Allowing Singaporean doctors to prescribe medicines to British patients could ease pressure on local GPs and help poorer people access medical care, a think tank argues today.
In a paper published today by the Social Market Foundation, with a foreword from former health minister Lord Norman Warner, healthcare researcher Max Thilo identifies lessons for the UK’s healthcare system from Singapore’s famously efficient and effective regime. As demand for GP services grows, he argues, the UK government should consider liberalising prescribing rights for Singaporean telemedicine providers and introducing Singaporean-style polyclinics in areas of England with poor access to primary care services.
Singapore spends 4.4% of its national income on healthcare – less than half as much as the UK – but enjoys much better outcomes. Its infant mortality rate is half that in the UK; it has much lower levels of obesity than us; and Singaporean life expectancy is several years higher than in the UK.
Some of these advantages are very specific to the Singaporean context, but others ought to be inspiration for British policymakers, Thilo argues. Specifically, he calls 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 – as Singapore has invested in highly productive polyclinics, as well as low-cost telemedicine. These polyclinics combine GP services with other healthcare offerings – such as diagnostic tests. Singaporean polyclinics 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. (See notes)
The UK has in fact explored the polyclinic idea in the past: Lord Darzi, a health minister in the Gordon Brown government, introduced polyclinics combining primary and some acute care. However, the plans were abandoned in the early stages. In his foreword, Lord Warner, health minister under Tony Blair, argues that the “time has come to revisit these ideas and draw on the experience of Singapore.”
Singapore-style polyclinics separate acute and chronic patients. This allows them to operate at higher volumes. 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. (See notes)
A recent survey by NHS England revealed that patients are finding it increasingly hard to get appointments with their GP. Only about half of patients had a good experience trying to book an appointment. Brits have increasingly been seeking out private care, as well as using international telemedicine apps to reach out to Singaporean GPs – their practices also comply with the Public Hospitals and Medical Clinics Guidelines, ensuring a high standard of medical care. But they cannot yet prescribe to their British patients.
Allowing them to prescribe medication to Brits would be a natural next step – and if this proves successful, the NHS could commission these services for rural areas with limited access to local GP practices, Thilo proposes.
Lord Norman Warner, in a foreword to the briefing, 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.
This pamphlet provides valuable service delivery ideas that would help rescue our beleaguered NHS.”
Max Thilo, healthcare researcher and author of the briefing, said:
“There is a popular myth that one weird trick, patient charges, explains why Singapore spends much less than other developed countries on health care. The truth is a lot more complicated.
This uncertainty over what is driving Singapore’s lower costs creates the opportunity for learning in other contexts, like the NHS. I propose adapting specific practices like telemedicine and polyclinics, to address challenges in primary care access and efficiency. But this approach can be applied more broadly.”
Notes
- The SMF briefing will be published at https://www.smf.co.uk/publications/nhs-lessons-from-singapore/ on Monday 4th March 2023.
- More information on Singapore-style ‘polyclinics’: Polyclinics now provide subsidised primary care services to 20 per cent of Singaporean citizens, focusing on low-income patients with chronic health conditions. In the past, patients were not assigned to specific doctors, but more recently polyclinics have adopted a “teamlet” model which provides continuity of care to chronic patients. 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. The costs of Singaporean polyclinics vary significantly depending on their specifications, but a 6,000 square metre polyclinic including dental services costs approximately £30 million to build and fit out.
- The briefing is published by Social Market Foundation. The author retains full editorial independence.
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