Employment status after HMRC withdrew the sector guidance

HMRC no longer publishes employment status guidance written for your profession. The manual page for locum pharmacists was withdrawn with effect from 30 June 2023, and the equivalent for associate dentists went on 6 April 2023. What is left is the general law, the Check Employment Status for Tax tool, and whatever evidence you can produce about how you actually work.

What was withdrawn, and what it did not change

ESM4270 had given a reasonably strong steer that a locum pharmacist on the standard National Pharmacy Association contract pointed towards self-employment. The page now says little more than: read the general status material at ESM0500, and use CEST. ESM2063, which also referred to locum pharmacists, went at the same time.

HMRC told the Pharmacists' Defence Association in May 2023 that removing the pages "does not mean HMRC has changed its view" on locum status, because the rules stem from case law rather than from the manual. True, and also the difficulty: withdrawal does not change the law, it changes who has to prove the position. Before, you could point at a page with HMRC's name on it. Now you show your own facts.

What the tests actually look at

Status turns on the whole picture, but four factors do most of the work.

Substitution. Can you send a suitably qualified person in your place, and would the engager have to accept them. A genuine, unfettered right, better still one that has been used, is the strongest single pointer towards self-employment. Hill Dickinson identifies the locum clause as the key indicator for associate dentists now the guidance has gone.

Control. Who decides what is done, how, when and where. Rate negotiation sits here, and it matters more than most people expect.

Mutuality of obligation. Whether there is an obligation to offer work on one side and to accept it on the other. Since the Supreme Court's PGMOL decision, this is a lower bar than contractors had hoped.

Financial risk. Whether you can actually lose money: unpaid invoices, putting right your own work in your own time, your own indemnity, equipment and professional costs. Someone who cannot lose is hard to describe as in business on their own account.

CEST sits on top of this. The gov.uk page, last substantially updated on 30 April 2025, says HMRC "will stand by all results given by the tool", provided your answers are accurate and in line with its guidance. A real protection, and a conditional one.

Pharmacy already had its test, outside a tribunal

HMRC opened an enquiry into the tax status of locums in community pharmacy in 2019, and in August 2023 wrote to all affected pharmacies setting out its approach to compliance enquiries for the tax year ending 6 April 2023 and earlier years. The PDA reported in January 2024 that the enquiry had concluded locum pharmacists should be treated as employees for tax, with the demand for past years going to the pharmacy businesses, which decide whether to settle or keep challenging.

The knock-on is what reaches locum pharmacists directly. The PDA argues that employers and some agencies responded by exerting more control, for example by removing the ability to negotiate rates, which in its view undermines the self-employed position rather than protecting it. It makes the same point about NHS training and payments being routed through pharmacy contractors rather than to locums, which it says reinforces a "master/servant" impression. Each tightening of control makes the next status argument harder.

Dentistry lost the standard agreement shortcut

Until 6 April 2023, ESM4030 told practices and associates that an associate engaged under a British Dental Association or Dental Practitioners Association standard agreement would be treated as self-employed. HMRC withdrew it, directing both sides to CEST and case law. As reported by ICAEW and the BDA, HMRC said it would not use the withdrawal itself as a reason to open retrospective enquiries into periods before 6 April 2023. That limits the backward reach and settles nothing since.

For locum dentists, hygienists and therapists on associate-style terms, the agreement alone no longer carries the argument. Dentistry.co.uk returned to the question in February 2025 and reached the same place: the written contract is a starting point, not an answer. Locum optometrists have no sector-specific HMRC guidance to work from either.

A locum doctor, two hospitals and twelve years

The case cited across the advice sector is Dr George Mantides. On the reporting by Waterfront Law, Kingsbridge and the CrowdJustice page for his appeal, rather than on the judgment itself, it runs like this. He supplied urology services to two NHS hospitals through his own company in 2013. The First-tier Tribunal split the decision, finding the Royal Berkshire engagement inside IR35 and the Medway engagement outside it. In April 2025 the Upper Tribunal dismissed his appeal, applying PGMOL and finding sufficient mutuality of obligation once sessions had been booked and worked. He crowdfunded that appeal, twelve years after the work.

The same doctor, in the same year, through the same company, got different answers for two hospitals: status is decided engagement by engagement. And an enquiry into 2013 was still running in 2025.

Since 6 April 2021, where you work through a personal service company for an NHS trust or a large GP or dental group, the client issues the Status Determination Statement. Blanket determinations across a category of worker do not demonstrate reasonable care. If you think yours is wrong, there is a process, set out in appealing an inside IR35 determination.

The umbrella rules that changed on 6 April 2026

The other rule change catches agency locums rather than company ones. From 6 April 2026, where an umbrella company employs the worker, responsibility for making sure PAYE is operated correctly sits with the recruitment agency holding the contract with the end client, or with the end client where there is no agency, and HMRC can recover underpaid PAYE from that party rather than only from the umbrella. It applies to new and existing supply chains for payments made on or after 6 April 2026. Workers supplied through personal service companies under the off-payroll rules are out of scope, along with managed service companies, salaried LLP members and workers employed directly by an agency.

What to keep as evidence

None of this is tax advice, and status is fact-specific, so that conversation is for your accountant. What you can do without advice is keep the record it will run on.

1. The contract for each engagement, including the substitution clause, and a note of any occasion you actually sent someone else.
2. Evidence that you set or negotiated your rate, rather than accepted a published one.
3. The organisations you worked for in each tax year, with dates. Working for several engagers does not settle status, but one long engagement is the pattern that draws attention.
4. Invoices in your own name with payment dates, and anything showing you carried risk: an unpaid invoice, a cancelled session, work corrected at your own cost, your own indemnity and equipment.
5. Any Status Determination Statement you have been given, kept with the CEST output and the answers it was based on.

If you keep shifts and invoices in Sessional, the shift log and invoice records cover most of items 3 and 4, and the IR35 guide explains what they will and will not show. The point is not the tool. It is that the evidence still exists when someone asks about a tax year you stopped thinking about.

Sources

• Employment Status Manual ESM4270: locum pharmacists (HMRC via GOV.UK, withdrawn with effect from 30 June 2023)
• Check employment status for tax (HMRC via GOV.UK, last substantive update 30 April 2025)
• HMRC withdraw sector specific guidance (Pharmacists' Defence Association, 30 May 2023)
• Locum tax status enquiry update (Pharmacists' Defence Association, 4 January 2024)
• Change to HMRC guidance on self-employed status for associate dentists (Hill Dickinson, undated)
• Associate dentist tax status changes (ICAEW, undated)
• To be or not to be self-employed (Dentistry.co.uk, 2 February 2025)
• IR35 and the Mantides case: Upper Tribunal finds a locum doctor's services were within IR35 (Waterfront Law, undated)
• George Mantides IR35 tribunal ruling (Kingsbridge, undated)
• George Mantides v HMRC (IR35) case page (CrowdJustice, undated)
• PAYE rules for labour supply chains that include umbrella companies from 6 April 2026 (HMRC via GOV.UK, last updated 19 June 2026)
• IR35 explained for locum doctors (WIS Accountancy, 2026)