Closing address by Ms. Yong Ying-I, Permanent Secretary (Health), at the National Primary Care Seminar

08 Oct 2011
By Ms Yong Ying-I
Venue: MARINA BAY SANDS EXPO & CONVENTION CENTRE

Introduction

1.  Let me start by thanking all of you for taking time off from your busy schedule to be here with us this afternoon. It has been a remarkable afternoon and it feels great to be here with our many partners in healthcare. I know that I stand between you and a well deserved weekend break so I’ll be brief. I am deeply impressed and touched by your passion; doctors are one of few groups of professionals willing to spend a sunny Saturday or Sundays at professional seminars.  Let me particularly thank Dr Theresa Yap for a passionate and insightful presentation. Someone asked me if she is from MOH! I said ‘No she isn’t’, and we did not even vet the speech.

2. Minister Gan and our presenters, Dr Lee Chien Earn and Theresa, painted the many challenges in primary care today especially in meeting the needs of the aging population and also the growing burden of chronic diseases. These are real challenges which are not easy to tackle.

3. In the past few years, we have been progressively transforming our healthcare system to meet our current needs as well as preparing to meet the challenges of the future.  We have decided that population-based care, continuous and long-term, is the way go to.  Hence the need for providers across the spectrum of care to enter into partnerships and alliances so that care for patients can be integrated for continuity.  Regionalisation should help facilitate partnerships between providers in the same geographic area to serve their respective communities more effectively.  The key to a successful Regional Health System (RHS) is not just about partnership and coordination between entities owned by the public sector entities, but strong partnerships with providers from the people and private sector, especially with GPs. Strong primary care services is crucial to ensuring that patients receive the right care at the right time and the right site.

4. In this regard I would like to acknowledge the contributions of those of you who have already participated in the Chronic Disease Management Programme (CDMP), Primary Care Partnership Scheme (PCPS) and shared care programmes with our hospitals. These programmes started small but have already made a visible difference in making care more accessible and better for our patients. MOH appreciates that these schemes have attached to them administrative work which is time consuming. We are committed to improving the administration of these schemes even as we expand them, but thank you for putting up with the hassles you’ve faced in the interest of looking after your patients.   

5. The question for today’s seminar is how can we then work together to do better? Your strong presence here today at this MOH organised seminar is heart-warming and is a good sign that we can move forward together.  

Feedback from GPs on Chronic Disease Management

6. My other purpose in speaking here today is to acknowledge the comments, suggestions and feedback that you have given us in our consultations.  It is not just today.  Some of you have taken the effort to write to us as well as participate in earlier forums organised by MOH and the Agency for Integrated Care (AIC), with suggestions on improving primary care. I have had the opportunity at earlier meetings and today to speak to some of you on the issues you have faced in managing chronic and elderly patients. Thank you for your very valuable inputs. I want to assure you that MOH is listening, and will take them into our plans, in refining the system and our programmes as we go along.

Response to Issues

7. Of the issues raised, the ones that seem to resonate with most GPs are those relating to administration of subsidies, billing systems, data submissions. There are also issues on IT and cost of drugs.

8. First, reducing the administrative burden. You have suggested submitting patient claims in batches or for MOH to provide administrative support. There are many of you who also felt that the submission of clinical data for CDMP is rather onerous and you hope that the submission procedure could be further streamlined and simplified. We agree with you and are exploring ways to streamline these processes.  One possibility could be for MOH to provide administrative support that could be stationed at the CHCs for GPs to tap on. We will think about it. As for the administrative cost for submitting Medisave claims, we will be review with the CPF Board to see how we could assist to make the transaction cost cheaper for your patients.

9. More generally, we recognise that our communications on policies, billing practices, administrative issues isn’t great.  So many of you have fed back that you simply didn’t know about policies and schemes as they have been updated.  We need to organise our processes to keeping in touch with you much better. And to keep you up to date with the policies as they change.

10. Next is the IT system.  We hear you about the need for an IT system for the GP community.  While there is no need for a system similar in complexity to the restructured hospitals, it must be compatible with the public sector systems so that you can connect to the NEHR.  Minister Gan mentioned that we have been working on the National IT system for primary care called CLEO, which will pilot next year.  Several of you have opined that considering the cost of CLEO, it should either be fully funded or heavily subsidised by the government, when the system is rolled out to the wider GP community. We agree that the cost challenge needs to be addressed.  I don’t have concrete answers today because we don’t yet know what the exact capital and operating costs will be, but I can commit today that we will offer subsidies for implementing CLEO, when you partner us in our initiatives.

11. Drug cost is also another issue of concern to chronic disease patients and many of you have asked for extension of GPO priced drugs to the GP community.  This is a complex issue.  I want to say today that MOH in-principle wants to extend GPO priced drugs to GPs who are on PCPS and CDMP and those working with us on platforms like CHCs and FMC partnerships.  We haven’t figured out implementation solutions yet, but I hope you will work with us to find a solution.  

Feedback on our ideas for the Primary Care Masterplan

12. Today’s forum is an opportunity to address issues beyond just the operational but also at the more strategic level. I have gone round the discussion rooms to hear your comments and feedback on the ideas my Minister and presenters shared for a possible Primary Care Masterplan, and am encouraged to see active discussions on the way forward.  While there seems to be good support for Community Health Centres, I do however sense concerns regarding the setting up of Family Medicine Clinics (FMCs) i.e. that these clinics would compete and potentially attract patients from existing clinics in the vicinity of the FMC.  Some of you had thus suggested that FMCs be sited away from existing GPs. Overall, I am very encouraged by many inputs during the discussions after tea and questions in pigeonhole – the questions focus on “how” – how to make it work, rather than “why” or “what”.  One group of solo GPs signed a collective letter of intent to explore opening an FMC with us during tea-break. The feedback is mixed – we do hear your concerns and we will take that into account.

13. I thank you for your frank feedback. I would like to share a few thoughts on these issues. The reality is that our population is growing in absolute size, nevermind with a much larger proportion of elderly. The Government is under political pressure to build more polyclinics. We don’t want to, ideally. MOH has been told many times that there are enough GPs in Singapore to cater to patients needs. We need to create a system that involves you in caring for the chronic and elderly patients if we can, rather than open more polyclinics. Wanting to work more closely with the GPs within an integrated national health system is not just MOH’s views. The Government believes in it which is why it was the Prime Minister who announced the increase in subsidies to patients under the PCPS scheme at his National Day Rally. This is the reason we have produced ideas like CHCs and FMCs to see what you think. They are just specific suggestions and we intend to modify them depending on your feedback or create other models. But the problem of treating patients needs to be solved one way or the other.  We want to work together with the GPs to make this happen. Minister Gan told me that someone posted on his Facebook page this morning, “the choice of Marina Bay Sands is telling; it shows that MOH is taking a bet on GPs.”

14. Well, if we are successful in our MBS casino bet to involve the GPs more closely, we think more patients would consider seeing their GPs for chronic care as they are more accessible, instead of pressuring the Government to open polyclinics.

15. This does appear to require new models of care, new services in a team-based environment. Some of you have also shared with us developments in other countries where larger practices with co-located support services have enhanced chronic disease management.  This is how we created the idea of FMCs or CHCs.  We will see after this seminar if there is interest and support from GPs, and we can launch pilots based on this. The actual management and operating model would depend very much on your feedback and inputs.  As my Minister said, we recognise that some subsidies and incentives are needed by the Government.  We intend these centres and clinics to be led by the private sector but are open to public-private partnerships.  The key is to find a model that works best for the various stakeholders.

Continue to Engage GPs    

16. The issues discussed today are complex and will mean significant changes to the primary care landscape. In finding ways to resolve the issues you face, we need to be mindful of the need to be equitable and not to disadvantage unintentionally one group over the other. So we have no intention to rush the process.

17. We will need to have a public consultation to seek the views of the public and all stakeholders. We will continue to engage and take in comments from you so that we could create a primary care ecosystem that incorporates your inputs and meets the needs of our patients. Prior to the meeting today, we have also sought your preliminary feedback through discussion threads on Singapore Medical Association (SMA) portal and AIC Primary Care Pages and through discussions with the professional bodies such as SMA and College of Family Physicians, Singapore (CFPS). Please keep your comments coming. Our RHSes have also announced their next engagement session and we hope you will participate in these sessions.  You can also choose to send your feedback and comments directly to MOH using the following email address: MOH_conversations@moh.gov.sg.

18. We will use your inputs today as well as the feedback received over the next few months to come up with concrete plans and announce the Primary Care Masterplan early next year.

Conclusion

19. Let me end by thanking you all once again for the fruitful discussion and for sharing your views with us openly.  We have a lot to take back, digest and think it over, to determine how we could bring in these many excellent suggestions into the plans.