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

Table 1.1 summarises the working hours results by dental and contract type, for England in 2019/20. Results for 2018/19 are shown in the time series section.

Table 1.1: Summary table for working hours analysis by dental and contract type, England, 2019/20

^{Note: Further explanatory notes can be found in the glossary and Methodology section.}

^{The Providing-Performer PDS and mixed GDS/PDS results shown in the table are based on small sample sizes (<100 by count and <75 per cent of group population).}

The main findings for 2019/20 are:

• Overall, dentists (full and part-time) reported working an average of 36.6 hours per week in dentistry in 2019/20, with 26.7 hours (73.0 per cent) devoted to NHS dental services. The remaining dental activity time – 27.0 per cent – was spent on private dentistry.
• On average, Providing-Performer dentists worked more weekly hours (42.4 hours) than Associate dentists, at 34.8 hours. Providing-Performers reported spending 65.4 per cent of their time on NHS dentistry (27.7 weekly NHS hours); for Associate dentists, this measure was 75.9 per cent (26.4 weekly NHS hours).
• Overall, dentists reported that their time spent on dentistry was split into 81.5 per cent on clinical work and 18.5 per cent on non-clinical work. Associate dentists spent more of their dental time on clinical work compared to Providing-Performers at 84.3 per cent compared to 74.1 per cent, respectively.

Tables 1.2 and 1.3 compare the working patterns of dentists according to their NHS/Private share.

Table 1.2: Providing-Performer dentists, summary table of working hours analysis by NHS/Private Share, England, 2019/20

^{Note: Further explanatory notes can be found in the glossary and Methodology section}
Table 1.3: Associate dentists, summary table of working hours analysis by NHS/Private Share, England, 2019/20

^{Note: Further explanatory notes can be found in the glossary and Methodology section}

The results highlight some trends when comparing dentists who spend most of their time on NHS work compared to those who spend more time on private work. Mainly NHS dentists tend to:

• Work longer weekly hours
• Take fewer weeks’ annual leave
• Spend more time on clinical work in the case of Associate dentists

In addition, dentists who spend more time on NHS work tend to be younger compared to those with a higher private share.

Table 1.4 presents responses to the individual motivation questions by dental type with the ‘overall average’ figure showing the average of the individual percentage scores for each response category. Please refer to the Introduction to the motivation and morale section and Annex D in the Methodology section, for more information on how the data is analysed.

Table 1.4: Percentage response (%) to each motivation question by dental type, England, 2019/20

^{Note: Dentists included in the analysis answered every motivation question}

Whilst it can be hard to distinguish trends from rows of figures, it is clear that answers to question (C) ‘I feel my pay is fair’ score lowest in terms of agreement (i.e. ‘strongly agree’ or ‘agree’) for both dental types. Furthermore, over half of all dentists either ‘disagree’ or ‘strongly disagree’ when asked if they felt their pay is fair.

Table 1.5 and figure 1.1 consider the results for ‘Strongly Agree’ and ‘Agree’ combined.

Table 1.5: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, England, 2019/20

^{Note: Difference column is calculated by subtracting Associate results from Providing-Performer results}

Figure 1.1: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, England, 2019/20

The results show some differences in how Providing-Performer and Associate dentists answered individual questions. The greatest difference is found for question (D) ‘I have all the equipment and resources I need to do the job properly’, with 55.7% of Providing-Performers responding ‘strongly agree’ or ‘agree’ compared to 46.0% for Associate dentists. As Providing-Performers have a responsibility to provide the necessary equipment in a practice, it is perhaps understandable that they are more satisfied than Associate dentists.

More than half of dentists of both dental types either ‘strongly agree’ or ‘agree’ with question (E) ‘My job gives me the chance to do challenging and interesting work’ whereas only a fifth said they were happy with their pay (C). Taken overall, the average figures at the bottom of table 1.5 suggest that both groups of dentists had similar levels of motivation.

Figures 1.2a and 1.2b show distribution plots of the average ‘motivation index’ by dental type with the figures in brackets showing the overall average index for each cohort; 51.2% for Providing-Performers and 49.8% for Associate dentists. Please see the Introduction for how the average ‘motivation index’ is calculated.

Figures 1.2a and 1.2b: Distribution plots of average ‘motivation index’ by dental type, England, 2019/20

The distribution of the Associate plot appears more normal than the Providing-Performer plot which exhibits a negative skew for lower motivation columns (<50%) but also a positive skew for the 62.5<75% band, meaning both cohorts of dentists have similar levels of motivation overall, mirroring results from the preceding section.

Motivation band and survey responses

Table 1.6 shows results for each motivation band (described in the Introduction) against the variables of age, weekly hours of work, annual leave, NHS share (%) and clinical work (%).

Table 1.6: Relationship between ‘motivation band’ and variables from the Dental Working Patterns Survey by dental type, England, 2019/20

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

The full-year population counts in table 1.6 show that for both dental types nearly 75% of dentists lie in the central motivation bands (i.e. ‘neutral & low’ or ‘high’) with the remaining dentists either in the most or least motivated bands (i.e. ‘very high or ‘very low’). The results suggest relationships between the motivation bands and some of the measured variables. For example:

• Both groups of dentists appear to show a strong relationship between NHS share and average ‘motivation index’; dentists with a higher ‘motivation index’ do less NHS work compared to those with a lower ‘motivation index’.
• Providing-Performer dentists appear to show a relationship between weekly hours of work, annual leave and the ‘motivation index’; those dentists who work longer hours and take less annual leave report a lower ‘motivation index’ compared to other colleagues.

Such potential relationships are more easily visualised when considered graphically.

Figures 1.3a and 1.3b: Providing-Performer dentists, plot of average working pattern variables by motivation band, England, 2019/20

Figures 1.4a and 1.4b: Associate dentists, plot of average working pattern variables by motivation band, England, 2019/20

^{Note: Error bars for some variables have been omitted to aid interpretation (as they would overlap making the chart more difficult to read). The omitted error bars are the same length as those shown. Please see table 1.6 for source data.}

Figures 1.3a and 1.3b illustrate that for Providing-Performer dentists there appears to be a relationship between their ‘motivation index’ and their average weekly hours of work, their NHS share and the amount of annual leave taken.

Of these three variables, only NHS Share appears to show a relationship for Associates, as seen in figure 1.4a. Clinical work (%) and age seem to have a weaker relationship with the ‘motivation index’. The error bars (displaying 95% confidence intervals) allow estimation of the statistical significance of observed changes.

Table 1.7 shows multiple linear regression results by dental type for the average ‘motivation index’. Variable results that are not statistically significant are in italics in the table.

Table 1.7: Parameter estimates¹ for ‘motivation index’ by dental type using multiple linear regression, England, 2019/20

^{1. Please see Annex E and F of the Methodology for descriptions of parameter estimate and intercept as well as all significance and adjusted R2 values relating to this table.}

The positive or negative values of the variable results indicate the relationship between each variable and the average ‘motivation index’. For both sets of dentists an increase in annual leave correlates with an increase in motivation, whereas increases in weekly hours of work or NHS share (%) have the opposite effect and lower motivation.

This type of analysis allows the individual relationships between each measured variable and the ‘motivation index’ to be assessed. For example, the statistical model predicts that if all other working patterns remained unchanged, but dentists switched from all private to entirely NHS work (from 0% to 100% NHS share) the ‘motivation index’ of Providing-Performers would decrease by 23.2 percentage points and by 20.4 for Associate dentists.

The model also predicts that weekly hours of work have a weaker relationship with the ‘motivation index’ of Associates compared to Providing-Performers. However, over a third of Associate dentists work part-time (<35 weekly hours), which is likely to affect the result and when these dentists are removed from the analysis the coefficient score changes from -0.09 to -0.31. The results suggest that choosing to work part-time actively limits the negative relationship between motivation and weekly hours of work, which may be one reason that some dentists make this work-life choice.

Finally, it is important to note that whilst regression analysis provides evidence for the existence of relationships between variables, it does not provide measures of causality. In other words, although there may well be a relationship between, for example, weekly hours of work and motivation, it is not possible to determine if longer working hours demotivate staff or whether demotivated staff tend to work longer hours.

Table 1.8 compares multivariate results for the average ‘motivation index’ for Providing-Performer and Associate dentists. The first rows (‘All’) repeat results from table 1.7, with the subsequent rows showing results for different cohorts of dentists. Variable results that are not statistically significant are in italics in each table.

Table 1.8: Parameter estimates¹ for ‘motivation index’ by split populations using multiple linear regression by dental type, England, 2019/20

^{1. Please see Annex E and F of the Methodology for descriptions of parameter estimate and intercept as well as all significance and adjusted R2 values relating to this table, respectively.   2. ‘Mainly NHS’ and ‘Mainly Private’ percentages will not sum to 100% due to the omission of the ‘Mixed’ NHS/Private cohort.}

There are some interesting results when dentists are split into different cohorts. For example, both Providing-Performer and Associate dentists who work full-time (≥35 hours) exhibit a statistically significant negative relationship between ‘motivation index’ and weekly hours of work, whilst their part-time colleagues (<35 hours) do not. This is also the case for male compared to female dentists, with the former showing a negative relationship between motivation and weekly hours. However, the fact that female dentists tend to work fewer weekly hours on average (43.4 compared to 39.9 hours[1]) may have an effect.

It is also noticeable, that unlike any other variable, NHS share (%) exhibits a statistically significant and negative relationship with ‘motivation index’ for all cohorts of dentists.

Table 1.9 and figure 1.5 show how dentists answered question (H) ‘How would you rate your morale as a dentist?’. 

Table 1.9: Level of self-reported morale (%) by dental type, England, 2019/20

Figure 1.5: Level of self-reported morale (%) by dental type, England, 2019/20

^{Note: Please see table 1.9 for source data}

Figure 1.5 shows that Associate dentists report higher levels of morale compared to Providing-Performers with 25.6% choosing ‘very high’ or ‘high’ morale compared to 20.7%. Furthermore, 56.0% of Providing-Performers report their morale as either ‘low’ or ‘very low’ compared to 46.3% for Associates. These results are in contrast with earlier sections that show Providing-Performer and Associate dentists with similar levels of motivation and may reflect increased levels of responsibility that Provider-Performers face when running their practices.

2012/13 to 2019/20 Time Series, Motivation and Morale shows how the morale and motivation of dentists have changed since these measures were first collected in the Dental Working Patterns Survey.