FORGING AHEAD - National Healthcare Group Polyclinics

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FORGING AHEAD - National Healthcare Group Polyclinics
FY2019 Annual Report

FORGING AHEAD
D E L I V E R I N G W O R L D - C LA S S P R I M A RY C A R E
FORGING AHEAD - National Healthcare Group Polyclinics
FORGING AHEAD
The National Healthcare Group Polyclinics’ (NHGP)
Annual Report FY2019, titled ‘Forging Ahead’,
showcases our journey in delivering quality primary
care. To provide care that is world-class, we must be
prepared to challenge old ideas and break new ground.

The paper-cutting imagery on the cover and
throughout the Annual Report depicts how NHGP has
navigated through the intricacies and complexities
of primary healthcare, forged ahead in the face of
challenges, and found breakthroughs as part of this
journey. On the cover, the burst of colours and the
blooming petals portray the collaborative synergy of
our staff and partners as well as our constant drive
to meet the growing needs of Singapore’s population.
This journey of constant growth and discovery has
made NHGP a leader in advancing Family Medicine
and transforming primary healthcare for the benefit
of all Singaporeans.
FORGING AHEAD - National Healthcare Group Polyclinics
CONTENTS

                                              OUR VISION
                                      To be the leading health-promoting institution
                                    that helps advance Family Medicine and transform                          04                                06                                08
                                             primary healthcare in Singapore.
                                                                                                      GROUP CEO’S MESSAGE                CEO’S MESSAGE                      NHGP SENIOR
                                                                                                                                                                            MANAGEMENT

                                             OUR MISSION
                                 We will improve health and reduce illness through                             10                                18                               24
                            patient-centred quality primary healthcare that is accessible,
                           seamless, comprehensive, appropriate and cost-effective in an
                                                                                                          CHAPTER 1                          CHAPTER 2                       CHAPTER 3
                             environment of continuous learning and relevant research.                    Combatting a                  Developing Population               Charting Our Way
                                                                                                         Global Pandemic                       Health                           Forward

                                              OUR VALUES                                                                       32                                  36

                     People-Centredness                                Compassion                                           CHAPTER 4                           CHAPTER 5
              We value diversity, respect each other               We care with love, humility                         Advancing Towards a                  Enhancing Our
                   and encourage joy in work.                            and empathy.                                   New Norm of Care                     Capabilities

                                  Integrity                            Stewardship                                             42                                  50
               We commit ourselves to the highest            We are responsible for the care of our
                  standards of ethical conduct.                people, patients and population.
                                                                                                                           APPENDICES                     SNAPSHOTS OF
                                                                                                                                                      PATIENTS ATTENDANCE
                                                                                                                                                         AND WORKLOAD
                                                                                                                                                            IN FY2019

02   Our Vision, Our Mission, Our Values                                                                                                                                          Annual Report FY2019   03
FORGING AHEAD - National Healthcare Group Polyclinics
GROUP CEO’S MESSAGE

                                                                      I sincerely thank all                           I sincerely thank all NHGP staff for soldiering on        I hope that marking this milestone spurs all staff to
                                                                                                                      during this period, despite the long hours you put        continue their efforts to reach even greater heights in
                                                                      NHGP staff for soldiering                       in and personal sacrifices you had to make. Such          the next 20 years and beyond. I am confident of the
                                                                      on during this period,                          demonstrated commitment underscores the fact that         journey ahead, guided by the foresight and experience

                                                                      despite the long hours                          — working as one NHG — we can and will overcome
                                                                                                                      any challenges we encounter.
                                                                                                                                                                                of Chairman, Madam Kay Kuok, the Board of Directors,
                                                                                                                                                                                the Ministry of Health, and Associate Professor Chong
                                                                      you put in and personal                                                                                   Phui-Nah, CEO of NHGP & Primary Care. I look forward
                                                                      sacrifices you had to                           BEYOND 20 YEARS                                           to working closely with all of you as we continue to
                                                                                                                      Against this backdrop of an unprecedented healthcare      transform care and achieve our vision of ‘Adding Years
                                                                      make. Such demonstrated                         crisis, NHGP commemorated its 20th Anniversary in 2020.   of Healthy Life’.
                                                                      commitment underscores                          While circumstances derailed many planned activities,

                                                                      the fact that — working as                      this milestone was no less momentous and memorable.
                                                                                                                      I wish to highlight some of the commendable milestones
                                                                      one NHG — we can and will                       that NHGP has achieved over its 20-year journey:
                                                                      overcome any challenges
                                                                                                                      • Launching the first Family Physician Clinic at
                                                                      we encounter.                                     Ang Mo Kio Polyclinic in 2005
                                                                                                                      • Establishing the Primary Care Academy in 2007           Professor Philip Choo Wee Jin
TOGETHER, WE SHALL OVERCOME                                                                                           • Establishing the Family Medicine Academy in 2013        Group Chief Executive Officer
Since the first case of COVID-19 was diagnosed in Singapore   Beyond the polyclinic walls, NHGP has also played       • Introducing the Teamlet Care Model in 2015              National Healthcare Group
in late January 2020, the entire NHG Family — from acute      a key role in NHG’s endeavours to support various
to community care — has been hard at work helping to          efforts at community facilities around Singapore.       All of these have established a strong foundation
manage the pandemic. Among those at the frontlines of this                                                            for primary care and enhanced our patients’ overall
battle is the National Healthcare Group Polyclinics (NHGP).   These included the setting up and managing of           experience. Through continued innovations in care
                                                              14 Medical Posts at migrant worker dormitories,         delivery, NHGP has not only made primary care more
Standing shoulder to shoulder with General Practitioners      running four Swab Isolation Facilities, and             accessible and holistic, they have also shifted the
in our Central-North Primary Care Network, NHGP has           participating in close to 70 mass swabbing missions     paradigm of care towards a patient-centric model that
spared no effort in swiftly preventing and containing the     across Singapore. All of this, done under challenging   empowers patients to become active participants in
outbreak within the polyclinics.                              conditions and in full Personal Protective Equipment.   their health. This is truly worth celebrating!

04   Group CEO’s Message                                                                                                                                                                                              Annual Report FY2019   05
FORGING AHEAD - National Healthcare Group Polyclinics
CEO’S MESSAGE

                                                                                                                           EMBRACING A NEW NORM OF CARE                                FORGING AHEAD
                                                                      The quiet resilience shown                           I am also pleased by how NHGP has risen to the              These achievements spur us on in our on-going quest to
                                                                                                                           occasion and turned the many obstacles faced during         raise the level of primary care — even as we continue the
                                                                      by our NHGP family in this                           the COVID-19 crisis into opportunities for real-world       battle against COVID-19 for the rest of FY2020. I would
                                                                      recent COVID-19 pandemic                             innovation. We are embracing new norms of care and          like to take this opportunity to once again thank all
                                                                                                                           leveraging technology to accelerate the implementation      NHGP staff for their dedication and perseverance in what
                                                                      has been inspiring and                               of initiatives that enable us to connect safely with        looks to be a long journey ahead of us. I am grateful for

                                                                      heartening. As healthcare                            patients, continue essential services and yet reduce
                                                                                                                           the risk of infection transmission. These initiatives
                                                                                                                                                                                       our valued partners in healthcare — NHG Central-North
                                                                                                                                                                                       Primary Care Network General Practitioner (GP) partners,
                                                                      providers, all of us at NHGP                         include the launch of Video-Consultations (by doctors),     community partners and other healthcare institutions –
                                                                                                                           Tele-Dietetics, Tele-Psychology and more.                   for working closely with us through this eventful year.
                                                                      are cognisant of the risks
                                                                      associated with infectious                           CELEBRATING EXCELLENCE                                      The year 2020 also marks NHGP’s 20th Anniversary —
                                                                                                                           And while FY2019 will be remembered largely for our         a two-decade journey that has been enriched by the
                                                                      disease. However, to support                         infection control and management efforts to counter         tremendous support of various parties. On behalf of the
                                                                      Singapore’s battle against                           COVID-19, this year will also be commemorated for           management team, I would like to thank the Ministry
                                                                                                                           several important achievements.                             of Health, NHG’s Board of Directors, our GP partners
                                                                      COVID-19, many of our staff                                                                                      and NHGP’s senior management members and staff for
                                                                      have risen to the challenge.                         One of these is winning the overall Excellence Champion     sharing our vision and supporting us. I am confident
                                                                                                                           Medal at the annual National Healthcare Innovation and      that whatever comes our way, we will draw from
                                                                                                                           Productivity Award, held in May 2019. NHGP’s project,       this collective strength and continue to make strides
                                                                                                                           titled ‘NHGP Teamlet Care Model: A Redesign of Chronic      towards transforming primary healthcare and advancing
                                                                                                                           Care Delivery’, was selected for this top spot from more    family medicine.
COURAGE IN THE FACE OF ADVERSITY                            The quiet resilience shown by our NHGP family in this recent   than 50 project submissions.
Since the establishment of the National Healthcare          COVID-19 pandemic has been inspiring and heartening.
Group Polyclinics (NHGP) in 2000, our staff have            As healthcare providers, all of us at NHGP are cognisant       In September 2019, NHGP also received two Excellence
served Singapore with dedication. This commitment is        of the risks associated with infectious disease. However,      Awards under the ‘Community Involvement’ and ‘Facility
not only lived out in our daily efforts to deliver sound,   to support Singapore’s battle against COVID-19, NHGP has       Management and Financial Improvement’ categories at the
patient-centred primary care, but also in the face of       risen to the challenge. Many of our staff overcame their       Asian Hospital Management Awards. This is a prestigious     Associate Professor Chong Phui-Nah
greater challenges, such as the SARS, H1N1 and Zika         own personal fears to care for patients, toiling for long      award that recognises and honours healthcare institutions   Chief Executive Officer
outbreaks in the past.                                      hours across our six polyclinics and various community         that take innovative and progressive approaches to          National Healthcare Group Polyclinics
                                                            facilities. This courage and resilience has done us proud!     improve healthcare in the region.                           & Primary Care

06   CEO’s Message                                                                                                                                                                                                             Annual Report FY2019   07
FORGING AHEAD - National Healthcare Group Polyclinics
NHGP SENIOR MANAGEMENT                                                                                                                                                        NHGP SENIOR MANAGEMENT

                                  Dr Simon Lee                Associate Professor Chong Phui-Nah                              Dr Karen Ng                                             Dr Tang Wern Ee                              Dr Kenneth Low                             Dr Darren Seah                              Dr Irwin Chung
                         Chief Operating Officer and                    Chief Executive Officer,                       Director, Clinical Services                                Head, Clinical Research Unit                  Director, Dental Division           Director, Family Medicine Development          Director, Primary Care Academy
                       Chief Clinical Informatics Officer               NHGP & Primary Care

                            Ms Chen Yee Chui                                  Mr David Kok                                   Mr Shawn Phua                                            Dr Mok Ying Jang                           Ms Chan Soo Chung                            Ms Lim Soh Har                            Dr Lim Chee Kong
                        Chief Nurse, Nursing Services                         Director, Finance                       Director, Human Resources                                  Deputy Chief Operating Officer            Executive Director, NHG Pharmacy          Executive Director, NHG Diagnostics          Deputy Director, Clinical Services
                                                                                                                                                                                                                                                                                                                            (Manpower)

      Dr Christopher Chong                           Dr Jonathan Ting                               Dr Kong Jing Wen                                  Dr David Ng                                         Dr Gowri Doraisamy                            Dr Wee Wei Keong                        Dr Tung Yew Cheong
     Head, Ang Mo Kio Polyclinic                   Head, Geylang Polyclinic                       Head, Hougang Polyclinic                     Head, Toa Payoh Polyclinic                                 Director, Care Integration        Director, Health Promotion & Preventive Care   Director, Quality and Patient Safety
                                                                                                                                                  (until 31 Jan 2020)

                                                                                                                                          Head, Special Projects, Primary Care
                                                                                                                                                  (from 1 Feb 2020)

         Dr Tan Khai Wei                                Dr Evan Sim                                 Dr Kwan Pek Yee                                  Dr Lim Ziliang                                          Mr Donald Wai                          Ms Noraizah Zainal Abidin                       Ms Jaclyn Fam
     Head, Toa Payoh Polyclinic                  Head, Woodlands Polyclinic                        Head, Yishun Polyclinic                      Head, Yishun Polyclinic                                      Director, Operations -        Deputy Director, Corporate Communications       Deputy Director, Corporate Planning
        (from 1 Feb 2020)                                                                            (until 31 Jan 2020)                          (from 1 Feb 2020)                               Facility Development and Planning Office

08    NHGP Senior Management                                                                                                                                                                                                                                                                                                 Annual Report FY2019      09
FORGING AHEAD - National Healthcare Group Polyclinics
FORGING AHEAD - National Healthcare Group Polyclinics
BATTLE AGAINST COVID-19                                                                                                                         Cleaning and Disinfection
                                                                                                                                                Processes
                                                                                                                                                                                                                Preventive Measures for Staff
                                                                                                                                                                                                                To minimise exposure to the virus and
                                                                                                                                                                                                                                                                                 Special COVID-19 Issue of Plexus
                                                                                                                                                                                                                                                                                 The Primary Care Academy (PCA) produced
Being the first line of defence in the primary healthcare setting, NHGP played a critical role to minimise
                                                                                                                                                For areas visited by a suspected or                             to reduce the risk of transmission for all                       a special COVID-19 issue of Plexus
and reduce the risk of COVID-19 transmission nationwide.                                                                                        confirmed COVID-19 patient, thorough                            staff, NHGP promptly implemented strict                          on containment and infection control
                                                                                                                                                cleaning and disinfection were done. All                        processes in February 2020. Staff were                           measures, which was distributed to
                                                                                                                                                instruments and environmental surfaces,                         required to follow Personal Protective                           GP partners. In line with the ever-evolving
In minimising the risk of COVID-19                                                                                                              from stethoscopes and thermometers                              Equipment (PPE) guidelines closely when                          health advisories and updates from the
transmission, NHGP swiftly developed                                                                                                            to telephones and keyboards, were                               in the clinic premises, adhere to strict                         government, a team of NHGP Family
the following framework to tackle the                                                                                                           also disinfected for safety. Routine                            safe distancing measures, and restrict                           Physicians addressed common queries
challenges brought about by the pandemic:                                                                                                       environmental cleaning procedures                               their movements across Public Healthcare                         from the frontlines in that issue.
                                                                                                                                                included disinfecting floors twice a                            Institutions (PHIs) and clinics.
Containing risk of cross-contamination                                                                                                          day and cleaning clinic common areas,
Observing safe distancing                                                                                                                       including lifts and toilets, as well as
Verifying infections quickly                                                                                                                    consult rooms within Red Zone areas. The
I solating at-risk staff                                                                                                                        frequency of wipe-downs and cleaning for
Developing new ways to care for patients,                                                                                                       high-touch areas was also increased.
and train staff and students

                                                                                                                                                Support for Primary Care Partners
CONTAINING RISK OF                                                                                                                              NHGP also provided support to its
CROSS-CONTAMINATION                                                                                                                             General Practitioner (GP) partners in
                                                                                                                                                the Central region during the COVID-19
Triage Area Measures                                                                                                                            period. NHGP’s nursing team helped
Since Singapore confirmed its first                                                                                                             conduct mask-fitting sessions for GPs in
case of COVID-19 in January 2020, all                                                                                                           the Central-North Primary Care Network
patients and visitors had to undergo                                                                                                            (CN-PCN), as well as non-CN-PCN GPs
mandatory temperature screening and                                                                                                             and their clinic staff. The CN-PCN
travel history declaration prior to entering                                                                                                    administrative team also assisted with
any of NHGP’s six polyclinics. Patients                                                                                                         the procurement of key items, such as
were further triaged depending on their                                                                                                         masks, protective goggles and hand
temperatures, symptoms displayed and                                                                                                            sanitisers. To ensure these GPs kept up
travel history to mitigate the risk of                                                                                                          with the evolving situation, the team
cross-infection spread between patients                                                                                                         helped set up virtual meetings to provide
of different risk levels.                            Screening and triaging area at Ang Mo Kio Polyclinic.                                      regular and timely updates.
                                                                                                                                                                                                                NHGP nurse conducting mask-fitting for a General Practitioner.

Segregation Measures
                                                                                                                                                                                                                                                                                 OBSERVING SAFE
                                                                                                                                                                                                                                                                                 DISTANCING
After being triaged, patients were
assigned to Green, Orange or Red Zones.
Patients suspected of having COVID-19                                                                                                                                                                                                                                            To create more safe distancing spaces
were managed in tentages at the Red                                                                                                                                                                                                                                              for patients and visitors, screening areas
Zone outside the main building. The                                                                                                                                                                                                                                              at all NHGP polyclinics were expanded.
Orange Zone catered to patients with                                                                                                                                                                                                                                             Tentages and standing fans installed
symptoms of upper respiratory tract                                                                                                                                                                                                                                              outside all six polyclinics in February
infection such as sore throat, cough,                                                                                                                                                                                                                                            2020 increased screening capacity and
breathlessness, runny nose or fever.                                                                                                                                                                                                                                             reduced cross-contact contamination.
The Green Zone saw patients with
chronic conditions, who passed the                                                                                                                                                                                                                                               Additionally, patients were limited to
screening criteria and did not have                                                                                                                                                                                                                                              only one accompanying visitor to further
acute respiratory symptoms. Satellite                                                                                                                                                                                                                                            contain the spread of infection within the
pharmacies were also set up at the                                                                                                                                                                                                                                               clinic premises. Safe distancing measures
Orange and Red Zones in the clinics to                                                                                                                                                                                                                                           markers were also placed at queues, seats
help minimise and contain cross-contact                                                                                                                                                                                                                                          and lifts to ensure that safe distancing
between patients and visitors from                                                                                                                                                                                                                                               guidelines were strictly adhered to.
different triaged zones. This allowed
pharmacists to prioritise and manage the
prescription needs of these patients.

                                                     Patients suspected of having COVID-19 were isolated and managed at designated Red Zones.   Tentage set up to expand screening areas at Toa Payoh Polyclinic to aid infection control and safe distancing measures.

   12     Chapter 1 – Combatting a Global Pandemic                                                                                                                                                                                                                                                  Annual Report FY2019   13
FORGING AHEAD - National Healthcare Group Polyclinics
VERIFYING INFECTIONS QUICKLY                                                                                                                       DEVELOPING NEW METHODS OF PATIENT CARE
                                                        Swab and Send Home Programme                  Contact Tracing                                                                                                                                                                       Video-Consultations with Doctors
                                                        Since February 2020, NHGP actively            For patients or visitors who were                                                                                                                                                     Eligible patients with well-controlled
                                                        facilitated systematic and national swab      in close contact with a COVID-19                                                                                                                                                      chronic conditions were encouraged to opt
                                                        testing efforts in the community under        patient while they were at a clinic,                                                                                                                                                  for video-consultations as part of NHGP’s
                                                        the Ministry of Health (MOH)’s Swab and       contact tracing was managed by                                                                                                                                                        shift towards the new norm of care.
                                                        Send Home (SASH) Programme. The aim           NHGP’s Operations and Contact Centre.
                                                        of the SASH Programme was to detect           Affected individuals were alerted on                                                                                                                                                  To reduce the risk of infection transmission
                                                        the virus early and reduce the risk of        the same day MOH released its daily                                                                                                                                                   during COVID-19 period, NHGP introduced
                                                        further transmission in the community.        confirmed case announcements. The                                                                                                                                                     Video-consultations in February 2020 for
                                                        A courier team from National Healthcare       Contact Centre also conducted follow-                                                                                                                                                 eligible patients to consult their doctor from
                                                        Group Diagnostics (NHGD) supported            ups after two weeks to check on the                                                                                                                                                   the comfort of their homes via a video call.
                                                        the delivery of swab samples from             health of affected individuals. If they                                                                                                                                               In the first three weeks of implementing this
                                                        polyclinics to the National Public Health     were unwell, they were asked to seek                                                                                                                                                  service, the number of patient visits to the
                                                        Lab and other referral laboratories in        medical attention immediately.                                                                                                                                                        polyclinics were reduced by 30%. Apart from
                                                        hospitals. As of 31 March 2020, NHGP’s six                                                                                                                                                                                          its own patients with well-controlled chronic
                                                        polyclinics had conducted 1,000 swabs.                                                                                                                                                                                              conditions, Hougang Polyclinic also offered
NHGP nurse conducting a swab test on a patient.                                                                                                                                                                                                                                             and extended Tele-consultation services to
                                                                                                                                                                                                                                                                                            the elderly patients of Sunlove Home who
                                                                                                                                                                                                                                                                                            had regular follow-ups with the care team.
IMPLEMENTING STAFF MEASURES                                                                                                                        Video-Consultation session being conducted with an eligible patient.

                                                        Staff Travel History and                      Split Team Arrangements
                                                        Health Surveillance                           To ensure the business continuity of
                                                        All staff were required to declare            essential functions, NHGP implemented        Tele-Psychology
                                                        their travel history and record their         workplace segregation and split team         To allow patients to better manage
                                                        temperature twice daily using the Staff       arrangements from February 2020.             depression, anxiety, insomnia and
                                                        Health Surveillance System (S3). Staff in     Face-to-face interactions between            other stress-related problems in the
                                                        close contact with those on Stay-Home         staff were kept strictly within the          convenience of their homes, NHGP
                                                        Notice (SHN) and Leave of Absence (LOA)       designated split teams, even outside         launched the Tele-psychology service
                                                        were also advised to closely monitor their    of working hours. Full work from             in March 2020. This service offers
                                                        health. Staff who were unwell were asked      home arrangements commenced                  patients with existing psychologist
                                                        to seek medical attention. These measures     from April 2020, as the government           appointments the option of a telephone
                                                        ensured that infection risk was minimised     implemented nationwide containment           consultation with a psychologist, which
                                                        for the safety of other staff and patients.   measures in three phases.                    reduces the need for a physical visit to
                                                                                                                                                   the polyclinic.
NHG’s Staff Health Surveillance System for
temperature recording.

CONDUCTING TRAININGS REMOTELY                                                                                                                                                                                             Tele-Psychology services offer patients with existing psychologist appointments the option of telephone consults.

SimConsults                                             Residency Tutorials                           Continuing Medical
In February 2020, Year 5 medical students               In strict compliance with infection           Education Sessions
from the Lee Kong Chian School of Medicine              control guidelines, face-to-face teaching     While Continuing Medical Education (CME)                                                                                                                                              Tele-Dietetics
(LKCMedicine), who were in the midst of                 sessions were no longer possible during       sessions have been live-streamed                                                                                                                                                      To allow patients to receive timely
their Family Medicine Student Assistantship             the COVID-19 period. NHGP’s Family            since 2018, NHGP ramped up its CME                                                                                                                                                    dietetic consults from the safety of their
Programme clinical placements at NHGP                   Medicine Residency Team re-organised          offerings delivered via a video-                                                                                                                                                      homes, NHGP started the Tele-dietitics
had their clinical postings at the polyclinics          all teaching sessions to be delivered via     conferencing platform since the start of                                                                                                                                              service in March 2020. This service offers
shortened due to COVID-19. Nevertheless,                a video-conferencing platform, while still    COVID-19. This gave NHGP the opportunity                                                                                                                                              patients with chronic conditions, as
NHGP’s Family Physicians continued to provide           providing adequate supervision, teaching      to engage more speakers across different                                                                                                                                              well as paediatric patients with feeding
clinical training to the medical students               and assessments for residents through         specialties and hospitals, and also                                                                                                                                                   and nutritional needs, the option of a
through simulated training sessions. Named              didactic teaching, tutorials, and project     improved the accessibility of the talks to                                                                                                                                            telephone or video consultation with
‘SimConsults’, these simulated sessions                 audit presentations.                          NHGP’s clinicians and community partners.                                                                                                                                             NHGP’s dietitians instead of having to
allowed students to carry out mock-up                                                                                                                                                                                                                                                       make a physical visit to the polyclinic.
consultations on simulated patients with
conditions commonly seen in primary care.
Family Physicians observed these sessions in
real-time via a video-conferencing platform.
After each consultation, in-depth feedback was                                                                                                     NHGP Dietitian on a video call with a patient.
provided to students on their communication
and clinical management skills.
     14      Chapter 1 – Combatting a Global Pandemic                                                                                                                                                                                                                                                                 Annual Report FY2019    15
FORGING AHEAD - National Healthcare Group Polyclinics
Photos included here were taken before Circuit Breaker measures started on 7 April 2020.
TRIBUTES
Tokens of Appreciation for
NHGP Staff
During the COVID-19 period, NHGP
received an outpouring of support and
appreciation from our partners and the
community. Thoughtful gestures and
encouragement for our staff included
hand-written ‘Thank-You’ notes, lunch
boxes and care packages, among others.

                                                                                                                                                                                                         Appreciation gifts from Bishan-Toa Payoh MP Mr Saktiandi Supaat and the Toa Payoh East-Novena Grassroots         Marine Parade MP Mr Tan Chuan-Jin gave out beverages and snacks, sponsored by Koufu,
                                                                                                                                                                                                         Leaders & Youth Network (above); as well as the Nee Soon East Youth Network (right and below).                   to NHGP staff for their continued dedication during this period.

                                                            Members of Al-Istiqamah Mosque presented tokens of appreciation to NHGP staff.

Hand-written appreciation notes from Hougang Secondary School students.

Staff from Al-Muttaqin Mosque Kindergarten presented care packages to NHGP staff.          Hand-written ‘Thank you’ cards made by Woodlands Ring Primary School students were presented to NHGP staff.   NHGP Staff from HQ put together COVID-19 Love Packages to show support for their colleagues serving in the frontline at the polyclinics. This initiative aimed to boost staff’s morale and spirits during
                                                                                                                                                                                                         the battle against COVID-19.
     16      Chapter 1 – Combatting a Global Pandemic                                                                                                                                                                                                                                                                                                                               Annual Report FY2019             17
MOVING HEALTHCARE UPSTREAM                                                                                                                                                                                             BRINGING CARE CLOSER TO HOME
In FY2019, NHGP delivered a series of community initiatives to help patients adopt healthy lifestyle                                                                                                                   In FY2019, NHGP continued its efforts to help patients receive appropriate care in the community and
habits and better manage their health outcomes.                                                                                                                                                                        closer to home.

                                                                                                                                                                                                                                                                                                                                                             Primary Tech-Enhanced Care
                                                                                                                                                    Frailty Screening in Primary Care                                                                                                                                                                        Hypertension Pilot
                                                                                                                                                    Piloted at Toa Payoh Polyclinic in 2019,                                                                                                                                                                 In collaboration with the MOH Office for
                                                                                                                                                    NHGP’s Frailty Screening Programme                                                                                                                                                                       Healthcare Transformation (MOHT), NHGP
                                                                                                                                                    aims to prevent the progression of                                                                                                                                                                       conducted a hypertension management
                                                                                                                                                    frailty. Patients identified as frail1 or                                                                                                                                                                tele-health pilot at Ang Mo Kio Polyclinic
                                                                                                                                                    at-risk elderly patients display symptoms                                                                                                                                                                from September 2018 to March 2019.
                                                                                                                                                    such as evident slowing of mobility, and                                                                                                                                                                 This pilot was the first in a series of
                                                                                                                                                    requiring assistance for basic physical and                                                                                                                                                              Primary Tech-Enhanced Care (PTEC)
                                                                                                                                                    cognitive activities.                                                                                                                                                                                    initiatives, which aims to provide simple-
                                                                                                                                                                                                                                                                                                                                                             to-use technologies to enable patients
                                                                                                                                                    For frail adults with more complex                                                                                                                                                                       with chronic diseases to confidently self-
                                                                                                                                                    dietary restrictions or physical limitations,                                                                                                                                                            manage their condition.
                                                                                                                                                    NHGP’s multi-disciplinary care team
                                                                                                                                                    provides customised advice to help                                                                                                                                                                       The pilot involved the use of a Bluetooth-
                                                                                                                                                    them better manage their condition.                                                                                                                                                                      enabled blood pressure monitoring
                                                                                                                                                    At-risk elderly patients aged 65 years and                                                                                                                                                               device, which transmitted weekly readings
Patients enrolled in NHGP’s Lighter Life programme are coached by a multi-disciplinary care team to achieve weight loss in a                        above are provided individualised advice                                                                                                                                                                 to the patient’s care team in Ang Mo Kio
healthy and safe manner.                                                                                                                            on nutrition, fall prevention measures                                                                                                                                                                   Polyclinic. By monitoring and managing
Tiered-Risk Interventions for                                       Lighter Life                                                                    and home exercises to help them better                                                                                                                                                                   their condition from their homes, patients
Managing Weight                                                     First launched in October 2018 at                                               manage their condition.                                                                                                                                                                                  saved at least one visit to the clinic in a
In order to identify the needs for specific                         Ang Mo Kio Polyclinic, NHGP’s Lighter                                                                                                                                                                                                                                                    year. For patients with poorly-controlled
groups of patients and provide the                                  Life is a risk-stratified weight management                                     Patients with milder degrees of frailty are                                                                                                                                                              hypertension, they received additional
                                                                                                                                                    referred to community exercise programmes                          Primary Tech-Enhanced Care (PTEC) pilot conducted at Ang Mo Kio Polyclinic in 2019.
right level of care, NHGP launched the                              programme designed for patients with                                                                                                                                                                                                                                                     tele-consultation advice from a nurse, and
Tiered-Risk Interventions for Managing                              chronic conditions. The programme aims                                          organised by the People’s Association (PA)                                                                                                                                                               had their medication adjusted if required.
Weight (TRIM) programme at Ang Mo Kio                               to help patients achieve weight loss in a                                       and Health Promotion Board (HPB) through                                                                                                                                                                 As part of the pilot, the first SMS Chatbot
Polyclinic in 2018 and at Woodlands                                 healthy and safe manner with the help of                                        the Community Network for Seniors.                                                                                                                                                                       for hypertension co-developed with a
Polyclinic in 2019. As part of this process,                        peer and community support. Patients are                                                                                                                                                                                                                                                 polyclinic care team was also trialled. The
NHGP reviewed and activated patients by                             monitored and coached over six months on                                        The Frailty Screening Programme will be                            While tele-health is not new, this pandemic has accelerated the                                                                       chatbot provided timely and interactive
systematically ascertaining health risks                            behavioural changes by a multi-disciplinary                                     progressively introduced to all six NHGP                           adoption of technology much faster among both healthcare                                                                              advice for patients, and prompted
and starting relevant conversations as                              Care Team comprising a Family Physician,                                        polyclinics by the end of 2021.                                    providers and patients. It has spurred healthcare providers to                                                                        patients who had missed submitting their
part of their care. These patients were                             nurse, dietitian, physiotherapist, clinical                                                                                                        innovate and create solutions to continue providing care for                                                                          weekly readings.
then referred to suitable health coaching                           psychologist, and health experts.                                                                                                                  patients & provided a nudge towards greater acceptance of
and intervention programmes within and                                                                                                                                                                                 simple-to-use technology for patients to monitor their own                                                                            Interim results from the study announced
outside of the polyclinics such as the                              In addition to Ang Mo Kio Polyclinic, the                                                                                                          condition and engage with providers.”                                                                                                 in July 2019 showed improvements in
NHG FitterLife weight-loss programme.                               programme was also made available to                                                                                                                                                                                                                                                     blood pressure control for all participants,
                                                                                                                                                                                                                       Associate Professor Chong Phui-Nah,                                                                                                   especially for patients who had poorly-
                                                                    patients of Woodlands Polyclinic and                                                                                                               Chief Executive Officer of NHGP and Primary Care
As of 31 January 2020, 15,000 patients have                         Toa Payoh Polyclinic by the end of 2019.                                                                                                                                                                                                                                                 controlled hypertension at the start of the
been engaged in weight management                                                                                                                                                                                                                                                                                                                            pilot study. The final pilot study results will
conversations. More than 70% either                                                                                                                                                                                                                                                                                                                          be released in FY2020.
took up the recommended intervention
                                                                                                                                                                                                                       Enhanced Community Screening
programme or opted for health coaching.
                                                                                                                                                                                                                       for Breast Cancer and Osteoporosis
                                                                                                                                                                                                                       To meet the increased screening needs in
Preventing Diabetes Workshop                                             AT A GLANCE
                                                                                                                                                                                                                       the community, NHG Diagnostics (NHGD)
First held at Toa Payoh Polyclinic in 2019,                                                                                                                                                                            officially launched its second Mammobus
                                                                                               NHGP’S FRAILTY                                                                                                          and second Mobile Bone Mineral
the Preventing Diabetes Workshop is a
                                                                                               SCREENING                                                                                                               Densitometry (BMD) in October 2019.
two-session workshop held on a quarterly                                                       PROGRAMME
basis. It aims to educate participants on                                                                                                                                                                              With this addition, screenings for breast

                                                                                                            Seven
impaired fasting glucose, impaired glucose                                   By 31 March 2020,                                                                                                                         cancer and osteoporosis are made more
tolerance and its risks. Participants are also
taught how to prevent diabetes and learn                                  1,200
                                                                            patients screened
                                                                                                            out of 10
                                                                                                            identified as frail
                                                                                                                                                                                                                       accessible and convenient for residents in
                                                                                                                                                                                                                       the Central region of Singapore.
more about proper nutrition and exercise.                                                                   or pre-frail

They are also introduced to community                                                                                                                                                                                  The Mobile BMD is available at
involvement programme that would                                                                                                                                                                                       Ang Mo Kio Polyclinic, Geylang Polyclinic,
                                                                                                                                                     Elderly patients who are identified to be frail and at-risk are
support their lifestyle modifications.                                                                                                               educated on how to prevent adverse health effects.
                                                                                                                                                                                                                       Woodlands Polyclinic and Yishun Polyclinic.                        NHGD’s Mobile Ultrasound service brings convenience to patients.
                                                                    1
                                                                     Frailty is a condition where patients become more prone to adverse events from relatively minor health stressors. People with frailty are at an
     20      Chapter 2 – Developing Population Health               increased risk of falls, disability and hospital admissions                                                                                                                                                                                                                                                   Annual Report FY2019    21
EDUCATING THE PUBLIC                                                                                                                                                                                                                                                                                                                               World Heart Day 2019
                                                                                                                                                                                                                                                                                                                                                   In conjunction with World Heart Day
To encourage patients to lead healthier lives, NHGP spared no effort in educating and motivating the                                                                                                                                                                                                                                               in September 2019, NHGP organised
community through various programme and events in FY2019.                                                                                                                                                                                                                                                                                          roadshows at all of its six polyclinics to
                                                                                                                                                                                                                                                                                                                                                   raise awareness on the symptoms and
                                                                                                                                                                                                                                                                                                                                                   risks of cardiovascular disease. During the
                                                                                                                                                                                                                                                                                                                                                   roadshows, NHGP staff educated patients
                                                                                                                                                                                                                                                                                                                                                   on what a healthy blood pressure range
                                                                                                                                                                                                                                                                                                                                                   is, and explained how lifestyle changes
                                                                                                                                                                                                                                                                                                                                                   can help reduce the risk of cardiovascular
                                                                                                                                                                                                                                                                                                                                                   diseases. Patients above 40 years old were
                                                                                                                                                                                                                                                                                                                                                   encouraged to attend regular screenings
                                                                                                                                                                                                                                                                                                                                                   for early detection and prevention.
                                                                                                                                                                                                      NHGP conducted roadshows to raise awareness on the symptoms and risks of cardiovascular disease at all NHGP polyclinics in
                                                                                                                                                                                                      September 2019.

                                                                                                                                                                                                      World Podiatry Day
                                                                                                                                                                                                      In April 2019, NHGP celebrated World
                                                                                                                                                                                                      Podiatry Day by hosting interactive booths
NHGP organised roadshows to educate patients on diabetes prevention and management in                NHGP Dietitians helped participants understand food labels and buy the right products during a   at Geylang Polyclinic and Woodlands
conjunction with World Diabetes Day 2019.                                                            supermarket tour in November 2019.
                                                                                                                                                                                                      Polyclinic. At these booths, podiatrists
World Diabetes Day 2019                                            Health Education Roadshows                                          Supermarket Tour                                               educated patients and members of the
To mark World Diabetes Day in 2019,                                Throughout November 2019, health                                    In November 2019, NHGP also organised                          public on the importance of foot health,
NHGP organised various events, such as                             education roadshows were held at all                                a supermarket tour for 25 participants                         and provided simple foot care tips.
a series of health education roadshows                             six NHGP polyclinics. At the roadshows,                             with diabetes or pre-diabetes. During the
and a supermarket tour to Fairprice Xtra                           participants were taught about lifestyle                            tour, NHGP dietitians taught participants
at AMK Hub. These efforts were targeted                            changes to reduce the risk of developing                            how to pick the right products through
at creating more awareness about                                   diabetes. Through an interactive activity,                          understanding food labels. Participants
diabetes management, and educating                                 participants learnt about the hidden                                also learnt how to choose healthier                                                                                                NHGP Podiatrists taught patients on managing foot health and simple foot care tips.

patients on adopting healthier lifestyle                           sugar content in popular local dishes, and                          products such as low Glycemic Index (GI)
changes to reduce their risk of diabetes.                          were reminded to limit their sugar intake                           food to avoid blood sugar spikes and                                                                                                                                                                       NSA Roadshows
                                                                   to less than 11 teaspoons daily.                                    weight increase.                                                                                                                                                                                           Primary Care Academy (PCA) participated
                                                                                                                                                                                                                                                                                                                                                  in a National Silver Academy (NSA) roadshow
                                                                                                                                                                                                                                                                                                                                                  held in August 2019 at the National Library.
                                                                                                                                       World Mental Health Day                                                                                                                                                                                    During the roadshow, PCA’s public courses,
                                                                                                                                       In conjunction with World Mental Health                                                                                                                                                                    such as ‘Care of the Elderly’ and ‘Basic
                                                                                                                                       Day in October 2019, NHGP conducted a                                                                                                                                                                      First Aid’ were offered to seniors.
                                                                                                                                       series of talks titled ‘The Healing Power
                                                                                                                                       of Optimism for Mind and Body Wellness’                                                                                                                                                                    The roadshow coincided with NSA’s third
                                                                                                                                       The talks were delivered in English, Malay                                                                                                                                                                 anniversary celebrations. Dr Irwin Chung,
                                                                                                                                       and Mandarin by NHGP psychologists to                                                                                                                                                                      Director, PCA received a token of
                                                                                                                                       senior citizens in the community, and staff                                                                                                                                                                appreciation from Guest-of-Honour
                                                                                                                                       at all six NHGP polyclinics.                                                                                                                                                                               President Halimah Yacob for PCA’s support
                                                                                                                                                                                                                                                                                                                                                  and efforts in promoting lifelong learning.
                                                                                                                                                                                                                                                                                                                                                  For the full list of workshops and courses
                                                                                                                                                                                                                                                                                                                                                  conducted in FY2019, please refer to
                                                                                                                                                                                                      Dr Irwin Chung, Director, PCA (left) received a token of appreciation from President Halimah Yacob at the NSA roadshow in
                                                                                                                                                                                                      August 2019.                                                                                                                                Appendix B.
NHGP Psychologists interacting with senior citizens in the community as part of World Mental Health Day in October 2019.

World Physiotherapy Day                                                                                                                                                                               Hand Hygiene Day 2019
In September 2019, NHGP celebrated                                                                                                                                                                    In celebration of Hand Hygiene Day 2019,
World Physiotherapy Day by co-organising                                                                                                                                                              NHGP organised roadshows across all its
roadshows with St Luke’s Eldercare and                                                                                                                                                                six polyclinics in May 2019. An activity
All Saints Home at Ang Mo Kio Polyclinic                                                                                                                                                              booth at each clinic was also set up to
and Yishun Polyclinic respectively.                                                                                                                                                                   educate patients and visitors on hand
Themed ‘Making Every Move Count,’                                                                                                                                                                     hygiene matters.
150 participants learnt how to manage
and reduce chronic pain through physical
therapy. Participants also took part in a
group exercise class designed to address
common muscle joint pains in the knees
and shoulders.
                                                                   Participants learning simple shoulder and knee exercises.                                                                                                                                             Activity booth at Toa Payoh Polyclinic to educate patients and visitors on hand hygiene matters in conjunction with Hand Hygiene Day 2019.

     22      Chapter 2 – Developing Population Health                                                                                                                                                                                                                                                                                                                           Annual Report FY2019             23
BUILDING RESEARCH CAPACITY                                                                                                                                                                                                                                                                                               MOH Value-Driven Care
                                                                                                                                                                                                                                                                                                                         Conference 2019
To bring patient care to the next level, NHGP recognises the importance of building and developing                                                                                                                                                                                                                       On 25 September 2019, the Ministry
talent in research. In FY2019, NHGP organised and participated in various local and international                                                                                                                                                                                                                        of Health (MOH) held the Value-
conferences which focused on transforming primary healthcare.                                                                                                                                                                                                                                                            Driven Care (VDC) Conference to bring
                                                                                                                                                                                                                                                                                                                         together healthcare administrators
                                                                                                                                                                                                                                                                                                                         and professionals from various public
Primary Care Forum 2019                                                                                                                                                                                                                                                                                                  healthcare institutions to learn and share
NHGP held its annual Primary Care Forum                                                                                                                                                                                                                                                                                  from one another.
on 10 and 11 October 2019. Themed
‘Primary Care: Innovative Communities,                                                                                                                                                                                                                                                                                   Dr Sabrina Wong, Family Physician and
Co-Design for Quality’, the forum was held                                                                                                                                                                                                                                                                               Consultant, Assistant Director, Clinical
in conjunction with the Singapore Health                                                                                                                                                                                                                                                                                 Services, and Dr Kung Jian Ming, Family
and Biomedical Congress (SHBC) 2019.                                                                                                                                                                                                                                                                                     Physician and Associate Consultant,
                                                                                                                                                                       Dr Sabrina Wong, Family Physician and Consultant, Assistant Director, Clinical Services, speaking at the MOH Value-Driven Care Conference 2019.   Yishun Polyclinic, were awarded the
The forum focused on moving primary                                                                                                                                                                                                                                                                                      Outstanding Oral Presentation for
healthcare upstream to detect various                                                                                                                                                                                                                                                                                    their respective projects titled ‘NHGP
social determinants of health at an early                                                                                                                                                                                                                                                                                Teamlet Care Model: Improving Patient
stage, and the importance of consumer                                                                                                                                                                                                                                                                                    Outcomes Through Redesign of Chronic
experience within a patient-centered care                                                                                                                                                                                                                                                                                Care Delivery Model’ and ‘Nurse Initiated
delivery system. In addition, a General                                                                                                                                                                                                                                                                                  Bronchodilator Therapy at Woodlands’.
Practitioner (GP) symposium was
also held for GPs to share and discuss
a range of clinical issues and workflow
challenges encountered.

                                                 Guest plenary speaker, Professor Kevin Grumbach (3rd from right), shared his thoughts on how to shape and co-create
                                                 patient-centred care at the Primary Care Forum 2019.

Singapore Primary Care Research Scientific Competition                                                                                                                 Dr Kung Jian Ming, Family Physician and Associate Consultant, Yishun Polyclinic, receiving the Outstanding Oral Presentation Award.

The Singapore Primary Care Research Scientific Competition recognises research efforts of healthcare professionals and showcases a
culture of research in primary healthcare. In 2019, the competition attracted 56 submissions on a wide range of topics. For the list of                                Oral and Poster Presentations by NHGP Staff at Local and International Conferences
abstracts accepted for the Singapore Health and Biomedical Congress (SHBC) Scientific Competition 2019, please refer to Appendix A.                                    The following table highlights the various research programmes undertaken by NHGP staff that have been presented at local and
The following NHGP winners were announced during the opening ceremony of SHBC on 10 October 2019:                                                                      international conferences in FY2019:

        ORAL CATEGORY                                                                                                                                                           ASIA PACIFIC PRIMARY CARE RESEARCH CONFERENCE 2019                                                                                        NORTH AMERICAN PRIMARY CARE
                                                                                                                                                                                                                                                                                                                          RESEARCH GROUP ANNUAL MEETING
    GOLD                                         SILVER                                                             BRONZE                                                   Oral Presentation                                               Short Oral Presentation                                                      2019 AND DISTINGUISHED TRAINEE
                                                                                                                                                                                                                                                                                                                          RESEARCH AWARDS
    Ms Koh Hui Li                                Dr Lee Eng Sing                                                    Ms Julia Zhu Xiaoli                                      FIRST PRIZE                                                     FIRST PRIZE
    Patients with Multi-morbidity                The Ethnic and Sex                                                 Fragile Wounds, Precarious Selves: An                    Dr Lee Eng Sing                                                 Dr Sabrina Wong
    – Does It Always Mean a                      Differences in the Patterns                                        Interpretative Phenomenological Study                    Family Physician                                                Family Physician                                                            Oral Presentation
    Lower Quality of Life?                       of Multi-morbidity                                                 on the Experience of Diabetic Amputees                   Senior Consultant,                                              Consultant,                                                                 THIRD PRIZE
                                                                                                                    in Primary Care                                          and Deputy Head of                                              and Assistant Director of                                                   Dr Lee Eng Sing
                                                                                                                                                                             Clinical Research Unit                                          Clinical Services                                                           Family Physician
                                                                                                                                                                                                                                                                                                                         Senior Consultant,
                                                                                                                                                                             The Ethnic and Sex Differences in                               Outcomes of the NHGP Teamlet care                                           and Deputy Head of
                                                                                                                                                                             the Patterns of Multi-morbidity in                              model on Chronic Disease Management                                         Clinical Research Unit
                                                                                                                                                                             Singapore Primary Care Patients                                 in Singapore
                                                                                                                                                                                                                                                                                                                         A Systematic Review on the
        POSTER CATEGORY                                                                                                                                                      THIRD PRIZE                                                                                                                                 Instruments Used for Measuring
                                                                                                                                                                             Ms Xie Ying                                                                                                                                 the Level of Multi-morbidity
    GOLD                                         SILVER                                                             BRONZE                                                   Senior Executive
    Ms Teo Sok Huang                             Dr Karen Ng Ming Yann                                              Ms Liow Hui Shi                                          Office of Clinical Informatics
    A Pilot Evaluation of the                    Prescription of Omeprazole                                         Targeting Muscle Loss with
    NHGP Chronic Care Plan                       in a Primary Care Setting                                          Medical Nutrition Therapy in                             Prevalence of Multi-morbidity in
                                                 in Singapore                                                       Older Adults – Dietary Protein                           Singapore: An Epidemiological Study
                                                                                                                    Intake and Hand Grip Strength                            Using Administrative Data

   26      Chapter 3 –Charting Our Way Forward                                                                                                                                                                                                                                                                                               Annual Report FY2019    27
LEARNING AND SHARING                                                                                                                                                                                Health Manpower Development
                                                                                                                                                                                                    Plan Visits
NHGP organised and participated in various learning sessions in collaboration with both local and                                                                                                   In October 2019, a team from NHGP                                    The team also learnt how the Danish
                                                                                                                                                                                                    visited three cities in Denmark, namely                              Ministry of Health and municipal
overseas intuitions as part of its continuous efforts to learn and share experiences.
                                                                                                                                                                                                    Copenhagen, Aarhus and Odense. There,                                authorities designed and ran various tele-
                                                                                                                                                                                                    they gained system-level insights into the                           health systems in Aarhus and Odense.
                                                                                                                                                                                                    Danish health, social and preventive care                            Site visits were also made to the Steno
                                                                                                                                                                                                    system. The two-week visit was hosted                                Diabetes Centre in Aarhus, university
                                                                                                                                                                                                    by Professor Roar Maagaard, a General                                hospitals in Aarhus and Odense, as well
                                                                                                                                                                                                    Practitioner (GP) and researcher. During                             as various GP clinics and community
                                                                                                                                                                                                    the visit, the team received first-hand                              care facilities, exposing the team to how
                                                                                                                                                                                                    experience of the Danish after-hours care                            technology was used for the delivery of
                                                                                                                                                                                                    system, and managed to shadow a group                                health and social care services.
                                                                                                                                                                                                    of GPs who conducted teaching, research,
                                                                                                                                                                                                                                                                                                                                          NHGP team with Prof Roar Maagaard in Denmark who shared
                                                                                                                                                                                                    and community care sessions.                                                                                                          more about the Danish healthcare setting.

                                                                                                                                                                                                                                                                                                                                          Visits to NHGP
                                                                                                                                                                                                                                                                                                                                          Ang Mo Kio Polyclinic
                                                                                                                                                                                                                                                                                                                                          Between May to July 2019, Ang Mo Kio
                                                                                                                                                                                                                                                                                                                                          Polyclinic hosted two visits, one from the
                                                                                                                                                                                                                                                                                                                                          Southern California Permanente Medical
                                                                                                                                                                                                                                                                                                                                          Group (SCPMG), a subsidiary of American
                                                                                                                                                                                                                                                                                                                                          care consortium Kaiser Permanente, and
A/Prof Brauer (back row, centre) with NHGP staff at Yishun Polyclinic.
                                                                                                                                                                                                                                                                                                                                          the other, a group of foreign nursing
Visits from Overseas Experts                                                                                                                                                                                                                                                                                                              delegates who attended the International
NHGP hosted three overseas experts,                                                                                                                                                                                                                                                                                                       Council of Nursing Congress (ICNC).
Associate Professor (A/Prof) Paula Brauer,
A/Prof Matthew Boyd and Professor
Louise Robinson, between July 2019 to
                                                                                                                                                                                                    In July 2019, a group of foreign nursing delegates, who was in Singapore for the ICNC, toured Ang Mo Kio Polyclinic.
January 2020. A/Prof Brauer sits on the
faculty in the Applied Human Nutrition
                                                                                                                                                                                                    Woodlands Polyclinic
Programme of the Department of Family
                                                                                                                                                                                                    In August 2019, a delegation from
Relations and Applied Nutrition, University
                                                                                                                                                                                                    Indonesia’s Public Health Services visited
of Guelph, Ontario, Canada. During her
                                                                                                                                                                                                    Woodlands Polyclinic. During these visits,
visit to Yishun Polyclinic from 11 to
                                                                                                                                                                                                    various clinic teams brought the delegates
26 July 2019, A/Prof Brauer discussed
                                                                                                                                                                                                    on a tour of the clinic premises, shared
the effectiveness of delivering allied
                                                                                                                                                                                                    about the history and transformation of
health services in the prevention and
                                                                                                                                                                                                    primary care in Singapore, and explained
management of chronic conditions. On
                                                                                                                                                                                                    the rationale behind NHGP’s operational
the other hand, A/Prof Boyd in Patient
                                                                                                                                                                                                    workflows and infrastructures.
Safety and Pharmacy Practice, University
of Nottingham, United Kingdom (UK),                                  NHGP and MOH co-hosted A/Prof Boyd (1st from left) at Yishun Polyclinic, who shared about pharmaceutical services in the UK.
shared his experiences on implementing
community pharmaceutical services in the                                                                                                                                                                                                                                 An NHGP team brought the Indonesian delegates on a tour around the Woodlands Polyclinic premises.
UK during his visit to Yishun Polyclinic on
5 October 2019.
                                                                                                                                                                                                                                                                                                                                         Yishun Polyclinic
                                                                                                                                                                                                                                                                                                                                         Between April to July 2019, Yishun
NHGP also hosted overseas expert
                                                                                                                                                                                                                                                                                                                                         Polyclinic hosted several visits
Professor Louise Robinson, a General
                                                                                                                                                                                                                                                                                                                                         including the Ministry of Home Affairs
Practitioner from the UK renowned for
                                                                                                                                                                                                                                                                                                                                         (MHA), the World Health Organization
her expertise on dementia care. During
                                                                                                                                                                                                                                                                                                                                         (WHO), and Mr Michael Chihoski, a
her visit from 13 to 17 January 2020,
                                                                                                                                                                                                                                                                                                                                         consultant with the Joint Commission
Prof Robinson visited all three polyclinic
                                                                                                                                                                                                                                                                                                                                         International (JCI).
clusters and the Tsao Foundation. She
also shared her thoughts on the various
aspects of dementia management in
primary healthcare at NHGP’s medical
forum, which saw over 100 doctors attending
the event. For the list of medical forums
and workshops conducted in FY2019,
                                                                                                                                                                                                    In July 2019, NHGP hosted Dr Takeshi Kasai (fourth from right), Regional Director of WHO Western Pacific Region Office; and
please refer to Appendix C.                                          NHGP hosted Prof Robinson (2nd from right), who shared insights on dementia care.                                              Dr Ying-Ru Jacqueline Lo (fifth from right), WHO Representative for Malaysia, Brunei and Singapore.

     28       Chapter 3 –Charting Our Way Forward                                                                                                                                                                                                                                                                                                                   Annual Report FY2019      29
ACHIEVING PROFESSIONAL STANDARDS                                                                                                Dr Tan Sherie
                                                                                                                                                                         NHG Teaching Award
                                                                                                                                                                         NHG’s Teacher’s Day was held on 6 September
                                                                                                                                                                                                                       MOH In-Service Scholarships
                                                                                                                                                                                                                       and NHGP Scholarships
NHGP encourages lifelong learning as a means to constantly improve and deliver the best evidence-based                          Resident Physician                       2019. This annual event included an award     In FY2019, several NHGP staff attained
                                                                                                                                Geylang Polyclinic                       ceremony, where 13 NHGP doctors and           the MOH In-Service Scholarship and
care to patients. To this end, NHGP supports staff in their professional and academic pursuits.                                                                          nurses were recognised for their roles as     NHGP Scholarship. These scholarships
                                                                                                                                Dr Wong Xiu Yi
                                                                                                                                                                         clinical teachers and educators.              allow staff to be equipped with essential
                                                                                                                                Medical Officer
                                                                                                                                Geylang Polyclinic                                                                     competencies and leadership capabilities
First Family Physician in                                                                                                                                                                                              to fulfil future healthcare needs.
NHG to be conferred PhD in                                                                                                      Dr Leonard Leng Qi An                         NHG TEACHING AWARD FOR
                                                 MASTER OF MEDICINE IN              Dr Laxmanan Raja Rajeswari                  Family Medicine Resident                      JUNIOR DOCTORS 2019
Family Medicine                                  FAMILY MEDICINE                    Family Physician                            Hougang Polyclinic                                                                        Ms Evonne Oh Siew Gek
In October 2019, Dr Lee Eng Sing, Family                                            Yishun Polyclinic                                                                       Dr Ian Koh Jan Ming                           Assistant Nurse Clinician
Physician, Senior Consultant and Deputy                                                                                         Dr Teo Jia Hui                              Family Physician – Associate Consultant       Ang Mo Kio Polyclinic
                                               16 NHGP doctors passed the Master    Dr Lee Yew Weng Andrew                                                                  Toa Payoh Polyclinic
Head of the Clinical Research Unit, NHGP,                                                                                       Family Medicine Resident                                                                  Ms Valerie Chong Chui Mei
                                               of Medicine in Family Medicine       Family Physician
was the first Family Physician in NHG to                                                                                        Hougang Polyclinic                          Dr Ooi Chung Ping                             Staff Nurse
                                               examinations in November             Yishun Polyclinic                                                                                                                     Ang Mo Kio Polyclinic
be conferred a PhD in Family Medicine.         2019. These doctors either did a                                                                                             Family Physician
                                                                                                                                Dr Wong Wai In                              Ang Mo Kio Polyclinic                         Ms Aslina Asbil
Dr Lee’s PhD programme was offered             three-year NHG Family Medicine       Dr Seet Qi Sharlene                         Resident Physician                                                                        Senior Assistant Nurse
by the Department of Family Medicine,          Residency Programme or NHGP          Resident Physician                          Hougang Polyclinic                          Dr Vivek Bansal                               Geylang Polyclinic
Schulich School of Medicine and Dentistry      Programme B. The respective          Yishun Polyclinic                                                                       Family Physician – Associate Consultant
                                               programmes prepare the doctors for                                               Dr Ang Ling Min                             Woodlands Polyclinic                          Ms Nor Hidayah Mohd Salleh
at the Western University in Ontario,                                               Dr Soh Puey Huang Jobina                                                                                                              Senior Assistant Nurse
                                               the breadth of exposure to acquire                                               Resident Physician
Canada. Dr Lee is also NHGP’s first                                                 Resident Physician                          Toa Payoh Polyclinic                                                                      Geylang Polyclinic
                                               the competencies required to         Yishun Polyclinic                                                                         NHG TEACHING AWARD FOR
Clinician Researcher.                                                                                                                                                         SENIOR DOCTORS 2019                         Ms Mohanambal D/O Sundravelu
                                               practice as Family Physicians.                                                   Dr Ng Xin Rong                                                                            Senior Staff Nurse
Family Medicine Convocation                    Dr Chua Yu Jing Andrew                                                           Resident Physician                          Dr Jason Chan                                 Hougang Polyclinic
                                               Resident Physician                                                               Toa Payoh Polyclinic                        Family Physician                              Ms Tuty Anida Masuri
Organised by the College of Family                                                                                                                                          Geylang Polyclinic
                                               Ang Mo Kio Polyclinic                                                                                                                                                      Senior Assistant Nurse
Physicians (Singapore) (CFPS), the Family                                                                                       Dr Julius Kang Jun Kai
                                                                                                                                                                            Dr Valerie Teo                                Yishun Polyclinic
Medicine Convocation Ceremony was held         Dr Ong Ai Li                                                                     Medical Officer
                                                                                                                                Woodlands Polyclinic                        Family Physician – Consultant                 Ms Wang Na
on 23 November 2019, during which 39           Family Physician                                                                                                             Ang Mo Kio Polyclinic                         Senior Staff Nurse
NHGP doctors were recognised. Four of          Ang Mo Kio Polyclinic                  GRADUATE DIPLOMA IN                                                                                                                 Yishun Polyclinic
                                                                                                                                Dr Tan Jinxuan
them attained the Fellowships from CFPS,       Dr Chan Ke Shuang Elizabeth            FAMILY MEDICINE                           Family Physician                                                                          Mr Zeng Jin Liang
                                                                                                                                                                              NHG TEACHING AWARD FOR
16 were conferred a Masters of Medicine in     Resident Physician                                                               Woodlands Polyclinic                          NURSING PRECEPTORS 2019                     Medical Social Worker
Family Medicine, and 19 doctors received                                            19 NHGP doctors passed the                                                                                                            Yishun Polyclinic
                                               Hougang Polyclinic
their Graduate Diploma in Family Medicine.
                                                                                    Graduate Diploma in Family                  Dr Ling Yee Von                             Ms Christine Chern Win Fah
                                               Dr Devasena Manoharan                Medicine examinations in July 2019.         Medical Officer                             Nursing Clinician
                                               Family Physician                     The diploma is a post-graduate              Yishun Polyclinic                           Toa Payoh Polyclinic                       NUSMedicine Dean’s Awards 2019
                                               Hougang Polyclinic                   training programme that equips                                                                                                     Organised by the National University of
                                                                                    family doctors in Singapore with skills     Dr Zeng Zhiyong                             Ms Wendy Ong Kim Leng
                                                                                                                                                                            Senior Nurse Manager                       Singapore (NUS) Yong Loo Lin School of
     FELLOWSHIP COLLEGE OF FAMILY              Dr Ding Si Yan                       to enhance their level of patient care.     Resident Physician
     PHYSICIANS (SINGAPORE)                                                                                                                                                 Woodlands Polyclinic                       Medicine, the Appreciation for Clinical Teachers
                                               Resident Physician                                                               Yishun Polyclinic
                                                                                    Dr Ang Wei Luong                                                                                                                   event held on 5 November 2019 honoured
                                               Hougang Polyclinic                   Resident Physician
                                                                                                                                                                            Ms Xiao Hui
  Four NHGP doctors completed                                                                                                                                               Senior Staff Nurse                         excellence in teaching medical students.
  the 24-month Advanced Training               Dr Amelia Ahmad Hatib                Ang Mo Kio Polyclinic
                                                                                                                                                                            Yishun Polyclinic
  Programme in Family Medicine,                Resident Physician                   Dr Darice Jill Ng Yu Ping
  and passed the summative exit                Toa Payoh Polyclinic                 Resident Physician                                                                                                                      DEAN’S AWARD FOR
  examinations in 2019. Dr Christopher                                                                                                                                        NHG OUTSTANDING NURSE                         TEACHING EXCELLENCE
  Chong, Family Physician, Associate           Dr Gan Wei Chun                      Ang Mo Kio Polyclinic                     NHGP Best Family Medicine                       TEACHERS AWARD 2019
  Consultant and Head of Ang Mo Kio            Resident Physician                   Dr Liew Pui Mun                           Trainers’ Award                               Ms Christie Anna
                                                                                                                                                                                                                          Dr Richard Lee Meng Kam
                                                                                                                              Dr Kee Kok Wai and Dr Steven Chao                                                           Family Physician – Consultant
  Polyclinic also obtained the Koh Eng         Toa Payoh Polyclinic                 Resident Physician                                                                      Nurse Educator
                                                                                                                              Chien Chih, both Family Physicians and                                                      Yishun Polyclinic
  Kheng Gold Medal for being the best                                               Ang Mo Kio Polyclinic                                                                   Nursing Services
  Fellowship Graduate in the 2019              Dr Kwek Sock Yuen Cassandra                                                    Associate Consultants at Toa Payoh
  fellowship examinations.                     Resident Physician                   Dr Ten Dick Xiang                         Polyclinic, were the recipients of the        Ms Susan Loh                                    JUNIOR DOCTOR TEACHING AWARD
                                               Woodlands Polyclinic                 Resident Physician                        NHGP Best Family Medicine Trainers’           Assistance Nurse Clinician
  Dr Christopher Chong                                                              Ang Mo Kio Polyclinic                                                                   Ang Mo Kio Polyclinic                         Dr Steven Chao Chien Chih
                                               Dr Moses Tan Mong Heng                                                         Award 2019. The annual award recognises
  (Dr Koh Eng Kheng Gold Medal)                                                                                                                                                                                           Family Physician – Associate Consultant
  Family Physician - Associate Consultant      Resident Physician                   Dr Janan Lee                              the dedication, passion and commitment        Ms Vernice Tay Ah Kiok                        Toa Payoh Polyclinic
  and Head of Ang Mo Kio Polyclinic            Woodlands Polyclinic                 Family Physician                          of Family Medicine Trainers.                  Senior Staff Nurse
                                                                                    Geylang Polyclinic                                                                      Geylang Polyclinic
  Dr Karen Ng Ming Yann                        Dr Tan Eng Liang Melvin
  Family Physician - Senior Consultant         Resident Physician
                                                                                    Dr Lim Teck Khai                          NHGP Nursing Best Clinical                    Ms Rajoo Thilaga Rani                           CERTIFICATES OF APPRECIATION

  and Director Clinical Services               Woodlands Polyclinic
                                                                                    Medical Officer                           Instructor Award                              Senior Staff Nurse                            Dr Richard Lee Meng Kam
                                                                                    Geylang Polyclinic                        Ms Kang Yi Min, Senior Staff Nurse,           Hougang Polyclinic                            Family Physician – Consultant
  Dr Teh Kailin                                Dr Chee Jia Yi (Lydia)                                                         Woodlands Polyclinic, received the                                                          Yishun Polyclinic
  Family Physician - Associate Consultant                                           Dr Loh Soon Shan
                                               Resident Physician                   Medical Officer                           NHGP Nursing Best Clinical Instructor           NHG INTER-PROFESSIONAL                      Dr Steven Chao Chien Chih
  Ang Mo Kio Polyclinic                        Yishun Polyclinic                                                                                                              TEACHING AWARD 2019
                                                                                    Geylang Polyclinic                        Award 2019. The annual award                                                                Family Physician – Associate Consultant
  Dr Gilbert Yeo                               Dr Ee Runhua Michelle
                                                                                                                              recognises excellent contribution             Dr Lim Ziliang                                Toa Payoh Polyclinic
  Family Physician - Associate Consultant                                           Dr Sim Shin Wei                           in providing effective clinical teaching
                                               Resident Physician                   Resident Physician
                                                                                                                                                                            Family Physician – Consultant                 Dr On Todd
  Woodlands Polyclinic                                                                                                        to newly-recruited nurses and students        Yishun Polyclinic                             Family Physician – Associate Consultant
                                               Yishun Polyclinic                    Geylang Polyclinic
                                                                                                                              in Nursing Services.                                                                        Toa Payoh Polyclinic

   30    Chapter 3 –Charting Our Way Forward                                                                                                                                                                                                Annual Report FY2019     31
INNOVATING FOR BETTER CARE                                                                                                                                                      NHGP Quality Day 2019
                                                                                                                                                                                NHGP held its annual Quality Day on
In FY2019, NHGP was recognised for its various innovative solutions to provide the best care possible for                                                                       11 October 2019. Themed ‘Innovative
its patients.                                                                                                                                                                   Communities, Co-design for Quality’, the
                                                                                                                                                                                event highlighted how co-designing
                                                                                                                                                                                programmes and processes with key
BCA UD Mark Awards 2019                                          AHMA 2019                                                                                                      partners and stakeholders could lead to
On 22 April 2019, Ang Mo Kio Polyclinic,                         At the Asian Hospital Management                                                                               better outcomes and impact.
Kallang Polyclinic and Yishun Polyclinic                         Awards (AHMA) in September 2019,
were among 37 projects to be conferred                           NHGP was awarded two Excellence                                                                                During the event, keynote speaker
the Building Construction Authority (BCA)                        Awards —one under the Community                                                                                Mr Keith Tan, Chief Executive of Singapore
Universal Design (UD) Mark Award.                                Involvement category and the other under                                                                       Tourism Board (STB), shared STB’s
Ang Mo Kio Polyclinic and Kallang                                the Facility Management and Financial                                                                          experience in designing quality visitor-
Polyclinic clinched BCA’s UD Mark GoldPLUS                       Improvement category.                                                                                          centric experiences by first having an          Winners at NHGP’s Quality Day 2019 were lauded for implementing innovative solutions that improved the quality of care.

award, while Yishun Polyclinic was                                                                                                                                              in-depth understanding of their target
conferred the UD Mark Gold Award.                                In the first category, NHGP’s entry titled                                                                     audience and, thereafter, assessing and
                                                                 ‘From Clinic to Community – Starting a                                                                         leveraging suitable technology solutions.
                                                                 Weight Management Conversation in the
SPAA 2019                                                        Clinic and Supporting Lifestyle Modification                                                                   A total of 24 OurCare and iCARE awards
NHGP’s Guiding Hands Volunteers                                  in the Community’, showcased NHGP’s                                                                            were given out to staff during the event. The
                                                                                                                  Mr Ryan Ang (left) and Ms Soh Ying Hua (right) received the
clinched the Singapore Patient Support                           efforts to enhance patient activation for        Excellence Awards on behalf of NHGP at the AHMA 2019.
                                                                                                                                                                                awards recognised NHGP’s staff efforts in
Group / Volunteer Group Award at the                             therapeutic lifestyle modification.                                                                            delivering service excellence and quality
Singapore Patient Action Awards (SPAA)                                                                                                                                          improvement, as well as exhibiting innovation
2019. Organised by Tan Tock Seng                                 In the second category, NHGP’s entry titled      CSISG 2019                                                    and transformation, during the year.
Hospital, the award honours volunteers                           ‘Re-Development of Ang Mo Kio and Yishun         NHGP received a 72.6 point rating for the
for making a positive difference to the                          Polyclinics to Increase Patient Capacity and     Customer Satisfaction Index of Singapore                      For the list of Quality Improvement Projects
healthcare ecosystem in Singapore.                               Improve Patient Care Delivery’, showed how       (CSISG) 2019, an increase from 71.7 points                    completed in FY2019, please refer to
                                                                 NHGP’s careful design and planning, coupled      in 2018. The survey, conducted annually by                    Appendix D.
                                                                                                                                                                                                                                NHGP’s winning staff and teams at NHG Quality Day 2019.
                                                                 with improved work processes, enabled it         the Singapore Management University’s
                                                                 to achieve highly-desirable outcomes for         Institute of Service Excellence, studies the                  NHG Quality Day 2019                            Action Awards (EIAA) for contributing                             enhancing experiences in healthcare
                                                                 patients, leading to a significant improvement   customer satisfaction level of consumers                      On 11 September 2019, NHG celebrated            significantly to work practices that                              service delivery. Quality Improvement
                                                                 in how patients managed their conditions.        in Singapore.                                                 Quality Day 2019 themed ‘System                 have improved customer service or                                 Awards (QIA) were also given to
                                                                                                                                                                                Reliability: Designing It Right, Doing It       patient safety. Two NHGP patients and                             eight project teams in recognition of
                                                                                                                  National HIP Medals 2019                                      Right, Detecting the Risk Right’. Nine          caregivers received the Exemplary Patient                         their contributions in improving and
                                                                                                                                                                                NHGP staff clinched the Excellence in           and Caregiver Award (EPCA) towards                                transforming care delivery for patients.
                                                                                                                  On 9 May 2019, NHGP was awarded the
                                                                                                                  National Healthcare Innovation and
                                                                                                                  Productivity (HIP) Excellence Champion
                                                                                                                  Medal for the redesign of its care model.                     BRINGING GREATER CONVENIENCE FOR PATIENTS
                                                                                                                  Dr Sabrina Wong, Assistant Director,
                                                                                                                  Clinical Services, who led the transformative                 As part of NHGP’s efforts to create a more streamlined patient journey, enhancements have been made to
                                                                                                                  work for NHGP’s Teamlet Care Model,                           both front-end patient-facing platforms as well as back-end systems.
                                                                                                                  received the award from Minister for
                                                                                                                                                                                                                                                                                                  number of staff required for routine tasks,
                                                                                                                  Health Mr Gan Kim Yong on behalf of                                                                           Enhancements to HealthHub                                         and allowed staff to offer more value-added
                                                                                                                  the team.                                                                                                     and Self-Help Kiosks                                              assistance at the clinics. For self-payment
                                                                                                                                                                                                                                As of September 2019, enhancements to
                                                                                                                                                                                                                                                                                                  kiosks, payment via one’s Child Development
                                                                                                                                                                                                                                the HealthHub mobile application allowed
                                                                                                                  MOH PES FY2019                                                                                                for more self-service options for the
                                                                                                                                                                                                                                                                                                  Account (CDA) was also made available.
                                                                                                                  NHGP achieved a composite of patient
                                                                                                                  satisfaction score of 91.3 per cent in
                                                                                                                                                                                                                                following services at NHG’s Polyclinics:
                                                                                                                                                                                                                                                                                                  Enhancements to Laboratory
                                                                                                                  MOH’s Patient Experience Survey (PES)                                                                                                                                           Information System
                                                                                                                                                                                                                                •   Registering for appointments                                  As of February 2020, the Laboratory
                                                                                                                  2019. All six NHGP polyclinics attained                                                                       •   Getting a queue number
                                                                                                                  individual score of above 88%.                                                                                                                                                  Information System (LIS) in laboratories
                                                                                                                                                                                                                                •   Viewing the electronic itinerary                              at Ang Mo Kio, Hougang, Toa Payoh,
                                                                                                                                                                                                                                •   Checking queue status                                         Woodlands and Yishun Polyclinics was
                                                                                                                  The survey assessed patients’ experience                                                                      •   Viewing upcoming appointments                                 upgraded from TD-Synergy to TDNexLabs
                                                                                                                  at public healthcare institutions and                                                                         •   Updating of particulars e.g. mailing                          (TDNL). The upgraded LIS comes with
                                                                                                                  helped identify areas of improvement.                                                                              address and contact number                                   improved security features for the user
                                                                                                                                                                                                                                •   Requesting for medication refill                              interface, and provides full automation of
Dr Sabrina Wong receiving the overall Excellence Champion Medal from the Minister for Health Mr Gan Kim Yong.
                                                                                                                                                                                                                                                                                                  processes such as e-orders and e-results,
                                                                                                                                                                                                                                Besides offering patients more convenience,                       thereby increasing the processing
                                                                                                                                                                                                                                these enhancements also reduced the                               efficiency of NHGD’s laboratories.
    34       Chapter 4 –Advancing Towards a New Norm of Care                                                                                                                                                                                                                                                                 Annual Report FY2019         35
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