$50 off CGH emergency bill if you see GP First

By Salma Khalik, The Straits Times, 28 Jan 2014

FACED with a busy accident and emergency department (A&E) that sees more than 400 patients a day, Changi General Hospital (CGH) has come up with a novel way to try to reduce the crowd.

It is offering a 50 per cent discount to patients who see a general practitioner (GP) first. With the offer, it hopes to divert as many as 100 patients a day.

Between a third and half of the patients who show up at the emergency department every day can be easily treated by a GP, said Mr T.K. Udairam, head of the Eastern Health Alliance to which CGH belongs.

The offer of a $50 discount off the $100 A&E bill is to remove "a perceived disincentive" - some patients do not go to a GP first as they think they would end up paying both the GP and the hospital and hence pay more, he noted.

But this may not be the case. As most of them do not need hospital care, seeing a GP first will likely save them money, noted Mr Udairam. Most GPs charge $30 to $50 in the day, which is when most A&E patients show up. And in the event patients have to go to both the GP and the hospital, the $50 discount should cover the GP's charges.

Currently, about 20 patients are diverted from the hospital to a clinic a day. They can save themselves a trip to the hospital and a long wait by going to a GP near their home first, he said.

"This will leave the medical staff more time to spend with patients who are more critically ill," said Mr Udairam at the launch of the GPFirst scheme yesterday. So far, 132 out of more than 200 GP clinics in eastern Singapore, in places like Tampines or Pasir Ris, are taking part.

Those referred to CGH by a participating GP will be given priority, said its chief executive officer, Dr Lee Chien Earn, as they have already been assessed by a qualified doctor to require emergency department care.

Dr Muhammad Iqmal Abdullah, whose clinic at Bedok Central sees a fair number of factory workers, said companies often send workers straight to CGH following an industrial accident.

"When it comes to small cuts, a GP can deal with it easily. We don't even need to suture it anymore; we just use glue."

CGH's offer is also to pre-empt a flood of patients during the Chinese New Year holidays. Clinics like Dr Muhammad's are open during the festive period. Patients turned up at his clinic last year after a six-hour wait at CGH, he said. Many were there for vomiting, an allergic reaction to something they ate and other ailments that can be easily treated by a GP, he said. For serious conditions like a suspected heart attack or stroke, he would give medicine immediately to ease the problem and call for an ambulance. "There will be no delay to their initial treatment."

CGH's Dr Lee stressed, though, that if it is a suspected heart attack or stroke, or other critical illnesses, patients should head straight for the hospital.

A list of GPs on the scheme, as well as conditions for which it is better to consult a GP, can be found at www.gpfirst.sg

GPs have also been given a 24-hour hotline number to call if they need to speak to an emergency specialist.

The Ministry of Health yesterday also issued a list of some 100 clinics which will remain open during the Chinese New Year period. More information is available at http://www.moh.gov.sg/cny2014

Measures in place to prevent abuse of 'GP first' scheme

WE THANK readers for their support of the GPFirst programme, which the Eastern Health Alliance launched in partnership with Changi General Hospital (CGH) and general practitioners in the east, to educate and encourage patients with non-urgent conditions to visit a GP first. This is because their conditions are usually manageable without the use of sophisticated diagnostic equipment or tests.

In the event that a patient who visits a GPFirst clinic needs to be further reviewed by CGH's accident and emergency (A&E) department, he will receive a $50 subsidy on the prevailing attendance fee. This helps to ensure there is no disincentive for patients who visit a GP clinic first.

To support GPs, we have provided a 24-hour hotline for them to contact our A&E specialists, as well as online teaching and learning resources.

We share similar concerns with some readers on potential abuse of the programme.

Some have suggested that we raise A&E charges, or base the charges on the patient's condition ("Base A&E charges on patient's condition, tests done" by Mr Henry Lim, and "Raise A&E fees to prevent abuse of system" by Mr Mike Chan, Forum Online; both published on Feb 4). We thank them for their suggestions.

Although the GPFirst scheme is new, we have put in place measures and review processes to ensure that patients are being appropriately referred to CGH's A&E. All referrals are tracked and reviewed with the GPs.

As GPFirst is a pilot scheme, we will monitor its take-up and responses. We welcome all the suggestions that have been made, and will continue to look at ways to enhance the scheme as we progress.

T.K. Udairam
Group Chief Executive Officer
Eastern Health Alliance
ST Forum, 12 Feb 2014

* 'GP first' scheme eases strain on CGH's A&E
Hospital seeing fewer patients with less serious conditions since its start
By Linette Lai, The Straits Times, 27 Aug 2014

AN INCENTIVE to encourage patients with less serious conditions to see their GP rather than go to the emergency department has eased the strain at Changi General Hospital.

The number of such patients at its accident and emergency (A&E) department has fallen by 10 per cent since it set up the GPFirst scheme in partnership with the Eastern Health Alliance and local GPs.

If patients are subsequently referred to the hospital, they will get $50 off the $108 emergency department fee.

From February to June last year, Changi General saw 25,728 A&E patients with less serious conditions.

In the five months after the GPFirst scheme was introduced in January, this fell to 23,187.

Of these, almost 1,500 were referred to CGH under the scheme with problems like chest pains, dengue or pneumonia.

The number of participating GPs has gone up from 132 to 157.

"We are encouraged by the impact of GPFirst on CGH's A&E attendances," said Mr T.K. Udairam, group chief executive of the Eastern Health Alliance. "This allows the A&E to optimise its resources for sicker patients."

For example, those with slightly more serious conditions now wait an average of 24 minutes before seeing a doctor, down from 29 minutes in January.

Those with less serious conditions which could potentially be treated by a GP might end up waiting up to six hours.

Since the programme started, the hospital has also been seeing fewer self-referrals to its emergency department.

From February to June last year, there were some 39,576 self-referrals.

In the same time period this year, there were 34,891.

"We are glad that the public is gradually recognising that GPs are able to treat a wide range of medical conditions," Mr Udairam added.

These include cuts, mild burns and scalds, and sprains and strains.

"For certain types of patients, they will have the A&E as a first priority," said Dr Lim Kim Show of Northeast Medical Group.

Others, he said, have a "close relationship" with their GPs and often see them first - a mindset that GPFirst is trying to cultivate.

"(For the) majority of patients who go to the A&E directly - sometimes, they do not have a close relationship with the GP," Dr Lim added.

"The understanding and acceptance needs time. We need to reach out."