Wednesday 28 December 2011

More community health centres to support GPs

By Salma Khalik, The Straits Times, 27 Dec 2011

THERE will be at least three more community health centres (CHC) next year offering support services to general practitioners (GP).

The Ministry of Health (MOH) is also looking at ways to allow some patients of GPs to get medicine at polyclinic rates.

Health Minister Gan Kim Yong told The Straits Times about the new initiatives after six focus group discussions with about 200 GPs in various parts of Singapore were held, following announcements made in August.

There is currently only one CHC, in Tampines, that is run by Changi General Hospital (CGH). GPs in the area can refer patients to the centre, which offers, among other services, foot and eye screening for diabetics and counselling services by nurses. Charges range from $12 to $15.

The reports are sent to the GP, who reviews the results with the patient.

So far, more than 1,000 patients from close to 200 GPs in the vicinity have been through the CHC.

In a blog post published yesterday, Mr Gan said CHCs 'received the strongest and broadest support from the GP community'.

He said: 'Many of our physicians recognise that with more ancillary support services available in the community, they will be better able to deliver good primary care, especially for older Singaporeans with chronic illnesses.'

Dr Jonathan Chan, a GP in Toa Payoh, would definitely welcome CHC services in the estate. Currently, he has to send diabetic patients to Tan Tock Seng Hospital to get their annual eye screening: 'The trip there is a bit tricky for some elderly patients.'

Diabetes is a top cause of blindness in Singapore, and the digital eye screening requires equipment most GPs do not have.

Mr Gan said GPs have also suggested locating a pharmacy at CHCs, or for CHCs to provide administrative support for claims submissions.

This refers to the subsidy under the primary care partnership scheme (PCPS), which will be extended to 710,000 people here from Jan 15. The ministry will subsidise part of their bills at GP clinics.

Those eligible are aged 40 and older, and come from families with an income per family member of $1,500 or less - which is the median per capita income.

At a focus group discussion held at the Khoo Teck Puat Hospital (KTPH) last Thursday, one doctor said that even with the subsidy, patients still might pay quite a lot more than at polyclinics.

Another doctor agreed that drug prices might stop patients from switching to GPs, and asked if the minister would let such patients get drugs at the same price as polyclinic patients.

Mr Gan said: 'That is one possibility that we are exploring.'

The PCPS subsidy would then have to be adjusted to cover only the GP's consultation fee, he said. PCPS card holders will also get a subsidy when they go to CHCs.

Mr Gan said the MOH would be flexible, so CHCs might offer different services, depending on what GPs in a particular area want.

Also, CHCs do not all need to be run by the Government. Even if they are, some of the services could be run by others, he said. These could be private enterprises or voluntary organisations.

In his blog post, the minister also spoke of the mixed reactions to the suggestion of Family Medicine Clinics (FMCs), where private sector doctors group together and share certain facilities and services, such as therapy.

The intention is for MOH to help these groups launch the centres.

'Some solo GPs were understandably concerned about the possible competition FMCs may pose to them,' he wrote.

However, on the third idea of opening Medical Centres (MCs) to provide specialist services, including day surgery, in the community, the response was much warmer.

They like it because 'with the support of specialists in these MCs, GPs can co-manage patients with more complex but stable conditions in the community as part of shared care programmes'.

Such centres, he said, would be convenient for patients who would not need to go to a hospital for treatment.

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