Opening address by Mr Gan Kim Yong, Minister for Health, at the National Primary Care Seminar

08 Oct 2011
By Mr Gan Kim Yong
Venue: MARINA BAY SANDS EXPO & CONVENTION CENTRE

Introduction

1.  It gives me great pleasure to be here at the first national primary care seminar. Over the last few months, I have been making rounds to the various healthcare institutions and met with various healthcare professionals, including having informal discussions with GPs amongst yourselves. I am greatly impressed by the deep commitment of our healthcare professionals in caring for our patients, and at the same time pursuing medical excellence. Covering 80% of our primary care, our GPs have and will continue to play an instrumental role in our healthcare system.

2. I have met some of you and you have already given me valuable feedback. MOH would now like to use this opportunity to seek the views of the wider GP community on how the Ministry can partner you in developing primary care to better meet the needs of Singaporeans.

The need to transform primary care in Singapore

3.  The aging population coupled with longer life expectancy and changing lifestyles could potentially lead to more Singaporeans with chronic diseases. The complexity of care has also increased as our elderly are more likely to have multiple chronic ailments.  They would appreciate being cared for by a doctor who can look after most of their needs in the community rather than in hospital settings.

4. With more than 2000 of you in the community, GPs are well-positioned to play this important role in providing accessible, holistic and continuing care for our patients. The care outcomes for patients on the Medisave for Chronic Disease Management Programme (CDMP) are comparable to those from developed countries like the US and the UK. Our challenge now is to bring these benefits to the wider population. Indeed, we would like to move these benefits from “programme” to “population”.

Current primary care landscape

5.  Today, our primary care delivery model comprises of both private GP clinics and public polyclinics. MOH’s primary care survey conducted in 2010 showed that while GPs’ overall market share was 81%, their share for chronic diseases was much less at 55%. This means that our polyclinics which have only 14% of doctors in the primary care sector, are managing 45% of patients with chronic diseases.
 
6. In my dialogues with GPs, many of you have expressed that you would like to contribute more to chronic disease management in the community. You have also shared with me factors that are constraining the GP community from doing more. For example, Dr Leong Choon Kit recently shared that many GPs have postgraduate training in Family Medicine and are well-trained to handle a variety of medical problems. However, GPs are often “under-utilised” and bypassed for specialists. He suggested greater government support in terms of support services and facilities to enable GPs to better manage chronic diseases. While GPs are easily accessible in terms of distance and convenience to patients, lower and middle income patients are often hesitant to see their GPs for the more expensive chronic care because of the lack of subsidies at GP clinics compared to polyclinics. The Medisave for Chronic Disease Management Programme has helped to increase affordability for this group of patients but more should be done. There is also the perennial bugbear of the need to simplify administrative processes for claims and data submission, as well as enabling GPs with the right IT infrastructure to enable patient information to flow seamlessly across sectors. In addition, some have also given several good insights and suggestions on the changes we need to improve our primary healthcare system.  We will try to address them in our proposed primary care masterplan. Firstly, how can we better support GPs like yourselves - including those in solo practices to be able to access support services to manage patients with chronic diseases? Secondly, how do we ensure that primary care remains affordable for our patients?  

Better supporting our GPs
New models of primary care

Family Medicine Clinics

7. Our preliminary thoughts for the primary care masterplan include the setting up of primary care facilities that are aimed at providing GPs with the support that you would need to better manage chronic diseases in the community. Best practices in chronic disease management both locally and overseas have highlighted the value of team-based care - bringing together doctors, nurses, allied health professionals and other related services in an integrated service delivery model.  Thus, we would like to seek your views if the Ministry should support the development of new models of care to enable you to leverage on the benefits of team-based care for better outcome and derive greater economies of scale.

8. Today, we recognize that a key constraint for this to happen is space constraints.  One possibility is for a small group of GPs to come together to set up Family Medicine Clinics with bigger spaces and with ancillary support services. In addition, you may wish to consider collaborating with our public sector entities if that may be helpful to the set up of your clinics. We are keen to pilot such clinics if there is indeed interest amongst you. We can subsequently share the lessons learnt with the wider GP community to see how this model can be refined.

Community Health Centres

9. We are also mindful that many of you already have established practices and would like to continue serving your community where you are currently sited. Hence, we would like to hear your thoughts on the idea of developing Community Health Centres that offer ancillary support services such as nurse educator and diabetic retinal photography services. However, the actual services to be delivered by these centres, if we do set them up, must depend on your needs. For example, they may also provide you with some administrative support services like data entry. These centres should not have any doctors practising there as we want patients to continue their care with the referring GPs. To ensure convenience for patients, such Community Health Centres can be sited close to clusters of GP clinics.

Medical Centres

10.  In addition, we are also considering setting up ambulatory Medical Centres in the community within each Regional Health System. As part of shared care programmes, specialists can help you to co-manage patients with more complex but stable conditions in the community, without the need to refer them to hospitals. Furthermore, you can also choose to refer patients to these Medical Centres for selected surgical procedures that can be safely and likely more cheaply managed in the community such as cataracts. We want to hear from you how such a concept could work for GPs.

IT system

11. Sharing of patient information is vital for continuity and integration of care, patient safety, as well as avoidance of duplicated investigations. Many of you have however given the feedback that it is costly to develop your own system, yet you do not need the high-end systems that we have developed for the hospitals. As such, I am pleased to note that MOH Holdings is working on developing simplified IT systems specifically for GPs that would enable access to the National Electronic Health Records (NEHR).  

Ensuring the affordability of primary care

12. Besides feedback on how we can better support you, many have also raised the importance on ensuring the affordability of primary care. On this note, we have recently announced that the enhanced PCPS will lower the age criteria from 65 to 40 years of age to help Singaporeans manage their chronic diseases at an earlier age; and the income criteria will be increased from $800 to $1500 per capita monthly household income to benefit middle-income Singaporeans. The Medisave withdrawal limit for Chronic Disease Management Programme will also be increased from $300 to $400.

13. I assure you that we will continue to monitor the affordability of primary healthcare. The other area that we are currently looking into is the differential in drug costs and pricings between our public sector institutions and GP clinics.   Several of you have highlighted that such a differential has been an important barrier in preventing patients from seeking care at GP clinics. While we do not have the answer now, I have asked my colleagues to study these issues and explore possible solutions. Your ideas and inputs are most welcome too.

A new era of public-private partnership

14. The development of our primary care masterplan marks a key milestone in public-private partnership. I have earlier touched on how we see all of you playing a bigger role in primary care, especially in managing chronic diseases. While we recognize the need to create sustainable business models for chronic disease management and would try our best to mitigate known risks, there would likely be business risks that are unexpected when we develop new care models. Thus, if you think that the various new concepts and models of care, which I mentioned earlier, are indeed the elements needed in our primary care masterplan, we will work with you to see how your clinics can be viable and at the same time ensure that care remains affordable for our patients. For example, the Ministry is looking into providing some financial support for these pilots, and also subsidies for patients using these services, to help the earlier doctors who participate in new pilots.

15. To recognize the contributions of our primary care doctors in both the private and public sectors, I would also like to take this occasion to commend your efforts and express our sincere appreciation. Besides providing good patient care, many of you have also been training future generations of doctors and are truly role models for these young doctors. I strongly encourage all of you to continue to do so as it is crucial to ensure our young practitioners are well-trained.

Concluding comments

16. In conclusion, I would like to stress that we need to transform the primary care landscape to better address the needs of Singaporeans. To do so successfully, we will need the inputs and support from all of you, both from the private and public sectors. Our common mission is to help Singaporeans live a long and healthy life; and to make quality healthcare affordable.   I have shared briefly our preliminary thoughts on how we can better support GPs. My colleagues will share further details in the subsequent presentation later.   This is the beginning of a long journey. This should not be my plan nor the Ministry’s plan. Instead, this is our shared plan with inputs from all stakeholders.  I hope to be able to present to you the masterplan that we co-develop sometime early next year. I wish you all a fruitful discussion this afternoon. Thank you.