Working practices in healthcare

How the work usually looks

• Clinical work is supervised and governed by the trust's or provider's own protocols.
• Shifts are set by the rota; there is rarely any real right to send someone else.
• Equipment and premises belong to the client.
• Frameworks usually set the pay route, and most require PAYE.

What tends to undermine self-employment

• Control is built into clinical governance, so arguments for self-employment are hard to sustain.
• Named-person bookings through a framework with no substitution in practice.
• Working within the ward team, on the same terms as employed staff.

Compliance points particular to the sector

• Check the framework's payroll terms before placing: many name approved routes.
• Public sector clients decide status themselves and must give a status determination statement.
• Hold professional registration and right-to-work checks with the payroll record.

Routes that come up

Healthcare routes, Direct PAYE for your own staff, PAYE umbrella.

General patterns, not a decision about any one placement. Test the engagement itself against HMRC's Check Employment Status for Tax tool.