A total of 13 free-text responses were received from dental practice managers and receptionists: three from England; three from Northern Ireland; four from Scotland and three from Wales. Responses from other professional groups, which explicitly referenced administrative staff, were also included for analysis: two dentists (one in England, one in Scotland) and two dental care professionals (one in England, one in Scotland). Analysis identified three main themes contributing to occupational stress. While these themes ought not to be considered as representative of the full sample of 130 respondents, considering the issue identified around lack of voice for this occupational group, it is important to allow space for experiences to be shared.

Increasing pressures on staff

Dental practice managers and receptionists are experiencing various pressures, many of which are attributed to the impact of the COVID-19 pandemic on the provision of dental services and subsequent crisis within NHS dentistry. As pressures around access and demand have increased, all members of the dental team have felt the impact, including reception staff:

‘Patient numbers and demand are much higher than dentists are now able to cope with and it's affecting all levels of staff from reception to surgery' (dental care professional, GDS independent, Scotland).

Difficulties created by the COVID-19 backlog were emphasised, as well as pressure on already stretched services from patients not being seen by their registered dentist. A respondent in England pointed to relentlessness in work intensity, with there having ‘not really been a lull in the business of [the] workplace' since COVID-19. Another respondent, in Wales, described the stress and workload on the team as ‘extreme'.

Respondents expressed concern about their practices being unable to fill dentist vacancies, which placed additional strain on capacity, at a time when demand was so high. Challenges with NHS recruitment and retention were viewed as largely due to frustration at NHS terms and conditions. Information overload in terms of governance making ‘it difficult to switch off' was also a complaint, as was the amount of legislation to deal with at management level. For one respondent in the public dental service, in Scotland, the daily pressures were no longer personally sustainable:

‘I am totally burned out at work at the moment and every day seems to be getting worse. Is it going to get any better? I feel that we can't continue with this pressure for much longer' (practice manager/receptionist, CDS/PDS, Scotland).

Managing relationships

Relationships with patients are described as having become increasingly difficult since the pandemic, with one respondent in Wales describing patient attitudes as ‘disgusting'. Several respondents recounted experiences of patients taking out their frustrations on members of the reception team:

‘The backlog still from COVID means lists aren't being cleared and patients take out their anger over lack of appointments on the reception staff' (practice manager/receptionist, GDS independent, Northern Ireland).

Both ‘irregular' and ‘loyal' patients were highlighted as problematic. The former as not being appreciative of being given appointments and the latter in terms of frustration at not getting the service they are used to. Verbal and written complaints are highlighted as having increased significantly:

‘We have verbal complaints daily about appointment waiting times and written complaints have increased 200%! Before COVID, we could go years without a written complaint' (practice manager/receptionist, GDS independent, Wales).

Team relationships are also described as being under strain due to work intensification:

‘Working in dentistry is draining…staff frustrations and tiredness as a result of this are impacting working relationships, and therefore further creating problems and a lack of enjoyment at work' (practice manager/receptionist, GDS independent, England).

Dental practice managers and receptionists are therefore exposed to the emotional dysregulation and frustrations of both patients and colleagues:

‘It is practice managers and reception staff that are taking the brunt from patient dissatisfaction, frustration and fear and from clinicians who are tired, unsupported, disregarded, [and] not understood' (practice manager/receptionist, GDS corporate, Wales).

Yet, despite the overall sense of despondency, the picture for one respondent remained positive, with patient relationships at the centre:

‘I love my job as a receptionist and I love the relationship with the patients' (practice manager/receptionist, GDS independent, Scotland).

Lack of recognition

Respondents described feeling undervalued and their work going unrecognised, despite their roles being critical for facilitating the work of more senior staff:

‘In my opinion, admin seems to be the least important members of staff in the department. I often feel like we are not given the same considerations as higher-grade staff. But we should be as we play a very important role. Sometimes automatically lower bands are seen this way but do a great amount of work which supports and makes higher grade/role jobs easier for them' (practice manager/receptionist, public health, Scotland).

For those working in the GDS, pay and terms and conditions were a subject of discontent. Reference is made to inequities in comparison to other healthcare settings delivering NHS services, in particular, pension and salary levels:

‘What's even more disgusting is staff carrying out full NHS work do not get any NHS perks! Doctors' staff get it, its time dental staff are recognised as NHS staff. If practices do 40% NHS then the staff should receive 40% NHS banding salary, pension and so on' (practice manager/receptionist, GDS independent, Wales).

Arrangements around sick pay are described as a source of stress in terms of staff worrying about how to pay their bills if they are unwell ‘because we know we won't be paid', especially in the context of a cost-of-living crisis. Remuneration is also cited as a barrier to recruitment in private practice:

‘The problem is privately owned dental practices do not pay their staff enough to warrant the amount of work and passion that is required. It is no wonder that there's a lack of interest in the industry because the pay doesn't match the job requirements' (practice manager/receptionist, GDS independent, England).