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Publication, Part of

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

Potential Causes of Low Morale

The 2018 Dental Working Patterns (DWP) Survey included a new question covering potential causes of low morale and was asked at the end of the survey rather than repeating for each financial year. Please refer to Annex D in the Methodology for a description of how and why this question was developed. This section considers the results by country in 2019/20 before reviewing changes since the last survey. For the sake of simplicity of prose, Providing-Performer dentists in England and Wales are referred to as Principals.

For reference, a list of the potential causes of low morale offered to dentists in the survey is shown in table 8.1.

Table 8.1: Potential causes of low morale in primary care dentists

Issue

1.

Administration and paperwork

2.

Disparity between treatment complexity and financial return1

3.

Inadequate levels of remuneration for preventative care

4.

Increasing expenses and/or declining income2

5.

Risk of litigation and cost of indemnity fees

6.

Regulations3

7.

Recruitment and retention issues4

8.

Other (Please state)5

1. Treatment complexity based on technical (and not patient) factors

2. Pre-tax income (after all expenses removed) for primary care dentistry

3. External regulations (including NHS/Health Service, GDC, practice inspection and decontamination)

4. Dental workforce staff (including other dentists, dental nurses, hygienists, technicians)

5. Please state any other issue(s) that have a detrimental effect on your morale in primary care dentistry.

The proposed potential causes of low morale were identified following extensive research, working in collaboration with the Dental Working Group and including a review of the British Dental Association Business Trends reports. Dentists were asked to rate on a five-point Likert scale the extent to which each of the possible causes had a detrimental effect upon their morale. Options were Major, Moderate, Minor, No effect and Not applicable. 

It was evident from the survey responses that most of the suggested causes were of great concern to dentists. Consequently, results are presented for only the first Likert category – ‘major effect’ – which was generally the most common response.


Results by Country and Dental Type

Table 8.2 and figure 8.1 show the percentage of Principal dentists that chose ‘major effect’ for each of the potential causes of low morale by country. Please note, ‘not applicable’ was considered a valid response and no adjustment was made by removing dentists who responded in this way. The ‘overall average’ figure at the bottom of the table is the average of individual percentage scores for each dental type. 

Table 8.2: Principal dentists, percentage (%) that answered ‘major effect’ for potential causes of low morale by country, 2019/20

Issue England  Northern Ireland Scotland Wales
1. Admin/paperwork 54.7 50.1 51.4 65.1
2. Complexity vs financial return 54.4 55.7 52.0 59.5
3. Preventative care remuneration 51.7 50.5 51.0 49.6
4. Expenses vs Income 71.1 80.5 69.9 60.3
5. Litigation risk/indemnity fees 70.3 55.8 57.6 57.0
6. Regulations 60.3 56.0 46.1 62.8
7. Recruitment and retention 43.7 38.5 30.5 45.6
Overall Average 58.0 55.3 51.2 57.1

 

Figure 8.1: Principal dentists, percentage (%) that answered ‘major effect’ for potential causes of low morale by country, 2019/20

A standout point from the results is how many of the issues adversely affect a large percentage of Principal dentists. Aside from issue (7) ‘recruitment and retention’, almost a half or more of Principal dentists cited all the other issues as having a majorly detrimental effect upon their morale. While this may be expected, since the potential causes were carefully researched, nonetheless the results highlight scale of the issues that are of concern to dentists. 

In terms of the most pressing issues, figure 9.1 shows that the same two areas consistently have a majorly detrimental effect on morale for Principal dentists: 

  • issue (4) ‘increasing expenses and/or declining income’ (60.3% – 80.5%)
  • issue (5) ‘risk of litigation and cost of indemnity fees’ (55.8% – 70.3%

Given that the motivation question (C) ‘I feel my pay is fair’ has the lowest score for Principal dentists across the UK (for example, please see the Motivation and Morale Analysis section), it is unsurprising that issue (4) relating to income is likewise similarly the greatest cause of low morale. However, it is also noteworthy that Principals in Wales do not list issue (4) as their main concern but issue (1) covering administration and paperwork. Interestingly, although these dentists have the lowest motivation compared to other countries, they report the highest satisfaction with pay (albeit still low), which explains some of the results seen here.

Table 8.3 shows the results for Associate dentists.

Table 8.3: Associate dentists, percentage (%) that answered ‘major effect’ for potential causes of low morale by country, 2019/20

Issue England  Northern Ireland Scotland Wales
1. Admin/paperwork 29.9 25.3 29.0 29.2
2. Complexity vs financial return 57.5 58.3 45.5 55.6
3. Preventative care renumeration 46.1 58.4 42.9 43.8
4. Expenses vs Income 55.1 68.9 45.1 51.0
5. Litigation risk/indemnity fees 74.2 79.7 65.7 73.1
6. Regulations 34.9 38.0 33.4 29.6
7. Recruitment and retention 17.8 11.0 11.3 15.6
Overall Average 45.1 48.5 39.0 42.6

Table 8.3 shows that, overall, fewer Associate dentists consider the issues to be a major cause for lowering their morale. This may also be a contributory factor in explaining why Associate dentists have higher levels of morale than Principals (as shown in sections relating to Motivation and Morale Analysis and the 2012/13 to 2019/20 Time Series).

A notable exception to these results is issue (5) ‘risk of litigation and cost of indemnity fees’ which scores more highly for Associates than Principal dentists and is clearly their greatest concern.

 

Figure 8.2: Associate dentists, percentage (%) that answered ‘major effect’ for potential causes of low morale by country, 2019/20

Figure 8.2 also shows that Associates in each country identified the same three issues as having the greatest effect upon lowering their morale:

  • issue (5) ‘risk of litigation and cost of indemnity fees’ (66.1% – 79.7.3%)
  • issue (4) ‘increasing expenses and/or declining income’ (45.1% – 68.9%)
  • issue (2) ‘Disparity between treatment complexity and financial return’ (45.7% – 58.3%)

Except for dentists in Wales, most Principal and Associate dentists identified issues (4) and (5) in their top three potential causes of low morale. However, while issue (6) ‘regulations’ was a concern to Principals it was less so for Associates, which may be expected if Associate dentists have less responsibility in this area than practice owners. Similarly, issue (1) ‘administration and paperwork’ and (7) ‘recruitment and retention issues’ score much lower for Associates compared to Principals, which may also be expected.


Changes since the last survey – 2019/20 compared to 2017/18

In this section, the percentage of dentists that chose ‘major [adverse] effect’ for each of the potential causes of low morale is compared from this and the last survey. Whilst results are shown for dentists in England, please be aware that the changes in methodology since the last survey, discussed in the Introduction, make it harder to assess genuine change in opinion as opposed to the large increase in identified Provider-Performer dentists (and corresponding drop in Associates) as outlined in table 8.1. In line with other chapters showing time series data, results from the last survey for Wales are not included in this section. 

Table 8.4 shows the results for England.

Table 8.4: Percentage of dentists (%) that answered ‘major effect’ for potential cause of low morale by dental type, England, 2017/18 and 2019/20

Issue Providing-Performer   Associate
17/18 19/20 Diff1   17/18 19/20 Diff1
1. Admin/paperwork 58.6 54.7 4.0   32.7 29.9 2.9
2. Complexity vs financial return 52.2 54.4 -2.1   58.2 57.5 0.7
3. Preventative care renumeration 53.2 51.7 1.5   48.7 46.1 2.6
4. Expenses vs Income 70.3 71.1 -0.8   61.2 55.1 6.1
5. Litigation risk/indemnity fees 67.9 70.3 -2.4   78.4 74.2 4.2
6. Regulations 65.8 60.3 5.5   44.6 34.9 9.7
7. Recruitment and retention 31.6 43.7 -12.1   19.9 17.8 2.1
Overall Average 57.1 58.0 -0.9   49.1 45.1 4.0

1. Difference columns are calculated by subtracting 19/20 results from 17/18 results

There are some clues that the results highlight the updated methodology as much as change in opinion for dentists in England. For example, issue (7) ‘Recruitment and retention’ shows a notable increase for Providing-Performers and decrease for Associates. Results from other countries suggest that this issue is far more of a concern for practice owners and as more are now being correctly identified in England, it is no surprise to see such a shift. Likewise, Associate dentists tend to be less concerned about increasing expenses and declining income (issue 4) and their apparent improvement in this score (from 61.2 to 55.1 per cent) would also suggest the identification of dental type in England has improved with the new methodology. 

Table 8.5 shows results for Northern Ireland. 

Table 8.5: Percentage of dentists (%) that answered ‘major effect’ for potential cause of low morale by dental type, Northern Ireland, 2017/18 to 2019/20

Issue Principal   Associate
17/18 19/20 Diff1   17/18 19/20 Diff1
1. Admin/paperwork 57.9 50.1 7.7   26.7 25.3 1.4
2. Complexity vs financial return 57.7 55.7 2.0   57.8 58.3 -0.5
3. Preventative care renumeration 61.1 50.5 10.6   49.4 58.4 -8.9
4. Expenses vs Income 83.3 80.5 2.8   69.1 68.9 0.2
5. Litigation risk/indemnity fees 65.4 55.8 9.6   82.3 79.7 2.6
6. Regulations 73.3 56.0 17.2   38.3 38.0 0.4
7. Recruitment and retention 36.3 38.5 -2.2   11.0 11.0 0.0
Overall Average 62.1 55.3 6.8   47.8 48.5 -0.7

1. Difference columns are calculated by subtracting 19/20 results from 17/18 results

Table 8.5 highlights an improved ‘overall average’ score for Principal dentists in Northern Ireland, suggesting that the issues listed generally had a less damaging effect on their morale. In particular, issue (6) ‘Regulations’ dropped 17.2 percentage points and, together with a drop in issue (1) ‘Administration and paperwork’, supports the increase in clinical work (%) and corresponding drop in administration reported in the Results Across the UK section. 

On the other hand, Associate dentists in Northern Ireland had roughly the same ‘overall average’ score for this survey as they did in the last. This is somewhat surprising given the drop in motivation and morale for this group discussed in earlier sections of this report, but the list of potential causes for low morale is not exhaustive and there may therefore be other contributory factors.

Table 8.6 shows the results for Scotland.

Table 8.6: Percentage of dentists (%) that answered ‘major effect’ for potential cause of low morale by dental type, Scotland, 2017/18 to 2019/20

Issue Principal   Associate
17/18 19/20 Diff1   17/18 19/20 Diff1
1. Admin/paperwork 52.7 51.4 1.3   23.3 29.0 -5.7
2. Complexity vs financial return 58.1 52.0 6.1   49.7 45.5 4.2
3. Preventative care renumeration 48.9 51.0 -2.1   45.3 42.9 2.4
4. Expenses vs Income 80.3 69.9 10.4   50.6 45.1 5.5
5. Litigation risk/indemnity fees 60.1 57.6 2.4   70.1 65.7 4.4
6. Regulations 62.4 46.1 16.3   43.8 33.4 10.3
7. Recruitment and retention 27.2 30.5 -3.4   13.0 11.3 1.7
Overall Average 55.7 51.2 4.4   42.2 39.0 3.3

1. Difference columns are calculated by subtracting 19/20 results from 17/18 results

Both dental groups in Scotland show a decrease in the ‘overall average’ score, which fits with their increased levels of motivation and morale since the last survey. Like results for Principals in Northern Ireland, both groups of dentists in Scotland show a marked improvement in issue (6) ‘Regulations’ compared to the last survey. Answers to issue (4) ‘Increasing expenses and/or declining income’, showed the second highest reduction as a ‘major effect of low morale’ for both groups of dentists and, taken together, these changes provide some clues to the increase in motivation and morale since the last survey.

However, there are some issues that appear to have more of a detrimental effect on dentists in Scotland, most notably issue (1) ‘Administration and paperwork’ for Associates, which scored 5.7 percentage points higher than the last survey. But, overall, this is the only issue to see a negative change for Associates in Scotland, with all others improving. Likewise, Principals in Scotland recorded two issues (3 and 7) that scored higher than the last survey but all other issues showed decreases, meaning they were less of a concern when compared to the last survey.


Summary

When comparing results from this survey to the last one, in Northern Ireland and Scotland at least, the most notable change in how dentists answered the final question on potential causes of low morale, is the reduction in issue (6) ‘Regulations’ for all dentists in Scotland and Principals in Northern Ireland.

Other notable improvements are for issue (4) ‘Increasing expenses and/or declining income’ that is less of a concern for dentists in Scotland and issue (3) ‘Inadequate levels of remuneration for preventative care’ that affects Principals in Northern Ireland to a lesser extent than previously. However, this last issue showed an increase of 8.9 percentage points for Associates in Northern Ireland and it is hard to explain the discrepancy between the two groups of dentists in the same country.


Last edited: 21 June 2021 3:45 pm