GPs warn of mounting strain as chronic illness cases rise in community clinics
The call for stronger support comes as the Ministry of Health seeks to reduce pressure on polyclinics and get more patient care to move upstream into the community.
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SINGAPORE: At Gryphon Family Clinic, preventive and chronic illness cases have risen in the past few months, and the sole doctor running the practice expects demand to climb even further.
The clinic in Bedok has seen around 30 per cent more patients seeking preventive healthcare services such as vaccinations and immunisations, as well as treatment for chronic conditions including diabetes and high blood pressure.
Dr Mark Khoo said the workload is expected to grow as more chronic conditions become eligible for subsidies under the Community Health Assist Scheme (CHAS) and the Chronic Disease Management Programme.
“For example, from next year onwards, cases such as thyroid issues are also going to be included,” he told CNA.
“So, as more conditions come on board to be treated by GPs, as the population ages, definitely the chronic cases and casework will also increase.”
Family doctors are calling for more support as demand for chronic illness management and preventive healthcare continues to climb, with further increases expected as more care shifts from polyclinics into the community.
Smaller clinics warn they are struggling to cope despite increased government grants aimed at easing the burden.
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Dr Khoo said resources are spread thin at his clinic.
He relies on support from a community of healthcare professionals, such as a Primary Care Network (PCN) which typically comprise 10 or more GP clinics.
Under the scheme, patients can receive care through a muti-disciplinary team including doctors, nurses and primary care coordinators to better manage chronic conditions.
Through the PCN, Dr Khoo has been able to refer some cases to diabetic nurse counsellors who help patients with lifestyle advice and medication. But he said waiting times remain a challenge.
“It will be good if we can aim to let patients see their diabetic nurse on the same day as their doctor consultation, or within the same week will be an excellent target. Currently, the waiting time can be a few weeks to even up to a month,” he added.
Dr Khoo also called for more care coordinators to ensure patients keep up with medical appointments and screenings. There is currently only one shared among the PCNs, with his own clinic staff handling the growing load.
PUSH TO REDUCE PRESSURE ON POLYCLINICS
The need for stronger support comes as the Ministry of Health pushes for more patient care to move upstream into the community, with family doctors taking on a bigger role.
The ministry also aims to reduce pressure on polyclinics, which Health Minister Ong Ye Kung has said cannot cope alone with growing demand from patients with complex chronic diseases.
But while the burden on polyclinics may ease, GPs said the strain is being transferred to smaller clinics like theirs.
Dr Vincent Tok of Shalom Medical Clinic, located in Bras Basah Complex, said many clinics are having trouble keeping up with the growing workload using their existing manpower.
The clinic has seen a 10 to 15 per cent rise in the number of chronic disease and preventive care cases.
“Right now, most clinics are struggling with the doctor and the clinic assistants that they had earlier, but that load is getting too heavy to bear,” said Dr Tok.
He added that if clinics have to increase their level of care, not only will its staff have to take on more responsibilities, but costs will also rise.
“Because obviously, while we try to help patients as much as we can financially, sometimes we reduce fees or we waive fees,” he said.
“Obviously that cannot be a mass model, and that's where we need the government's help with the fair remuneration for the additional services and costs that we're now being asked to provide.”
Last year, the government increased its grants for family clinics by 52 per cent to S$350 million (US$273 million), up from S$230 million in 2022. This works out to an average of more than S$140,000 per clinic.
Still, Dr Tok said more support is needed as operating costs continue to rise. For his clinic, costs have increased by at least 20 per cent over the past year.
He added that clinics also need more manpower for administrative work and patient outreach efforts.
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