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

Table 4.1 summarises the working hours results by dental and contract type, for Wales in 2019/20. Results for 2018/19 are shown in the time series section in Results Across the UK section. 

Table 4.1: Summary table for working hours analysis by dental type, Wales, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology}

^{The Provider-Performer 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 36.0 hours per week in dentistry in 2019/20, with 26.8 hours (74.3 per cent) devoted to NHS dental services. The remaining dental activity time – 25.7 per cent – was spent on private dentistry.
• On average, Providing-Performer dentists worked more weekly hours (39.3 hours) than Associate dentists, at 35.0 hours. Providing-Performers reported spending 64.7 per cent of their time on NHS dentistry (25.5 weekly NHS hours); for Associate dentists, this measure was 77.6 per cent (27.2 weekly NHS hours).
• Overall, dentists reported that their time spent on dentistry was split into 83.2 per cent on clinical work and 16.8 per cent on non-clinical work. Associate dentists spent more of their dental time on clinical work compared to Providing-Performers at 85.3 per cent compared to 77.2 per cent.

Tables 4.2 and 4.3 compare the working patterns of dentists according to their NHS/Private share. 

Table 4.2: Providing-Performer dentists, summary table of working hours analysis by NHS/Private Share, Wales, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology}

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

Table 4.3: Associate dentists, summary table of working hours analysis by NHS/Private Share, Wales, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology}

^{The ‘mainly private’ and ‘mixed’ results shown in the table are based on small sample sizes (<100 by count and <75 per cent of group population).}

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 (for Principal dentists)

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

Table 4.4 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 Motivation and Morale Analysis section in the Introduction towards the start of the report and Annex D in the Methodology, for more information on how the data is analysed.

Table 4.4: Percentage response (%) to each motivation question by dental type, Wales, 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, with half of both Providing-Performer and Associate dentists disagreeing or strongly disagreeing when asked if they feel their pay is fair.

Table 4.5 and figure 4.1 consider the results for ‘Strongly Agree’ and ‘Agree’ combined.

Table 4.5: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Wales, 2019/20

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

Figure 4.1: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Wales, 2019/20

^{Please see table 4.5 for source data.}

Figure 4.1 shows that Associate dentists respond more positively to most questions compared to Providing-Performers, meaning they have a higher ‘overall average’ score as shown in table 4.5. The biggest difference is found for question (F) ‘There are opportunities for me to progress in my career’, with over 40% of Associates reporting they ‘strongly agree’ or ‘agree’ with the question compared to 23.5% of Providing-Performers.

Nearly a half of all dentists either ‘strongly agree’ or ‘agree’ with question (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’. In contrast, only a quarter of Associates and less than a fifth of Providing-Performers said they were happy with their pay (C).

Figures 4.2a and 4.2b show distribution plots of average ‘motivation index’ by dental type with the figures in brackets showing the overall average score for each cohort; 46.1% for Providing-Performer dentists and 49.9% for Associates. Please see the Introduction for how the average ‘motivation index’ is calculated. 

Figures 4.2a and 4.2b: Distribution plots of average ‘motivation index’ by dental type, Wales, 2019/20

Both plots exhibit negative skews towards the lower motivation bands, which is more pronounced for Providing-Performer dentists. The overall effect is a lower average ‘motivation index’ for these dentists when compared to Associates, mirroring results in the preceding section (i.e. table 4.5).

Table 4.6 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 4.6: Relationship between ‘motivation band’ and different variables from Dental Working Patterns survey by dental type, Wales, 2019/20

^{Note: Some of results shown in the table are based on small sample sizes (<100 by count and <75 per cent of population).}

^{c: Results have been supressed to ensure anonymity due to small sample size}

^{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 4.6 show that over 70% of both dental types lie between the central motivation bands (i.e. ‘neutral & low’ and ‘high’) with the remaining dentists in either 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.

• Both groups of dentists appear to exhibit a relationship between NHS share and average ‘motivation index’; those with a higher ‘motivation index’ do less Health Service work compared to those with a lower ‘motivation index’.
• Likewise, there appears to be possible relationships between weekly hours worked and clinical share and the average ‘motivation index’ of both sets of dentists.

Such potential relationships are more easily visualised when considered graphically. The error bars (displaying 95% confidence intervals) allow estimation of the statistical significance of observed changes, and the effect of the low sample size is quite apparent in the charts for both Providing-Performers.

Figures 4.3a and 4.3b: Providing-Performer dentists, plot of average working pattern variables by motivation band, Wales, 2019/20

Figure 4.4a and 4.4b: Associate dentists, plot of average working pattern variables by motivation band, Wales, 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 4.6 for source data.}

Figure 4.3a illustrates a possible relationship for Providing-Performer dentists between the ‘motivation index’ and NHS share (%). However, the other variables appear to have weaker relationships with Providing-Performers’ motivation. 

The results for Associates appear to be somewhat clearer, with negative relationships between NHS share and age and the ‘motivation index’ and a positive relationship between clinical share (%).

Table 4.7 shows linear regression results by dental type for the average ‘motivation index’. Variable results that are not statistically significant are in italics in the table. 

Tables 4.7: Parameter estimates¹ for ‘motivation index’ by dental type using multiple linear regression, Wales, 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 results indicate the relationship between each variable and the average ‘motivation index’. For both sets of dentists, increases in the Health Service share correspond with a decrease in 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 Health Service work (from 0% to 100% NHS share) the ‘motivation index’ of Providing-Performer dentists would decrease by 16.5 percentage points and by 24.9 for Associates.

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, whilst there may well be a relationship between NHS commitment (NHS share %) and motivation, it is not possible to determine if a greater Health Service commitment demotivates staff or that demotivated staff tend to gravitate towards NHS as opposed to private work.

Table 4.8 and figure 4.5 show how dentists answered question (H) ‘How would you rate your morale as a dentist?’. 

Table 4.8: Level of self-reported morale (%) by dental type, Wales, 2019/20

Figure 4.5: Level of self-reported morale (%) by dental type, Wales, 2019/20

Figure 4.5 clearly shows that Associate dentists rate their morale more highly than Providing-Performer dentists with 26.4% reporting their morale as either ‘very high’ or ‘high’ compared to 17.3% of Providing-Performers. It is also noticeable that nearly two-thirds (66.0%) Providing-Performers rate their morale as ‘very low’ or ‘low’ (compared to 44.7% of Associates).