Saturday, July 24, 2010

GP SUMMIT 2010: GPs AT THE CROSSROADS 14-15 August 2010

14-15 August 2010, One World Hotel, 1Utama, PJ

Over the past several months, the Primary Care Providers’ Coalition (PCPC involving MMA, AFPM, PCDOM, Qualitas, KDM, & Society of FMS) has met several times to discuss the mounting challenges afflicting the GPs, which have arisen in the recent past few years. A GP Summit was felt to be timely and necessary to help focus our attention as to the realities of these challenges and problems.

The PCPC felt that this GP Summit should come together to help evolve a robust yet nimble but cost-effective primary care-led healthcare system. This Summit should provide the initial impetus to establish a strong network or coalition of GPs who can provide the highest standards of General Practice, within a restructured healthcare system. We must come together collectively and represent ourselves with one voice rather than to become divided and self-serving. We must establish strong lobbying power to help protect our profession and our position from unreasonable challenges and top-down regulatory oversight which are unfair or which are too micromanaging or potentially discriminating.

We have planned a programme with the objective of getting as many like-minded primary care doctors as possible to come together to share their thoughts and viewpoints as to what these problems are, how we perceive these changes or challenges and how these can impact on our livelihood and future. Perhaps we need to come together to redefine what constitutes a GP for the future. We must reiterate our strengths and contributions, our worth, rather than to be saddled with perceived weaknesses that have been dumped against us. But we must be prepared to change for the better, for higher quality primary care practices.

The ultimate goal is to arrive at some form of a consensus statement or document, which we can then present to the government, to convey our frustration, our viewpoints and some possible solutions, even suggest some possible alternate plans for restructuring.

Among the more worrisome challenges are:

1.     The impact of the implementation of the private healthcare facilities and services act and the continuing effects on GP practice;
2.     The possible implementation of newer regulations and Acts which can impact on our practice, e.g. Medical Act 2010, Medical Devices Act?
3.     Changing position of the MOH on the future of Private Primary Care Practice; 1Care for 1Malaysia Health reform, single payer system (NHFS).

We also need to comprehensively review of the current and future challenges of the GP's.

By looking at cross border experiences, we can review alternative approaches, which encourage greater physician buy-in of the reform plans. We need to explore the possible contributory roles of government agencies (MOH, EPU, MOF etc.) to extend financial assistance in the form of outright start-up or matching grants, tax relief or incentives or exemptions, and see how these can support efforts to raise the standards of care delivered in the private sector. Simply mandating changes, regulations or threats would not help to create a collaborative atmosphere of cooperation or synergy.

We also need to get the authorities to clearly define the role of MOH in the private sector, more specifically in the sector of Primary Care. How would the proposed integration of primary care services be implemented? Would the government’s public sector amenities be corporatised or privatised to an outside agency with the MOH reducing its role to that of regulatory function? Would public sector amenities be given priority in the distribution of patients, at the expense of GPs. Would GPs be marginalized?

We also need to send a very clear and strong message to the government concerning the problems the private GP's are in and what needs to be done. Let’s all rally together and unite for a common good!

Supported by a generous unrestricted educational grant from Sanofi-Aventis (Winthrop)


GP Summit 2010: Programme

Saturday, August 14, 2010
7.30 – 8.30 am:                                    Arrivals & Registration

8.30 – 9.00 am:
P1 – Overview (Dr David KL Quek, MMA)
Why are we here? What’s expected of this first GP Summit? Where do we see our future as medical practitioners in Malaysia? Should we agree to the proposed integration of the primary care service? Does the government via its various agencies need to incentivise the GPs to enhance our services? Roles of EPU, MOF, MOH, matching grants or tax incentives, breaks for EHR (H/CIS); Quality enhancement programs; structural or allied health improvement programs; seamless CPD programs; Objective of Summit: Develop a consensus blueprint document to present to the MOH and Minister

9.00 – 9.30 am
P2 - GPs: Past, Present and Future (Dato’ Dr Noorul Ameen)
Scanning the Scenario for GPs—past to future of primary care providers; Shrinking income, Diminishing pie, growing intense competition, Realities vis-à-vis current challenges; Regulations, Funding, Training, Patient Safety, Quality issues; Public Private Integration, likely scenarios, uncertain future

9.30 – 10.00 am
P3 - Whither the GP? MOH’s Perspective (Dr Safura)
Role of GPs in the 1Care for 1Malaysia Health restructuring; Integration of GPs into Public Sector Primary care—how, who, when? What are the roles of Family Medicine Specialists, Members of Academy of Family Physician diploma?  Are they to be de facto in charge, controlling other GPs? If this is selective and not inclusive, why should the public contribute to an untried system, which reduces choice, and may not ensure fairness and equity? Would all GPs be required to become a FMS? Isn’t this potentially increasing healthcare costs? If so why should GPs buy into such a system? What goals and objectives have not yet been achieved, since GPs now look after about 60% of all primary care patients in the country? Are there indicators, which have shown inferiority of our current system compared with other countries’? Credentialing—another layer of bureaucracy? MSQH? Who pays who? How much? Co-payment for prescriptions, for ‘special care’, chronic disease management?

10.00 – 10.30 am:            
P4 – Comparative GP systems – US, Australia, Singapore (Dr IS Ludher, AFPM)
A review of what’s happening around good established GP practices in the region. Credentialing, CPD/CME programmes, HIS/EHR systems, scopes of practice, reimbursement mechanisms, GP fees and remuneration

10.30– 10.50 am:                     MORNING TEA BREAK

10.50 am – 12.20 pm: 
P5 - Whither the GP? Perspectives from GPs
Views, practical and reality bites from representative GPs from Sabah, Sarawak, Kedah, Johor, Kuala Terengganu, KlangValley

12.20 – 1.00 pm:                        LUNCH

1:00 – 1:30 pm:             Keynote Address (Dr David Quek)
1:30 – 2:00 pm:             Managing Allergic Rhinitis in a Primary Care Setting (Dr Ong Chun Chiang)
2:00 – 2:30 pm:            What they don’t teach you in Medical School  GI Fellowship – The Role of Diet in Gut Dysfunction (Dr Yin Thing Phee)
2:30 – 3:00 pm:             What’s your legal standing in Malaysia today? (Dr Milton Lum)
3:00 – 3:30 pm:            Q&A
3:30 – 4:00 pm:             Tea Break
4:00 – 4:30 pm:            Men’s Health: Sexually Active Men with LUTS – Is there hope? (Prof George Lee Eng Geap)
4:30 – 5:00 pm:             Metabolic Issues in the Primary Setting (Dr Alex Tan)
5:00 – 5:30 pm:             Non-alcoholic Fatty Liver Disease (NAFLD) – What physicians should know (Dr Ong Tze Zen)
5:30 – 6:00 pm:            Q&A            
6.30 – 10.00 pm            Prayers, Breaking of Fast Dinner (Courtesy sanofi-aventis)

Sunday, August 15, 2010
8.30 – 9.00 am:                 
P6 – Quality & Patient Safety Issues in GP/FP (Dato’ Dr M Thuraiappah, AFPM)
Quality In Practice, AFPM diploma, Family medicine specialist diplomas, CPD programmes
How can the GP improve further, evolution of smart clinics, chronic disease management, clinic clusters

9.00 – 10.15 am: Breakout Session 1 Workshops: Groups of 30-50 GPs
WS1: Scope of Practice (Value-added services/income streams/gatekeepers?)
Dr Inderjit Singh Ludher & Dr Ravi Naidu

WS2: Reimbursement & Fees (including Capitation vs Fee-for-service, grants for upgrading of services)
Dato’ Dr Noorul Ameen & Dr S R Manalan

WS3: Training & Quality (QIP, Accreditation, Credentialing, CPD/CME)
Dato’ Dr M Thuraiappah & Dr Noor Azizah Tahir

10.15 – 10.45 am:                                    Morning TEA BREAK
10.45 – 12.00 pm: Breakout Session 2 Workshops: Groups of 30-50 GPs
WS4: How do we move forward? (How do we as GPs improve ourselves & our livelihoods?)
Dr Sudhananthan

WS5: National Health Policy (Integration, Restructuring & Change, are we ready, agreeable?)
Dr David Quek

WS6: Health Information Systems (Electronic Health Records (EHR) & Information technology enhancements in GP practice; Common platform for National HIS framework?)
Dr Molly Cheah & Dr P Vythilingam

12.00 -1.00 pm
Report of Workshops, Summary, Plan of Action, GP Summit Consensus Declaration, Dispersal
1.00 – 2.00 pm                                    FAREWELL LUNCH

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