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Publication, Part of

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

Introduction

Data Sources

The primary source of data for this report is the Dental Working Patterns (DWP) Survey. This short section provides summary information on the survey, including data sources for the report. The accompanying Methodology document contains more detailed information on the survey sample, population and weighting for each country, as well as information on the development and analysis of the motivation and morale questions and assumption testing for the multivariate analysis found in the motivation chapters of this report.

The DWP Survey was sent to all primary care UK dentists who conducted some NHS/Health Service work in 2018/19 and/or 2019/20 (please see Annex A for a copy of the survey). Dentists answer questions about their working patterns, motivation, and morale for each of the two financial years covered by the survey. We added a new question to the end of the 2018 survey, asking about issues that may affect dentists’ morale and have was asked this again in the 2020 survey.

Participation in the survey is voluntary. We sent invitational letters to dentists in Wales, Northern Ireland, and Scotland along with email invitations to those dentists for whom we held a valid email address; dentists in England were invited to participate by email only.

We used workforce data provided by each country, which contains dentists’ working activity and demographic information, to compile the population and weighting variables, as described in the accompanying Methodology document. A Glossary and an explanation of the dental and contract type classifications applicable in each country are available in Annex B.

The survey was conducted online and monitored by NHS Digital. Inbuilt validation rules ensured that all respondents provided a valid response to every applicable survey question; some questions, such as those relating to business arrangements were not relevant to certain dentists and thus did not require a response from all.

Only those dentists who indicated they worked for the entirety of a financial year, excluding any annual leave, are included in the analysis; part-year dentists are excluded from the sample. The full-year populations used in this report were estimated from the survey response and will, therefore, differ from the dental populations presented in other NHS Digital publications. Up-to-date workforce numbers in England can be found at https://digital.nhs.uk/data-andinformation/publications/statistical/nhs-dental-statistics. The sample and ‘full-year’ population sizes are shown in the separate Methodology.

  • All results are estimates based on samples. These results are then weighted up to the dental population in each country and are, therefore, subject to sampling error which can occur because a sample population may not respond or behave in the same fashion as the entire population.
  • Small dental populations for some subgroups mean that extreme values can have noticeable effects on the averages, and where results are based on small samples a footnote has been included. In such cases results may be subject to more uncertainty and differences may not be statistically significant. However, in some charts, error bars (displaying 95% confidence intervals) have been used to clarify any statistical significance.
  • All averages are means.
  • The majority of values within tables are rounded and totals and differences may appear not to sum. This includes full-year population counts where given, as these are weighted estimates calculated from the entire population and from the proportion of dentists who responded to the survey and had worked for the full year discounting any annual leave taken.

When comparing these results to earlier years, it is important to note that for a variety of reasons, including changes in the survey administration, the response rate has decreased for most dental cohorts. However, the sample population has remained closely aligned to the overall population as detailed in Annex C of the Methodology document that discusses the representativeness of the survey. The Methodology document also lists changes to each iteration of the survey since it was first run in 2008. Whilst results for each country are shown in this report it should be borne in mind that there are differences in dental contractual arrangements, which may affect the country specific results and mean that care should be taken when making comparisons between countries.

Symbols used in the report

Tables within this publication use the following symbols, where needed:

Symbol Meaning Comment
c Confidential Results that have been suppressed due to low sample numbers
z Not applicable Used when an observation is not applicable
: Not available Data unavailable for reasons other than those already specified

Motivation and Morale Analysis

The motivation and morale questions were first added to the 2014 DWP Survey and now cover 8 years of data. Please see the accompanying Methodology document for further information on the development and analysis of the questions and assumption testing for the multivariate analysis found in the motivation chapters of this report. The motivation and morale questions are listed below and are asked for both years covered in each survey (please see Annex A for a copy of the entire survey). In built validation rules mean that dentists must answer every question to complete the survey, so the motivation data is not distorted by missing data.
 

Motivation Questions Category
A. I feel good about my job as a dentist Self
B. I receive recognition for the work I do1 Others
C. I feel my pay is fair2 Pay
D. I have all the equipment and resources I need to do my job properly Equipment
E. My job gives me the chance to do challenging and interesting work Self
F. There are opportunities for me to progress in my career Progression
Leaving Question Category
G. I often think about leaving general dentistry Self
Morale Question Category
H. How would you rate your morale as a dentist? Environment

1. Spoken recognition or acknowledgement (i.e. not financial) from colleagues  2. Pre-tax income (after all expenses removed) for primary care dentistry

The analysis considers the responses to the questions in two main ways:

A. Individual Motivation Question Analysis
Results show the percentage of dentists who responded in each Likert category (‘strongly agree’, ‘agree’, ‘neutral’ etc) to each question. To help interpretation, responses to the two positive categories (‘strongly agree’ and ‘agree’) are then combined and an ‘overall average’ figure is also presented which is the average of the ‘strongly agree’ and ‘agree’ percentage scores for each question. This also compares results for Providing-Performer/Principal dentists and Associates by simple subtraction.

B. Average ‘Motivation Index’

A ‘motivation index’ is calculated for each dentist by taking the average score of their responses to the six motivation questions. Responses are scored from 0% for ‘strongly disagree’ in increments of 25 to 100% for ‘strongly agree’. The highest possible ‘motivation index’ for dentists is 100% and the lowest is 0%.

This is a different methodology to that used in the ‘Individual Motivation Question’ (and ‘Strongly Agree/Agree’) analyses. The average ‘motivation index’ considers the proportion of dentists choosing each Likert category (‘strongly agree’, ‘agree’ to ‘strongly disagree’) for every motivation question to represent all responses as accurately as possible.

The ‘motivation index’ allows the relationship between motivation and different working patterns such as weekly hours of work or NHS/Health Service share to be explored using multivariate analysis. Details about the assumptions made to support this calculation are discussed in Annex D of the accompanying Methodology document.

Motivation band and survey responses

The relationship between the average ‘motivation index’ and working pattern characteristics has been explored by allocating dentists to one of four motivation bands (based on their ‘motivation index’) shown below:

  1. Very Low (≤25%)
  2. Neutral & Low (>25% & ≤50%)
  3. High (>50% & ≤75%)
  4. Very High (>75%)

Multivariate analysis

A review of the individual questions, the ‘motivation index’ and analysis of motivation band and survey responses suggests that there are relationships between motivation and other variables (such as a dentist’s age or working patterns). However, those analytical techniques do not allow each response to be considered in isolation while holding the other variables constant.

For example, it may be the case that dentists taking five weeks’ annual leave have a higher average ‘motivation index’ than colleagues taking only three. However, dentists taking more annual leave also tend to work fewer weekly hours. This too will affect their motivation, making it difficult to quantify the contribution more weeks’ annual leave has on the ‘motivation index’. Multivariate analysis using multiple linear regression allows each relationship between motivation and specific survey response variables to be explored separately. More detail can be found in the accompanying Methodology document along with supporting technical information relating to statistical significance and adjusted R‑squared values.

The effect of different dental populations

Different groups of dentists may have different levels of motivation and these relationships are explored further. For example, the ‘motivation index’ of part-time dentists may differ from that of full-time dentists when considering the effect of weekly working hours upon motivation. Because of smaller sample sizes in Northern Ireland, Scotland and Wales, this analysis is available only for dentists in England and considers the effect of the dental populations using multivariate analysis for the following subsets of dentists:

  1. Part-time (<35 weekly hours) or full-time (≥35 hours)
  2. Mainly NHS (or mainly private) dentists
  3. Gender

As well as the six motivation questions listed at the start of this Chapter, responses were also elicited from dentists on one question covering morale, as discussed below, as well as a question on leaving general dentistry which is considered in the section entitled Leaving General Dental Practice.

Morale

Unlike motivation, which is usually defined as an individual’s internal drive for behaving in a particular way, morale generally relates to feelings of satisfaction and confidence in life. Motivation and morale are often linked but while higher motivation often leads to higher morale in employees, high morale does not guarantee that employees work more effectively even though they may have a positive attitude towards their work.

Because of the differences between motivation and morale, responses to the morale question are not included in the calculation of average ‘motivation index’ but are analysed separately.

Please note, all dentists who responded to the survey answered every motivation and morale question as well as the question on leaving general dentistry.


Substantive changes since the last Dental Working Patterns (DWP) Survey

England and Wales – Methodology changes and break in time-series

Unavoidable changes in the collection system used at NHS Business Services Authority (BSA) for England and Wales workforce data has necessitated a major change in the methodology to determine the working arrangements (i.e. dental type) of dentists in both countries. This is discussed in more detail in the accompanying Methodology document and the Methodological Change notice. These changes have also led to a review of the stratification and weighting methodologies used for both countries which is also discussed in more detail in the Methodology document. These changes, along with the separation of the England and Wales figures, necessitate a break in the time-series between this and earlier reports; more details are available in the England and Wales chapters. We have recalculated high-level time series figures for England using the new weighting strata and identified relatively little impact on the figures.

However, the effect of the change in methodology for determining dental type has a far greater effect upon Wales’ figures which are based upon a far smaller dental population. As a result, figures are for dentists Wales for 2018/19 and 2019/20 only and comparisons should not be made with results from previous years which are based upon the original methodology.

DWP Survey – Changes in data entry

In previous surveys, questions three and eleven, and questions four and twelve, which ask respondents to estimate the amount of time they spend on clinical activity and NHS/Health Service work respectively, used an on-screen slider for users to select values. Respondents using mobile devices found it difficult to use the slider and advised us that it was an inaccurate means of data collection. As a result, we changed the collection tool this year to capture these numerical values in data entry boxes instead of using the sliding bar, and there is a possibility that this change in the collection has affected the data collected for 2018/19 and 2019/20. Footnotes have been included in affected sections as applicable.

Coronavirus Pandemic

The survey opened on 16 January 2020 and officially closed on 26 February (although the collection remained open until 2 March 2020). As the Coronavirus did not gain widespread coverage (with subsequent lockdown measures) until the second week of March, it is unlikely that answers to the survey were affected by the pandemic.


Last edited: 21 June 2021 3:45 pm