Supporting dentists' health and wellbeing - workforce assets under stress: a qualitative study in England

Dental practice workforce challenges in rural England: survey into recruitment and retention in Devon and Cornwall

Introduction Devon and Cornwall have been identified as 'dental deserts' with limited NHS dental access and high levels of oral health inequality. Challenges around recruitment and retention of the dental workforce have been acknowledged as an important contributory factor.Aims The aim of this research was to explore the experiences of dental practices within Devon and Cornwall in relation to recruitment and retention of the dental workforce.Method A self-administered, online questionnaire was used to explore various aspects of workforce recruitment and retention. The questionnaire included categorical rating scale and free-text question formats providing quantitative and qualitative data.Results In total, 106 dental practices responded to the survey, providing a response rate of 36%. The vast majority of respondents (94%) considered recruitment and retention to be a major barrier to delivering NHS services. Additionally, 77% of practices had a current staff vacancy, 57% had a dentist vacancy and 48% had a vacancy for dental nurses. Thematic analysis led to identification of four main themes which were considered to influence recruitment and retention: NHS system; economic challenges; logistics; and support networks.Conclusion A large number of dental practices in Devon and Cornwall are failing to operate at capacity due to workforce shortages, which is affecting access to services in both NHS and private practices. Recruitment and retention of dentists and dental nurses appears to be the most challenging factor, with NHS practices affected more than the private sector.

The dental workforce recruitment and retention crisis in the UK

The precarious state of NHS dentistry is widely acknowledged, yet there is limited progress in addressing the underlying issues. Further delays will undoubtedly impact patient care, leading to oral health deterioration and unnecessary suffering. This will predominantly affect the most vulnerable in society, resulting in greater oral health inequalities.The underlying issues contributing to the current NHS dental crisis are many, and they include: prolonged delays in contract reform; long-term underinvestment; private sector growth; and fewer dentists working full-time and/or in the NHS. In England, an NHS dental contract that fails to promote prevention or equality of access continues to have a deep and pernicious impact on the future of NHS dentistry. The devastating impact of the COVID-19 pandemic on access cannot be underestimated and neither should the effect of Brexit on the availability of workforce.The recruitment and retention of dentists, and other members of the dental team, is undoubtedly a major issue in terms of capacity and access to NHS dental care. These problems, seen across the UK, are a particular issue in England, with acute challenges within rural and coastal areas.There is an urgent necessity to develop coherent, multifaceted strategies, aided by the collection of clear and accurate workforce data, to tackle these issues.

Recruitment and retention in dentistry in the UK: a scoping review to explore the challenges across the UK, with a particular interest in rural and coastal areas

Introduction There is currently reduced access to NHS dental services in the UK, particularly in England, with rural and coastal areas significantly affected. Recruitment and retention in dentistry has been highlighted as an issue contributing to the problem.Objectives To explore what is known or unknown about recruitment and retention of the dental workforce in the UK, with a particular focus on rural and coastal areas. We were keen to gain information relating to factors affecting recruitment and retention, geographical distribution of the workforce, anticipated challenges, strategies or proposals to assist workforce planning and the extent of empirical research.Methods Searches for peer-reviewed literature and reports were undertaken and included when they met the eligibility criteria. Data were extracted and the findings narratively synthesised.Discussion The findings suggested wide ranging recruitment and retention issues of the dental workforce in the UK. Most issues were associated with NHS dentists, followed by dental nurses across both the NHS and private sectors. The worst affected parts of the country were rural and coastal areas.Conclusion It appears from the evidence that there are many dental professionals discussing recruitment and retention issues, followed by stakeholders. However, there is limited research and data to initiate change.

A survey of mental wellbeing and stress among dental therapists and hygienists in South West England

Introduction Mental health and wellbeing of the dental team has been brought into sharp focus during the COVID-19 pandemic. Despite this renewed interest, there has been longstanding issues with poor mental health and wellbeing in the dental profession for some time. While there is some evidence that documents poor mental wellbeing amongst dentists, there appears to be a lack of evidence concerning dental care professionals.Aims To explore the level of mental wellbeing and stress amongst dental hygienists and therapists (DHTs) in South West England.Method An online survey was distributed to DHTs in South West England via two professional networks.Results A total of 129 surveys were completed. The mean levels of reported wellbeing were lower amongst DHTs than the general population and 45% of respondents reported high anxiety levels. Younger respondents reported lower levels of life satisfaction. Plus, 43.5% of dental therapists reported performing solely dental hygiene treatments, with those performing no dental therapy reporting lower happiness levels.Conclusion Low mental wellbeing amongst DHTs in the South West has been identified in this survey and this is likely to impact negatively on the morale and motivation of the workforce, leading to increased levels of absenteeism and ultimately, loss of colleagues from the dental workforce. The stress encountered by DHTs is largely workplace-related and therefore, there is an increased need for team- and organisation-delivered interventions to improve mental wellbeing for this group.

Quality of Life and Satisfaction from Career and Work-Life Integration of Greek Dentists before and during the COVID-19 Pandemic

Quality of life (QoL) of dental professionals is a basic parameter of the quality of dental services (QS), a fact well-documented before and during the COVID-19 pandemic in different countries. This study is a comprehensive, cross-sectional survey aimed to explore possible differences in satisfaction from career and work-life integration, as well as QoL in a sample of Greek dentists during the second lockdown in March 2021. Methods: 804 dentists from the vast metropolitan area of Athens and Piraeus selectively responded by completing a self-reported questionnaire based on: the Copenhagen Questionnaire (CQ) for assessing work stress; the Maslach Burnout Inventory-Human Service Survey (MBI-HSS) for evaluating personal accomplishment; and the Quality-of-Life work scale (ProQOL-CSF). Data were analyzed using the independent t-test, ANOVA, Pearson's correlation, and multiple linear regression. Results: QoL and career satisfaction were significantly diminished during the pandemic. Career satisfaction despite the pandemic was overall influenced in tandem by age (b = 0.427, p = 0.001), marital status (b = 0.276, p = 0.021), and inversely by years of practice (b = -0.330, p = 0.007) and income (b = -0.221, p = 0.015). Satisfaction from the work-life integration was influenced before the pandemic by marital status (b = 0.255 p = 0.013), years of practice (b = -0.371, p = 0.0001), while gender, years of practice, age, higher education, and income played a significant role during the pandemic. QoL was impacted before pandemic by age (b = -1.007, p = 0.001), number of children (b = -1.704, p = 0.018), and higher degree (b = -1.143, p = 0.001), while during the pandemic by gender (b = -0.582, p = 0.002), number of children (b = 0.469, p = 0.037), higher degree (b = 0.279, p = 0.009), and years of practice (b = -0.523, p = 0.0001). Males were more prone to low QoL, and dissatisfaction with career and work-life integration, during the pandemic. Income is a predictor of career satisfaction despite the pandemic. Personal resources through deep human relationships, higher education, beliefs, and values can offer a resilience shield against professional difficulties in periods of unexpected stressful events.

Estimation of Factors Affecting Burnout in Greek Dentists before and during the COVID-19 Pandemic

This study is a comprehensive, cross-sectional survey in occupational burnout, career satisfaction, and quality of life conducted in March 2021 among dentists in the vast area of metropolitan Athens, Greece. Data were collected using a self-reported questionnaire based on the Copenhagen Questionnaire (CQ) for assessing work stress and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS) for evaluating occupational burnout. Using the independent t-test, ANOVA, Pearson’s correlation, and multiple linear regression, 804 valid questionnaires were analyzed. During the pandemic, personal exhaustion was affected by gender (b = 1.862, p = 0.0001), age (b = −0.598, p = 0.0001), number of children (b = −0.886, p = 0.020) and higher degree (b = −0.450, p = 0.012). Exhaustion due to working with patients was affected by gender (b = 0.662 p = 0.0001), age (b = −0.513, p = 0.0001), number of children (b = −0.701, p = 0.0001), higher degree (b = −0.207, p = 0.028) and years in practice (b = 0.408 p = 0.0001). Males were more prone to unhappiness, dissatisfaction, and professional physical and emotional exhaustion, but personal resources through higher education, beliefs, values, and hobbies can offer a preventive shield to all dental professionals. Economic management issues can also enhance dentists’ satisfaction and feeling of safety in a rapidly changing environment.

Uncertainty and Fears Around Sustainability: A Qualitative Exploration of the Emotional Reactions of Dental Practitioners and Dental Care Professionals During COVID-19

INTRODUCTION

Recent cross-sectional surveys have shown the detrimental impact of COVID-19 on the health and well-being of dental practitioners and dental care professionals. This qualitative study complements the growing quantitative evidence base with an in-depth exploration of the lived experiences of those working in primary care dental teams in Scotland.

METHODS

Focus groups were carried out with primary care dental team members and trainees between July and October 2020. Olsen's tripartite framework of health service sustainability was operationalised to explore how participants experienced uncertainty and their attempts to sustain dental services.

RESULTS

Analysis revealed significant concerns surrounding the sustainability of dental services and dental training programmes as a consequence of the emergency level response to the pandemic. Restrictions on dentistry were seen to be severely impeding desirable clinical outcomes, particularly for the most vulnerable groups. Participants experienced being unable to deliver high quality care to their patients as both confusing and distressing. The capability of the dental health care system to meet a growing backlog of dental need and manage this effectively in a pandemic era was called in to serious question. Ongoing uncertainties were affecting how participants were thinking about their professional futures, with stress about income and employment, along with heightened experiences of professional isolation during the pandemic, resulting in some looking at possibilities for retraining or even considering leaving their profession altogether.

DISCUSSION

The impact of the pandemic has produced considerable uncertainty regarding the sustainability of dental services in the medium to longer term. It has also served to expose the uncertainties practitioners grapple with routinely as they attempt to sustain their NHS dental service delivery.

CONCLUSION

This study brings in to sharp focus the diversity of challenges, confusions and uncertainties experienced by dental practitioners and dental care professionals during the COVID-19 pandemic and the need for suitable and ongoing measures to be put in place to support their mental well-being.

Supporting dentists' health and wellbeing - a qualitative study of coping strategies in 'normal times'

Background Research has highlighted multiple determinants of dentists' health and wellbeing, and has raised concerns over workforce morale and retention. Limited research has been undertaken on possible solutions. Thus, the aim was to explore the coping strategies used or advocated by dentists to protect and support their health and wellbeing.Methods This qualitative study involved a purposive sample of dentists working in England taking account of age, gender, career stage, work sector, geographical area, position and route of entry to registration. Dentists were approached via gatekeepers across England to participate in semi-structured interviews. A topic guide, informed by past research, was used to guide the discourse. Informants' views were audio-recorded and field notes were made. Data were transcribed and analysed using an interpretative phenomenological approach to generate theory with the support of the framework methodology.Results Twenty dentists were interviewed from a range of backgrounds. Self-reported coping strategies included a range of strategies for 'taking control', including 'embracing self-care' and 'seeking professional support', while drawing on 'supportive personal and social networks'. Managing professional careers included diversifying through greater 'mixing' of NHS with private work, privatising, specialising, or combining dentistry with another role. Strengthening job security and facilitating diversity of experience remain important for supporting the health and wellbeing of dentists. Selling practices or, in the extreme, completely leaving the profession were considered practical options. At organisational level, building sustainable teams and transforming culture were advocated as important; while at systems level, reforming the NHS and bridging the gap between the profession and regulatory body were considered vital. Additionally, the need for strong professional leadership and wider societal debate was advocated as part of a whole systems approach to enable job satisfaction in delivering high-quality, patient-centred, evidence-based care in future.Conclusion While dentists demonstrated a range of coping mechanisms, multi-level action was advocated to enhance the health, wellbeing and retention of dentists. Systems reform at macro- and meso-levels is urgently advocated to enable fulfilling careers within dentistry, particularly for those at the front line of primary dental care in the public sector. Personal resilience alone will not suffice and recommendations for action are explored to avert a public health catastrophe. This is a time for reflection, debate and action.