October 2018

The College Council has urged the Government to increase resources in Family Doctors Training in the coming Policy Address and recommends optimal utilization of District Health Centres. The College would also clarify Primary Healthcare is NOT just for the grassroots. Dr. Lau Ho Lim, Professor William Wong and I had represented the College and held a press conference at our Wanchai premises on 23rd September 2018. The details of the press release are as follow. In advanced countries around the world, family doctors are the core of quality primary healthcare systems. Although the Government has actively engaged in the development of primary healthcare, and made breakthroughs in some policies like the Elderly Health Care Voucher Scheme, resources invested in training in Family Medicine are still grossly inadequate. Meanwhile, there has been considerable misunderstanding amongst the general public about “primary care” which associates primary care with provision of healthcare services to the grassroot, hindering the development of primary care.

Recently, given the government has started to invite open tenders to provide services for the operation of the Kwai Tsing District Health Centre (DHC), The Hong Kong College of Family Medicine (HKCFP) deems that family doctors should play an important coordination role in DHC. With reference to the imminent 2018 Policy Address, HKCFP urges the Government to increase resources in family doctors training and recommends optimal utilisation of DHC, achieving the goal of “One Family Doctor for Each Citizen” to improve our primary healthcare system. 

More well-trained family doctors are required to meet population needs

With a population of 7.5 million people, at least 3,750 trained family doctors are needed to maintain a quality primary healthcare system in Hong Kong. In China, the national policy is to have one family doctor to 2000 people. In the United Kingdom, this ratio has reached 1 to 1500. Assumingly, the working life of each family doctors is 40 years, we need to train at least 100 doctors, let alone some doctors may leave their profession, or have shorter professional life, or change to part-time practice due to family and other commitments. As a result, the city needs even more trained family doctors. 

However, Hospital Authority, the main training provider in Hong Kong, only allocates less than 10% of local medical graduates to receive training in Family Medicine. Not only is it well-below other healthcare systems in developed countries but is also insufficient to meet the population needs. Dr. Angus Chan, President of HKCFP said, the government need to increase the number of local medical graduates receiving training in Family Medicine and enhance resources on training family doctors.

According to the Medical Registration Ordinance, only specialists in Family Medicine must have compulsory CME programme. HKCFP strongly advocates all primary care and family doctors to participate in continuing medical education (CME) programme to update their medical knowledge and standard.

One of the main objectives of the HKCFP is to set standard for training high quality family doctors for the primary healthcare system in Hong Kong. Primary care doctors can attend a oneyear part-time course in Diploma in Family Medicine in the entry level. For the vocational training, doctors completed a four-year basic training programme and passed the Fellowship Examination in Family Medicine will be granted Fellowship of HKCFP (FHKCFP) which signifies competence in quality independent family practice. Further two years of higher training will be accredited Fellowship of the Hong Kong Academy of Medicine (FHKAM) that certifies the status of Specialist in Family Medicine.

Meanwhile, there has been considerable misunderstanding amongst the general public about “primary care” which associates primary care with provision of healthcare services to the grassroot, hindering the development of primary care. Dr. William Wong, Honorary Secretary of HKCFP explained, “primary care” or “primary healthcare” refers to the first point of contact in the healthcare system by the general public.

Unlike secondary care, primary care should be as comprehensive as possible. It is also supported by various studies’ results showing only 9 patients in every 250 were referred to the hospitals. Additionally, more and more evidences show that the provision of continuous and coordinating care to patients by family physicians are the most effective and cost-effective in healthcare system.

Adopt One Family Doctor for Each Citizen to serves multi-functions

As family doctor is familiar with patients’ health conditions, he is the best person to provide continuity of care for the patients, avoiding the risks such as those related to repeated investigations, and potential drug-drug interactions due to polypharmacy. A family doctor can also detect subtle changes in health status in early stage of an illness and hence tailor the appropriate treatment plan accordingly. Besides, it must be noted that a patient tends to communicate better with a family doctor whom he/she knows well. The rapport and mutual trust built over the years helps to enhance the patient’s involvement in the management plan which would be beneficial to the treatment outcome.

With the aging population and the spread of chronic diseases in the community, another benefit of having a regular family doctor is that they can advise on the preventive activities of an individual throughout the different stages in life, reducing their likelihood of suffering from preventable illnesses. HKCFP strongly advocates that every Hong Kong citizen should have one regular family doctor.

Family doctors enhance the utilisation of medical resources
The Government set up the Steering Committee on Primary Healthcare Development to develop a blueprint for the sustainable development of primary healthcare services for Hong Kong last year. HKCFP warmly welcomes the Government’s determination to strengthen primary healthcare services to address the needs of an ageing population, and its plan to devise a new primary healthcare service model via district-based medical-social collaboration in the community, in the form of District Health Centres. HKCFP believe these new District Health Centres will provide an improve efficiency in utilisation of present and future healthcare resources for the benefit of the public.

Dr. Lau Ho Lim, Vice President (General Affairs) of HKCFP said, these proposed District Health Centres are expected to provide important support to family doctors in providing holistic care for the patients and to further strengthen family doctors’ role as the coordinator in a primary healthcare team, and their contribution to the healthcare system functioning through managing and triaging undifferentiated symptoms, making diagnosis, matching patients’ needs with available healthcare resources and providing care at a much lower cost outside of hospitals.

HKCFP urges the Government to increase resources in family doctors training in the coming Policy Address and recommends optimal utilisation of District Health Centres. Primary Healthcare is NOT just for the Grassroots.

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