Debated in Parliament on 20 Feb 2017.
Miss Cheryl Chan Wei Ling asked the Minister for Health in light of efforts to encourage Singaporeans to seek primary healthcare services at polyclinics and family clinics (a) what is the current proportion of patients visiting general practitioners (GPs) within their neighbourhood or their family doctors; and (b) what has been the referral rate of cases from GPs to specialists.
Mdm Speaker, in 2015, the number of primary care visits totalled 7.3 million, based on our records which cover polyclinic and Community Health Assist Scheme (CHAS) general practitioner (GP) visits. Non-CHAS visits to GPs are not included as the Ministry of Health (MOH) does not routinely collect such data from GPs. Of the patients included in our records, 82% visited polyclinics and 36% visited GP clinics. Some among them visited both polyclinics and GPs.
Referrals from polyclinics and GPs make up 32% and 7% respectively of new attendances at our Specialist Outpatient Clinics (SOCs). The rest include hospital referrals and walk-ins.
MOH has introduced initiatives to anchor the care of patients in the primary care setting. We enhanced CHAS and the Chronic Disease Management Programme to make care in the community more affordable. We also provided GPs better access to support services, such as diabetic eye and foot screening, through the Community Health Centres.
In addition, we have introduced standardised management and referral protocols between polyclinics and SOCs, starting with high volume conditions in the areas of orthopaedics, gastroenterology, and cardiology. The early results are encouraging. On cardiology, for example, preliminary findings showed that about 57% of heart patients who previously would have been referred to specialists can be safely managed mainly in the primary care setting.
MOH will continue with efforts to strengthen primary care and anchor the care of more patients, especially those with chronic conditions, in the primary care setting.
Miss Cheryl Chan.
I thank the Minister of State for his answer. I have two supplementary questions for him. The first one is: in order for us to reduce the waiting time and the load at our polyclinics, are there more measures that MOH is planning to put in place?
Second, in order for us to encourage, especially the elderly to go to the GPs, because it reduces their transportation towards the polyclinics or even some of the private hospitals, are we going to put in place more community health workers or volunteers who can help them gain access to the GPs if they are not willing to take the first step?
I would like to thank the Member for the questions. MOH is increasing infrastructure development as one way to cope with the increased waiting times in the polyclinics. In the coming few years, we will be building more polyclinics. But at the same time, we are also encouraging patients who qualify for CHAS to utilise some of the services that are provided by the CHAS GP. This is one way we can shift the utilisation of polyclinic services to the GPs, where they have more spare capacity.
With regard to having more community volunteers, that is a good suggestion that we can take up. We can work with partners and other stakeholders within the community to see how we can provide such services to the elderly who find that going to the polyclinics or GPs can be a bit of a hindrance because of the distance and their physical conditions.
Mr Seah Kian Peng.
Just a question for the Minister of State. Some years back, we rolled out the Family Medicine Clinics. I would like to ask, as we have piloted it for a while, what is the outcome of this? Are we going to see more of this or are we putting a stop to it?
I would like to thank the Member for the supplementary question. MOH is constantly trying out different pilot programmes to see how we can provide better primary care and enhance primary services in the community.
The Family Medicine Clinics have shown some positive results but, at the same time, we do understand that the scalability can be a challenge because of the fact that we need to mobilise the GPs, who are mainly in the solo practices, to come together to form a Family Medicine Centre. At the same time, MOH is trying out other initiatives and one of these initiatives that MOH will be embarking on is that of a primary care network, where a network of GPs can come together to provide team-based care on a virtual basis, where they will still practise at their own clinic premises but, at the same time, share processes, resources as well as other ancillary support.
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