新加坡卫生部：正在增加护士、药剂师等人手

3月6日，新加坡卫生部兼通讯及新闻部高级政务部长普杰立医生在国会上有关家庭医生的发言。

以下内容为新加坡眼根据国会英文资料翻译整理：

叶汉荣先生强调，确保参与健康SG计划全科医生诊所的家庭医生拥有必要的资源和专业知识，以有效应对慢性疾病。黄玲玲女士也问到政府打算如何支持家庭医生的专业发展，特别是他们可能涉足越来越多的领域，例如影响病人生活方式选择的社会处方，以获得更佳的健康结果，以及治疗常见的精神健康状况。赛义德哈伦医生询问了支持健康SG计划向预防保健转变的专业人员的留任计划。

卫生部正在与高等教育机构（IHLs）密切合作，以增加本地培训渠道。我们也致力于发展初级和社区护理中的家庭医生，并更加强调家庭医学培训，例如鼓励更多医生参加研究生家庭医学培训，如家庭医学毕业文凭（Graduate Diploma in Family Medicine）和家庭医学硕士（Masters of Medicine in Family Medicine）课程。家庭医学的研究生培训也得到加强，以帮助家庭医生更好地应对不同年龄组的复杂疾病。培训通过各种形式进行，包括视频会议和网络研讨会，让家庭医生更灵活地跟上家庭医学领域的最新发展。

同时，我们正在增加社区护士、药剂师和其他联合卫生专业人员的数量，并为他们提供跨学科培训，使他们能够在其执照的最高级别上实践。我们还将扩大社区药剂师和其他联合卫生专业人员在初级和社区护理中的作用，以改善社区护理的提供。我们还将培训更多的无医学训练人员。这些人员可以承担任务，例如安排初级体检和协调转诊到社区项目。医护专业人员可以专注于临床护理。

为了确保患者得到一致、高质量的护理，初级照护团队将得到健康SG计划护理协议的支持。这些护理协议明确规定了指导家庭医生管理每种健康状况的清晰流程、转诊和数据流。在健康SG计划启动期间发布了12个护理协议，涉及糖尿病、高胆固醇等常见慢性疾病的管理，以及吸烟戒断和体重管理等预防保健措施。未来将开发更多护理协议，涵盖更多慢性疾病。我们意识到，一些家庭医生可能在管理某些慢性疾病方面拥有更多经验。因此，我们将与新加坡家庭医学学院（CFPS）、护联中心（AIC）和医疗保健集团紧密合作，为每个护理协议的家庭医生和护理团队开展培训。我们还将加强与社区辅助小组（COMIT）的联系，为有心理健康需求的患者提供非药物心理健康支援，以支持家庭医生提供综合护理。

陈有明医生询问卫生部是否正在审查家庭医生诊所提供全面护理所需的时间。随着我们动员家庭医生与他们的患者共同制定健康计划，其中可能包括生活方式调整和定期健康筛查，我们预计长时间在诊所咨询的患者比例将增加。在规划未来初级护理能力时已考虑到了这一点。为了让家庭医生专注于优化临床护理，我们在诊所和私人家庭医生诊所采取了团队护理的方法。在诊所中，患有慢性疾病的患者被分配到由家庭医生、护理经理和护理协调员组成的多学科护理团队中。

在私人家庭医生诊所中，PCNs扎根并加强慢性疾病的团队护理，通过整合资源来组织由护士和护理协调员提供的核心辅助服务，他们与家庭医生共同管理患者的状况。参与大型基层医疗护理网络计划（PCN）的诊所数量已经增长，从2018年的340家诊所增加到了今天的1000多家诊所。

我们的医疗保健集团也将作为区域健康管理者，与家庭医生和其他合作伙伴合作，解决其地区居民的健康和社会需求，并在社区中提供护理。例如，家庭医生可能与专科医生或医院医生合作管理具有更复杂需求的患者。出院后，医院将把患者转介给他们注册的家庭医生，以确保医院空间和初级护理空间之间的护理连续性。

以下是英文质询内容：

Mr Yip Hon Weng highlighted the need to ensure GPs in participating Healthier SG GP clinics have the necessary resources and expertise to effectively manage chronic conditions. Ms Ng Ling Ling also asked how the Government intends to support the professional development of GPs, especially in areas that they may be increasingly involved in, such as social prescriptions to influence patients’ lifestyle choices for better health outcomes and treatment of common mental health conditions. Dr Syed Harun asked about retention plans for healthcare professionals to support Healthier SG and the shift towards preventive health.

MOH is working closely with Institutes of Higher Learning (IHLs) to increase local training pipelines. We are also committed to the development of family doctors in primary and community care and have placed a stronger emphasis on family medicine training, such as encouraging more doctors to take up postgraduate Family Medicine training like the Graduate Diploma in Family Medicine (GDFM) and the Masters of Medicine in Family Medicine. Postgraduate training in Family Medicine is also strengthened to help family doctors be more equipped to manage a wider range of complex conditions across different age groups. Training is delivered through various modalities including video conferencing and webinar platforms, allowing GPs more flexibility as they keep up to date with the latest developments in family medicine.

At the same time, we are increasing the number of nurses, pharmacists and other allied health professionals in the community, and are providing interdisciplinary training to empower them to practise at the highest level of their licences. We will also expand the role of community pharmacists and other allied health professionals in primary and community care to improve care delivery in the community. We will also train more lay extenders. These are non-medically trained persons who can undertake tasks, such as arranging the initial health screening and coordinating referrals to community programmes. Healthcare professionals can then focus on clinical care.

Primary care teams will be supported with Healthier SG Care Protocols to ensure consistent, quality care for patients. These care protocols lay out clear processes, referrals and data flows to guide GPs in managing each health condition. Twelve care protocols were released during the launch of Healthier SG on the management of common chronic conditions, such as diabetes, high cholesterol and preventive health, such as smoking cessation and weight management. More care protocols will be developed to cover more chronic diseases in the future. We recognise that some GPs may have more experience in managing certain chronic conditions than others. Therefore, we will work closely with the College of Family Physicians Singapore (CFPS), AIC and healthcare clusters to roll out training for GPs and their care teams for each care protocol. We will also support GPs in the provision of holistic care for patients with mental health needs by strengthening the links to COMIT for non-pharmacological mental health support.

Sir, Dr Tan Wu Meng asked if MOH is reviewing the time required by GP clinics to deliver holistic care. As we mobilise family doctors to co-develop health plans with their patients, which can include adjustments to lifestyles and regular health screening, we expect that the percentage of patients requiring longer clinic consultations to increase. This has been taken into account when planning for future primary care capacity. To allow family doctors to focus on optimising clinical care, we have adopted a team-based care approach in polyclinics and private GP clinics. In polyclinics, patients with chronic conditions are assigned to multidisciplinary care teams comprising family physicians, nurse care managers and care coordinators.

In private GP clinics, PCNs anchor and strengthen team-based care for chronic diseases, by pooling resources to organise core ancillary services provided by nurses and care coordinators who work with GPs to jointly manage the patients’ conditions. The number of clinics participating in a PCN has grown, from 340 clinics in 2018, to more than 1,000 clinics today.

Our clusters will also step up as regional health managers, working with family doctors and other partners to address health and social needs of residents in their region and anchor care in the community. Family doctors may work with specialists or hospital doctors in the management of patients with more complex needs, for example. Upon discharge, the hospitals would refer patients to the family doctor they are enrolled with, to ensure continuity of care between the hospital space and the primary care space.

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新加坡国会丨来源

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