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The evolution of primary care

In the past, Singapore’s population was predominantly young. A good public healthcare system built upon hospital-centric tertiary care was sufficient to meet most of our healthcare needs. As our population began to age, it led to a steep increase in demand for specialised tertiary healthcare services, which put pressure on the system. Healthcare needs became complex as patients are increasingly burdened by a host of chronic diseases affecting more than one organ system.

An effective and integrated primary care system, one which empowers and supports the patients, their families and the communities’ health and wellness through the delivery of primary medical treatment, preventive healthcare and health education, became necessary to help patients with multiple chronic diseases manage their conditions within the community, while minimising visits to the specialist clinics.

In SingHealth, primary care is offered by our network of polyclinics managed by SingHealth Polyclinics (SHP). SHP aims to provide holistic primary care services to the community and has been transforming and expanding our care and treatment offerings throughout the years.

The first such facility in Singapore, Queenstown Polyclinic, was opened in 1963. This was the oldest clinic under SHP. It was also Singapore’s first combined clinic offering outpatient, maternal and child health services. It relocated to Stirling Road in 2007 to offer a wider range of services such as radiology and a Nurse Clinician Clinic.

In 2000, seven polyclinics (Bedok, Bukit Merah, Geylang, Marine Parade, Outram, Queenstown, Tampines) were reorganised under SHP to provide primary care services in Singapore.


 

In 2002, SHP increased its network of polyclinics with the opening of Pasir Ris Polyclinic, which serves as a one-stop facility for outpatient medical care, including radiology and laboratory services. Sengkang Polyclinic was subsequently opened in 2005 to provide primary care services to residents living in the new northeast housing estates. Sited within a community hub, Sengkang Polyclinic was specially built to include infection-control measures such as rooms with negative air pressure and a modular layout to enhance patients’ health and safety in the event of any infectious disease outbreak.

In January 2017, the Ministry of Health (MOH) reorganised the public healthcare system into three integrated clusters. Queenstown Polyclinic and Geylang Polyclinic were transferred to come under the care of National University Polyclinics (NUP) and National Healthcare Group Polyclinics (NHGP), respectively. In the same year, Punggol Polyclinic was officially opened, bringing SHP’s current network of polyclinics to eight island-wide.

Reducing visits to the doctor for chronic illnesses

Keeping the community out of the hospital necessitates expanding the services that patients can access without having to visit a hospital, which includes allied health services. By 2016, physiotherapy and podiatry services were offered in SHP to provide management of musculoskeletal conditions in patients and reduce the need for patients to be referred to orthopaedic clinics in the hospitals.

Primary care is a key function in the management of chronic diseases like diabetes and hypertension. The Family Physician Clinic (FPC) was launched in June 2005 to ensure that chronic patients receive the right treatment at the right time in managing their conditions. With a team-based approach, the FPC provides continuing and holistic care for patients with poorly controlled diabetes, hypertension and hyperlipidemia, and helps such patients to better manage their conditions.

Closing the gap on the health and well-being of mothers and young children, KK Women’s and Children’s Hospital (KKH), SHP and Temasek Foundation launched Singapore’s first Integrated Maternal and Child Wellness Hub (IMCWH) programme in 2019, a collaborative effort that support the emotional health and well-being of mothers, as well as the immunisation and developmental assessment of their children. Find out more information about the IMCWH service.

In line with MOH’s strategy to maintain the high quality and affordability of healthcare in Singapore, SHP undertook the “Health Up!” initiative to carry out the strategy of “Beyond Healthcare to Health”, which sees Primary Care stepping up as advocates of preventative health for the wider community in partnership with key stakeholders. The programme, which will be launched in Tampines in the second half of 2021, is supported by SingHealth’s Regional Health System and in alignment with the vision of supporting the individual to Keep well, Get well and Live well in the community. Through community and digital engagements, SHP will have conversations with residents and journey with them towards better health and wellness, educate the wider community on preventive health, and provide personalised preventive care plans for residents and families enrolled.

Enhancing convenience and lowering costs with technology

Technology such as teleconferencing and mobile apps allowed SHP to further enhance patient care while reducing the number of clinic visits. In 2010 TeleCare services were launched. With TeleCare, patients monitor their own blood pressure at home and nurses will call them to review their conditions. Based on their readings and review, patients would be advised to collect their new supply of medication or see a doctor for further assessment. By reducing the number of visits made by the patients, the overall cost of consultation also drops.

In 2020, telemonitoring services were enhanced with the launch of the Primary Tech-Enhanced Care – Hypertension (PTEC-HT) programme for patients with hypertension in Bedok Polyclinic. The programme, which allows the polyclinic care team to monitor a patient’s blood pressure readings remotely, was collaboratively developed by the Ministry of Health Office for Healthcare Transformation (MOHT), in partnership with SHP, National Healthcare Group Polyclinics (NHGP) and National University Polyclinics (NUP), and supported by the Integrated Health Information Systems (IHiS). PTEC-HT will be rolled out to SHP’s remaining seven polyclinics progressively so that more patients may benefit from the service.

In 2020, SHP made further progress in telemedicine with the successful scale up of TeleCare services with the adoption of Video Consultation (VC) enabled by IHiS for chronic disease management, wound care, and drug observed therapy. With phone and video conferencing, medication can be dispensed remotely.

Find out more about SHP’s VC programme.

Building up for the future

To meet the increasing demand of primary care services in Singapore, more SingHealth polyclinics will be opened to serve residents in the community, including Eunos Polyclinic in 2021, along with Tampines North Polyclinic and Kaki Bukit Polyclinic in the coming years. The current Pasir Ris Polyclinic will also be relocated and developed at a larger site, and redevelopment of other SingHealth Polyclinics will progressively take place over the next few years to transform the way we deliver primary care to our patients.

SHP will continue to leap forward in transforming primary care with research and innovation for better health in the community.