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Contracts and rights

Employment status for healthcare professionals

Employee, worker or self-employed. The label on your contract is a starting point, not the answer.

By , Editor Updated How we check sources

Where this applies

This guide covers employment law in England, Wales and Scotland. Tax status rules apply across the UK. In Northern Ireland, status works on similar tests but under separate legislation, and disputes go to an industrial tribunal. Read nidirect: employment status (opens another website) or contact the Labour Relations Agency (opens another website).

Short answer

UK employment law has three main types of status: employee, worker and self-employed. Your status decides your rights, and depends on how you work in practice as well as what your contract says.

Employees get the widest rights, including statutory notice and protection from unfair dismissal. Workers get core rights such as the minimum wage, paid holiday and protection from unlawful deductions. Self-employed people have few employment rights. Your status for tax is a separate question with its own tests.

Key facts

Three types
Employee, worker and self-employed, defined through the Employment Rights Act 1996 and case law (Acas).
What decides status
The contract, what was agreed at the start, and how you and the organisation work together in practice (Acas).
Tax status
Assessed separately. HMRC's Check employment status for tax tool gives HMRC's view for tax only.
Final decisions
Courts and tribunals decide disputed employment status (GOV.UK).
Unfair dismissal
Employees currently need two years' service for most claims. The government plans to cut this to six months from 1 January 2027.

The three types of status

  • Employee: you work under a contract of employment. Your employer controls your work, must offer work and you must do the work offered.
  • Worker: you have a contract to do work personally for a reward, with only a limited right to send someone else, and the organisation is not your client or customer.
  • Self-employed: you run your own business. You decide how and when to work, can send a substitute, carry financial risk and work for several clients.

All employees are also workers. Not all workers are employees.

Rights by status

GOV.UK lists these rights for workers:

  • the National Minimum Wage
  • protection from unlawful deductions from pay
  • the statutory minimum of paid holiday and rest breaks
  • the 48-hour average weekly limit, unless you opt out
  • protection from discrimination and whistleblowing protection
  • equal treatment as a part-time worker

Employees get these rights plus statutory notice, statutory redundancy pay after two years, protection from unfair dismissal after the qualifying period, the right to request flexible working, and time off for emergencies. Self-employed people keep health and safety protection and, in some cases, discrimination protection. Most other rights depend on the terms of their commercial agreement.

How status is decided

A tribunal looks at the whole relationship. The main questions are:

  • Personal service: must you do the work yourself, or can you send a substitute?
  • Control: who decides what you do, how and when?
  • Mutual obligation: must the organisation offer work, and must you accept the work?
  • Integration: do you wear the uniform, appear on rotas, attend team meetings and follow staff policies?
  • Financial risk: do you invest in your own equipment, set your rates and bear the cost of mistakes?

The contract wording matters, but a tribunal will look past a label which does not match reality. A clause allowing substitution carries little weight if no one ever expected you to use the clause.

Common healthcare arrangements

These are typical patterns, not fixed rules. Your own facts decide your status.

  • Salaried GPs, hospital doctors, employed pharmacists and nurses are usually employees.
  • NHS bank staff are often workers, though a long, regular pattern can point to employee status.
  • Agency locums and agency nurses are usually agency workers, with equal treatment rights after 12 weeks in the same job.
  • Community pharmacy locums and locum GPs who invoice directly are often self-employed.
  • GP partners are self-employed partners in the practice business.

Our guides to locum contracts and zero-hours contracts cover those arrangements in detail.

Tax status and the GOV.UK tools

Acas says someone treated as self-employed for tax is not necessarily self-employed for employment rights. GOV.UK also says a person may have a different status in tax law.

HMRC's Check employment status for tax (opens another website) tool is anonymous. HMRC says the tool gives HMRC's view of status for tax and National Insurance, and HMRC will stand by the result if your answers are accurate. The tool says nothing about employment rights. If you work through your own limited company, the off-payroll working rules (IR35) also apply. GOV.UK explains these in understanding off-payroll working (opens another website).

A clinic example

Say an advanced nurse practitioner invoices a private clinic as self-employed. The clinic sets a fixed Monday to Wednesday pattern, supplies the room and equipment, requires the clinic uniform and has never allowed a substitute. When the clinic stops the sessions without notice, the nurse asks an adviser about status. The fixed pattern, the control and the lack of substitution point towards worker or employee status, which would affect holiday pay and notice.

Prepare your facts

  1. Collect your contract, booking terms, invoices or payslips and any emails about how the work runs.
  2. Write a one-page summary: who sets your hours, who supplies equipment, who you report to and any time you sent a substitute.
  3. Note how long you have worked there and how regular the pattern has been.
  4. Write down the problem you need solved, such as unpaid holiday, a sudden end to work or a tax query.
  5. Check your deadline. Most employment tribunal claims have a limit of six months less one day for problems on or after 1 October 2026, and three months less one day for earlier problems. Start with Acas early conciliation.

Questions to ask an adviser

  • Based on how I work, am I an employee, a worker or self-employed?
  • Which rights have I missed out on, such as holiday pay?
  • Does my tax status match my employment status?
  • Do the off-payroll rules apply to my limited company?
  • What is my deadline for any claim?

Where to get advice

  • Acas helpline: call 0300 123 1100 for help with status questions. See our Acas guide.
  • Labour Relations Agency: for Northern Ireland, call 03300 555 300.
  • Your union or professional body: the BMA, the RCN and the PDA advise members on status, including locums.
  • Citizens Advice: free help with status and pay. See Citizens Advice for work problems.
  • A solicitor or accountant: an employment solicitor for a status dispute, an accountant for tax status and IR35.

Common questions

What is the difference between a worker and an employee?

Both have core rights such as the minimum wage and paid holiday. Employees also get statutory notice, redundancy pay and protection from unfair dismissal after the qualifying period.

How do I check my employment status?

Compare your contract with how you work in practice, using the GOV.UK and Acas guidance on status. For tax, HMRC's Check employment status for tax tool gives HMRC's view. A tribunal makes the final decision in a dispute.

Can I be self-employed for tax and a worker for employment rights?

Yes. Acas and GOV.UK both say tax status and employment status are assessed separately, so the two can differ.

Are locum doctors and pharmacists self-employed?

Many locums who invoice directly are self-employed. Locums supplied through an agency are usually agency workers. Status depends on the facts of each arrangement.