Speech by Prof Tan Chorh Chuan, Chief Health Scientist, Ministry of Health, at World Family Doctor Day dinner, 14 May 2022

Adjunct Associate Professor Tan Tze Lee, President, College of Family Physicians Singapore

Mr Ng How Yue, Permanent Secretary, Ministry of Health

Family Medicine colleagues and friends,

Good evening.

     It is really such a great pleasure to be able to meet so many colleagues and old friends in person after all this time, and to join you to mark World Family Doctor Day this evening. As family doctors and leaders in primary care, you play a vital role in our healthcare system. Tonight we celebrate your good work, and mark your many achievements and contributions. Through your individual and collective leadership, primary care in Singapore has made enormous strides in continually raising the quality of care and health outcomes. This evening, I would like to reflect on some major new opportunities for primary care to create an even greater impact in the years ahead.

Lessons from 2 pandemics

2.     As we all know, Singapore has a world-class healthcare system. All of us who contribute to it feel very proud of this, and our residents achieve excellent health outcomes.

3.     Despite this, as our population ages and healthcare demands grow in volume and complexity, we have to ask ourselves a crucial question: how will we maintain or achieve even better health outcomes at affordable costs in the future?

4.     I would like to start with the main learning points from two ongoing pandemics. The first pandemic is the fast one we are all too familiar with – COVID-19. The second is a slow pandemic, which actually causes several-fold more deaths around the world every year, most of them prematurely. This is the familiar pandemic of chronic diseases. It is a major challenge for Singapore, compounded by our rapidly ageing population.[1]

5.     These two pandemics are very different. But they highlight four common factors that are critical to transforming health, and which must therefore be adequately addressed.

• First, a focus on prevention and early concerted action;
  Second, the crucial role of behaviour at the level of individuals and communities;
  Third, data that can be safely shared and used across settings, and to track and improve outcomes; and
  Fourth, ensuring the health ecosystem is well integrated.

6.     These are powerful insights but what then, should we do differently? What are the pivotal changes that if implemented well, would ensure our health system will remain future-ready?

7.     The pivotal changes needed are captured in the three key pillars of the strategy for Healthier SG, which was recently announced by Minister for Health, Mr Ong Ye Kung, and which represents the national health transformation agenda. The three pillars are:

a.    Transforming primary care;

b.    Integrating the health ecosystem, and aligning incentives towards preventive health and care; and

c.     Enabling residents and patients to actively manage their own health.

8.     These three strategies are clearly intertwined. I would like to speak briefly first about the nature of the challenges, before outlining how Healthier SG would seek to address them comprehensively.

9.     The current challenges in primary care are well known to this expert audience. In fact, we get most of our insights from you. General Practitioners (GPs) provide 80% of primary care, but manage only 60% of chronic disease attendances. By and large, preventive health is not a prominent part of most GPs’ work. 85% of GP clinics are single or small group practices and they will find it increasingly hard to provide the holistic, team-based care that more and more of our patients require. The majority of residents do not have a regular family doctor, even though local studies[2] show that patients enrolled to a regular care team tend to achieve better results and outcomes with fewer hospital visits and admissions. On the plus side, through the Primary Care Network (PCN) scheme, GPs can access better support to provide team-based care. Extensions to the Community Health Assist Scheme and Chronic Disease Management Programme have improved the financing and patient payment issues. But as we all know, substantial challenges persist.

10.     In general, GPs are also not well integrated into the wider health ecosystem. Data flows and linkages between GPs and healthcare clusters vary, and are often not strong. Similarly, GPs are often not well connected to community resources and services, which would be essential for a strengthened focus on prevention and patient empowerment. The ability of our family doctors to empower their patients to better self-manage their conditions is therefore constrained.

Healthier SG

11.     With Healthier SG, we hope to work together with all of you and other stakeholders, towards a transformed primary care that will have several important new features which will make it future-ready:

a. Progressive enrolment of residents to family doctors will be a crucial move, it will help us to move towards the long-term goal that each resident will have a regular family doctor, who provides trusted and holistic care, which will underpin the main thrust of Healthier SG.

b. At the same time, we have to make sure that GPs receive greater support so that they can be the key drivers of Healthier SG. This means that GPs would be better able to help their patients keep healthy, prevent the onset of disease, as well as the progression of chronic diseases to severe medical complications. To do this, peer professional support has to be greatly enhanced. This can be achieved by GPs being members of PCNs, and through strong connections with a cluster. Many of you are helping us with care protocols, and these care protocols are being developed for common conditions, with specific support being thought about and developed, in terms of counselling, subsidised drugs and services, which will be put in place to facilitate their implementation by GPs. Changes will also be made to funding so that the GPs’ work in Healthier SG will be sufficiently attractive, and anchor a new business model for GPs, which are centred on preventive health and holistic care. We will also look into the differences in payments that patients have to make for common drugs between GPs and polyclinics, so that patients can continue to be managed affordably by their GPs even if their medication requirements increase.

12.     In parallel with all these, Healthier SG will also work to strengthen the integration of our health system.

a. Central to this is good data and IT connectivity, and we will work to progressively establish this between GPs, clusters, the Ministry of Health (MOH) and other agencies. This will greatly enable the data sharing, which is absolutely necessary for good and coordinated patient care, analysis of trends and gaps in patient coverage, and the timely use of data for monitoring and continual clinical quality improvement.

b. In parallel with this, we will also work towards more facilitated social prescribing by primary care teams, and we will facilitate this by developing linkages between polyclinics and GPs, and relevant community services. The goal is to enable family doctors to readily activate community resources to support patients who require additional support to achieve preventive or curative health goals which involve sustained behaviour change.

13.     Through Healthier SG, we will also plan to develop approaches to empower patients to actively participate in the management of their own health and medical conditions. This is absolutely crucial because we all know that no matter what we do on the provider’s side, if we do not also enable and engage patients to actively participate in their own health, then we will not be able to achieve the most optimal outcomes. While initially, this empowerment will involve targeted patient education, prompts and nudges, as we bring on board progressive abilities for GPs to activate community services through social prescribing, this would also support patient empowerment. Then later on, when we introduce telehealth for common chronic diseases, this will substantially add to patient empowerment. The provision of the digital infrastructure for telehealth will also pave the way for the future deployment of new wearable and digital technologies that would provide a step-change enhancement in the ability of patients and their care teams to manage chronic conditions.

Invitation to Join

14.     I hope that my speech today conveys some of my great personal excitement about Healthier SG. It is one of those key moments in time, when we all have the opportunity to contribute to a critical upward inflection in Singapore’s primary care and health ecosystem.

15.     MOH has set up a primary care Implementation Workgroup which includes representatives from the College of Family Physicians Singapore (CFPS), Singapore Medical Association, leads from all PCNs and our polyclinic clusters. The first meeting held at the end of April 2022, was very fruitful. In the coming months, we plan to engage and consult the wider primary care community so that we will have the benefit of your views and inputs.

16.     I really hope that all of you will actively participate in these consultation sessions and the co-creation of Healthier SG. We have to be realistic. The journey will be a very challenging one and it will take multiple years. But, the reward will be very fulfilling – better and healthier outcomes for our patients, even greater professional satisfaction for primary care colleagues, and a health ecosystem which will be better poised for the future.

Closing

17.     Ladies and gentlemen, my first deep engagement with CFPS and the primary care community was in the late 1990s, when I was Dean of the National University of Singapore Faculty of Medicine. At that time, I worked closely with the College on revamping primary care training for medical students and young doctors. But I want to highlight that it is very notable that it was the College which came forward proactively to propose a range of very meaningful changes. And what struck me most was the passion and deep sense of professional commitment of the College and the primary care community.

18.     This passion and proactive leadership have been a consistent hallmark – most recently demonstrated by the indispensable role which primary care colleagues played in our COVID-19 response. Your selfless devotion to our patients and our community was truly inspiring. Beyond COVID-19, the careful attention that the College has been paying to the training of future generations of primary care physicians has also been very commendable. On behalf of my colleagues in MOH, we wish to express our heartfelt thanks to all of you!

19.     As we take steps to shape the future, all of us look forward very much to your support, wise counsel and help to design and implement the different elements of Healthier SG. Your active leadership and participation will be critical to its effective implementation and longer-term success. As we mark World Family Doctor Day this evening, this is a fitting occasion to embark on a new journey – one that aspires to realise the full potential of a high performing primary care system, one that lays the foundation of a future ready primary care system and health ecosystem, but also one which is poised to ride on the new approaches, technologies and opportunities of the future, to produce the best possible outcomes for our patients and population. Please join us on this most meaningful endeavour! Thank you.

[1] Department of Statistics Singapore – https://www.singstat.gov.sg/find-data/search-by-theme/population/elderly-youth-and-gender-profile/latest-data

[2] Based on preliminary evaluation of polyclinics team-based care model using data from NHGP and NUP where outcomes of patients who were empanelled to a team-based care as of 31 December 2017 to patients who were not empanelled over a 3-year period.