Impact of change in remuneration system on dentists' job satisfaction

Prior to April 2006 UK dental practitioners working in the National Health Service (NHS) were either paid on a fee-per-item basis (GDS) or on a block contract (PDS) with the Primary Care Trust (PCT). Many dentists also mixed this with providing a service in the private sector. Introduction of a new system of payment involving a block contract based on activity targets has meant a change in remuneration system for all NHS practitioners. Objectives: to investigate the impact of the change in payment system on dentists' job satisfaction.

Methods: A postal questionnaire containing attitudinal statements relating to facets of job satisfaction was completed by 440 practitioners in January 2006. A postal questionnaire was sent to the same dentists using the same scale, in June 2007, over one year after the change in remuneration system had been introduced.

Results: Response rate was 76% (335). Twenty previously fully NHS dentists had moved to work fully with the private sector. Their attitudes towards Factor 1 (restriction in being able to provide quality care) and Factor 3 (control) were significantly more positive (p<0.001 and p<0.05 respectively), compared to baseline. Previously PDS dentists showed more negative attitudes towards Factor 1 (p<0.005), compared to baseline. They also showed more negative attitudes towards Factor 2 (respect), p< 0.001. There were no observed differences in job satisfaction facets of GDS practitioners. There were no observed differences in perceived workload among GDS or PDS practitioners following the changes.

Conclusion: Transfer from a fee-per-item payment system to a block contract with targets gave rise to no observed differences in job satisfaction facets, however practitioners moving from a block contract without targets to a block contract with targets were significantly less satisfied.