SG’s Primary Care Network empowers private GPs to manage chronic diseases

Singapore’s Primary Care Network (PCN) helps improve the capacity of general practitioners (GPs) to manage patients with chronic condition, according to a recent study.

Nevertheless, several barriers still need to be worked out, particularly a heavier administrative load for healthcare providers and steeper out-of-pocket costs for patients.

“To tackle the imbalance in chronic care attendances, Singapore’s Ministry of Health undertook a large coordinating role to use the capabilities of private GPs,” the researchers explained. “This shift came in the form of the PCN which organizes private GPs into groups de novo,” in turn enhancing their chronic care management.

Through 30 semi-structured interviews with enrolled GPs, three main themes emerged in relation to facilitators of the PCN: the availability of ancillary services, the chronic disease registry (CDR), and funding. [BMJ Open 2021;11:e046010]

The PCN provides its participating GPs with wrap-around ancillary services, such as diabetic retinal photography and foot screening, as well as nurse counselling, along with the necessary manpower to run them. For many private practices with small clinics, these services made it easier for them to provide holistic and preventive care to their patients.

In order to facilitate systematic tracking of the patients’ care components, the PCN also provides a platform in the form of the CDR, which includes an extensively designed spreadsheet and involves the PCN oversight agency. According to the surveyed GPs, the CDR improved the quality of care delivered to the patient.

To keep the care systems going, each PCN is provided funding by the government, mainly on a reimbursement basis through the PCN oversight agency. This has helped them offset costs incurred by seeing chronic vs acute cases and time spent on fulfilling PCN duties, as well as hire coordinators to oversee ancillary services and other administrative tasks.

Despite these benefits, though, GPs agreed that the PCN still faced two important barriers: administrative burden on GPs and high out-of-pocket costs for patients.

Because the spreadsheet is so extensive, maintaining the CDR has become a labour-intensive task for GPs, even with the help of the coordinator. Other administrative tasks, sparse manpower, and the lack of a smart extraction tool for their clinic management system all contribute to the heavy administrative burden of the CDR.

In addition, because the GPs participating in the PCN are private practices, they are out-competed by publicly subsidized healthcare institutions, which many price-conscious patients prefer. In addition, more complex chronic conditions require more visits and more medications, corresponding to higher out-of-pocket costs for the patients, further making private care less attractive.

“The PCN initiative offers immense potential for the management of chronic diseases,” the researchers said. “The funding for streamlining back-office functions and increased manpower capacities to deliver a range of ancillary services to patients is a huge enabler for solo practices, who are now able to tap on more resources.”

“The challenges surrounding the administrative burden of maintaining the CDR need to be prioritized, and financial gradient between private and public primary care systems partially surmounted through enhancements to private healthcare subsidies remain to be addressed,” they added.