Hire when your busiest intervals need another pair of hands, not simply because the whole day feels busy. A full-time hire may be exactly right. But first check whether the pressure lasts all day or only appears around opening time, lunch and closing.
Sometimes the answer is yes. Small phone queues cope badly with overlapping calls, so a second person can do much more than double capacity. Hire if the peak lasts for hours, the clinic depends on one person's knowledge, or patients in the building need more help. Just do not make a £31,500-a-year decision because one Monday felt awful.
Why standard staffing ratios miss phone pressure
Most dental staffing advice starts with revenue or clinician headcount. Roger Levin suggests roughly one front-desk person per $350,000–$400,000 of production.1 Scott Leune uses two front-office people per doctor as a broad ceiling.2 Kiera Dent separates admin roles as collections grow.3
Those ratios help with budgeting and role design. They do not include call arrivals, handling time or caller patience. A practice can look correctly staffed on paper and still miss calls at 8am.
No single benchmark settles the question. Your busiest intervals can.
Your front desk is a queue, and small queues break early
A phone line is a queueing system, and queueing systems have been modelled since 1917. The standard formula is Erlang C, still the basis of call-centre staffing worldwide.4 It takes four inputs: calls arriving in an interval, how long a call takes to handle end to end, the answer speed you want, and how many people are available.
The number that matters is offered load, in erlangs: calls per hour × handling time in seconds ÷ 3600. Twelve calls an hour at three minutes each is 0.6 erlangs — the desk must talk for 36 minutes of every 60.
Here is what the model shows for one person, dedicated to the phone, with three-minute calls and a target of answering 80% within 20 seconds.
| Calls per hour | Share of the hour on calls | Answered within 20s | Average wait, all callers |
|---|---|---|---|
| 4 | 20% | 82% | 45 seconds |
| 6 | 30% | 72% | 1 min 17s |
| 8 | 40% | 63% | 2 minutes |
| 12 | 60% | 43% | 4 min 30s |
| 14 | 70% | 32% | 7 minutes |
| 16 | 80% | 22% | 12 minutes |
At about 4.4 calls an hour, a one-person desk falls below the 80%-within-20-seconds target. That is only 22% of the hour spent on calls. The line is not technically full, but callers begin waiting longer than the chosen target.
At twelve calls an hour, the receptionist is talking for 36 minutes out of 60. That may not look extreme. Yet more than half of callers wait longer than 20 seconds.
Calls do not arrive at tidy three-minute intervals. If a second call lands during the first, it waits for that conversation to end. With nobody else available, a small burst becomes a queue.
Two caveats make a real clinic harder to model:
- A receptionist does more than answer calls. Greeting an arrival, taking payment or chasing a lab makes them unavailable to the phone. The report may show little talk time while callers still go unanswered.
- The model assumes callers wait forever. Real callers hang up. That makes the recorded queue look shorter, but the clinic may have lost the enquiry.
Why a second person can make such a big difference
The second person absorbs overlaps that would otherwise wait. At 12 calls an hour, the model takes average wait from four and a half minutes to eighteen seconds. At 14 calls an hour, it falls from seven minutes to twenty-five seconds. Each person then spends about a third of the hour on calls.
A desk that answers quickly will sometimes look underused. That spare capacity is what lets the next call be answered straight away.5
By the time someone looks overwhelmed, callers are probably already waiting. Visible busyness is a late trigger for a staffing decision.
Why peaks matter more than daily totals
So why not just hire? Because the load is not spread across the day, and a full-time contract is.
NHS England advises practices to look separately at Mondays and peaks such as 8am, lunchtime and 3pm.6 Its goal is to smooth the morning rush and other predictable spikes.
That is why a daily total can mislead. Sixty calls spread across eight hours is 7.5 an hour. If 30 arrive between 8 and 9, the same total creates a very different staffing problem.
NHS England includes a simple peak-volume exercise:
That is a throughput calculation, not a full queueing model. It shows why adding one person may not clear a concentrated spike.
A person is not the same as a permanently covered seat. Statutory holiday is 5.6 weeks and average UK sickness absence is 4.4 days a year.7,8 On the assumptions below, one full-time employee provides about 1,712 productive hours from 1,955 paid hours.
| Desk open per week | Seat-hours a year | FTE to cover one seat | FTE to cover two seats |
|---|---|---|---|
| 40 hours | 2,080 | 1.22 | 2.44 |
| 50 hours (8am–6pm, Mon–Fri) | 2,600 | 1.52 | 3.05 |
| 60 hours | 3,120 | 1.83 | 3.66 |
On these assumptions, a clinic open 8am to 6pm needs about three full-time equivalents to keep two seats covered all year. That includes lunch, statutory holiday and average sickness absence.
What a second receptionist actually costs in the UK
Published estimates vary. Under the assumptions below, our bottom-up model comes to £31,506 a year.
| Line item | Amount | Source |
|---|---|---|
| Base salary, full-time, outside London | £27,000 | Modelled salary benchmark, above the ONS 2025 median and April 2026 wage floor9 |
| Employer National Insurance, 15% above £5,000 | £3,300 | GOV.UK, 2026/2710 |
| Employer pension, 3% of qualifying earnings | £623 | GOV.UK / DWP thresholds, 2026/2711 |
| Statutory holiday | £0 extra | Already inside the salary — it reduces hours, not adds cash7 |
| Recruitment, £1,750 spread over three years | £583 | CIPD median cost per hire, private sector12 |
| Total loaded annual cost | £31,506 | salary + 16.7% |
Using the same formula, a £42,000 total would imply a base salary of about £35,900, above the ONS 90th percentile. That may be realistic for a senior or London role. It is not a suitable default for every UK receptionist.
Divide the modelled total by the hours actually worked and the cost is £18.40 per productive hour of cover, or about £19.64 in the London version. Employer costs and paid time away from work explain the difference from the headline hourly rate.
Part-time work can fit the peak better, but it does not automatically make each hour much cheaper:
One modelling trap: the £10,500 Employment Allowance is per employer, not per employee. If the clinic has already used it, the marginal hire carries the full employer-NI charge. Mixed NHS and private practices should check the public-sector restriction with their accountant.
CIPD found that only 18% of SMEs calculate what staff turnover costs them.12 If you have never run the numbers, you are not unusual. This is a good moment to do it.
Three fixes that are not a hire
Several practice-management advisers make the same point: check the process before adding headcount. Otherwise, the new person inherits the same bottlenecks.
Laura Nelson describes a practice that hired a front-desk coordinator, then found the same problems six months later.13 Paul Etchison makes a similar case: a poorly designed admin process can leave the new hire as overwhelmed as the existing team.14
Audit for single points of failure
Map the critical tasks: phones, scheduling, billing and check-out. Count how many people can do each. Etchison's rule is that every critical function needs at least two trained people.15 If most answers are "one", cross-training may help more than another junior hire.
Offset the shift instead of adding one
Leune covers the peak by moving hours, not adding them: someone on 10–7 against a practice running 8–4, overlapping deliberately where the phone spikes.2 His warning about the obvious alternative is worth hearing: "It's hard to hire great people for only three days a week."
Get incompatible work off the peak
When calls, check-ins, payments and admin share one queue, the urgent task wins. Move claims, recalls and paperwork out of the 8–10 window where possible.16
Do not assume that adding an online channel removes work. In one small study of eight English GP practices, online services spread demand across more channels rather than clearly reducing it.17 Your clinic may see a different result, so measure the workload before and after the change.
Where an AI receptionist fits, and where it does not
Everything above is true whether or not you buy anything. Here is the narrow place a system like Aimée belongs in this decision.
The constraint here is overlapping calls at the peak, not total workload. One person can answer one call at a time. Aimée can answer overlapping calls up to the concurrent-call limit of the clinic's plan. A second person can also absorb the overlap, but only during their scheduled hours.
Our own data shows the pattern. In a documented 28-day study at a UK dental practice, the clinic had three receptionists and still missed 228 calls. More telling is what those calls were: only 53 were new bookings. The rest were reschedules, questions about prices and opening hours, and existing patients chasing appointments — routine work displacing the calls with money in them.
For many two-to-six-chair clinics, the choice is not simply software or a person. Compare £31,506 a year for 1,712 modelled hours of scheduled cover with a plan for after-hours and overflow calls. Then check which option fits the work you actually need covered.
The capacity check you can run this week
You can get a useful first answer from four weeks of call data.
Pull one interval, not one day
Export 15- or 30-minute intervals around opening time for the last four Mondays. Record abandoned calls, missed calls, wait time, answered calls and handling time.6 Keep engaged calls separate from callers who joined a queue and left.
Work out the offered load
Convert the interval to an hourly rate, then use: calls per hour × handling time in seconds ÷ 3600. Fourteen calls at three minutes is 0.70 erlangs. Include notes written after the call.
Compare one desk against two
At 0.70 erlangs one person answers 32% of callers within 20 seconds, average wait seven minutes. Two answer 84% within 20 seconds, waiting 25 seconds, each on calls about a third of the time.
Price the callers you are losing
Do not value every delayed call as a new patient. Estimate the share of new-patient enquiries, the share that abandon, the booking conversion and first-visit value. Our missed-call cost calculator helps with the scenario; the call-audit method helps replace assumptions with observations.
If the pressure lasts all day and much of the work needs a person in the building, hire. If it is a short phone spike followed by a quiet afternoon, change the rota or add overflow cover first.
The decision is not "does the receptionist look busy?" It is: during the busiest interval, what work is going unanswered, and what kind of cover would complete it?
FAQ
More staff or more efficiency: how do I tell?
Measure the peak interval, because the two produce different symptoms. Efficiency problems show up all day at moderate load; capacity problems concentrate at 8am, lunchtime and 3pm and vanish in between.
The question is the title of a Dental Practice Heroes episode, and Etchison's answer is a story rather than a threshold: during COVID his practice automated check-ins, digitised forms and streamlined communication instead of hiring, and absorbed the extra workload with no new headcount.18
We're short-staffed right now — shouldn't we fix the systems once we're fully staffed again?
Waiting can keep the practice stuck. Etchison recommends three moves while short-handed: tell the team clearly what is happening, fix one recurring frustration, and protect training time so fewer tasks need escalation.19
What would happen if we lost our office manager tomorrow?
If the answer is "we would be in serious trouble", you have a resilience problem, not simply a volume problem. A junior second receptionist may not solve it.
Kiera Dent frames the issue as dependency on one office manager.3 Etchison's practical rule is that every critical function should have at least two trained people.15
Why do we miss calls when the receptionist is not on the phone that much?
Because calls overlap. In this model, a one-person desk starts missing the answer target at around 22% occupancy. It also assumes the receptionist does nothing except answer calls.
Check-ins, payments and desk work make the person unavailable for more of the hour than the phone report shows. Missed calls can therefore be a capacity pattern rather than a performance problem.
Is it cheaper to hire two part-timers instead of one full-timer?
It lowers the annual bill, but in this model the productive hourly cost is only about 1.5% lower. The exact result depends on pay, hours, pension eligibility, employer NI and recruitment cost.
Two part-timers may still suit the rota because they can cover different peaks and absences. Hiring quality and continuity may be harder, so compare both options on cover as well as cost.2
Related reading
- How dental clinics lose bookings to missed calls — the call-audit method that turns a red number in the phone log into a defensible recovery model.
- What happens when patients call your clinic after hours — the evening and weekend half of the same capacity problem.
- A UK dental practice, 28 days, 228 missed calls — what those calls actually were, in a practice that already had three receptionists.
A note on the numbers
Every capacity figure here was computed with the standard Erlang C formula and validated against a published worked example first. The cost model is built line by line from ONS, GOV.UK, DWP and CIPD sources for the 2026/27 tax year, not from a vendor estimate. Your clinic's numbers will differ — the point of the method is that you can rebuild it with yours.
Sources
- Levin RP, "Should you hire more staff?", Dental Economics, 1 September 1999. https://www.dentaleconomics.com/practice/article/16393776/should-you-hire-more-staff (US) — accessed 2026-09-08
- Leune S, The Dental CEO Podcast, Episode 36, "The Staffing Formula Every Dental Practice Should Follow". https://dentalceopodcast.com/episodes/efficient-dental-practice-staffing-guide/ (US) — accessed 2026-09-08
- Dent K, The Dentist Money Show, Episode 119, "What Would Happen if You Lost Your Office Manager?". https://dentistadvisors.com/education-library/podcast/kiera_dent/ (US) — accessed 2026-09-08
- "Erlang C Formula — Made Simple With an Easy Worked Example", Call Centre Helper. https://www.callcentrehelper.com/erlang-c-formula-example-121281.htm — accessed 2026-09-08
- Gans N, Koole G, Mandelbaum A, "Telephone Call Centers: Tutorial, Review, and Research Prospects", Manufacturing & Service Operations Management 2003; 5(2): 79–141. https://columbia.edu/~ww2040/tutorial.pdf — accessed 2026-09-08
- NHS England, "How to improve telephone journeys in general practice", published 7 May 2024, updated 28 May 2024. https://www.england.nhs.uk/long-read/how-to-improve-telephone-journeys-in-general-practice/ (UK) — accessed 2026-09-08
- GOV.UK, "Holiday entitlement". https://www.gov.uk/holiday-entitlement-rights (UK) — accessed 2026-09-08
- ONS, "Sickness absence in the UK labour market: 2025", released 1 May 2026. https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2025 (UK) — accessed 2026-09-08
- ONS, "Earnings and hours worked, occupation by four-digit SOC: ASHE Table 14", 2025 provisional, released 23 October 2025 (SOC 4216, full-time median £24,678 at April 2025, uprated here to the April 2026 wage floor). https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/datasets/occupation4digitsoc2010ashetable14 (UK) — accessed 2026-09-08
- GOV.UK, "National Insurance rates and categories" (employer secondary Class 1: 15% above a £5,000 secondary threshold, 2026/27). https://www.gov.uk/national-insurance-rates-letters (UK) — accessed 2026-09-08
- GOV.UK, "Workplace pensions: what you, your employer and the government pay", with DWP, "Review of the Automatic Enrolment Earnings Trigger and Qualifying Earnings Band for 2026/27", published 18 December 2025. https://www.gov.uk/workplace-pensions/what-you-your-employer-and-the-government-pay (UK) — accessed 2026-09-08
- CIPD, Resourcing and talent planning report 2024, published September 2024, fieldwork April 2024, n=1,016 UK HR professionals. https://www.cipd.org/globalassets/media/knowledge/knowledge-hub/reports/2024-pdfs/8662-resource-and-talent-planning-2024-report-web.pdf (UK) — accessed 2026-09-08
- Nelson L, "Stop Hiring, Start Analyzing: Your 2026 Staffing Strategy Might Surprise You", Front Office Rocks, 19 December 2025. https://frontofficerocks.com/stop-hiring-start-analyzing-your-2026-staffing-strategy-might-surprise-you/ (US) — accessed 2026-09-08
- Etchison P, "Stop the Front Desk Chaos in Your Dental Practice", Dental Practice Heroes newsletter, 11 March 2026. https://www.dentalpracticeheroes.com/newsletters/dental-practice-heroes-newsletter/posts/front-desk-chaos (US) — accessed 2026-09-08
- Etchison P, Dental Practice Heroes, Episode 697, "The Subtle Trap Undermining Your Practice's Success", 27 August 2026. https://www.buzzsprout.com/2311108/episodes/19709611-the-subtle-trap-undermining-your-practice-s-success (US) — accessed 2026-09-08
- Nottingham A and Nottingham H, "Dental Front Office Training", All-Star Dental Academy. https://allstardentalacademy.com/dental-podcast/dental-front-office-training-2/ (US) — accessed 2026-09-08
- "Evolution of the general practice receptionist role and online services: a qualitative study", British Journal of General Practice 2025; 75(759): e703. Focused ethnographic case study, eight English general practices, 19 interviews. https://bjgp.org/content/75/759/e703 (UK) — accessed 2026-09-08
- Etchison P, "More Staff, or More Efficiency? How to Tell", Dental Practice Heroes, 24 March 2025. https://podcasts.apple.com/gb/podcast/more-staff-or-more-efficiency-how-to-tell-with-dr-paul/id1315253777?i=1000700547596 (US) — accessed 2026-09-08
- Etchison P, Dental Practice Heroes, Episode 687, "Short Staffed? Here's What to Do", 23 July 2026. https://www.buzzsprout.com/2311108/episodes/19536425-short-staffed-here-s-what-to-do (US) — accessed 2026-09-08