國民醫療體系人滿爲患 英國頻現“看牙難”
Under new system, dentists must spend longer assessing each patient
In a bid to reduce waiting times, patients could see therapists, who have studied for three years, instead of dentists, who trained for five
Dentists would concentrate on more complex procedures
Dental therapists should stand in routinely for dentists and start drilling and filling patients’ teeth to tackle growing NHS waiting lists, the Government’s tooth tsar has said.
Patients are waiting weeks longer for an appointment at many surgeries piloting a new NHS system of check-ups, which could be rolled out across the country within two years.
The new check-ups require dentists to spend longer assessing each patient, and now Barry Cockcroft, the chief dental officer, has recommended that, to avoid delays, junior staff should take on some tasks traditionally carried out by dentists.
This could see therapists – who study for three years, compared with five years for dentists – drilling and filling adults’ teeth, and extracting children’s milk teeth. Dental nurses should also play a bigger role, doing procedures such as fluoride varnishes, he said. Speaking to The Mail on Sunday at the British Dental Conference in Manchester, Dr Cockcroft said: ‘A dentist is very highly trained and can carry out complex work such as crowns and bridges. Therapists can do extractions and fillings.’
Health Minister Earl Howe said patients needed to accept that dentists would do less work on their teeth in the future, and that nurses, hygienists and therapists would do more. He said: ‘Sometimes in GP practices you see a nurse and sometimes a GP. People are used to that.’
The pilot of the new dental system involves a traffic-light rating where patients are given a ‘green’, ‘amber’ or ‘red’ notice on the condition of their teeth and gums. Patients flagged as ‘red’ can be refused advanced treatment until they have improved their oral health – by cleaning their teeth more and cutting down on sugary foods.
Dentists largely welcome the scheme, which has been running for two-and-a-half years, because it focuses on preventing problems as well as treating them. But the initial check-ups take up to half an hour per patient rather than 15 minutes, meaning that waiting times for an appointment have increased.
Dr Len D’Cruz, of Woodford Dental Care in North-East London, who has been on the pilot since 2011, said: ‘It’s halved the number of patients we can see and increased waiting times which has been frustrating for the practice and patients.’
Dentist Dr Tony Kilcoyne, from Haworth, West Yorkshire, said he had no problem with therapists doing fillings but warned the move could be a ‘false economy’ as they tended to take longer. And dentist Dr Suzanne Baker, from Dewsbury, said. ‘People are going to lose the family-dentist feel patients appreciate.’
Earl Howe said no new scheme would be rolled out before 2016.
A DoH spokesman said: ‘Our pilots are exploring how we prevent people needing treatment in the first place, but will not be a blueprint for a new system.’據《每日郵報》4月13日報道，在新醫療制度下，牙醫必須花更長時間爲每個患者診斷。
爲了縮減等待時間，患者可以向理療師就診，他們畢業時間爲3年，而牙醫則是5年，牙醫將專注於更復雜的病例。
政府的“牙齒沙皇” （tooth tsar）說，牙科理療師應該接替牙醫，開始進行患者牙齒修補工作，從而滿足日益增長的英國國民保健服務（NHS）的等待名單。
新NHS診斷系統正在試行並可能在兩年內正式推行。在新系統下，患者需要多等待數週才能通過預約。
新的檢查系統要求牙醫花費更長時間來診斷每位患者，而現任首席牙科官員巴里·科克羅夫特曾提醒，爲免耽誤醫療，初級人員應當代替牙醫處理一些傳統項目。
對於這種情況，理療師——相比牙醫學習5年，他們畢業只需要3年時間——可以修補成人的牙齒以及拔出兒童的乳牙。牙科護士應當擔任更重要的角色，例如進行塗氟防齲理療，他說。在週日曼徹斯特舉行的英國牙科會議上，科克羅夫特對每日郵報說：“一名牙醫經歷過非常高端的培訓，可以完成諸如鑲牙冠或搭橋等複雜任務。理療師可以進行拔牙和補牙。”
衛生部長厄爾·豪說，患者需要接受，未來牙醫對他們牙齒的治療將會減少，而護士、保健師和理療師的工作會增加。他說：“有時候，你在普通診所會見到護士和全科醫生已經這樣做了。”
試行新牙科系統，涉及到一個“紅綠燈等級”，即根據病人牙齒和牙齦的情況，會分成“綠色”、“黃色”或“紅色”警示。標記爲“紅色”的病人可能會拒絕進行進一步治療，直到他們改善其口腔健康——通過多清潔牙齒和少吃糖果類食物。
很大程度上，這個已經推行了兩年半的計劃受到牙醫歡迎，因爲該計劃在治療牙齒疾病的同時，也專注於預防牙齒問題。但初期檢查每位病人要花費大約半個小時，而不是以前的15分鐘，這意味着等待預約的時間提高。
在倫敦東北部的伍德福德牙科護理中心工作的倫恩·D·科魯茲從2011年開始已經試行該計劃，他說：“這計劃讓我們可以診斷的病人數量減半，而更長的等待時間使得診所和患者都感到沮喪。”
來自西約克郡霍爾斯的牙醫托尼·基爾科因博士稱他對於理療師補牙沒有問題，但提醒這個改變可能是“錯誤的經濟決定”，因爲他們要花更長時間。來自迪尤斯伯裏的牙科博士蘇珊娜·貝克則稱：“以前患者喜愛的家庭牙醫的感覺將會失去了。”
厄爾·豪說在2016年之前不會有新的計劃再推行。
一名衛生部發言人說：“我們試行的計劃爲的是找出我們如何能夠在源頭預防人們的疾病，但這不會成爲新系統的藍本。”
