Prof Gabriel Leung, Under-Secretary of the Food and Health Bureau, Hong Kong Government presented a paper to the Legislative Council's Panel of Health Services on the latest progress of Primary Care Development Strategy formulated by the Working Group on Primary Care (WGPC) on 12 July 2010. One of the recommendations was to set up a Primary Care Directory for people to search for doctors working in primary care. Legislators were not impressed and doubted the value of this Directory. The details and how this Directory should be established and what kind of information should be included was hotly debated at various stages of the discussion among members of the Task Force from different stakeholders. Some members suggested that doctors should be allowed to list their expertise such as Botox injection or laser for cosmetics. What do you think?

Another controversial issue was the inclusion criteria for doctors who wish to join the Primary Care Directory. Who should be allowed to join? Who can claim that they practise primary care based on the principle and teaching of Family Medicine? Apart from basic medical qualification for registration with the Hong Kong Medical Council, is there any additional qualification or basic training that is essential as a kind of quality assurance to the public? The medical profession cannot decide these issues on behalf of the government because it will require statutory power to enforce these conditions. Otherwise the function of the resulting directory will be no more than a “Yellow Page” directory.

The government should also educate the public to understand the difference between primary and secondary care services. What will be the essential information needed for end-users of this Directory to choose a family doctor for primary care services? What are the basic and essential primary care services which the government should aim to provide? 

It seems I keep raising questions but have no answer. It is probably there has been a lack of an agreed curriculum or core knowledge and skills for primary care in the education and training of medical students and our Family Medicine trainees in Hong Kong. Historically, Hong Kong’s healthcare system has never been so developed or based on a robust primary care foundation built on the family doctor concept. We have the Hospital Authority which should be responsible to provide secondary care but they also run the General Out-patient Service for public primary care. The Hospital Authority is also the major training provider for Family Medicine trainees. We do not have a Primary Care Authority to integrate all the services and development in primary care both in the public and private sectors. That is why primary care is fragmented and standards are variable.

The training of future family doctors will be more oriented to team approach for common geriatric problems in primary care setting. It is no easy task without proper training and support from community and social resources for family doctors, in their role of providing coordinated care, to deal with these patients and their family members or carers, as well as to collaborate with social workers, community nurses, physiotherapists, and also internal medicine physicians and geriatricians in charge of the many medical problems with co-morbidities and multiple prescriptions. Family doctors should be the team leader and act in the best interest of these elderly patients. It will require more than just patient-centred approach by the family doctors because many of these elderly people have difficulties in decision-making.

A consultation paper on “Mental Health Service Plan for Adults in Hong Kong 2010-15”¹ was released in May this year. This paper is primarily a strategy document but there are possible stages of implementing some of its recommendations for the coming years. Among the strategic objectives, the operational priorities and a number of detailed actions will be implemented. One of the objectives is: “To manage common mental disorders in primary care settings.” The resources was identified in (a) the HA Family Medicine Specialist Clinics and General Outpatient Clinics, and (b) private GPs.

What are “common mental disorders? According to the note on terminology in the paper, common mental disorders (CMD)” are those that occur with the largest prevalence in the population and usually refer to affective disorders, such as anxiety and depression. However, a person may suffer from a CMD and have complex needs; and may suffer from a CMD which causes severe mental illness (SMI) such as schizophrenia and other psychoses.” 

How well have we been trained or prepared if these challenges were thrown upon us, whether in GOPC or in our own private practice? The six years of training in Family Medicine with the two assessments may not be sufficient to test our competency in the handling of complex clinical and social scenarios that may arise from the care of mental or elderly health issues. Adequate knowledge and skill training plus ancillary support must be readily available to family doctors to shoulder such professional primary care services. Adequate exposure under supervision is mandatory before such services are to be provided by our Family Medicine colleagues in the Hospital Authority. As for private practitioners, self-study by enrolment in various diploma courses is a good way to acquire the necessary and updated knowledge, but supervised practice is equally important for them to reach a reasonable standard and discharge their duties. 

Earlier this year, Postgraduate Medical Education Working Group of the Education Committee of HKAM has presented a Position Paper on “ Postgraduate Medical Education”² to all Colleges of the Academy to consider whether there is a need to set up an Education Unit to assist the Academy and Colleges to keep pace with current scientific developments in education, training and assessments. There are concerns about the capability of a single professional educationalist (whether medical or non-medical) to know the specific competencies of every medical specialty of the Academy. The concept of a “general specialist” was brought up and the term Hong Kong’s Specialist was coined. Recommendation was made that the Academy should define the generic core competencies that every specialist should possess. It will be interesting to see how each College will bring up their own specific curriculum to complement the generic core competencies as defined by the Academy. I would encourage readers to go through the whole paper to grasp the full picture.

But no matter what future changes will be, our basic philosophy in providing excellent patient care in Family Medicine will never change. Your expertise will be appreciated by your patients. Our Hong Kong College of Family Physicians prepares to adapt to future changes in the primary health care system and is committed to providing the necessary training or support for Members and Fellows to deal with the new tasks.

Editor’s note: The note itself appears to have problems - anxiety is not an affective disorder, and depression is not a cause or an aetiology of schizophrenia, but can be a complication of schizophrenia.