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The woes of general practitioners and a call to invest in private clinics — Dr John Teo

JULY 13 — In 2010, Malaysia`s general practitioners came together in a GP Summit with the theme “GPs at the Crossroads”. The objective was to discuss all the myriads of issues facing the GPs, offer possible solutions and present them to the government in a united voice. That summit generated a 177 page detailed document which was published and presented to the Government. 

Fast forward 7 years later, another summit was organised in the interim by GPs termed the 1000 GPs Meeting in 2015 and resulted in a memorandum submitted to the Prime Minister. 

Today`s general practitioners in Malaysia, numbering more than 7,000, face even more pressure to stay afloat and provide the much needed and critical public health service. 

The two summits are cries in desperation as they are squeezed, regulated, threatened, and attacked from all directions. 

One of the biggest problem facing GPs are the microregulation of the practice of GPs with the implementation of the Private Healthcare and Facilities services Act in 2006 regulating everything from the size of the door to whether GPs are allowed to do certain procedures such as intravenous treatments. Many felt the unfairness of the Act as it only specifically targets the private sector, implying that Government clinics and facilities need not be subjected to the same requirements nor the tight scrutiny and enforcement. 

Third party administrators (TPAs) add to the woes of GPs whereby many GPs are dependent on but yet are subjected to such low consultation fees and charges, that are way below the recommended rates. In addition, many are being slapped with administration fees, terminal fees etc that the GPs at the end of the day are only receiving a pittance, surviving in many instances by working extremely long hours to be viable. 

Regulation after regulation is plied upon the GPs, each taking a toll in the survival of the clinics and each coming at a cost to the clinics. 

A typical GP clinic is subjected to the doctor`s annual practicing certificate, signboard license, pest control certificate, clinical waste disposal contract, regulation and inspection by the Medical Practice Division, The Pharmacy Enforcement division, the Department of

Environment, the Local Authorities, the Fire Department and a myriads of teams from Ministry of Health on certain enforcement requirements or issues. The latest requirement being the PDPA Act and premises license by certain local authorities. 

Looming regulations include the requirement for Continuing Medical Education points and professional malpractice liability for Annual Practicing certificate renewal, the internet regulations of GPs services advertisements and the control of medicine prices, some in the very near future. 

Many find it difficult to survive especially solo GPs, with more than 500 clinics estimated to have closed since 10 years ago. 

Malaysia`s general practitioners play a central role in the delivery of healthcare at an extremely  affordable and cost effective way with many of the general public utilising their services for generations and decades. Often, the GP is the first point of contact for any health ailments, the person that is most trusted to the patient and knows the patient`s history like the back of his or her hand. 

Many families see the same GP for generations as he or she is always there consistently providing the high quality and holistic service to them faithfully. 

Many near fatalities and many hospitals admissions were averted by the GPs due to the sheer consistent preventive medicine practised by GPs as well as their experience in the field by horning their skills after extremely long hours of patient contacts everyday for decades. 

This central role is fully recognised by the Ministry of Health with their Healthcare Transformation plan prioritising the Enhancement of Primary Care. 

The more than 7,000 GP clinics that are currently operational nationwide were all fully set up with private funds attending to thousands of patients everyday who otherwise would need to go to government clinics or hospital emergency departments, further depleting the already stretched resources and funds available. 

They contribute to employment of more than 30 to 50,000 employees providing many families with work and security nationwide. 

They are also a significant contributor of income tax to the nation contributing to the RM127 billion target set by the Inland Revenue Board for 2017. 

Many GPs go beyond their call of duties, donating their time and resources to charities and non-governmental agencies, again averting the costs that otherwise governmental agencies have to shoulder. 

It has been clearly shown that prevention is much more cost effective than treatment, and investment in primary care is the most effective means of reducing healthcare expenditure. 
In addition, investment into primary care promotes better outcomes with lower costs and higher patient satisfaction. 

From an economic viewpoint, one of the most cost effective ways is to invest in infrastructure that are already existing with no capital costs to the government. 
Indeed the government has done that on multiple occasions by buying over already existing private hospitals at significant savings. 

The returns can be tremendous with every ringgit invested yielding significant healthcare cost savings for the government.

The government can invest into the following areas as examples:

1) Enhancing GPs’ skill set by subsiding and creating alternative pathways  for Postgraduate training.
2) Purchasing services from GPs at a negotiated cost.
3) Investing in IT technology in GP clinics enabling increase efficiency in patient management and better private — public collaboration.
4) Subsidising Training Courses for Nurses working in GP clinics to increase their knowledge and patient management
5) Cutting the red tape and microregulations for GPs

The question that begs to be answered is “Isn’t it time now for the Government to invest into the 7,000 private clinics and enhance this cornerstone of the nation`s healthcare or let it wither, struggle like a fish on dry land and inevitably cease to exist?” 

Let’s make GPs great again!

* Dr John Teo is a consultant, obstetrician and gynaecologist.

** This is the personal opinion of the writer and does not necessarily represent the views of Malay Mail Online.

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