Speech by Minister Gan Kim Yong, at The World Family Doctors' Day Gala Dinner, 17 May 2014

A/Prof Lee Kheng Hock, President of College of Family Physicians Singapore

Distinguished Guests

Ladies and Gentlemen,

INTRODUCTION

1.           Good Evening. It gives me great pleasure to be here tonight to commemorate the World Family Doctors’ Day. The World Organisation of Family Doctors (WONCA) declared World Family Doctors' Day in 2010 to recognise and highlight the important role of family doctors in their communities. In Singapore, we are celebrating this day for the first time. I am glad that we have a diverse group of family doctors gathered here tonight; it is testament to how our primary healthcare system has grown over the years.

2.           Singapore, like many other countries, is seeing an increasing number of people with chronic conditions. About one million Singaporeans today are affected by the four main chronic diseases, namely diabetes mellitus, hypertension, lipid disorders and stroke. As the population ages, we will be faced with not only a growing number of people with chronic diseases but also patients with more complex comorbidities which will in turn place a heavier demand for healthcare services. This shift in disease burden calls for a strong, comprehensive and integrated people-centred primary care.

INCREASING ACCESSIBILITY AND AFFORDABILITY

3.           Even as we build and upgrade our polyclinics, my Ministry has also worked closely with the General Practitioners (GPs) in the private sector to explore different models of care and collaboration. We have also piloted new models of care through the establishment of Community Health Centres (CHCs) and the Family Medicine Clinics (FMCs). To date, we have built CHCs in Tampines, Bedok and Jurong East, where GPs can refer patients for support services such as physiotherapy, x-rays, ultrasound and diabetic foot and eye screening. We have also piloted five FMCs, and one more will be ready by June this year in Bedok to provide multidisciplinary, team-based care to our patients.

4.           We have grown the Community Health Assist Scheme (CHAS) in a big way since its roll-out in 2012. Indeed, many people now know the scheme by just referring to it as ‘CHAS’, and the blue or orange Health Assist card are now familiar to many residents. Recently, in January this year, we removed the age floor for CHAS, so that younger Singaporeans from lower- to middle-income families can also benefit. These CHAS subsidies now cover recommended health screening tests and a larger number of chronic conditions.

5.           Many of you would be aware of the Pioneer Generation Package we announced earlier. We want to assure our Pioneers that the Government will help them with their healthcare in their old age. This package covers a range of healthcare needs, and one of which is the Pioneers’ outpatient needs. From 1st September this year, as part of the Pioneer Generation Package, we will extend special CHAS benefits to all Pioneers. Some pioneers have asked whether they will receive the blue or the orange card. Their CHAS benefits will be unique, better than orange and better than blue cards. We will make it simple for them. All Pioneers, regardless of their income or housing types, will receive a special Pioneer Generation card by September.

6.           With the Pioneer Generation card, Pioneers will enjoy higher CHAS subsidies as compared to the existing blue and orange cards. For example, for common illnesses such as cough and cold, Pioneers can receive a subsidy of $28.50 per visit, which is higher than the $18.50 for those on the Blue tier. For Pioneers with complex chronic conditions, they can receive up to $540 subsidy per year, compared with $480 for those on the Blue tier.  As with all CHAS beneficiaries, Pioneers who are assessed to require specialist care can also be referred by CHAS clinics to the Specialist Outpatient Clinics (SOCs) in the public healthcare institutions as subsidised patients and they no longer need a referral letter from our polyclinics. In the coming weeks, we will be holding GP engagement sessions to share details regarding these CHAS benefits for our Pioneers. We are heartened that a growing number of GPs are playing a greater role in caring for patients with chronic conditions and we hope more GPs will join the CHAS scheme.

EVOLVING ROLE OF THE FAMILY DOCTOR

(I) Care Integration

7.           Singapore has continued to make progress in integrating care across the healthcare continuum and between different healthcare sectors. The National Electronic Health Record (NEHR) has enabled the sharing of patients’ medical records and information, thus facilitating the movement of patients across different care sectors, and improving care delivery. We are encouraged by the participation from GPs since its introduction. Currently, about 200 GP clinics have access to the NEHR, and of these, more than half are CHAS GP clinics. This year, we hope to double the number of GPs who have access to the NEHR.

8.           The need for better care integration will become more critical as our patients grow older and need to access various parts of the healthcare system. Beyond providing direct clinical care, a family doctor’s role will need to be expanded to include coordinating care and assisting patients and caregivers to navigate their way around the healthcare system. They will play an important role in facilitating smooth transition between different healthcare settings and providers, and advising patients on when to seek specialist, acute, or step-down care. 

(II) Family Medicine Training

9.           To increase public appreciation of the skills and knowledge of family doctors, the College called for greater recognition of post-graduate training in Family Medicine and in 2011, MOH, in partnership with the College, established the Register of Family Physicians with the aim of raising the standards of Family Medicine training and practice in Singapore. Given the broad scope of Family Medicine, which spans across different healthcare settings, the Family Physicians Register was positioned to be inclusive, recognising family doctors working in various settings, and moving beyond the traditional ambulatory primary care services to include home care and step-down and long-term care services. Today, many family doctors continue to improve and upgrade themselves, with the majority registered on the Register of Family Physicians.

10.       Moving forward, family doctors will need to become highly competent generalists, preferably with home care and transitional care training and experiences, as well as the competence to work with other healthcare professionals across an integrated healthcare system. Under the Family Medicine Residency programme, our residents not only receive broad-based training in polyclinics and acute hospitals, they also undergo attachments in community hospitals and 17 private GP clinics and groups which partner with our sponsoring institutions. Beyond the residency programme, our private GPs are also actively involved in training their peers under the postgraduate diploma and Master of Medicine (MMed) degree programmes run by the College.

11.       Hopefully, with the vastly expanded role and more career opportunities together with a well-structured residency training programme, we will be able to attract and train more young doctors in Family Medicine and tackle the increasingly complex needs of our population.

12.       Over the past 40 years, the College has kept pace with the growth and development of Family Medicine in Singapore. It has shown foresight and has been strategic in developing a robust training framework for family physicians in Singapore. The College is a key institution for training our family doctors pursuing postgraduate degrees and diplomas as well as College fellowship, the pinnacle of advanced Family Medicine training in Singapore. My Ministry will continue to engage and partner the College to further advance Family Medicine in Singapore.

CONCLUSION

13.       I would like to commend the College for their outstanding leadership in shaping and developing the Family Medicine community in Singapore over the last 40 years. I would also like to thank all family doctors for your dedication and commitment in providing quality primary care to our patients and in particular, the family doctors who have participated in our CHAS, Chronic Disease Management Programme, Pandemic Preparedness Clinic Scheme, Haze Subsidy Scheme, and the various Regional Health System partnership programmes. I am heartened by your strong support and partnership with the Ministry of Health on various initiatives throughout these years. I look forward to continue working with all of you to strengthen our primary care sector and deliver better care for our patients. 

14.       Thank you.