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Home > About TTSH > News > GPs roped in to better support residents with ‘social medicine’
Care Corner staff (in blue) with (from left) Dr Kevin Loy, a family physician at Doctors Inc Medical Group; Dr Tan Lye Yoong, deputy head of Toa Payoh Polyclinic; and Dr Tham Kwong Lum, a family physician at Mediview Clinic and Surgery, at the social service agency’s active ageing centre in Lorong 4 Toa Payoh on Saturday. ST PHOTO: CHONG JUN LIANG​​

The Sunday Times (14 May 2023)​

Scheme gets Toa Payoh doctors aware of health, social services in area for the benefit of patients​​

In order to help residents in Toa Payoh, especially seniors, live more healthily, Tan Tock Seng Hospital (TTSH) and Care Corner Singapore are actively reaching out to general practitioners (GPs) in the area.​

This is so that the more than 60 family doctors practising in the neighbourhood are aware of the health and social services available within their communities, and can refer patients to these services.​

It will also help prepare GPs for the July launch of Healthier SG – a national scheme that encourages residents to enrol with a family doctor who knows their conditions well and can work with them to practise preventive care.

​The scheme represents a fundamental reform of the Republic’s healthcare system that will see GPs taking on a key role in ensuring that individuals are kept healthy and avoid falling ill, instead of reactively caring for those who are already sick.​

Healthier SG will kick off with those aged 60 and above. But patients with chronic illnesses aged 40 and above can sign up earlier through a pre-enrolment process.

​On Saturday, 10 GPs working in the Toa Payoh area visited Care Corner’s active ageing centre in Lorong 4 Toa Payoh to learn about the programmes that the social service agency provides, including daycare for seniors and specialised counselling services for them.

These are referred to as “social medicine” by Care Corner Seniors Services senior group director Daniel Chien.

During the engagement session, the doctors were taught how to spot potential fall risks among seniors and how to help them avoid getting frail – an issue that is expected to grow markedly as Singapore’s population ages.

They were also briefed about local care networks that TTSH is building to bring GPs, community partners and various agencies together.

In a statement, Care Corner and TTSH said a fifth of the residents in Toa Payoh are above 65 years old, and almost one in three of these seniors lives alone. Hence, there is a pressing need to ensure that these seniors are better supported to lead healthier lives.

TTSH said it will work with other community partners in central Singapore to conduct similar engagement sessions for family doctors in places such as Ang Mo Kio, Serangoon and Kallang.

​Adjunct Assistant Professor Jerome Goh, Clinical Director of the Division for Central Health​ at TTSH, said: “With an ageing population, frailty, social isolation and disabilities become key social determinants for health. These cannot be managed using a medical model alone.”

What happens to patients after they leave the clinic is equally important – what they do in terms of adopting a healthy lifestyle, eating healthy and the social connections that they make.

​- Adjunct Assistant Professor Jerome Goh, Clinical Director of the Division for Central Health at Tan Tock Seng Hospital.

He added: “What happens to patients after they leave the clinic is equally important – what they do in terms of adopting a healthy lifestyle, eating healthy and the social connections that they make.”

Care Corner said collaborations between GPs and social service agencies can greatly benefit seniors by combining medical and social interventions.

For example, some senior patients may have difficulty managing their treatment, including forgetting appointments, being unsure of what medication to take, or lacking the motivation to take their pills.

In this case, social workers can work with GPs to provide follow-up support.

GPs can also refer seniors to Care Corner for social and exercise activities that can strengthen their support network and lower their risk of falls.

Care Corner said it plans to work closely with GPs in Toa Payoh to identify cases of neglect, abuse, social isolation and other mental health concerns among residents that may otherwise go unnoticed.

Another area that is being looked at is the management of patients with complex conditions who have been recently discharged from hospital.

The plan is to include GPs in joint case consultations conducted by TTSH, National Healthcare Group polyclinics and other partners, including Care Corner.

TTSH’s Prof Goh said the hospital also wants to simplify how GPs refer patients for specialist treatment and other health and social programmes.

He noted that it is also important for a feedback loop to be in place so that GPs are aware of what their patients have tried and what the outcome was.

TTSH will trial an electronic referral system later in May so that GPs can more easily make referrals to the hospital’s specialists.

Using the system, GPs will be able to track the progress of the referral, and receive an update from the hospital’s specialists on the patients’ conditions.

In addition, the system will guide GPs on how to prescribe social support programmes for patients by prompting them on potential programmes and activities based on the doctor’s assessment of the patient’s conditions and interests.

Dr Kevin Loy, 54, who has been running a GP clinic in Toa Payoh Central for 18 years, said Saturday’s engagement session was useful.

“I was not aware that the social service network in Toa Payoh was so big,” the family physician at Doctors Inc Medical Group told reporters.

​He has referred patients to Care Corner before, but only in an ad hoc manner.

“Now that I am more aware, I can make more accurate referrals for the various services,” he said.


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