GPFirst

Background

The GPFirst programme encourages patients with non-urgent conditions to first seek treatment at General Practitioners (GPs) rather than at the acute hospital's Accident & Emergency Department (A&E). Should the GPs assess that patients require onward referral to either an Urgent Care Clinic (UCC) or an ED for acute interventions, patients will be referred to the UCC/ED that is geographically nearest to the GP. Upon arrival at the UCC/ED, patients will be given queue priority over other less urgent cases and $50 off the prevailing UCC/ED fees to offset the charges they had incurred at the GP.

In this way, the programme seeks to shift care from the hospitals to the community and reduce the demand for acute hospital services for non-urgent conditions. GPFirst also aims to foster closer cluster-GP relationships and empower GPs to manage a wider variety of non-urgent medical conditions (through continuing professional development in acute care), further enabling the appropriate siting of acute care within the community.

For general administrative or clinical enquiries, GPs may reach out to the participating acute hospitals through the channels found here .

Exclusion Criteria (i.e. Cases that should not be referred to the ED/ UCC)

Examples (non-exhaustive) of conditions that generally do not need urgent laboratory, radiological investigations, emergency procedures/treatment:

Minor Trauma/ Mild Orthopaedic/ Mild Musculoskeletal Conditions:

Simple Lacerations less than 5cm for T&S
Simple Bruising / Abrasions
Closed Fractures of Distal Phalanx of Lower Limbs
Minor burns (less than 5 cm in width)
Ankle/Foot with Negative Ottawa Rules
Knee Injury with Negative Ottawa Rules
Back Pain with no Red Flags

Exacerbations of Chronic Disease

Asymptomatic Uncontrolled Hypertension¹
Asymptomatic & Uncomplicated Poorly Controlled DM (RBS < 20mmol/L)

Acute Conditions

Headache with no Red Flags
Dizziness with normal gait and no symptoms/signs of posterior circulation/cerebellar deficits
Dengue with no indication for admission
Head Injury with no indication for CT Brain
Cervical Spine Injury with no indication for Radiography
Suspected Pulmonary Embolism low pre-test probability
For Fast Tracking Referrals
For non-urgent Specialised Radiology Investigations (e.g., MRI)
For non-emergent Laboratory Investigations (e.g., FBC, UE, LFT, Dengue)

NB: This list is not exhaustive and UCC/EDs are advised to refine appropriateness referral criteria with their GP partners.

Terms & Conditions of the GPFirst Programme

GPs are responsible for informing the patient of all of the terms and conditions relating to the eligibility criteria for the $50 subsidy off prevailing UCC/ED fees before the referral is made. These terms and conditions are as follows:

The patient must be seen at the UCC/ED indicated on the GPFirst referral form;
Within the same day* of referral;
With their NRIC/Passport/Work Pass/Permit; and
The original GPFirst referral form provided by the GP at the point of registration at the UCC/ED.

*The GPFirst referral form is valid only on the day of issue, and up to 0200 hrs of the following day if the referral form is issued close to midnight (i.e., between 2200 to 0000 hrs). Patients should be advised to visit the ED without delay given that the GPs had assessed that their condition requires urgent follow up/acute hospital care.

The Referral Form (printed out from the online referral form) must be duly completed, and the Patient must produce this at the UCC/ED together with his/her NRIC / Passport / Work Passes / Permits for verification.
Specialised investigations required at the UCC/ED/acute hospital will be separately charged.
GPs shall attend Continuing Medical Education (CME) events as appropriate, to ensure that referrals could be made appropriately to the UCC/EDs under the GPFirst programme.
The Cluster/Hospital will monitor the volume and appropriateness of referrals received at their UCC(s) and/or ED(s) through the GPFirst programme. The Cluster/Hospital reserves the right in its sole discretion to exclude clinics from this programme if of the view that the GP clinic persistently refers inappropriate cases to their UCC and/or EDs despite feedback or breach the terms and conditions of the programme. In such events, if requested by the Cluster/Hospital, the GP shall return to the Cluster/Hospital any materials related to the programme with immediate effect.
In the event where a patient seen under GPFirst programme raises concerns to the Cluster/Hospital with regard to their GP bill, the Cluster/Hospital reserves the right to seek clarifications from the GP clinic.
The Cluster/Hospital reserves the right to change the terms and conditions of the GPFirst programme as approved by the Ministry of Health, or terminate/withdraw the programme without prior notice, which shall be deemed effective immediately upon such change or withdrawal and without liability towards GP clinics and patients.

Referral Pathway

Appropriateness Algorithm

To determine if a referral is appropriate and eligible for $50 off the prevailing UCC/ED fee, UCCs/EDs will utilise the following appropriateness algorithm.

References