Morale and Motivation of Dentists in
the Salaried Primary Dental Care
Service
October 2012
By Henry Edwards and Martin Kemp
British Dental Association
64 Wimpole Street
London W1G 8YS
1
About the BDA
The British Dental Association (BDA) is the professional association for dentists in the UK. It
represents more than 23,000 dentists working in general practice, in community and hospital
settings, in academia and research, and in the armed forces, and includes dental students.
Copyright notice
Copyright © BDA 2012
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means electronic, mechanical, photocopying,
recording or otherwise, without either the permission of the publishers or a license permitting
restricted copying in the United Kingdom issued by the Copyright Licensing Agency Ltd, 90
Tottenham Court Road, London W1P 9HE
i
Contents
List of figures ........................................................................................................................ iii
Abbreviations ........................................................................................................................iv
Summary .............................................................................................................................. 1
1
Introduction ................................................................................................................... 3
2
Research strategy and design ....................................................................................... 4
3
Respondent characteristics ........................................................................................... 8
4
Morale ......................................................................................................................... 14
5
Motivation .................................................................................................................... 20
6
Workload ..................................................................................................................... 31
7
Staffing ........................................................................................................................ 35
Appendix I - Questionnaire .................................................................................................. 40
Appendix II – Invitation Email .............................................................................................. 44
Bibliography ........................................................................................................................ 45
ii
List of tables
Table 2.1 Survey population.................................................................................................. 5
Table 2.2 Outcome of Salaried Morale Survey ...................................................................... 6
Table 3.1 Profile of survey respondents ................................................................................ 8
Table 3.2 Survey characteristics compared with survey population ....................................... 9
Table 3.3 Profile of respondent salary grade ....................................................................... 12
Table 4.1 Level of self-reported morale by salary grade country and years in service ......... 14
Table 4.2 most commonly cited issues impacting negatively on morale in the SPDCS ....... 15
Table 5.1 Motivation: How far do participants agree or disagree with the following
statements? ........................................................................................................................ 21
Table 5.2 Motivation: How far do participants agree or disagree with the following
statements? ........................................................................................................................ 22
Table 5.3 Motivation: How far do participants agree or disagree with the following
statements? ........................................................................................................................ 24
Table 5.4 Motivation: How far do participants agree or disagree with the following
statements? ........................................................................................................................ 26
Table 5.5 Motivation: How far do participants agree or disagree with the following
statements? ........................................................................................................................ 28
Table 5.6 Proportion of dentists that would recommend dentistry as a career ..................... 30
Table 6.1 Proportion of participants with an excessive caseload ......................................... 31
Table 6.2 Proportion of respondents who believe that their excessive caseloads puts
pressure their clinical standards .......................................................................................... 32
Table 6.3 Proportion of respondents who believe that their excessive caseload causes an
inability for them to see patients as frequently as clinically necessary ................................. 33
Table 6.4 Proportion of respondents who believe that they are not given sufficient time in
appointments to complete the treatment necessary ............................................................ 34
Table 7.1 Proportion of respondents who consider their service as currently understaffed .. 35
Table 7.2 Top ten effects of understaffing on respondents and their service ....................... 36
List of figures
Figure 3.1 Distribution of age and sex of the respondents ................................................... 10
Figure 3.2 Distribution of age and sex of the workforce taken from BDA database (CARE) 11
Figure 3.3 Proportion of male and female respondents in each salary grade ...................... 13
Figure 5.1 Proportion of respondents that agreed or strongly agreed with the factors of
motivation ........................................................................................................................... 23
Figure 5.2 Proportion of respondents that agreed or strongly agreed with the factors of
motivation ........................................................................................................................... 25
Figure 5.3 Proportion of respondents that agreed or strongly agreed with the factors of
motivation ........................................................................................................................... 27
Figure 5.4 Proportion of respondents that agreed or strongly agreed with the factors of
motivation ........................................................................................................................... 29
iii
Abbreviations
BDA – British Dental Association
CDS – Community Dental Service
CQC – Care Quality Commission
DCP - Dental Care Professional
GDC – General Dental Council
GDS – General Dental Services
LHB – Local Health Board
NHS – National Health Service
HS – Health Service
PCT – Primary Care Trust
SPDCS – Salaried Primary Dental Care Service
SDC – Salaried Dentists Committee
UDA – Unit of Dental Activity
iv
Summary
This report provides the findings from a survey of salaried dentists carried out by the British
Dental Association (BDA) to assess morale and motivation of dentists in the Salaried
Primary Dental Care Service (SPDCS) in the UK.
The survey was carried out in the summer of 2012 with dentists in the salaried services who
are current members of the BDA. The survey sought to investigate the following areas:



Levels of morale in the service;
Levels of motivation in the service;
Impact of understaffing in the service.
Fieldwork for this survey took place between 20st July and 8th August 2012 via a paper
survey. The survey population included all dentists working in SPDCS who were members of
the BDA and for whom the BDA had current and reliable information.
Of the 1,264 individuals who were invited to participate, a total of 415 participants
responded. This gave us a response rate of 33 per cent. Findings from the survey fell into
four main areas:
About the respondents and their practices







Three-quarters (74.1 per cent) of respondents were based in England;
Over two-thirds (69.1 per cent) of respondents were female;
Just over half (52.3 per cent) of respondents are over the age of 50;
The majority (77.9 per cent) of respondents were based in an urban location;
Over a third of respondents were employed in Band A positions, and a similar proportion
worked in Band B positions;
More than two in five (44.8 per cent) respondents had been working in the service for
more than 20 years, at an average of 18 years;
Three in five (60.3 per cent) respondents had been at their current grade for ten years or
fewer years, with an average of 11 years.
Dentists’ morale




More than half (52.7 per cent) of respondents reported that their morale was low or very
low;
Those in Band C Managerial roles were less likely to report low or very low in
comparison with those in more clinical roles;
Three in ten (30.4 per cent) respondents who had been working in the SPDCS for less
the ten years reported high or very high morale. This is in contrast to 13.7 per cent those
who have been working in the SPDCS for 10 years or more;
Participants were asked what is having a negative impact on their morale. Participants
most commonly cited inadequate staffing levels in their service and that there is an
inability or unwillingness to fill empty positions as the issues which were impacting on
their morale;
1

Dissatisfaction with management was frequently noted among participants as an
influence on their morale. One of the main complaints regarding the managers in the
service was their general lack of understanding of the service, as well as their
unwillingness to consult or take advice from clinical staff.
Motivation







Over 40 per cent of participants did not consider their pay fair and a third were not
satisfied with the terms and conditions of their employment;
Only one in five (20.8 per cent) salaried dentists felt there were opportunities to progress
their career in their service; while more than half (53.0 per cent) did not believe that this
was true;
A third (33.7 per cent) of salaried dentists felt that they receive recognition for the work
that they do, this is compared to 39.6 per cent who felt they do not;
Less than half (48.7 per cent) of salaried dentists felt that their supervisor was doing a
good job;
A third (33.8 per cent) of salaried dentists felt secure in their job; under a quarter (23.6
per cent) of participants with a Band A job role felt secure about their job, in comparison
with 43.5 per cent of those in Band C Managerial posts;
Three in five participants (61.0 per cent) considered the staffing levels inadequate with
only a quarter (25.6 per cent) stated that they have sufficient staff in their service;
Two in five salaried dentists (41.0 per cent) often think about leaving the salaried
services. Only a third (33.0 per cent) would recommend a career in the salaried services.
Workload




Almost half of participants (46.8 per cent) believe their current caseload is excessive;
The majority of participants (76.7 per cent) felt they were unable to see patients as
frequently as clinically necessary due to their excessive caseload;
A third of participants (38.1 per cent) felt they were under pressure to cut clinical
standards because of their excessive caseload;
Half of participants (51.3 per cent) felt that they are not given sufficient time in
appointments to complete all the necessary treatment.
Understaffing




Almost three quarters of participants felt that their service was currently understaffed;
Participants stated that the main impact of the understaffing in the service has been on
patient waiting times and lists. Some participants commented that this has led to
increase pressure on staff and an increase in patient complaints;
Many participants felt that the current levels of staffing were threatening the quality of
care patients receive;
Participants have seen an increase in stress levels and stress related illness among staff
because of inadequate staffing levels.
2
1 Introduction
This report provides the findings from a research project carried out by the British Dental
Association (BDA) to investigate the levels of morale and the factors influencing motivation
on the Salaried Primary Dental Care Service (SPDCS) across the UK.
The Doctor and Dentists Review Body (DDRB) is an independent body appointed to review
evidence and make recommendations to Government in regards to the remuneration of
doctors and dentists. The review body consider the following when making their
recommendations:





The need to recruit, retain and motivate doctors and dentists;
Regional/local variations in labour markets and their effects on the recruitment and
retentions of doctors and dentists;
The health departments output targets for the delivery of services as set out by the
government;
The funds available to the health departments as set out in the governments Expenditure
Limits;
The government’s inflation target.
The BDA presents written and oral evidence to the DDRB to help it keep up to date on
recruitment, retention, motivation and changes in practice expenses in dentistry. Evidence is
submitted on behalf of dentists in England, Scotland, Wales and Northern Ireland in general
dental practice, the salaried primary dental care services.
We have submitted evidence to the 2013/14 DDRB on the following:



The morale and motivation of dentist in the UK;
Recruitment and retention of the dental workforce;
Financial circumstances of dentists.
The central aim of this research was to gather information from salaried dentists on morale
and motivation in the profession. A mixed-method research design was used, consisting of:
a survey of 1,565 members of the BDA who work in the SPDCS.
This report presents a detailed account of the findings from a UK wide survey of dentists in
the SPDCS which took place in July and August 2012. This first section introduces the
report. Section 2 gives an account of the research and survey design and the datacollection. Sections 3 to 7 give a detailed account of key findings from this survey.
3
2 Research strategy and design
This section gives an overview of the research strategy and design underpinning the BDA‟s
salaried morale and motivation research.
2.1 Aims and objectives
The overall aim of the research was to examine and explore morale and motivation among
dentists in the salaried services in the UK. The research sought to:


Estimate current and changing levels of morale and motivation among SPDCS dentists;
Assess the factors which affect motivation.
Our research sought to answer the following research questions:



What are current levels of morale and motivation among dentists?
What is currently having an impact on the morale of dentists?
Is the salaried service currently understaffed? If so, what is the effect of understaffing in
the service?
2.2 Research design
A survey research strategy was used to investigate these questions. The research consisted
of a large scale national survey of SPDCS BDA member dentists. An online mode of
administration, in the form of SurveyMonkey1, was used to conduct the survey. An online
mode of administration for the questionnaire was chosen because of its advantages in terms
of cost and time.
2.2.1 Population of interest
The population included all dentists in the salaried services across all four UK countries:
England, Scotland, Wales, and Northern Ireland.
2.2.2 Survey population
The effective survey population included all dentists in the population of interest who were
also members of the BDA and for whom the BDA had current and reliable information.
Respondents were identified using the BDA database, CARE2. The data selected included
age, sex and country of workplace or residence3. All dentists who work within the salaried
services must have an email; therefore we knew that it would not exclude any potential
participants. The following groups were excluded from the survey population:



Members who had previously asked not to be contacted by the BDA;
Those who had opted out of receiving emails from the BDA;
Those who had previously opted out from SurveyMonkey.
1 Survey Monkey is an online tool used for conducting surveys http://www.surveymonkey.com/
2 CARE is a contact management system, used by not-for-profit organisations
3 The address and country information stored for BDA members in CARE can either be a practice or place of
work address, or it can be the member‟s home address. We assume in the analyses that follow that in the
majority of cases country location of practice and home address will be identical.
4
Table 2.1 shows the size of each of these groups and the impact on the effective population
size.
Table 2.1 Survey population
Total number of salaried dentists BDA membership in CARE
Of these:
Those who had previously opted out of receiving email from BDA
Those who had opted out of Survey Monkey in past BDA research
Invalid email
Effective size of survey population
N
1348
46
37
1
1,264
2.2.3 Data collection
Fieldwork for this survey took place between 20th July and 8th August 2012. An email was
composed explaining the purpose of the research, its rationale, what participation would
involve, and assuring respondents of confidentiality and anonymity. On 20th July, all dentists
included in the survey population were then sent an email with a link to the online
questionnaire in SurveyMonkey. On 8th August, the survey was closed, at which point the
data were drawn down from the SurveyMonkey website.
2.2.4 Survey schedule
The questionnaire was designed to be administered online based on questions to meet our
overall research objectives. Some of the questions were based on the questionnaire used in
the Salaried Morale survey conducted in 2011 (BDA, 2011). Questions around motivation
were developed after conducting a rapid assessment (UK Government Social research
service, 2010) of the literature4 on motivation, and specifically motivation in a healthcare and
NHS setting. For the purpose of this report, the Morris definition of morale has been used,
where morale is defined as “the state of the spirits of an individual or group as shown in the
willingness to perform assigned tasks” (Morris, 1981). After the factors of motivation were
identified, an individual question for each facet was designed to measure it. Questions were
formed into statements which participants were then asked how well they agreed or
disagreed with.
The final schedule included mixture of closed and open questions that explored the following
themes:



Morale;
Motivation;
Wellbeing.
The questions were refined through consultation with colleagues at the BDA and the Chair of
the Salaried Dentists Committee.
4 See bibliography for key texts identified with relevance to this research.
5
Of the 1,264 individuals who were invited to participate, a total of 415 participants
responded. This gave us a response rate of 33 per cent5, compared to 43 per cent in 2011.
2.2.5 Managing the data
Upon closure of the survey, the data were downloaded from Survey Monkey and imported
into SPSS. Once in SPSS, demographic data stored in CARE were appended to the dataset
using the unique identifier.
An initial cleaning process was undertaken on the data. First, a duplication test was run on
the data to identify any duplicate cases; no duplicate cases were identified. Second, the first
question of the survey was a filter question to ensure all participants worked in the salaried
services; 13 cases were identified not to be working in the salaried services and these were
removed from the dataset. Table 2.2 sets this out schematically.
Table 2.2 Outcome of Salaried Morale Survey
N
Number of those who responded to survey
415
Of these:
Duplicates
0
Those who said that they were not working in the SPDCS
Total valid cases
13
402
There were three open-text variables in the questionnaire. For each variable a coding frame
was developed inductively and responses were recoded according to this scheme.
The questionnaire asked participants to record the grade of their job role. Across each of the
UK countries there are differences between the grades of job roles. To be able to combine
and compare data it was necessary to group the job role into categories. In consultation with
the Chair of the Salaried Dentists Committee these categorisations were assigned. Table 2.3
defines the categories for each job role that has been assigned.
5 Completed at least one item in the online survey
6
Table 2.3 Job grade category
Job Grade
Combined categories
Foundation dentist DF1
Foundation dentist DF2
Band A
Dental Officer
Salaried GDP
Band B
Senior Dental Officer
Senior salaried GDP
Band C Clinical
Associate specialist
Band C Managerial
Clinical Director
Assistant Clinical Director
CADO
Consultant
Other
Foundation dentist DF1/DF2
Band A/ Dental Officer/Salaried GDP
Band B/ Senior Dental Officer/ Senior
salaried GDP
Band C Clinical/ Associate specialist
Band C Managerial/ Clinical Director/
Assistant Clinical Director/ CADO
Consultant
For ease of reporting the combined categories were given simplified label names defined in
Table 2.4.
Table 2.4 Job grade label names
Combined categories
Label name
Band A/ Dental Officer/Salaried GDP
Band A
Band B/ Senior Dental Officer/ Senior salaried GDP
Band B
Band C Clinical/ Associate specialist
Band C Clinical
Band C Managerial/ Clinical Director/ Assistant Clinical Director/ CADO
Band C Managerial
Consultant
Foundation dentist DF1/DF2
Other
Other
7
3 Respondent characteristics
This section provides information on the characteristics of respondents. Table 3.1 and 3.3
show the respondent characteristics.
Table 3.1 Profile of survey respondents
Column %
N
Country
England
Wales
Northern Ireland
Scotland
Total
Missing
74.1
5.8
3.6
16.5
100.0
292
23
14
65
394
8
Sex
Male
Female
Other
Total
Missing
30.1
69.4
0.5
100.0
116
268
2
386
16
Age
<35
35-49
50+
Total
Missing
9.9
37.9
52.2
100.0
39
149
206
394
8
77.9
22.1
100.0
307
87
394
8
Location
Urban
Rural
Total
Missing
Base: All salaried dentists
Table 3.1 shows that about three-quarters (74.1 per cent) of respondents are based in
England. Over two-thirds (69.1 per cent) of respondents were female and more than half
(52.3 per cent) of respondents are over the age of 50. About three-quarters (77.9 per cent)
of respondents are based in an urban location.
It was not possible to compare the survey population with the wider BDA SPDCS
membership on all variables, but we have been able to make a comparison on some key
variables based on data in CARE to assess representativeness. We are able to compare
8
country of residence or work, sex and age. Table 3.2 shows survey data the comparison with
the BDA CARE data.
Table 3.2 Survey characteristics compared with survey population
CARE data
Column %
Country
England
Wales
Northern Ireland
Scotland
Total
Sex
Male
Female
Other
Total
Age
<35
35-49
50+
Total
Survey respondents
Column %
76.0
5.5
3.4
15.1
100
74.1
5.8
3.6
16.5
100
30.2
69.8
100
30.1
69.4
0.5
100
14.2
40.6
45.2
100
9.9
37.9
52.2
100
The first column shows the sample populations (taken from the BDA CARE database), while
the second column shows some key respondent characteristics. The sample population and
the respondents are broadly similar when considering country and sex. However, noticeable
differences are apparent when considering the age of respondents.
A higher proportion of those aged 50 years and over responded to the survey, than present
in the actual population. Similarly, a lower proportion of those under 35 years old responded
to the survey, than present in the actual population. This must be taken into consideration
when interpreting the findings in this report.
Figure 3.1 shows the distribution of age and sex in the SPDCS workforce.
9
Figure 3.1 shows the distribution of age and sex of the respondents, while Figure 3.2 shows
the distribution of age and sex of the total population taken from CARE.
Figure 3.1 Distribution of age and sex of the respondents
10
Figure 3.2 Distribution of age and sex of the workforce taken from BDA database
(CARE)
Figure 3.1 and 3.2 illustrates that the SPDCS workforce is predominately female and older.
The figures demonstrates that the workforce is top heavy (i.e. skewed towards an older
workforce), with a small proportion under the age of 40. They also illustrates that the
workforce is predominantly female.
11
Table 3.3 shows further the respondent characteristics.
Table 3.3 Profile of respondent salary grade
Column %
N
Job role
Foundation dentist DF1/DF2
Band A/ Dental Officer/Salaried GDP
Band B/ Senior Dental Officer/ Senior salaried GDP
Band C Clinical/ Associate specialist
Band C Managerial/ Clinical Director/ Assistant Clinical Director/ CADO
Consultant
Other
Total
Missing
1.0
36.5
36.0
5.8
15.2
2.0
3.3
100.0
4
144
142
23
60
8
13
394
8
Years in the SPDCS
<= 5.00
6.00 - 10.00
11.00 - 15.00
16.00 - 20.00
21.00 - 25.00
26.00 - 30.00
31.00 - 35.00
>35
Total
Missing
11.1
19.3
15.5
9.3
14.7
14.7
12.4
3.1
100.0
43
75
60
36
57
57
48
12
388
14
Average number of years in the SPDCS
18
Years in current grade
<= 5.00
6.00 - 10.00
11.00 - 15.00
16.00 - 20.00
21.00 - 25.00
26.00 - 30.00
31.00 - 35.00
>35
Total
Missing
39.2
21.2
14.6
8.2
7.7
3.7
4.2
1.3
100.0
Average number of year at current grade
Base: All Salaried dentists
148
80
55
31
29
14
16
5
378
24
11
12
Over a third of respondents were employed in Band A positions and a similar proportion
were in Band B positions. Over two in five (44.8 per cent) respondents had been working in
the service for more than 20 years, at an average of 18 years. Three in five (60.3 per cent)
respondents had been at their current grade for ten years or less years, with an average of
11 years.
Figure 3.3 shows the proportion of male and female respondents in each salary grade.
Figure 3.3 Proportion of male and female respondents in each salary grade
Salary grade
Figure 3.3 shows the proportion of male and female respondents in each job role. It
illustrates the difference in the sex split in each grade. There is a higher proportion of women
in each grade but, there are differences among the grade. Over four in five Band A positions
were held by women, however, over forty per cent of Band C role were held by men.
13
4 Morale
Respondents were asked to state their level of self-reported morale from very high to very
low. Table 4.1 shows the level of self-reported morale for dentists in the SPDCS.
Table 4.1 Level of self-reported morale by salary grade country and years in service
Row%
Morale
Very
high
High
Neither
low nor
high
Low
Very
low
Total
%
Total
N
Salary grade
Band A
1.4
16.0
22.9
37.5
22.2
100.0
144
Band B
2.1
10.6
34.0
36.2
17.0
100.0
141
0
13.0
30.4
39.1
17.4
100.0
23
Band C Managerial
3.4
27.6
31.0
27.6
10.3
100.0
58
Other
4.2
25.0
33.3
29.2
8.3
100.0
24
Band C Clinical
Missing
12
Years in service
<10 years
4.9
25.5
29.4
30.4
9.8
100.0
102
10-19 years
1.0
10.5
29.5
35.2
23.8
100.0
105
20+ years
1.1
14.0
29.2
37.1
18.5
100.0
178
Missing
UK
17
2.0
16.1
29.2
35.0
17.7
100.0
391*
Base: All salaried dentists
Missing: *11
Table 4.1 shows that more than half (52.7 per cent) of respondents reported that their
morale was low or very low. There was some variation dependent on the grade of the
participant‟s job and the number of years they have worked in the SPDCS.
Those in Band C Managerial roles were less likely to report low or very low morale in
comparison with those in more clinical roles. There was a gradient effect present from Band
A to Band C Managerial, showing that those in lower salary grades were more likely to have
very low morale.
Three in ten (N=31) respondents who had been working in the SPDCS for less the ten years
reported high or very high morale. This is in contrast to 13.7 per cent (N=39) those who have
been working in the SPDCS for 10 years or more.
14
Participants were asked to write about the factors that are having a negative impact on their
morale. A coding framework was developed inductively to demonstrate the main factors
participants claim are having an effect on their morale.
Participants reported a wide variety of issues which were affecting them, but a few key
themes emerged. Table 4.2 shows the most commonly cited issues which participants stated
were affecting their morale.
Table 4.2 most commonly cited issues impacting negatively on morale in the SPDCS
Most common issues impacting morale
% of cases
Inadequate staffing levels/ recruitment of staff
Poor management/ leadership
Cuts in funding
Uncertain future
High workloads
Unrealistic targets/ target monitoring (UDAs)
Poor career development/ progression
Concerns regarding pensions and retirement
Poor remuneration
Not recognised or valued
No job security/ redundancies threats
No training or study leave allowed
Total N
26.3
26.3
19.1
18.3
17.5
11.9
11.9
11.4
11.1
9.7
9.4
8.9
N
95
95
69
66
63
43
43
41
40
35
34
32
361
Base: All salaried dentists
Missing: 41
Table 4.2 shows that the most commonly cited negative impact on morale was in reference
to staffing; both inadequate staffing levels and an inability or unwillingness to recruit to staff
into vacant positions.
Their concerns about the lack of staffing in the service were not limited to dentists, but dental
nurses, receptions and other support staff. For example, one participant claimed that “The
level of staffing does not meet the service demand”, while another felt that there was a “lack
of staff to provide adequate service”. Some participants said that the level of staff was
inadequate to run the service, but also that it is contributing to increasing pressure on
workloads. For example, one participant said that “shortage of staff, both dentists and
support staff, in the face of an ever-increasing workload” was their main concern. Other
respondents‟ comments included:
“Lack of staff, causing high workloads.”
“Staff vacancies not filled, which increases the work load on those remaining.”
15
The responses suggest that many salaried dentists felt that the problems with low staffing
levels are being exacerbated with problems in recruitment. While some participants
complained of a “freeze on recruitment”, others were concerned with the amount of time it
takes to recruit into vacant positions. For example, one respondent though there was
“insufficient staffing or extremely long time lapse between interview and start date”. Another
noted that there was a “slow recruitment process. Requests to recruit over the past year
have taken 3 to 6 months to get approval. The delay is due to very structured approval
process”. This demonstrates that some participants felt their service has been too slow in
recruiting to vacant positions.
Many participants believed that the frozen or slow recruitment process is having an impact
on the service provided. For example one participant commented that they are having
problems with “recruitment difficulties and a general slowness of the trust to facilitate
recruitment, despite long term vacancies at various clinical grades, is tending to hamper the
everyday clinical role, exacerbating waiting times, which in turn frustrates both clinicians and
patients”. Other participants claimed that:
“[We are required to do] extra work to cover staff absences affecting working in
stressed environments.”
“There is increasing administrative pressure on dentists and nurses alike as we have
no Reception staff to assist with the general running of the clinics.”
This demonstrates that some participants are concerned that frozen or slow recruitment
process is having an impact on the service provided; including waiting times, workloads and
the morale of the remaining staff.
Table 4.2 shows that one in four participants suggested that the management of the service
is another major factor influencing their morale. Dissatisfaction with management was
frequently noted among participants. Respondents had many concerns about the
management of the service and the quality of their managers. Some comments were quite
general, for example, one respondent noted that “managers display no leadership”. Others
said that there is a “complete lack of respect for clinicians among management” and that
there are “too many managers, not enough people to provide service at the coal face”.
However, one of the main concerns about managers in the service was their general lack of
understanding of the service they are managing. Many respondents felt that their manager
had a lack of clinical knowledge and a poor understanding of the salaried service;
specifically the complexity of the patient mix in the service. For example, one respondent
believed that “management who appear to know nothing about the salaried dental service”.
Another stated that “non-clinical management do not understand clinical issues & have
inappropriate viewpoints on patient care”. Others participants echoed this concern stating
that:
“I feel that the management of the service is poor, with too many under-qualified
people who have little understanding of the job we are trying to do, holding senior
management posts.”
16
“Management run as a separate entity from the clinical service by people with limited
experience of the clinical service. There is a split between management and the
clinical service with very little accountability by management.”
“An increase in interference from managers to increase the number of patients seen,
without regard for the complicated patient base accessing the service.”
“Management without dental qualification or experience trying to organise service
without taking advice from the Acting Clinical Director or other dentally qualified
personnel.”
These comments demonstrate the consternation some participants were feeling about the
lack of clinical leadership in their service.
Some participants expressed frustration with the lack of understanding among mangers and
also their unwillingness to consult or take advice from clinical staff. For example, one
participant commented that “dental managers [are] fine but their managers don't understand
dentistry and have no interest in taking advice on the service from clinical staff”. Others
claimed that:
“[There is a] lack of meaningful communication with management.”
“Decisions being taken that affect the dentists, yet no dentist has been involved in the
decision.”
“[There is a] lack of clear leadership. Not being consulted on matters directly
impacting on my work.”
This demonstrates that some participants are concerned with the lack of consultation which
is taking place between management and their clinical colleagues.
A number of participants felt that their managers had the wrong focus in the service. They
felt that managers were less concerned with quality of care that was being provided but
focused on the levels of activity driven by targets and goals.
There was real concern among some respondents that “patient care quality is being sidelined” and that “senior management concentrates on number of „bums on seats‟ rather than
quality of care”. One participant expressed this succinctly when they said “managers are
more interested in targets rather than patient's wellbeing. A shift has been noted of quantity
over quality”. Other participants agreed with this view commenting that:
“The most negative aspect is trying to battle on providing quality care (patients really
appreciate the work we do) - in an environment which is increasingly unsupportive
and seems driven by management goals.”
“Clinical excellence and patient care quality is being side-lined when managerial
decisions are being made regarding the service.”
17
“Managers seem to want to see patients as just "bums on seats" rather than clients
who have special needs who need the appropriate time spent on them in order to
give them the quality care they need.”
This demonstrates how some participants expressed concern about the focus of targets in
the service at the detriment of patients care.
Some participants were concerned with their managers‟ focus on targets, but they also felt
that the targets being imposed were not fit for use given the patient mix experienced in the
service. For example, one participant commented that “a UDA [Unit of Dental Activity] target
system which is completely inappropriate for the CDS [Community Dental Service];
pressures to achieve UDA's means that there is insufficient time to focus on the patient
needs”. Another participant stated that “unrealistic demands with UDA targets that do not
reflect the work I do in any way”. Others concurred with this assessment commenting that:
“UDA type contracts not applicable to Special care, but used by commissioners”
“Pressure to achieve UDA's in a patient group which this system simply does not
work for.”
“UDA targets which are difficult to achieve when working in compromised
circumstances.”
“Having to meet unrealistic uda targets whilst treating special needs patients.”
“Target driven which is having impact on patient care.”
These comments demonstrate the deep concerns of some participants that activity based
targets that are used in the general dental service (GDS) are not appropriate for the SPDCS.
Table 4.2 shows that almost one in five participants commented that uncertainty which they
are facing in the service was impacting on their morale. Some participants stated that they
were concerned about the future of the NHS and the salaried service. For example,
participants stated that:
“For me, certainly the most important issue is the uncertainty about the future of
SPDCS in the United Kingdom.”
“There is uncertainty as to what the future holds for this service.”
“Uncertainty about the shape of our service in the future.”
“The uncertainty for the future of our service. Clinics are threatened with closure, but
no timescale given.”
“Uncertainty about future remit of SPDCS and funding and increased involvement of
LA within health.”
18
“Uncertainty after 2013 about new commissioning arms.”
Some participants that commented on the uncertainty also commented on their concern over
job security. For example, one participant stated that there is “generally uncertainty in
service as none feels secure about their jobs”. Another participant claimed that they felt
“uncertainty about whether or not we will have jobs next April”.
Some respondents felt a lack of recognition for the work that they do. A few stated that they
felt undervalued by their managers, commissioners and others in the profession. For
example, one participant stated that they had “absolutely no recognition of the difficult role
carried out by the CDS with very limited and diminishing resources”. Other commented that
there was a “lack of respect for the profession within the existing healthcare management”
and a “lack of practical recognition from government of our specialised role”.
The views that have been included above are a summary of the main negative impacts on
morale; however, this account is not exhaustive as table 4.2 shows .Participants also
expressed concerns about the lack of career development available to them; the fact their
pay has not kept pace with the cost of living; and, that they are not recognised for the work
that they do.
19
5 Motivation
Participants were asked questions about various factors of motivation. Table 5.1 shows the
proportion of participants who agree to each construct of motivation.
20
Table 5.1 Motivation: How far do participants agree or disagree with the following statements?
Statements
“The environment I work in is comfortable and safe”
“I get support from my work colleagues”
“My trust/local health board is a good employer”
“My immediate supervisor does a good and efficient
job”
“I feel secure about my job”
“I have all the equipment I need to do my job
properly”
“There are sufficient staff in my service to complete
the required work”
“I feel that my pay is fair”
“I am satisfied with the terms and conditions of my
employment (NHS Pension, annual leave and study
leave)”
“I receive recognition for the work I do”
“There are opportunities for me to progress in my
career”
“There is strong support for training in my
service/trust”
“Managers involve staff in important decisions”
Factors influencing motivation
Strongly Agre
Neutral
Disagree
agree
e
21.3 50.3
14.5
10.4
Strongly
disagree
3.6
Don't
know
0
Total
%
100.0
Total
N
394
Missing
Values
8
20.9
55.7
13.5
6.4
3.3
0.3
100.0
393
9
5.9
32.1
35.4
17.3
8.4
1.0
100.0
393
9
13.7
35.0
21.1
16.8
12.4
1.0
100.0
394
8
8.4
25.4
21.4
27.0
17.0
0.8
100.0
393
9
11.4
38.3
19.5
23.1
7.4
0.3
100.0
394
8
7.1
18.5
12.4
37.1
23.9
1.0
100.0
394
8
6.4
28.3
23.0
24.5
17.1
0.8
100.0
392
10
8.4
36.2
20.4
20.2
13.5
1.3
100.0
392
10
4.6
29.1
26.8
26.8
12.8
0
100.0
392
10
2.8
17.9
24.6
31.5
21.5
1.5
100.0
390
12
7.1
29.6
26.5
23.2
13.0
0.5
100.0
392
10
5.9
14.8
20.2
29.7
28.6
0.8
100.0
391
11
“I have full clinical freedom in my job”
“My job gives me the chance to do challenging and
interesting work”
“I have sufficient time to complete all my work”
9.5
40.0
23.8
19.2
6.9
0.5
100.0
390
12
17.6
55.9
17.1
6.9
2.6
0
100.0
392
10
5.9
27.7
17.4
31.8
16.9
0.3
100.0
390
12
“I often think about leaving the salaried service”
16.0
25.0
19.1
23.7
14.2
2.1
100.0
388
14
7.2
35.5
28.9
16.4
11.8
0.3
100.0
391
11
“I feel good about my job”
Base: All salaried dentists
21
Table 5.2 shows the overall agreement levels for each of the factors of motivation, however,
some variation exists across difference characteristics of the participant. Across many of the
factors of motivation some variation exists by participant‟s job role and the number of years
in service. Tables 5.2 to 5.5 show the proportion of those that strongly agree and agree
(combined) by their job role and NHS commitment.
Table 5.2 Motivation: How far do participants agree or disagree with the following
statements?
% that agree or strongly agree
Grade of job role
UK
Band A
Band B
Band C
Clinical
Band C
Managerial
Other
“I feel that my pay is fair”
34.7
25.2
33.3
52.2
50.8
40.0
“I am satisfied with the terms
and conditions of my
employment”
44.6
34.0
43.3
54.5
62.7
60.0
“My trust/local health board is
a good employer”
37.9
35.7
31.7
39.1
49.2
56.0
“My immediate supervisor
does a good and efficient job”
48.7
45.1
40.1
60.9
66.1
64.0
“I feel secure about my job”
33.8
23.6
36.6
43.5
41.4
48.0
Base: All salaried dentists
5.1
Pay
Participants were asked how far they agree with the statement „I feel that my pay is fair‟.
Table 5.2 shows that 34.7 per cent of salaried dentists felt that their pay was fair, compared
to 41.6 per cent that did not consider their pay fair. Figure 5.1 shows that those in Band C
roles were more likely to consider their pay fair with over half of those in Band C roles stating
so. In comparison, only a quarter of those in Band A and one-third of those in Band B
considered their pay fair.
5.2
Terms and conditions
Participants were asked how far they agree with the statement „I am satisfied with the terms
and conditions of my employment‟. Table 5.2 shows that 44.6 per cent of salaried dentists
strongly agreed or agreed with this statement`. Figure 5.1 shows that those in Band C roles
were more likely to be satisfied with the terms and conditions of their employment compared
to those in Band A and B.
22
Figure 5.1 Proportion of respondents that agreed or strongly agreed with the factors
of motivation
5.3
Employer
Participants were asked how far they agree with the statement „My trust or local health board
is a good employer„. Table 5.2 shows that only 37.9 per cent of salaried dentists strongly
agreed or agreed with this statement. Figure 5.1 shows that there is some variation between
by the grade of the participant‟s job role. For example, almost half of those in Band C
Managerial roles felt that their trusts/local health board were a good employer; compared to
only 31.7 per cent of Band B roles.
5.4
Management
Participants were asked how far they agree with the statement „My immediate supervisor
does a good and efficient job‟. Table 5.2 shows that almost half of salaried dentists felt that
their supervisor was doing a good job. The table shows that this proportion was higher for
those in those in Band C roles, especially Band C managerial where two-thirds stated that
their supervisors was doing a good job. Only two in five participants in Band B roles stated
that their supervisor was doing a good job.
5.5
Job security
Participants were asked how far they agree with the statement „I feel secure about my job‟.
Table 5.2 shows that a third of salaried dentists felt secure in their job, while 44 per cent did
not. Figure 5.1 shows that there is some variation by grade of their job. Just under a quarter
of participants with a Band A job role felt secure about their job, in comparison with 43.5 per
cent of those in Band C Managerial posts.
23
Table 5.3 Motivation: How far do participants agree or disagree with the following
statements?
% that agree or strongly agree
Grade of job role
UK
Band A
Band B
Band C
Clinical
Band C
Managerial
Other
“I have all the equipment I
need to do my job properly”
49.7
43.1
45.8
60.9
67.8
56.0
“There are sufficient staff in
my service to complete the
required work”
25.6
23.6
20.4
39.1
33.9
32.0
“The environment I work in is
comfortable and safe”
71.6
68.8
67.6
73.9
81.4
84.0
“I get support from my work
colleagues”
76.6
68.5
77.5
82.6
81.4
100.0
Base: All salaried dentists
5.6
Equipment
Participants were asked how far they agree with the statement „I have all the equipment I
need to do my job properly‟. Table 5.3 shows that almost a half of salaried dentists strongly
agreed or agreed with this statement. There is some variation between job grades; Figure
5.2 shows that those in Band C roles were more likely to consider the equipment at their
disposal sufficient in comparison to those in Band A and Band B.
5.7
Staff levels
Participants were asked how far they agree with the statement „There is sufficient staff in my
practice to complete the required work‟. Three in five participants considered the staffing
levels inadequate with only a quarter stating that there they have sufficient staff in their
service. Figure 5.2 shows that participants in Band B roles were the least likely to consider
the staffing levels in their service sufficient, and those in Band C Clinical roles were the most
likely.
24
Figure 5.2 Proportion of respondents that agreed or strongly agreed with the factors
of motivation
5.8
Environment
Participants were asked how far they agree with the statement „the environment I work in is
comfortable and safe„. Table 5.3 shows that the majority (71.6 per cent) of salaried dentists
are happy with the environment that they work in. There is some variation between job roles;
Figure 5.2 shows that those in Band C roles were more likely to consider their environment
is safe in comparison to those in Band A and Band B.
5.9
Colleagues
Participants were asked how far they agree with the statement „I get support from my work
colleagues‟. Table 5.3 shows that over three-quarters of salaried dentists are happy with the
support they receive from their colleagues, however, there is some variation by the
participants grade of job (Figure 5.2). More than four in five participants in Band C (Clinical
82.6 per cent; Managerial 81.4 per cent) stated they get support from their colleagues
compared to 77.5 per cent of those in Band B and 68.5 per cent in Band A.
25
Table 5.4 Motivation: How far do participants agree or disagree with the following
statements?
% that agree or strongly agree
Grade of job role
UK
Band A
Band B
Band C
Clinical
Band C
Managerial
Other
“I receive recognition for the
work I do”
33.7
20.3
29.8
47.8
57.6
64.0
“There are opportunities for
me to progress in my career”
20.8
13.3
16.3
26.1
37.9
45.8
“There is strong support for
training in my service/trust”
36.7
27.3
32.6
43.5
61.0
52.0
“Managers involve staff in
important decisions”
20.7
10.5
15.7
21.7
54.2
28.0
“I have full clinical freedom in
my job”
49.5
40.6
44.7
65.2
71.2
60.9
Base: All salaried dentists
5.10 Recognition
Participants were asked how far they agree with the statement „I receive recognition for the
work I do‟. Table 5.4 shows that only a third of salaried dentists feel that they receive
recognition for the work that they do compared to 39.6 per cent who feel they do not. Figure
5.3 shows that there is some variation in the grade of job roles of participants. More than half
of participants in Band C Managerial roles felt recognised for their contributions compared
to one in five of those in Band A roles.
5.11 Opportunities to progress
Participants were asked how far they agree with the statement „There are opportunities for
me to progress in my career‟. Table 5.4 shows that about one in five of salaried dentists felt
there were opportunities to progress; while more than half did not feel that this was true.
Figure 5.3 shows that dentists in Band C positions were more likely to agree with this
statement than participants in Band A and Band B roles. Thirteen per cent of Band A
participants showed that they did not feel that there was opportunity to progress in their
career.
26
Figure 5.3 Proportion of respondents that agreed or strongly agreed with the factors
of motivation
5.12 Opportunities to develop
Participants were asked how far they agree with the statement „There is strong support for
training in my service/trust‟. Table 5.4 shows that over a third of dentists strongly agreed or
agreed with this statement. Figure 5.3 shows that there is variation in the job grade of
participants. For example, 61.0 per cent of those in Band C Managerial roles agreed or
strongly agreed with the statement compared to 27.3 per cent with those in Band A roles.
5.13 Staff Involvement
Participants were asked how far they agree with the statement „The practice involves staff in
important decisions‟. Table 5.4 shows that one in five of dentists strongly agreed or agreed
with this statement. Figure 5.3 shows that there is dramatic variation between salary grades.
Over half of Band C Managerial roles agree or strongly agree with the statement, compared
to just 10.5 per cent of Band A roles.
5.14 Clinical autonomy
Participants were asked how far they agree with the statement „I have full clinical freedom in
my job‟. Table 5.4 shows that half of salaried dentists are happy with the clinical freedom
they have. Figure 5.3 shows that almost three-quarters of Band C Managerial roles agree or
strongly agree with the statement, compared to just 40.6 per cent of Band A roles.
27
Table 5.5 Motivation: How far do participants agree or disagree with the following
statements?
% that agree or strongly agree
Grade of job role
UK
Band A
Band B
Band C
Clinical
Band C
Managerial
Other
“My job gives me the chance
to do challenging and
interesting work”
73.5
60.1
76.6
69.6
91.5
92.0
“I have sufficient time to
complete all my work”
33.6
36.2
32.6
39.1
20.3
48.0
“I feel good about my job”
42.7
33.1
40.4
47.8
62.7
60.0
“I often think about leaving the
salaried service”
41.0
43.0
41.7
43.5
37.9
28.0
Base: All salaried dentists
5.15 Interesting and challenging work
Almost three-quarters of participants agree or strongly agreed with the statement „My job
gives me the chance to do challenging and interesting work‟ (Table 5.5). Almost all of those
in Band C Managerial roles (91.5 per cent) found their work challenging and interesting.
5.16 Sufficient time to complete work
Participants were asked how far they agree with the statement „I have sufficient time to
complete all my work‟. Table 5.5 shows that a third of salaried dentists strongly agreed or
agreed that they sufficient time to complete all their work; while almost half (48.7 per cent)
disagree or strongly disagreed with this statement.
Figure 5.4 shows that while across the salary grades the majority of participants did not feel
that they had sufficient time to complete all of their work. However, those participants in
Band C managerial roles were less likely to agree with the statement compared to those who
work in more clinical roles.
28
Figure 5.4 Proportion of respondents that agreed or strongly agreed with the factors
of motivation
5.17 Attitude towards their job
Participants were asked how far they agree with the statement „I feel good about my job‟.
Table 5.5 shows that 42.7 per cent of salaried dentists strongly agreed or agreed with this
statement. Figure 5.4 shows that one third of Band A dentists agreed or strongly agreed with
the statement, compared to just almost 62.7 per cent of Band C managerial dentists.
5.18 Leaving the salaried services
Participants were asked how far they agree with the statement „I often think about leaving
the salaried services‟. Table 5.5 shows that the two in five salaried dentists often think about
leaving the salaried services. There was almost agreement across the salary grades with
43.0 per cent of Band A dentists, and 37.9 per cent of Band C Managerial dentists thinking
about leaving the services.
5.19 Career in the SPDCS
Participants were asked if they would recommend a career in in the salaried services (Table
5.6).
29
Table 5.6 Proportion of dentists that would recommend dentistry as a career
Row %
Recommend a career
Yes
No
Don't know
Total
N
Grade of job role
Band A
26.6
42.0
31.5
100.0
143
Band B
28.6
39.3
32.1
100.0
140
Band C Clinical
18.2
36.4
45.5
100.0
22
Band C Managerial
61.0
25.4
13.6
100.0
59
Other
43.5
21.7
34.8
100.0
23
UK
33.0
37.1
29.9
100.0
388*
Base: All salaried dentists
Missing: *14
Table 5.6 shows that only a third of respondents would recommend a career in the salaried
services. A slightly higher proportion (37.1 per cent) would not recommend a career, and
29.9 per cent did not know. The table shows that there is some variation between by salary
grade.
Those in more clinical roles were less likely to recommend a career in the service compared
to managerial roles. For example, less than one in five Band C Clinical dentists would
recommend a career compared to three in fiver of those in Band C Managerial positions.
30
6 Workload
This section describes the findings of the current workload of respondents. It covers current
caseloads of participants and the impact on dentists‟ work.
6.1 Caseload
Participants were asked if they believed there caseload to be excessive. Table 6.1 show the
proportion of participants who think that there caseload is excessive.
Table 6.1 Proportion of participants with an excessive caseload
Row %
Do you believe that your caseload is excessive?
Yes
No
Don't know
Total
N
Salary grade
Band A
Band B
Band C Clinical
Band C Managerial
Other
40.3
51.8
47.8
55.0
37.5
50.0
39.0
47.8
38.3
62.5
9.7
9.2
4.3
6.7
0.0
100.0
100.0
100.0
100.0
100.0
144
141
23
60
24
Year in the service
<10
10-19
20+
35.0
53.3
51.1
52.4
40.0
42.1
12.6
6.7
6.7
100.0
100.0
100.0
103
105
178
46.8
45.0
8.1
100.0
393*
UK
Base: All salaried dentists
Missing: *9
Table 6.1 shows that almost half of participants believe their current caseload to be
excessive. Participants that have been working in the service for less than ten years were
less likely to consider their caseload excessive, than those who had been working in the
service for more than ten years.
To understand some of the effects of an excessive caseload we asked those who have an
excessive caseload how far they agree or disagree with a series of statements.
First, participants were asked how far they agree with the statement „My excessive caseload
puts pressure on me to cut clinical standards‟ (Table 6.2).
31
Table 6.2 Proportion of respondents who believe that their excessive caseloads puts
pressure their clinical standards
Row %
My excessive caseload puts pressure on me to cut clinical standards
Strongly
Strongly
Agree Neutral Disagree
Total
agree
disagree
Salary grade
15.5
24.1
32.8
22.4
5.2 100.0
Band A
20.8
25.0
15.3
27.8
11.1 100.0
Band B
Band C Clinical
*
*
*
*
* 100.0
11.8
14.7
23.5
47.1
2.9 100.0
Band C Managerial
Other
*
*
*
*
* 100.0
N
58
72
11
34
9
Year in the service
<10
10-19
20+
16.7
16.4
16.3
22.2
23.6
21.7
25.0
23.6
25.0
30.6
29.1
29.3
5.6
7.3
7.6
100.0
100.0
100.0
36
55
92
UK
16.3
22.3
24.5
29.9
7.1
100.0
184
Base: All salaried dentists
Missing: 0
* N too low to report
Participants‟ opinions were split as to whether excessive caseloads put pressure on them to
cut clinical standards. While over a third agreed that they felt they were under pressure to
cut clinical standards because of their caseload, a similar proportion (37.0 per cent, N=68)
felt the opposite.
There was minimal variation between the number of years participants had spent in the
service; however, variation was more apparent by salary grade. For example, almost half of
participants in Band B positions felt under pressure to cut clinical standards compared to
over a third of those in Band C Managerial positions.
Next, participants were asked how far they agree with the statement „Due to my excessive
caseload I am unable to see patients as frequently as clinically necessary‟ (Table 6.3).
32
Table 6.3 Proportion of respondents who believe that their excessive caseload causes
an inability for them to see patients as frequently as clinically necessary
Row %
Due to my excessive caseload I am unable to see patients as frequently as clinically
necessary
Strongly
agree
Agree
Neutral
Disagree
Strongly
disagree
Total
N
Salary grade
Band A
Band B
Band C Clinical
Band C Managerial
Other
32.8
42.5
*
24.2
*
43.1
35.6
*
51.5
*
15.5
15.1
*
3.0
*
8.6
5.5
*
21.2
*
0
1.4
*
0
*
100.0
100.0
100.0
100.0
100.0
58
73
11
33
9
Year in the service
<10
10-19
20+
36.1
35.7
36.3
36.1
30.6
39.3
46.2
41.0
19.4
12.5
9.9
12.6
11.1
12.5
7.7
9.8
2.8
0
0
0.5
100.0
100.0
100.0
100.0
36
56
91
183
UK
35.9
40.8
12.5
10.3
0.5
100.0
184
Base: All salaried dentists
Missing: 0
* N too low to report
Table 6.3 shows that participants‟ opinions were not as divided with this proportion. The
majority (76.7 per cent) of participants felt they were unable to see patients as frequently as
clinically necessary because of their caseload.
Finally, participants were asked how far they agree with the statement „I do not feel that I am
given sufficient time in appointments to complete the treatment necessary‟ (Table 6.4).
33
Table 6.4 Proportion of respondents who believe that they are not given sufficient
time in appointments to complete the treatment necessary
Row %
I do not feel that I am given sufficient time in appointments to complete the treatment
necessary
Strongly
Strongly
Total N
agree
Agree Neutral Disagree disagree
Salary grade
Band A
20.7
31.0
25.9
20.7
1.7 100.0
58
Band B
16.4
43.8
15.1
21.9
2.7 100.0
73
Band C Clinical
11
*
*
*
*
* 100.0
Band C Managerial
8.8
26.5
20.6
44.1
0
100.0
33
Other
9
*
*
*
*
* 100.0
Year in the service
<10
10-19
20+
11.1
17.9
17.4
30.6
32.1
38.0
19.4
28.6
15.2
33.3
21.4
28.3
5.6
0
1.1
100.0
100.0
100.0
36
56
92
UK
16.2
35.1
20.0
27.0
1.6
100.0
184
Base: All salaried dentists
Missing: 0
* N too low to report
Table 7.4 shows that half of participants felt that they are not given sufficient time in
appointments to complete the treatment necessary in their caseload. There was some
variation by salary grade. For example, 60.2 per cent of participants in Band B positions felt
that they are not given sufficient time in appointments to complete the treatment necessary
compared to just over a third of those in Band C Managerial positions.
34
7 Staffing
The Salaried Primary Dental Care Services Morale Survey 20116 identified understaffing in
the service as a major factor that was affecting the morale of dentists in the salaried service.
To gain a greater understanding, dentists were asked about the effects of understaffing.
7.1 Levels of staffing
Table 5.3 showed that three in five participants considered the staffing levels inadequate
with only a quarter stating that they have sufficient staff in their service. Participants were
then asked if they considered their service to be understaffed (Table 7.1).
Table 7.1 Proportion of respondents who consider their service as currently
understaffed
Row%
Service as currently understaffed
Yes
No
Don't know
Total
N
Salary grade
Band A
Band B
Band C Clinical
Band C Managerial
Other
74.3
77.3
73.9
66.7
66.7
19.4
19.1
17.4
31.7
29.2
6.3
3.5
8.7
1.7
4.2
100.0
100.0
100.0
100.0
100.0
144
141
23
60
24
Year in the service
<10
10-19
20+
65.0
76.2
78.1
29.1
20.0
17.4
5.8
3.8
4.5
100.0
100.0
100.0
103
105
178
73.8
21.6
4.6
100.0
393
UK
Base: All salaried dentists
Missing: 9
Table 7.1 shows that almost three quarters of participants felt that their service was currently
understaffed. Band C Managers were less likely to consider their service as understaffed
compared to more clinical roles.
7.2 Impact of understaffing
Participants that considered their service as understaffed were asked what the impact of
understaffing is having on you and the service they work in.
6
BDA 2011Salaried Primary Dental Care Services, Morale Survey 2011
35
Participants wrote about a wide variety of issues which were affecting them, but some key
themes emerged. Table 7.2 shows the most commonly cited issues which participants stated
are the impact of understaffing in their service.
Table 7.2 Top ten effects of understaffing on respondents and their service
Effects of understaffing
% of cases
34.9
21.2
20.1
17.3
16.2
12.2
11.5
9.4
8.3
7.9
Waiting lists / times
Patient care
Stress
Workload
Morale
Admin
Other
Working hours
Increased pressure
Cancelled
N
97
59
56
48
45
34
32
26
23
22
Base: All salaried dentists
Missing: 51
Table 7.2 shows that the most frequently stated impact of understaffing was waiting times
and waiting lists. Over a third of participants stated that they considered this to be one of the
main impacts of understaffing. For example, one participant stated that “there are not
enough special care dentist, which means that patients are waiting a unnecessarily long time
to be seen”. Another participants commented that “patients who should be seen are not
being seen and those that do are waiting excessive times for treatment”. Other respondents‟
comments included:
“I feel that all of these lists are way too long and must impact on the treatment of
patients.”
“[There are] longer wait for appointments which for special care patients is
unacceptable.”
“We have so many patients on our waiting lists and no time to see them in.”
These comments demonstrate some participants‟ concern that understaffing in their service
is causing patients to wait “unacceptable” amounts of time.
Some participants expressed that view the increasing time patients are waiting for treatment
has led to an increase in the number of complaints and increased pressure on staff. For
example, one participant commented that there is “pressure & justifiable complaints from
patients & carers due to long waiting times between appointments”. Other participants
comments agreed with this concern commenting that understaffing resulted in:
36
“Extremely long waiting lists for new referrals and frustration for all staff, from the
reception team upwards, as well as complaints from patients about long waits for
assessment when referred.”
“Long waiting lists which puts pressure on everyone.”
“Patient dissatisfaction and complaints regarding waiting for responses to phone calls
and appointments.”
“Long waiting lists which puts pressure on everyone.”
“Long waiting lists and overbooked appointment books and the stress that leads to.”
These views illustrate that some participants are concerned that the increasing waiting times
is causing increased patient dissatisfaction.
Table 7.2 shows that one in five participants expressed concern that understaffing was
compromising patient care. Some participants commented that due to understaffing patient
care was being threatened. For example, one participant expressed that view that they had
“a feeling that patients are not receiving the high quality service they deserve”. Another
participant commented that the lack of staff can “at times, it can make the effective delivery
of dental care for the patients with special needs difficult.” Other comments that echoed this
concern stated that understaffing caused:
“Patient's treatment is compromised.”
“Special needs patients cannot get the service they need. Only those articulate
enough to complain get what they want. I can't wait to retire.”
“It means that patients that need treatment are not seen.”
“Patients are not getting the service they deserve / need.”
“Patients who have had to wait for treatment are more difficult to treat and disease
levels may have progressed to their disadvantage.”
“We are overstretched clinically, not enough receptionist, jeopardises patient care
and dignity.”
These comments show that a number of participants were concerned that understaffing is
impacting on patient care.
Some participants expressed concern about the increased stress levels due to understaffing.
For example, one participant commented that that “staff are disillusioned and stressed”,
while others said that “everyone is overworked and overstressed”, and “staff are being made
to work harder and thus having more stress”.
Some participants were further concerned that the stress levels are impacting on the health
of employees. A few participants stated that increased stress is leading to increased
absence for ill-health in the service. For example, one participant commented that “there is
an increased level of sickness absence amongst all staff groups for stress related disorders”.
Another participant agreed with this view commenting that “because there is more stress
37
then there is more sickness absence making even more work for those left”. Other
participants echoed this concern commenting that:
“Everyone is suffering from stress, there is a waiting list for our staff counselling
service, a high proportion of our staff have been off work with stress.”
“I feel stressed and anxious much of the time, am too exhausted to enjoy my free
time. In the long term, I wonder what the impact will be for my health.”
“General lowering of morale; more people off with illness due to lowered immune
system caused partly by stress.”
“Because there is more stress then there is more sickness absence making even
more work for those left.”
These comments illustrate that some participants are concerned that understaffing is
causing increased stress levels, which in turn had led to increase in ill-health.
A few participants commented that the decrease in staff numbers has led to an increase in
their workloads. One participant commented that “the number of dentists over the last 10
years has been reduced, while our workload and remit has increased”. Other participants
agreed with this view stating:
“Less dentists have to do more and more work.”
“We have a shortage of dentists working which makes us overloaded in number of
patients we see everyday. We need more dentist to join the service.”
“Constant feeling of running but never catching up, running downhill out of control
knowing at some point you will fall and there will be a catastrophe.”
These comments show that some participants are concerned that understaffing has
impacted on their workloads.
Some participants commented that an increasing workload and decreasing staff levels has
impacted on the working hours of staff, and often led them to work outside of their contracted
hours. One participant commented that “we are squeezing more and more patients in which
means that the admin I am required to do more often gets taken home or I am staying on
late to complete”. Other participants agreed with his view commenting that:
“Staff being asked to work weekends to clear the backlog.”
“Existing staff working unpaid longer hours and working late nights / doing admin at
home in the evenings.”
“Long waiting lists and overbooked appointment books and the stress that leads to.”
These views illustrate that some participants are concerned that their work-life balance is
being affected by the decreasing staff levels.
While this chapter illustrate some of the more common views expressed it is not exhaustive.
Participants also spoke about other impacts of understaffing; for example, the cancellation of
38
clinics and appointments, additional pressure and increase in the working hours they have to
undertake.
39
Appendix I - Questionnaire
Salaried services morale survey 2012
Section A: About you
This section asks you questions about you and your role in the Salaried Primary Dental Care
Service (SPDCS)
1.
In which country are you based?
England
Wales
Northern Ireland
Scotland
2.
How would you describe the location of the SPDCS practice where you spend most of your
time?
Urban
Rural
3.
What is your job role?
Foundation dentist DF1/DF2
Band A/ Dental Officer/ Salaried GDP
Band B/Senior Dental Officer/ Senior salaried GDP
Band C clinical/ Associate specialist
Band C managerial/ Clinical director/assistant clinical director/ CADO
Consultant
Other, please specify
i
4.
How old are you?
<25
25 – 29
30 – 34
35 – 39
40 – 44
45 – 49
50 – 54
55 – 59
60 – 64
65+
5.
What is your gender?
Male
Female
Other
6.
In what year did you join the salaried services?
7.
In what year did you start on your current grade?
40
Section B: Your motivation and morale
In this section asks you questions about factors which motivate you in your profession.
8.
How far do you agree with the following statements?
Strongly agree, Agree, Neutral, Disagree, Strongly disagree, Not applicable
a)
b)
c)
d)
e)
f)
g)
h)
i)
9.
The environment I work in is comfortable and safe
I get support from my work colleagues
My trust/local health board is a good employer
My immediate supervisor does a good and efficient job
I feel secure about my job
I have all the equipment I need to do my job properly
There are sufficient staff in my service to complete the required work
I feel that my pay is fair
I am satisfied with the terms and conditions of my employment (NHS Pension, annual
leave and study leave)
How far do you agree with the following statements?
Strongly agree, Agree, Neutral, Disagree, Strongly disagree
a)
b)
c)
d)
e)
f)
g)
h)
i)
I receive recognition for the work I do
There are opportunities for me to progress in my career
There is strong support for training in my service/trust
Managers involve staff in important decisions
I have full clinical freedom in my job
My job gives me the chance to do challenging and interesting work
I have sufficient time to complete all my work
I often think about leaving the salaried service
I feel good about my job
10.
How would you rate your morale as a dentist at the moment?
Very high
High
Neither low nor high
Low
Very low
11.
Would you recommend a career in the SPDCS?
Yes
No
Don‟t Know
12.
What issues are currently having a negative impact on your morale as a dentist in the
SPDCS?
41
Section C: Well being
We are now going to ask you questions about your overall wellbeing. These questions relate
to your life as a whole rather than your work as a dentist.
13.
Overall, how satisfied are you with your life nowadays?
Not at all
1
14.
5
6
7
8
9
Completely
10
2
3
4
5
6
7
8
9
Completely
10
2
3
4
5
6
7
8
9
Completely
10
6
7
8
9
Completely
10
Overall, how anxious did you feel yesterday?
Not at all
1
17.
4
Overall, how happy did you feel yesterday?
Not at all
1
16.
3
Overall, to what extent do you feel the things you do in your life are worthwhile?
Not at all
1
15.
2
2
3
4
5
Do you believe that your caseload is excessive?
Yes
No
Don’t know
[If yes]
18.
How far do you agree with the following statements:
Strongly agree, Agree, Neutral, Disagree, Strongly disagree
a) My excessive case load puts pressure on me to cut clinical standards
b) Due to my excessive caseload I am unable to see patients as frequently as clinically
necessary.
c) I do not feel that I am given sufficient time in appointments to complete the treatment
necessary
19.
Would you characterise your service as currently understaffed?
Yes
No
Don’t Know
[If yes]
42
20.
What is the impact in the understaffing having on you and the service you work in?
21.
What improvements would you like to see made in the salaried services?
43
Appendix II – Invitation Email
Dear XX,
I am writing to ask for your assistance in completing a short BDA survey about morale in the
Salaried Primary Dental Care Services (SPDCS).
The survey will be used to inform our submission of evidence to the Doctors‟ and Dentists‟
Review Body as well as our more general policy work campaigning on behalf of dentists in
the SPDCS. This year we have also been asked by the Minister to make known to the
Department of Health any evidence of cuts to services or increased pressures on staff
which may impact on patient care.
Any information you provide in the survey will be treated with the upmost confidentiality and
all report information will be depersonalised to ensure anonymity. The survey should take
no longer than 10-15 minutes to complete and can be accessed using this link:
http://www.surveymonkey.com/s.aspx
The survey includes questions about: your morale generally, and your satisfaction with
various elements of your job including your terms and conditions, management, training and
development.
We really appreciate each and every response we receive, as a good response rate is vital
to ensure that the information is valid and representative.
If you took part in last year‟s survey you may be interested to read the report which can be
found using this link: www.bda.org/moralesurvey
All responses received by the 6th August will go in the draw to win a £75 of Marks and
Spencer voucher.
If you are not currently working in SPDCS or do not wish to complete the survey for any
other reason reply to this email with OPT OUT in the subject line and we will make sure you
do not receive any reminder emails.
Many thanks for your co-operation.
Yours sincerely,
Peter Bateman
Chair, Salaried Dental Committee
British Dental Association
44
Bibliography
Bowman G et al.1997. The Morale of the Story Nursing Times June 11;93:24.
British Dental Association. 2011. Salaried Primary Dental Care Service Morale Survey
Available at www.bda.org/moralesurvey
Collins K et al. 2000. Do New Role Contribute to Job Satisfaction and Retention of Staff in
Nursing and Professions allied to medicine? Journal of Nursing Management. 8: 3-12
Finlayson B. 2002. Counting the Smiles: Morale and Motivation in the NHS London, King‟s
Fund
Luzzi L et al. 2005 Job Satisfaction of Registered Dental Practitioners Australian Dental
Journal 2225;50:(3)179-185
Macdonald S. 1997. The Generic Job satisfaction Scale: Scale Development and Its
Correlates Employee Assistance quarterly 13(2)
Morris, J.H and J.D. Sherman.1981. Generalizability of an Organizational Commitment
Model. The Academy of Management Journal, 24, (3), 512-526.
NHS partners. 2005. What Makes a Career as a Salaried Dentist Rewarding?
Totman J et al. 2011. Factors affecting staff morale on inpatient mental health wards in
England: a qualitative investigation BMC Psychiatry 11:68
UK Government Social research service. 2010. Rapid Evidence Assessment tool kit.
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45
British Dental Association
64 Wimpole Street
London W1G 8YS
020 75634563
www.bda.org
46