On the initiative of the Hong Kong College of Family Physicians, there was a round table discussion on the captioned on the 14th January 2006. Besides representatives from our Union and the Hong Kong Medical Association, other guests invited were representatives from the Hospital Authority, Department of Health, LegCo and ExCo, Hong Kong College of Physicians and Paediatricians, ALMCHK, and Primary Care Working Group of Health & Medical Development Advisory Committee (HMDAC).
There was a proposal from the Hong Kong College of Family Physicians to establish a Primary Care Register (PCR) to set standards and to register those who are committed to provide quality primary care. The College thinks that for the Registry to be effective, the Government needs to be actively involved and confer it statutory status. And the College further thinks that the Registry will facilitate a smooth Public Private Interface in health care.
Such proposal from the College is a response from the College to the document on ¡§Building a Healthy Tomorrow¡¨ by the HMDAC in July 2005. And as they said, this is just the beginning of a brainstorming exercise on the way forward for establishment of concept of Family Doctors in Hong Kong proposed by the Government.
Dr. Lee Chok Huen and myself were invited to be discussants in the round table discussion. I could observe there was no strong consensus within the College of Family Physicians on the PCR. There was no general agreement for the establishment as there were still too many questions unanswered.
Since there are already two registers for doctors under the auspice of the Medical Council of Hong Kong, namely the General Register and the Specialist Register which are both statutory in status, would the new PCR complicate the issue if it is to be established under legislation? From the onset, I strongly opposed to establish the PCR (if it is be established) with statutory status for the aforesaid reason and for the reason that such Register would further divide our already decompartmentised profession.
For such a Family Doctor Concept to be established as proposed by the consultation paper: ¡§Building a Healthy Tomorrow¡¨ from the HMDAC released in July last year, we should have the consensus and approval from the Legislative Councilors and the citizens. Without the approval of the Family Doctor Concept in the city, there is no point of establishing any such Register.
If ultimately the PCR is established, the sole purpose of the Register is to ease the workload of the Public Medical Service and of course the burden of the public health expenditure. There would be frequent Public Private Interface of the medical service sectors such that patients would be shared among those working in the hospitals and out patient clinics, and those between private and public sectors. The PCR should operate somewhat like panel doctors of Health Maintenance Organizations where doctors can join at their own wish.
I have voiced out the following principles for the PCR in the round table discussion:-
The establishment of the PCR should not be statutory in nature ¡V as such, it should not be advisable to be established under a statutory body like the Hong Kong College of the Family Physicians. Our Union will look into the possibility of establishing one together with other Medical bodies;
The PCR should be inclusive AND NOT exclusive ¡V every doctor, whether a generalist or specialist, is welcome to join as long as he/she is willing to provide the service of a Family Doctor and is willing to join the shared care programme established through Public Private Interface;
The PCR should be facilitative AND NOT discriminative ¡V doctors in the Register should enter some form of continuing medical education, e.g. CME for Family doctors and other ad hoc CME courses. Mechanisms should be established to see the doctors continuously upgrade their medical knowledge so as to better serve the patients. However, doctors in the PCR should be encouraged to participate in the CME and NOT penalized on attending not enough.
In the 40s to 50s and even before, we have plentiful of primary care doctors in Hong Kong. With the establishment of the Specialist Register in 1996, there is a wish, at least from the eyes of the generalists, that doctors attaining further specialist training would serve the patients in the secondary and tertiary levels only. However, in real life business, many generalists and specialists are working beyond their boundaries in order to make a living in Hong Kong. We are not in the
Dr. Yeung Chiu Fat Henry