAs being performed by associates. If an associate is passed to another dentist in the practice and whether the associate’s target can
underperforming, the issue should be discussed as soon as possible and remedial therefore be reduced.
plans put in place.
Some practice owners may give associates unrealistically high UDA targets. If
In any event, it is essential that expectations are properly set in a written contract. they do, and if the associates are responsible for all the clawback, the associate
Failure of a practice to meet its UDA target is likely to result in clawback by the is at a substantial disadvantage and the practice owner can be confident of
PCO. If that failure is as a result of an associate, the practice owner will want to receiving their percentage of the contract value at the expense of the associate.
claw that money back from the associate. If the PCO takes action against the practice for breach of contract, the practice
owner will suffer, however.
The question of how much of that clawback should be paid by the associate and
how much by the practice owner is a commercial matter for the parties. There
are two schools of thought:

© BDA May 2016 Associate contracts for England and Wales Page 14
 An associate with a personal GDS/PDS contract/agreement should be Further information is available in BDA advice Dentists’ parental leave and
compensated financially if they are going to lose out through the failure of the pay. For the way in which entitlements to NHS sickness, maternity, paternity
practice owner to provide adequate facilities, or, with agreement, the practice or adoption leave payments are calculated, see Pensions and superannuation
owner should cooperate to give the associate the opportunity to make up the contributions, above.
UDAs.
NHS orthodontics and associates
These are all matters that need careful consideration at the start of an An associate providing NHS orthodontic care should be given an agreement that
associateship to avoid a difficult dispute in difficult times. The objective is to is slightly modified to take account of the way NHS orthodontic agreements are
ensure that targets are achievable and there is consistent provision of support monitored. Orthodontic contract payments are based on a specified workload.
services to enable the associate to reach the target. This is measured by Units of Orthodontic Activity (UOAs), which generally record
case starts and do not take account of incomplete courses of treatment or
Continuing professional development (CPD) courses of treatment completed by another performer. For associates, thought
The GDS and PDS regulations require the practice owner (in a practice-based must be given to whether payment will be made according to a fixed target or
contract) to make reasonable arrangements for CPD for performers. Normally for each case started or completed.
this is in the form of a certain number of days’ leave for CPD.
Choosing carefully
NHS sickness, maternity, paternity or adoption leave payments
NHS sickness, maternity, paternity or adoption leave payments are payable The best way to avoid potential future problems is of course to choose your
by PCOs to GDS/PDS dentist performers who meet the qualifying conditions. practice owner or associate very carefully. The following checklists of questions
Payments are made directly to the contractor and should be passed on to the for practice owners and associates to ask and points to look for could provide
dentist concerned. Indeed, the contractor is required to pay the performer in full. a basis for the interview. At interview each is assessing the other. Prospective
associates, in particular, should spend time in the practice - a full working day if
The contractor’s contractual sum will continue to be paid provided the UDAs possible - in order to evaluate the practice.
are met. As discussed in the section on Locums, the self-employed associate
is responsible for engaging a locum or another performer at the practice to Recruiting an associate
undertake their UDAs while on leave, although the practice owner may decide to Questions for practice owners to ask
deal with these arrangements directly. If it is not possible to obtain locum cover,
the absent associate should either complete the UDA shortfall or compensate Practice owners generally like associates who:
the practice owner for the non-performance of the contract. Care must be taken
in asking associates (especially those on maternity leave) for a contribution as • Work hard
this could be discriminatory. It is suggested that, if there is no locum, the practice • Have good clinical standards
owner and associate could agree to a percentage split of the NHS sickness, • Are reliable
maternity, paternity or adoption leave payment. Practice owners should also • Are able to work in a team
discuss this as soon as possible with the PCO. It may be possible to obtain a • Are interested in the practice and its future
temporary reduction in the contract value and UDA target amount from the • Would like to stay
PCO, but the associate would still have to compensate the contractor for the loss. • To whom they can relate

In any event, associates are strongly advised to discuss any absence with the
practice owner as soon as possible to ensure that there is early agreement on the
best way to manage the absence and UDA target.

© BDA May 2016 Associate contracts for England and Wales Page 15
 The following questions are suggested for interview: • Would we have a written agreement and if so please can I see a draft?
• What are the financial arrangements?
• Where did you qualify? • How are bad debts handled?
• Summarise your career to date • Is the practice owner a member of a professional organisation such as the
• What are your long-term career plans? BDA?
• How many postgraduate sessions did you do last year? • Is the practice computerised?
• What are your continuing education interests and why? • Is the practice CQC registered?
• How much did you gross in your previous practice?
• What was your patient base like? Ask to see
• What sort of patients do you enjoy treating, and why?
• Are you involved in any local dental groups? • The associate’s surgery and equipment
• Do you want to run your own practice? • Appointment books
• What are your earnings expectations? • Record cards
• What do you think are the three most important qualities in a dentist? • Materials and store cupboards
• What do you think are the three most important qualities in a dental nurse? • Oxygen equipment and emergency drugs kit
• What sort of mix of patients would you like? • Autoclaves
• Are you prepared to sign a contract? • Radiographic machine and developer
• The practice computer system
Finding the right practice
Questions for associates to ask Ask to meet

• Why did the previous associate leave or is it a new vacancy? • Reception staff
• How many staff are employed in the practice? • Nursing staff
• Will I have a dedicated dental nurse and will my dental nurse be qualified or • Hygienists
a trainee? • Other dentists.
• Is there a dental hygienist?
• What are the practice opening hours? Check the proposed contract
• Would I be taking over a full list of patients? Or am I expected to build up a
book? • Understand it, seek independent advice if necessary
• How many new patients does the practice attract each month? How many • Query the terms of the contract
patients attend regularly? • Negotiate.
• What mix of patients will I be seeing?
• What is the practice policy regarding acceptance of NHS patients?
• Are NICE recall guidelines followed?
• Does the practice see private patients?
• Does the practice use a private dental plan scheme? If so what are the
arrangements?
• What is the infection control routine?
• What are the emergency arrangements?
• Do the nurses or the dentists usually take radiographs?
• What are the materials ordering policies?
• Is a local laboratory used? Do I have a choice of laboratory?

© BDA May 2016 Associate contracts for England and Wales Page 16
 Put it in writing BDA code of practice for associates and practice owners
Amazingly, around a third of associates do not have a written contract; the BDA The job market for associates is changing. Competition for associateship
Business Trends Survey 2010 showed that 63.5 per cent of associates had a positions is increasing in many areas and disputes are becoming more serious.
written contract and 34 per cent did not (2.5 per cent did not say). The BDA These reflect the complex new contractual relationships in NHS practice in
Practice Support team reports that those without written contracts experience England and Wales, working to UDA targets, the limits on practice expansion
severe problems if the arrangement breaks down, since there is no clarity about and the influence of practice owners on associates’ pay.
each party’s rights and obligations in respect of each other. Also, the lack of a
written contract does not mean that either party is free of legal obligations as Fair treatment for associates is becoming more important to young dentists, and
the courts would merely infer a verbal contract. In fact it is likely that in this practice owners with NHS contracts also need to be able to recruit and retain
way those without a written contract are encumbered by more difficult legal good and reliable associates. Working to a code of practice where both sides
obligations than those who have signed a written contract. understand what is expected of them will help to reduce the disputes that arise
all too frequently.
Whilst written contracts must contain legal jargon in order to be precise the,
BDA has simplified this by producing a model contract. It is designed to be Practice owner /Associate code of practice
straightforward and to balance the interests of practice owners and associates. Associates seek to contract with a practice/company that can give them the
You must make every effort to understand your contract. A little work at the opportunity to provide quality dentistry for a reasonable reward. Practice owners
beginning will pay dividends in the longer term. Individual legal advice is also seek to contract with associates who provide quality dentistry and customer care
essential. The BDA Practice Support team is happy to comment on the content and who meet their targets. The BDA’s Code of Practice sets out the reasonable
of individual contracts. expectations of practice owners, associates and patients, which we believe form
the basis for productive and successful business relationship between dentists.
Nevertheless, even a written contract depends upon trust and cannot guarantee
complete success if one party is determined to act unreasonably, but at least it Associates and practice owners will
can provide a legal framework if you need to challenge actions or make a claim. • Deal openly and honestly with each other
• Provide each other with clear and transparent information
Associateship contracts - essential elements • Deal promptly and openly with problems and disagreements that arise
• Names and addresses of parties • Seek the help of the BDA in resolving disputes
• Date of commencement
• Address of the practice An associate expects their practice owner to
• Facilities and equipment to be provided, including terms for breakdowns • Provide a reasonable and fair written agreement with time to consider the
• Hours, holidays, emergency cover terms before signing
• Patients • Provide a copy of the signed, written agreement
• Record keeping • Provide a copy of their monthly NHS Schedule/Performer Statement and a
• Collection of fees monthly summary of private patient fees earned
• Payment methods, including regular payment date • Provide sufficient patients to obtain their expected level of earnings and
• Maternity, paternity and adoption arrangements performance targets
• Absences and locum cover • Agree with the associate reasonable appointment times
• Termination, including notice period and restriction clauses • Agree performance targets that are reasonable and achievable in the
• Dispute resolution procedures such as independent arbitration and mediation circumstances of the practice
• Regular review of terms • Not to penalise the associate financially if targets cannot be met for reasons
• Signature of the parties that are the responsibility of the practice owner
• Provide opportunities to increase their professional experience and clinical
A model contract accompanies this advice: Model associate contract (NHS) - skills if they wish
mixed practices in England and Wales.
© BDA May 2016 Associate contracts for England and Wales Page 17
 • Provide the services of a suitably experienced and trained dental nurse Patients expect
• Provide a reasonable period of maternity/paternity/adoption leave • Practice owners and associates to work together as part of the practice team
• Pay the full amount of any NHS maternity, sickness, paternity, adoption and • Practice owners to ensure that they work with associates who provide a good
commitment payments to which they are entitled standard of clinical care
• Keep the associate informed of practice changes, particularly if the practice • Associates and practice owners to cover for each other in the case of illness or
is to be sold holidays
• Ensure that the associate’s NHS claims are completed accurately and • Associates and practice owners to share information where this is in the best
submitted promptly interests of patients
• Enable the associate to use the services of a dental laboratory of their choice • Not to be involved in disputes between associates and practice owners
• Agree with the associate the dental materials to be used • To be advised when an associate is leaving the practice and to be told, if they
• Provide a surgery that is fit for purpose and any breakdowns rectified quickly ask, where the associate is now practising.
• Provide protected time to ensure that their knowledge and skills are up to
date
• Give a reasonable period of notice of termination of their contract and enable
reasonable arrangements to be made for their departure from the practice,
including the information that is to be given to the patient
• Enable the associate to be an integral part of the practice team
• Provide a copy of any NHS contract to which the practice is party.

The Practice Owner expects that their associates will

• Provide a high standard of clinical care to their patients
• Comply with reasonable practice rules and procedures
• Work as part of the practice team and treat members of the practice team
with courtesy and respect
• Use the surgery time that is made available to them for the treatment of
practice patients
• Make every effort to meet agreed performance targets
• Pay a reasonable amount for their licence to practise at the practice
• Comply with any contract that the practice has with the NHS
• When leaving the practice, complete treatment commenced
• Take responsibility for work that needs to be replaced or repaired
• Keep full and accurate records of clinical work
• Maintain high professional standards
• Adopt high standards of customer service
• Give reasonable notice of their intention to take holidays or study leave.

© BDA May 2016 Associate contracts for England and Wales Page 18