Speech by Dr. Lam Pin Min, Minister of State for Health, at the Family Medicine Convocation Ceremony and Dinner, 19 November 2016

Associate Professor Lee Kheng Hock, President, College of Family Physicians Singapore,

Council Members,

Distinguished Guests,

Ladies and Gentlemen,

Good Evening

Introduction

       It gives me great pleasure to join you today at the Family Medicine Convocation Ceremony and Dinner. First and foremost, I would like to congratulate this year’s graduands on attaining your postgraduate Family Medicine qualifications. This is an important milestone in your career and we wish you every success in the years to come.

2.     As you continue to hone your clinical practice with the skills and knowledge acquired during your training, I urge you to keep in mind the vital role you play as a Family Physician in tackling some of the challenges facing our healthcare system.

Role of family physicians

3.     Our population is ageing rapidly. The average life expectancy increased from 75 years in 1990 to nearly 83 years in 2015. The chronic disease burden has also increased. Many of you would also be aware that a key challenge we face is the rising healthcare cost. Our government healthcare spending doubled from about $4 billion in 2011, to nearly $9 billion in 2015. As our care needs change, our current hospital-centric approach to healthcare is increasingly unsustainable. We need to bring about a fundamental shift, from providing healthcare, to improving health. We need to think about more upstream behavioural changes towards healthy living, and be proactive in taking responsibility for our own health. Examples include going for regular health screenings and follow-ups; as well as shifting the centre-of-gravity of our care, from the acute hospital setting into the community. This will help us live better and stay healthy longer, and also to provide good, accessible and quality care, at more manageable healthcare costs.

4.     In this regard, Family Physicians play multiple critical roles. In line with MOH’s vision of “One Singaporean, One Family Doctor”, Family Physicians are uniquely placed to build mutual trust and form deep-rooted therapeutic relationships with their patients. By anchoring care for patients in the community, Family Physicians act as patients’ health advocates in the context of their families and the wider community, while being effective gatekeepers against unnecessary escalation of care and associated costs for patients as well as for the system. As patient care needs become more complex, Family Physicians also play key roles as coordinators and trusted advisers to patients and their caregivers to help them navigate the healthcare system.

5.     There has also been an increasing shift towards team-based care to manage patients in a more holistic way. Evidence has shown that there are significant improvements in outcomes when chronically ill patients are managed by an inter-professional clinical team. Family Physicians must therefore develop roles as team leads and members in multi-disciplinary primary care teams, with members complementing one another in knowledge, skills and expertise.

6.     In addition to managing increased case load and complexity in the community, another key challenge facing Family Physicians is the unpredictability of global public health threats. Hence, Family Physicians also play an important role as the frontline of defence for public health threats. Our primary care doctors in the community have time and again remained watchful and supported Singapore in various public health emergencies, from the SARS outbreak over a decade ago to the recent Zika outbreak, where the first reported case of community spread was picked up by an astute Family Physician in Aljunied. His vigilance and prompt action led to the timely discovery of the Zika outbreak, and allowed us to swiftly take action to contain and mitigate the situation. I believe we can continue to rely on the professionalism and clinical acumen of the primary care community to rally around and safeguard the health of our population.

Growing the primary care landscape

7.     As the disease burden and complexity increase with our ageing population, the primary care sector will continue to evolve and expand to remain relevant to a wide spectrum of patients with increasingly complex medical needs. To better meet the needs of our population, MOH is enhancing public sector primary care capacity, including redeveloping and building new polyclinics. This goes beyond building more of the same, but also includes a review of care models to enable greater integration of care our frail elderly to age well in the community.

8.     To facilitate good chronic disease management in the private GP sector, MOH has been exploring various innovative models over the years to enhance GPs’ access to nurse and allied health services. One model is the Community Health Centre (CHC), where GPs can refer patients for services such as diabetic eye and foot screening, and nurse counselling. Our GP partners have also actively spearheaded ground-up initiatives such as Primary Care Networks (PCN) to improve chronic disease management through team-based care. The PCN aims to bring together GPs into networks, and provide them with access to shared support services. The model has shown promising results and MOH is looking at resourcing more GPs to form PCNs.

9.     To support these and other primary care facilities, we will need to grow our pool of well-trained Family Physicians. MOH is strongly supportive of the key roles Family Physicians will play in primary and community sectors, and has been working with the College of Family Physicians Singapore (CFPS) and the FM fraternity to review our postgraduate Family Medicine training framework to develop the training capacity and curriculum to meet current and future care needs in Singapore. I am heartened to know that the proportion of Family Physicians practising in GP clinics and polyclinics has steadily increased from under 50% in 2012, to about 60% in 2016. I believe this will continue to grow.

10.     MOH is also developing IT as another critical enabler to strengthen primary care. With patient care increasingly straddling across various healthcare settings, the National Electronic Health Record (NEHR) becomes increasingly relevant for sharing useful patient information across providers and supporting continuity of care. MOH and MOH Holdings are currently developing GPConnect, an integrated IT system comprising a Clinic Management System (CMS), electronic medical record (EMR), with direct links to national systems such as NEHR, CD-LENS and CHAS Online. This will support GPs in delivering more efficient and better quality primary care.

The next generation of family physicians

11.     As you join the ranks of fellow Family Physicians and continue the good work of Family Medicine, besides contributing in terms of clinical practice, I hope you will consider giving back to the fraternity by becoming a Family Medicine trainer in the future. Just as you have benefited from the generous teaching and guidance of your mentors, you can play your part and “pay it forward” by moulding our next generation of Family Physicians. For those of you with the interest and aptitude, we also hope that you can contribute to the field of primary care research, which has the potential to not only improve patient care, but also raise the profile of Family Medicine. I also challenge you to constantly think out of the box and seek continual improvement in the delivery of primary care, by innovating new models of care or patient work flows to enhance our healthcare efficiency and cost-effectiveness.

12.     Our pace and degree of success in shifting from a hospital-centric model to a community-based one depend very much on how quickly primary care can be transformed to anchor the care of patients. I am heartened to see that so many of our young doctors such as yourselves have chosen this path.

13.     I would like to thank the College and all Family Medicine tutors for their hard work, and their close collaboration with the Ministry to ensure that there is a ready pool of highly trained Family Physicians to meet the needs of our nation. More importantly, I am glad to see this pool of dedicated Family Physicians devoting much time and effort in developing the discipline further, so as to keep our healthcare system sustainable, and ready for future challenges.

14.     I wish you all the best. Thank you.