Al-Haboubi Mustafa, Newton Paul, Gallagher Jennifer E
University of Greenwich, Faculty of Education and Health, Avery Hill Campus, London, UK.
Prim Dent J. 2016 May 1;5(2):54-65. doi: 10.1308/205016816819304259.
A pilot scheme was established across London to train NHS primary dental care practitioners to provide endodontic treatment of moderate difficulty. It was co-led by the former London Deanery (Health Education England: North West London) and local NHS commissioners. This research aimed to explore key stakeholders' perceptions about the purpose of the initiative, its advantages, disadvantages and future implications.
Nineteen semi-structured interviews were conducted with stakeholders (commissioners and providers of the educational initiative; commissioners and providers of care, including trainees, principal dentists and specialists) involved in establishing, running and participating in the initiative and wider endodontic service provision in London. Interviews were based on a topic guide informed by the literature, and a workshop involving the London trainees. Interviews were recorded, transcribed and analysed using framework methodology.
The project was perceived as supporting four key areas: addressing services, improving quality/outcomes, delivering education and enhancing professional status. There was evidence that dentists were harnessing health policy in facilitating 'reprofessionalisation' of dentistry with the creation of dentists with enhanced skills (DwSIs). Learning outcomes from the pilot were related to the accreditation of the participants, service tariffs, reimbursement for endodontic treatment on the NHS, and the need for continuity within and between services across the dental system. Uncertainty about funding and the changes within the NHS were among the concerns expressed regarding the future of the initiative.
The findings of this research suggest that extending the skills of primary care practitioners may contribute to the reprofessionalisation of dentistry, which has much to contribute to patient care and the development of an integrated and accessible dental care system of quality, with improved outcomes for patients. The implications for health policy and further research are discussed.
在伦敦开展了一项试点计划，培训国民保健制度（NHS）的初级牙科保健从业者，以提供中等难度的牙髓治疗。该计划由前伦敦教区（英国健康教育署：伦敦西北部）和当地NHS专员共同牵头。本研究旨在探讨关键利益相关者对该计划的目的、优缺点及未来影响的看法。
对参与该计划的制定、实施和参与以及伦敦更广泛牙髓服务提供的利益相关者（该教育计划的专员和提供者；护理的专员和提供者，包括实习生、首席牙医和专家）进行了19次半结构化访谈。访谈基于一份由文献启发的主题指南，以及一次涉及伦敦实习生的研讨会。访谈进行了录音、转录，并使用框架方法进行分析。
该项目被认为支持四个关键领域：解决服务问题、提高质量/结果、提供教育和提升专业地位。有证据表明，牙医正在利用卫生政策促进牙科的“重新专业化”，培养技能增强的牙医（牙髓专科强化牙医，DwSIs）。试点的学习成果与参与者的认证、服务收费、NHS牙髓治疗的报销，以及整个牙科系统内服务之间和服务内部的连续性需求有关。对该计划未来的担忧包括资金的不确定性和NHS内部的变化。
本研究结果表明，扩展初级保健从业者的技能可能有助于牙科的重新专业化，这对患者护理以及发展一个综合、可及的高质量牙科护理系统有很大贡献，能为患者带来更好的结果。文中还讨论了对卫生政策和进一步研究的影响。
