The NHS should trial Singapore-style ‘polyclinics’ to ease pressure on GP practices and even allow Singaporean doctors to prescribe medicines to British patients, a health and social care think-tank has said.
A report from The Social Market Foundation has recommended that the NHS should grant prescribing rights to Singaporean doctors to allow medicines to be prescribed to British patients via a Singaporean telemedicine app.
It has also argued NHS England should test Singaporean-style ‘polyclinics’ in areas of England with too few GPs.
Polyclinics in Singapore combine GP services with other healthcare offerings, such as diagnostic tests. They operate a ‘teamlet’ model, where patients with long-term conditions are cared for by a team comprising the same doctor, two nurses and health coordinator.
The UK has in fact explored the polyclinic idea in the past under the Gordon Brown government, the briefing paper, What the NHS can and cannot learn from the Singaporean health care system, points out.
Primary care pressures
Lord Darzi, a health minister in that administration, introduced polyclinics combining primary and some acute care. However, the plans were abandoned in the early stages.
In his foreword the latest briefing, Lord Norman Warner, health minister under Tony Blair, has said: “These reforms were seen off by the British Medical Association and the powerful acute hospital lobby. The time has come to revisit these ideas and draw on the experience of Singapore.”
The report has called for a shift from delivering acute services in hospitals, the most expensive part of any healthcare system because of their fixed overheads and expensive maintenance.
Singapore-style polyclinics separate acute and chronic patients. This allows them to operate at higher volumes, the foundation has argued.
Doctors that cater for walk-in patients see 56 acute patients a day, during regular working hours. Polyclinics also drive down costs by staffing the urgent care clinic with junior doctors. Singaporean polyclinic doctors earn slightly more than the average English GP, but cost per appointment is lower in Singapore than in England.
Such polyclinics now provide subsidised primary care services to 20% of Singaporean citizens, focusing on low-income patients with chronic health conditions.
Patients with multiple chronic health conditions sign up to a ‘teamlet’, made up of two doctors, a nurse, and a health coordinator. Consultation rooms are connected by sliding doors and doctors see multiple patients at once. While the health coordinator is seeing a patient in one room; the doctor can attend to a second patient in another.
Allowing Singaporean doctors to prescribe medication to British patients would be “a natural next step”, the foundation has also argued. “If this proves successful, the NHS could commission these services for rural areas with limited access to local GP practices,” it has said.
Lord Warner, in his foreword to the document, said: “The NHS is in serious decline, struggling to recover from the devastating impact of the pandemic, Brexit and over a decade of austerity. Politicians know radical change is necessary but are fearful of explaining what’s needed to their electorate. Part of the trouble is they lack models they can draw on and cite as a way forward.”
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