This is a follow up report on the progress of the Proposed Primary Care Registry (PCR) since my message in the February 2006 issue of HKDU Bulletin. I do believe the initiative for such PCR is not from the Hong Kong College of Family Physicians but some one higher or highest in the Medical and Health arena.
Following on the Round Table Discussion on 14th January 2006, I have attended two more meetings on the same subject held by the Hong Kong Medical Association and the College on 6 March 2006 and 4th April 2006 respectively. I have voiced out our views on the proposed PCR as written in my last message, i.e., (1) the establishment of the PCR should not be statutory in nature and our Union will look into the possibility of establishing one with or without collaboration with other Medical bodies; (2) the PCR should be inclusive AND NOT exclusive and (3) the PCR should be facilitative AND NOT discriminative though doctors in the Register should have some form of continuing medical education yet doctors in the PCR should be encouraged to participate in the CME and NOT penalized for attending not enough. I have also voiced out that if there is no such an initiative from above, HKDU would not embark on the discussion and organization of PCR, further, HKDU would withdraw from such a proposal if all agree that it is unnecessary in the end.
In the meeting hosted by the Hong Kong College of Family Physicians, I was shown a paper on General Practitioners (GP) register of United Kingdom (UK) which was newly introduced on 1st April 2006. I surfed the web on the General Medical Council ( http://www.gmc-uk.org ) and have made a summary of such GP register of UK in the followings for members' reference:
1. The purpose of the GP Register is one of a package of measures aimed at making the medical Register a more useful and transparent resource for the public, the profession and employers;
2. The GP Register is a register of all those eligible to work in general practice (apart from doctors in training such as GP registrars) in the UK health service;
3. Entry in the GP Register is evidence that a doctor's qualification is acceptable in the UK;
4. Admission to a list is based on the following 4 criteria: (a) Whether the doctor is suitably experienced; (b) Whether the doctor is suitably qualified; (c) Whether the doctor is an appropriate person to deliver health care and treatment to the PCO's patients; (d) Whether the doctor is free from regulatory body sanctions etc;
5. The entry into the GP Register is free of charge for only registered medical practitioners who satisfy one of a number of criteria for inclusion which include mainly holders of specific certificate of training or experience in General Practiceor registered medical practitioners who have an acquired right because of certain Grand Father status;
6. As long as doctors are on the Medical Register, they can practise in the UK health service and exercise the other privileges of registration while doctors need to be on the GP Register if they are practising as GPs in the UK health service.
As the proposal from the Hong Kong College of Family Physicians to establish the PCR is to set standards and to register those who are committed to provide quality primary care, I envisage such framework from UK would be more or less imposed in the future PCR if it is to be made statutory. Apparently it would turn out to be a dangerous move for the Government to control the private sector without injecting money as in the National Health Services of the United Kingdom.
On 11st April, 2006, I was interviewed in my clinic by the Asia Pacific Society of Healthcare Quality who was commissioned by the Department of Health (DoH) to conduct a study on the quality framework for primary healthcare in Hong Kong and to recommend possible improvements for the future. It took me over an hour to fully voice out our objection on the proposal of statutory body to oversee primary health care which was said to be supported by a clear majority of the public (68.7% of phone survey conducted by the University of Hong Kong) and views on other matters during the interview.
DoH is exploring the possibility of establishing a licensing process for clinics to ensure minimal standards (said to have 75% public support from same phone survey); mandatory training of registered medical practitioners (62% public support from the survey) and clinic accreditation (64% public support). I believe in the matters of clinic licensing and accreditation, input from the Medical Profession is much more important than that from the public as the Profession knows the matter best; furthermore, input from colleagues in the Private sector should receive paramount importance in the deliberation. Since clinic settings are more or less dominated by the landlords, the cooperation of them should be sought before any endeavor by the DoH. As regards CME, I maintain our Union¡¦s stand that Mandatory CME Status Display in the clinic is a much better alternative than CME linking with the annual practicing certificate.
I strongly believe if PCR is finally to be established to facilitate Public Private Interface, it should operate like panel doctors of Managed Care. There would be PCR 1, PCR 2, PCR 3, etc for free choice by both patients and doctors. The standard level of doctors in each PCR should be worked out by individual administrator. I have conveyed this message to certain Directors and even the Chairman of the Hospital Authority last month and their response were positive. So if PCRs are to be established, let¡¦s furnish them in a user-friendly manner and not introduce hardship to our fellow colleagues in the private sector.
Dr. Yeung Chiu Fat Henry