Direct Access Endoscopy in TTSH

Direct Access (also known as Open Access) refers to the direct referral of a patient to medical services without prior need for formal consultation.


In Tan Tock Seng Hospital (TTSH), Direct Access endoscopy services for colonoscopy and gastroscopy have been available to General Practitioners (GPs) since 2007.

GP BUZZ spoke to Adj. Asst. Prof. Charles Vu, to understand how Direct Access could potentially enhance a patient’s healthcare journey and create more opportunities for TTSH to partner GPs to provide better care for their patients.

How was Direct Access established in TTSH?

Due to the increasing and ageing population, demand for healthcare has grown significantly, resulting in long wait times in the specialist outpatient clinics and more stress on the tertiary healthcare system.

Direct Access service is useful in conditions in which GPs can manage at the primary care setting but do not have the facilities or expertise to do certain specific investigations or procedures.

In TTSH, a set of screening process is in place to determine if patients are medically fit or suitable for the Direct Access procedure before it is performed.

How will Direct Access benefit your patients?

In addition to smoother coordination and continuation of patient care, patients could get the procedure or investigation done in a shorter time by obviating the need for outpatient consultation with a specialist. An investigation report is provided to the patient on same day and a report will also be sent to the referring GP.

What roles do GPs play? What are some opportunities for Specialists and GPs to work together?

In general, Direct Access patients will be referred back to their GPs for follow-up, unless a more complex finding e.g cancer, is diagnosed. For more complex conditions that require specialist care, we will take the initiative to continue the patient’s care, after discussing with the referring GP.

There is a need for continuing dialogue with our GPs, to gauge their needs for Direct Access to other services and to improve our existing services.

Direct Access is not the only way we can improve the patient referral journey. “Front-loaded” investigations can also be done before seeing the specialist e.g. imaging of a joint is performed before seeing an Orthopaedic surgeon.


By Adjunct Assistant Professor Charles Vu
Senior Consultant
Department of Gastroenterology & Hepatology
Tan Tock Seng Hospital