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

This chapter compares 2019/20 results between each country detailed in the previous chapters. Comparisons are first made for the (‘strongly agree’ and ‘agree’) motivation results followed by the ‘motivation index’, with the morale results considered at the end of this Chapter. For the sake of simplicity of prose, Providing-Performer dentists in England and Wales are referred to as Principals, matching dentists in the other countries. It is important to note that the contractual arrangements in England and Wales, Scotland and Northern Ireland are different and that this needs to be borne in mind when making comparisons across the countries.

Table 6.1 and figures 6.1 and 6.2 compare results for the individual motivation questions across each country. Results are based on the percentage of dentists who responded ‘strongly agree’ or ‘agree’ to each question and are shown by dental type. 

Table 6.1: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question, dental type and country, 2019/20

Figure 6.1: Percentage of Principal dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and country, 2019/20

Figure 6.2: Percentage of Associate dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and country, 2019/20

The results show some general patterns for both dental groups in each country. For example, all dentists report the lowest scores for question (C) ‘I feel my pay is fair’, whilst question (A) ‘I feel good about my job as a dentist’, (D) ‘I have all the equipment and resources I need to do my job properly’ and (E) ‘My job gives me the chance to do challenging and interesting work’ usually score the highest for most countries.

For every motivation question, Associate dentists in Northern Ireland show a lower percentage score of ‘strongly agree’ or ‘agree’ compared to those in the other countries. This result is also highlighted by the ‘overall average’ motivation score for Associate dentists in table 6.1, which is lowest for all dentists. Overall, Associates in Scotland have the highest motivation with responses to question (D) and (E) notably higher than other countries. The results for Principal dentists are a little different, with those in Northern Ireland and Wales generally scoring lower compared to England and Scotland.

However, when reflecting upon the results it is important to also consider the average working patterns of the dental populations for each country, which are summarised in table 6.2 by dental type.

Table 6.2: Working patterns by dental type and country, 2019/20

^{Note: NHS/HS and clinical (%) do not take account of the weekly hours of work of individual dentists but just the values recorded in the DWP Survey. This methodology differs to that used in Working Hours Results chapters and these figures may differ.}

The results show generally similar working pattern variables between dental cohorts across the countries. There are two exceptions of interest: dentists in Scotland, who are the most highly motivated according to the survey, tend to do more NHS work, which has been shown to have a relationship with lower motivation. On the other hand, Principals in Wales, who have the lowest motivation levels, do less NHS work and work fewer average weekly hours, both of which would usually be expected to correspond with higher levels of motivation.

Such differences alone cannot explain the motivation findings discussed earlier, however, it is also important to consider the relationships between working pattern variables and dentists’ motivation in each country, as explored in the next section.

Figures 6.3a and 6.3b show distribution plots of average ‘motivation index’ by dental type with the figures in brackets showing the overall average score for each country. These are the same plots shown in each country (average ‘motivation index’ chapter) but plotted by line, rather than bar chart, for easier comparison.

Figures 6.3a and 6.3b: Distribution plots of average ‘motivation index’ by dental type and country, 2019/20

The overall average ‘motivation indices’ (shown in brackets) accurately mirror the findings of the percentage scores (of ‘strongly agree’ or ‘agree’) shown in table 6.1. For example, Principal dentists in Scotland are the most motivated, followed by those in England. Likewise, there are quite clear negative skews in the average ‘motivation index’ distributions in Northern Ireland and Wales, which account for index scores below 50% in these countries.

For Associate dentists, the positive skew in Scotland is distinct, meaning dentists in this country have the highest average ‘motivation index’; the negative skew in Northern Ireland is also clear illustrating the lowest score for this cohort.

Table 6.3 compares linear regression results for the average ‘motivation index’ for Principal dentists in each country. Table 6.4 shows the results for Associate dentists. Variable results that are not statistically significant are in italics in the tables.

Table 6.3: Principal dentists, parameter estimates¹ for ‘motivation index’ using multiple linear regression by country, 2019/20

^{1. Please see Annex E of the Methodology for descriptions of parameter estimate and intercept.   Note: Please see Annex F of the Methodology for all significance and adjusted R2 values.}

The results show that Principal dentists in Northern Ireland have a stronger negative relationship between Health Service share (%) and the ‘motivation index’ (‑0.28) than the other countries, which provides one explanation why they have low motivation. The same group also show the largest positive relationship with annual leave but overall, they take the least amount of leave at 3.8 weeks, which may also may adversely affect their motivation.

Principal dentists in Wales have a weaker negative relationship with NHS share (%) and a positive relationship with age both of which might be expected to help improve motivation, however, their ‘intercept’ is low compared to other countries. The ‘intercept’ represents the average value of the ‘motivation index’ when all the working pattern variables are zero (i.e. the dentists do no work) and in this case predicts lower motivation for Principal dentists in Wales. 

Table 6.4: Associate dentists, parameter estimates¹ for ‘motivation index’ using multiple linear regression by country, 2019/20

^{1. Please see Annex E of the Methodology for descriptions of parameter estimate and intercept.  Note: Please see Annex F of the Methodology for all significance and adjusted R2 values.}

Like the results for Principal dentists, results for Associate dentists highlight the fact that those in Northern Ireland have the strongest negative relationship between Health Service share (%) and ‘motivation index’ (‑0.37), as well as the largest negative relationship with age, both of which help explain their lower levels of motivation (even though they also have the highest ‘intercept’).

On the other hand, Associates in Scotland have a lower negative relationship with NHS share (%) and a larger positive relationship with clinical work (%) both of which provide suggest some potential reasons for their higher levels of motivation.

However, it is important to note that these are only model predictions and not certainties. Furthermore, the smaller sample sizes in the Northern Ireland and Wales increase the uncertainty associated with their results and make such modelling less accurate.

By placing the country results together, it is evident that NHS/Health Service share has a strong negative association with the motivation of dentists. This is the only significant parameter for all dentists in all countries, and the scale of the negative relationship between motivation and Health Service work for dentists in Northern Ireland is particularly marked.

This section compares answers to the morale question for each country. Table 6.5 shows the percentage of dentists that responded, ‘very high’ or ‘high’ as well as ‘low’ or ‘very low’ to question (H) ‘How would you rate your morale as a dentist?’. For the sake of simplicity of prose, Providing-Performer dentists in England & Wales are referred to as Principals matching dentists in the other countries.

Table 6.5: How dentists (%) answered the morale question by dental type and country, 2019/20

A fifth or less of Principal dentists across the UK consider their morale to be high; for Associates, who usually score more highly than Principals, this figure is less than a third. The percentage of Principal and Associate dentists in Northern Ireland reporting high morale was markedly lower than in the other countries. In terms of low morale, over a half of all Principals across the UK selected ‘very low’ or ‘low’ when answering the question.

This pattern of low morale in all countries prompted the development of a new survey question in 2018 on its potential causes, which was repeated for the latest survey. Responses are presented in Potential Causes of Low Morale section.