国民医疗体系人满为患 英国频现“看牙难”

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.’

据《每日邮报》4月13日报道，在新医疗制度下，牙医必须花更长时间为每个患者诊断。

为了缩减等待时间，患者可以向理疗师就诊，他们毕业时间为3年，而牙医则是5年，牙医将专注于更复杂的病例。

政府的“牙齿沙皇” （tooth tsar）说，牙科理疗师应该接替牙医，开始进行患者牙齿修补工作，从而满足日益增长的英国国民保健服务（NHS）的等待名单。

新NHS诊断系统正在试行并可能在两年内正式推行。在新系统下，患者需要多等待数周才能通过预约。

新的检查系统要求牙医花费更长时间来诊断每位患者，而现任首席牙科官员巴里·科克罗夫特曾提醒，为免耽误医疗，初级人员应当代替牙医处理一些传统项目。

对于这种情况，理疗师——相比牙医学习5年，他们毕业只需要3年时间——可以修补成人的牙齿以及拔出儿童的乳牙。牙科护士应当担任更重要的角色，例如进行涂氟防龋理疗，他说。在周日曼彻斯特举行的英国牙科会议上，科克罗夫特对每日邮报说：“一名牙医经历过非常高端的培训，可以完成诸如镶牙冠或搭桥等复杂任务。理疗师可以进行拔牙和补牙。”

卫生部长厄尔·豪说，患者需要接受，未来牙医对他们牙齿的治疗将会减少，而护士、保健师和理疗师的工作会增加。他说：“有时候，你在普通诊所会见到护士和全科医生已经这样做了。”

试行新牙科系统，涉及到一个“红绿灯等级”，即根据病人牙齿和牙龈的情况，会分成“绿色”、“黄色”或“红色”警示。标记为“红色”的病人可能会拒绝进行进一步治疗，直到他们改善其口腔健康——通过多清洁牙齿和少吃糖果类食物。

很大程度上，这个已经推行了两年半的计划受到牙医欢迎，因为该计划在治疗牙齿疾病的同时，也专注于预防牙齿问题。但初期检查每位病人要花费大约半个小时，而不是以前的15分钟，这意味着等待预约的时间提高。

在伦敦东北部的伍德福德牙科护理中心工作的伦恩·D·科鲁兹从2011年开始已经试行该计划，他说：“这计划让我们可以诊断的病人数量减半，而更长的等待时间使得诊所和患者都感到沮丧。”

来自西约克郡霍尔斯的牙医托尼·基尔科因博士称他对于理疗师补牙没有问题，但提醒这个改变可能是“错误的经济决定”，因为他们要花更长时间。来自迪尤斯伯里的牙科博士苏珊娜·贝克则称：“以前患者喜爱的家庭牙医的感觉将会失去了。”

厄尔·豪说在2016年之前不会有新的计划再推行。

一名卫生部发言人说：“我们试行的计划为的是找出我们如何能够在源头预防人们的疾病，但这不会成为新系统的蓝本。”