Dentists' Working Patterns, Motivation and Morale - 2018/19 and 2019/20

The Dental Working Patterns (DWP) Survey is run biennially and collects data for two distinct years. The motivation and morale results discussed so far relate to 2019/20, which is referred to as the ‘lead-year’ because dentists complete the survey retrospectively for the previous financial year. However, the analysis has also been carried out for 2018/19 and is reproduced in the accompanying CSV.

The motivation and morale questions were first included in the 2012 DWP Survey and full comparable results for 2012/13 to 2017/18 are published in earlier reports. This chapter presents results for 2012/13 to 2019/20 together to explore any trends or changes over time. Some emphasis is given in comparison between the last two ‘lead-years’ – 2017/18 and 2019/20 – because these results are from the same stage in the two-year cycle of the survey.

As discussed in the Introduction, methodological changes to determine the working arrangements (i.e. dental type) of dentists in England and Wales for 2018/19 and 2019/20, along with changes to the strata used for weighting purposes mean there would be a major break in the time series. This also corresponds with the separate publication of England and Wales results.

Whilst the new dental type methodology cannot be retrospectively applied, time series results for England have been re-weighted using the updated stratification. However, given the large changes in dental type methodology, comparisons between results from the latest survey (covering 2018/19 and 2019/20) and earlier ones should be made with great caution and such discussions are limited in this report.

Due to the much smaller population of dentists in Wales and major change in methodologies, results are presented for Wales for 2018/19 and 2019/20 only. Although previous reports have provided separate headline results for Wales the methodological changes, new weighting strata and large increases in the numbers of Providing-Performer dentists mean that comparisons should not be made with previously published figures.

Table 7.1 and figures 7.1a and 7.1b show the percentage scores for the ‘strongly agree’ and ‘agree’ motivation results for dentists in England.

Table 7.1: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, England, 2012/13 to 2019/20

^{1. Difference columns are calculated by subtracting 2017/18 results from 2019/20 results.   I  Major break in time-series}

Figures 7.1a and 7.1b: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, England, 2012/13 to 2019/20

^{Please see table 7.1 for source data.}

The full-year population counts in table 7.1 show the dramatic increase in defined Providing-Performer dentists (and decrease in Associates) in England when comparing 2019/20 to 2017/18. Although the time series results have been re-weighted to match the new methodology for 2018/19 and 2019/20, it is still unadvisable to compare results from the latest survey with previous years.

Results for Principal and Associate dentists in Northern Ireland are shown in table 7.2 and figures 7.2a and 7.2b.

Table 7.2: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Northern Ireland, 2012/13 to 2019/20       

^{1. Difference columns are calculated by subtracting 2017/18 results from 2019/20 results}
Figures 7.2a and 7.2b: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Northern Ireland, 2012/13 to 2019/20

^{Please see table 7.2 for source data.}

Table 7.2 highlights some mixed results for Principal dentists in Northern Ireland: whilst there has been a notable drop in answer to question (B) ‘I receive [spoken] recognition [from colleagues] for the work I do’ (from 34.5% to 26.2%) there have been large increases in responses to other questions. Most notably, question (D) ‘I have all the equipment and resources I need to do my job properly’, which increased from 37.1% of dentists answering positively to 52.6% (an increase of 15.5 percentage points). Together with an increase in question (A) ‘I feel good about my job as a dentist’, means that overall, the motivation of Principals in Northern Ireland has increased from the last survey. In April 2019, a revenue grant scheme was provided for Principal dentists in Northern Ireland, which could explain the increase in positive responses to question (D).

For Associate dentists in Northern Ireland, the picture is somewhat different with table 7.2 showing a decrease in positive answers for every motivation question since the last survey. The biggest drop is for question (A) ‘I feel good about my job as a dentist’, which dropped 11.1 percentage points, underlining the drop in the ‘overall average’ seen over the same time.

Table 7.3 and figures 7.3a and 7.3b compare results for the individual motivation questions in Scotland.

Table 7.3: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Scotland, 2012/13 to 2019/20

^{1. Difference columns are calculated by subtracting 2017/18 results from 2019/20 results}

Figures 7.3a and 7.3b: Percentage of Principal dentists (%) that answered ‘strongly agree’ or ‘agree’ by question, Scotland, 2012/13 to 2019/20

^{Please see table 7.3 for source data.}

Table 7.3 shows that the majority of motivation questions saw an increase in positive answers for both sets of dentists in Scotland, meaning that overall, there were increases in motivation. The increases are more apparent in figure 7.3b which highlights a gradual increase in positive answers to a number of questions since 2015/16 for Associates, meaning their ‘overall average’ motivation has also gone up.

Such increases in Scotland mean that the motivation of dentists in the country are now the highest across the UK, as shown in the summary table 7.4 and figure 7.4b.

It is important to note that the contractual arrangements in England and Wales, Northern Ireland and Scotland are different and that this needs to be borne in mind when attempting to make any comparisons across the countries.

Table 7.4 and figures 7.4a and 7.4b show the ‘overall average’ motivation percentage scores from 2012/13 to 2019/20 from each of the preceding tables in this section and includes figures for Wales from the latest survey. As before, the difference column is calculated by subtracting the 2017/18 results from the 2019/20 results. For the sake of simplicity of prose, Providing-Performer dentists in England and Wales in the next sections are referred to as Principals, matching dentists in the other countries.

Table 7.4: ‘Overall average’ percentage score (%) of ‘strongly agree’ and ‘agree’ responses to the six motivation questions by country and dental type, 2012/13 to 19/20

^{1. Difference columns are calculated by subtracting 2017/18 results from 2019/20 results.  I Major break in time-series  z: 08/09 to 17/18 Wales results not applicable due to change in methodology}

Figures 7.4a and 7.4b: ‘Overall average’ percentage score (%) of ‘strongly agree’ and ‘agree’ responses to the six motivation questions by country and dental type, 2012/13 to 2019/20

^{Please see table 7.4 for source data.}

Figure 7.4a highlights that increases in motivation for Principal dentists in Northern Ireland and Scotland in the last survey have helped arrest the gradual decline in both countries over the last few surveys. The picture is different for Associate dentists, with those in Scotland recording the highest level of motivation since 2013/14, while motivation for Associates in Northern Ireland have dropped after a period of relative stability.

Whereas Principals in Wales show lower motivation than those in England for the last survey, the opposite is true for Associates as shown in figures 7.4a and 7.4b.

Table 7.5 and figures 7.5a and 7.5b show how dentists across the UK answered question (H) ‘How would you rate your morale as a dentist?’. Table 7.5 shows the percentage for those dentists who recorded their morale level as either ‘very high’ or ‘high’.

Table 7.5: Percentage of dentists (%) that answered ‘very high’ or ‘high’ morale levels by country and dental type, 2012/13 to 2019/20

^{1. Difference columns are calculated by subtracting 2017/18 results from 2019/20 results.  I Major break in time-series  z: 08/09 to 17/18 Wales results not applicable due to change in methodology}

Figures 7.5a and 7.5b: Percentage of dentists (%) that answered ‘very high’ or ‘high’ morale levels by country and dental type, 2012/13 to 2019/20

^{Please see table 7.5 for source data.}

The general trend of the morale results map the motivation results shown in the previous section. Once again, Principal dentists in Northern Ireland and Scotland appear to have largely arrested drops in morale seen in earlier surveys, whilst there is now a considerable difference for Associates. In 2017/18 just 1.2 percentage points separated the morale of Associates in Northern Ireland and Scotland, which has increased to 15.0 percentage points in 2019/20.

Similar to the motivation results, Principals in England report higher levels of morale compared to those in Wales, with the opposite true for Associates. However, unlike the motivation results, figures 7.5a and 7.5b highlight that the morale of Associate dentists has always been higher than their Principal colleagues throughout every iteration of the survey. This contrasts with the motivation results where Principals and Associates are more similar and may reflect increased levels of responsibility that Provider-Performers face when running their practices.

As mentioned at the end the Results Across the UK section, when reflecting upon the time series motivation and morale results it is can be useful to consider changes in each dental populations’ working patterns such as weekly hours of work, NHS share (%), clinical work (%) and annual leave over the same period. The results from Results Across the UK (since 2012/13) can be briefly summarised as:

• Little change in average weekly hours of work and annual leave
• A decrease in the percentage of time spent on Health Service work for Principals in Northern Ireland up to 2017/18 with an increase in the last survey, whereas less change for other dentists
• An increase in Clinical work for all dentists since the last survey

The multivariate analysis of the ‘motivation index’ for each country presented in the Motivation and Morale Analysis section generally shows a negative relationship between motivation and both weekly hours of work and NHS commitment, and a positive relationship between motivation and each of clinical work and weeks of annual leave. The changes in dental working patterns in terms clinical activity would be expected to increase motivation since the last survey, which is the case for Principal dentists in Northern Ireland and Scotland as well as Associates in Scotland. However, the recent increase in Health Service work for Principals in Northern Ireland might have counteracted some of this increase.

On the other hand, Associates in Northern Ireland have seen a considerable drop in motivation and it is, therefore, likely that other factors beyond the changes in their working patterns are also affecting their motivation and morale. The next section explores potential causes of low morale.