Developing Primary Care Networks for Better Care in the Community

1.         The Ministry of Health (MOH) will launch an application call on 1 April 2017 for General Practitioners (GPs) to join the Primary Care Networks (PCN) scheme. Participating GPs will be able to tap on funding and administrative support to implement team-based care to better monitor and manage their patients’ healthcare needs.

2.        Primary care is the bedrock of our healthcare system. A strong primary care sector helps keep Singaporeans healthy, and manage their chronic conditions well. With an ageing population, rising chronic disease prevalence and increasing complex care needs, primary care plays a critical role in enabling MOH’s transformative efforts to shift healthcare beyond hospitals into the community and bringing person-focused care closer to home.

Funding and Administrative Support for GPs

3.        Under the PCN scheme, MOH will provide funding and administrative support to GPs to form virtual networks and deliver care as multi-disciplinary teams which include doctors, nurses and other supporting staff. The support includes funding for nurse counsellors and care coordinators, as well as support to establish chronic disease registries. PCN GPs will also be resourced to manage patients with more complex chronic conditions and care needs. The PCN scheme also provides participating GPs a platform for cross-sharing of best practices for patient care. Please see Annex A for a schematic representation of the framework of a PCN.

4.        GPs participating in the PCN scheme will adhere to stipulated clinical requirements designed for effective care to patients. For example, each PCN is expected to establish a chronic disease registry for more effective monitoring and early intervention of patients’ clinical and care outcomes. All PCNs will also provide nurse counselling, diabetic foot screening and diabetic retinal photography.

Coordinated and Team-based Care for Patients

5.        Patients will benefit from more coordinated and better care through the PCN scheme. They will be able to access nurse counsellors for individualised advice to manage their conditions, including lifestyle and dietary modifications. There will be closer monitoring of their chronic conditions for earlier intervention, and more convenient access to services such as diabetic foot and eye screening. Care coordinators will help coordinate services where needed for a more seamless patient experience.

6.        Said Minister of State for Health Dr Lam Pin Min, “Primary care is the foundation of our healthcare system, and will play an increasingly important role in our care transformation to move beyond hospital to community. Our GPs look after 80 percent of our primary care needs. They are our key partners in providing the first and continuous line of care. With the PCNs, GPs will be able to tap into a team of nurses, allied health professionals and even their peers to bring better care and outcome for their patients. I strongly encourage GPs to organise themselves into PCNs and access the additional resources and support extended by MOH.”

7.        The application call will commence on 1 Apr 2017 and close on 31 May 2017. Interested GPs may refer to the link below for more information, and to access the application form: https://www.moh.gov.sg/our-healthcare-system/healthcare-services-and-facilities/primary-care-networks

MINISTRY OF HEALTH
29 MARCH 2017

ANNEX A
FRAMEWORK OF PRIMARY CARE NETWORKS (PCNs)