GPFirst
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​Last updated on 24 January 2024

Recent key changes:

  • Updated info on operating hours for NUH Accident & Emergency and NTFGH Accident & Emergency
  • New section added with links to additional resources (more background reading for doctors who may find it helpful)


The GPFirst programme encourages patients with non-urgent conditions to first seek treatment at GPs rather than at the acute hospital's Accident & Emergency Department (ED). 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 nearest appropriate UCC/ED. 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 clinic.

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 .

More information on Pitfalls of Common Conditions seen in Primary Care​​1.

Children requiring onward referral to Children's Emergency are excluded from the GPFirst programme. Click​ to find out more about PaedsENGAGE2, a pilot programme, led by KK Womens' and Childrens' Hospital and National University Hospital.​


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

Minor Trauma/Mild Orthopaedic/Mild Musculoskeletal Conditions:

  • Simple lacerations less than 5cm for toilet and suturing3
  • Simple bruising/abrasions
  • Closed fractures of distal phalanx of lower limbs
  • Minor burns (less than 5 cm in width)
  • Ankle/foot with negative Ottawa Rules4
  • Knee injury with negative Ottawa Rules5
  • Back pain with no red flags  6
  • Head injury with no indication for Computed Tomography (CT) scan of the brain7​
  • Cervical spine injury with no indication for radiography​​

Stable Exacerbations of Chronic Disease:

  • Asymptomatic uncontrolled hypertension8​
  • Asymptomatic and uncomplicated poorly controlled diabetes mellitus (Random Blood Glucose <20 mmol/L)
Non-Urgent Acute Conditions:
  • Headache with no red flags9​
  • Dizziness with normal gait and no symptoms/signs of posterior circulation/cerebellar deficits10​
  • Dengue11 with no indication for admission to acute hospital 12​
  • Acute Respiratory Illness with no suspicion of pneumonia13
  • Red eye with No Red Flags14
  • Suspected pulmonary embolism with low pre-test probability15
  • For Fast Tracking Referrals
  • For non-urgent Specialised Radiology Investigations (e.g. MRI)
  • For non-emergent Laboratory Investigations (e.g. Full Blood Count (FBC), Urea and Electrolytes (UE), Liver Function Tests (LFT), Dengue serology) 
NB:  This list is not exhaustive and UCC/EDs are advised to refine appropriateness referral criteria with their GP partners.

​

  1. GPs are responsible for informing the patient of the terms and conditions relating to the eligibility criteria for the $50 subsidy off prevailing UCC/ED fees before the referral is made. Specifically, GPs should inform their patients to:
    • Arrive at the UCC/ED indicated on the GPFirst referral form within the same day* of referral;
    • With their NRIC/Passport/Work Permit/ Foreigner Pass; 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 UCC/ED without delay given that the GP had assessed that their condition requires urgent follow up/acute hospital care.

  2. For a GPFirst referral to be valid, the original GPFirst Referral Form
     (i.e. the serialised hardcopy form provided by participating hospitals or the hardcopy printout generated through the Healthier SG-compatible Clinic Management System (CMS)/Primary Care Digital Services (PCDS)​) must be fully completed. GPs may be contacted by the referred hospital if the form is incomplete.

    Specialised investigations required and/or non-standard medication prescribed at the UCC/ED/acute hospital will be separately charged.

  3. GPs shall attend Continuing Medical Education (CME) events as appropriate, to ensure that referrals are made appropriately to the UCC/EDs under the GPFirst programme.

  4. The cluster/hospital will monitor the volume and appropriateness of referrals received at their UCC(s) and/or ED(s) through the GPFirst programme.  

  5. 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.

  6. MOH reserves the right to change the terms and conditions of the GPFirst programme. 




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.


​
Under GPFirst, patients will pay the prevailing hospital ED fees less $50 if referred through the GPFirst Programme.

As an existing scheme offering patients a discount on their ED bill, GPFirst is applicable to both enrollees and non-enrollees.

​

  1. Pitfalls and Red Flags in Common Clinical Syndrome Title: Singapore Family PhysicianVol3 Jul- Sep20 1 3: 3 2 2013; 39(3): 32-36. 

  2. PaedsEngage 

  3. Continuous Core Content, EMRAP, October 2018 | Volume 2 Issue

  4. Ian Wedmore, Scott Young, Jill Franklin, Emergency Department Evaluation and Management of Foot and Ankle Pain, Emergency Medicine Clinics of North America, Volume 33, Issue 2,2015, Pages 363-396, ISSN 0733-8627, ISBN 9780323375948

  5. Moira Davenport, Matthew P. Oczypok, Knee and Leg Injuries, Emergency Medicine Clinics of North America, Volume 38, Issue 1, 2020, Pages 143-165, ISSN 0733-8627, ISBN 9780323712736​

  6. Corwell, Brian N. "The emergency department evaluation, management, and treatment of back pain." Emergency Medicine Clinics 28.4 (2010): 811-839. The emergency department evaluation, management, and treatment of back pain - PubMed (nih.gov)

  7. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001 May 5;357(9266):1391-6.

  8. Gauer, Robert. "Severe asymptomatic hypertension: evaluation and treatment." American family physician 95.8 (2017): 492-500. Severe Asymptomatic Hypertension: Evaluation and Treatment | AAFP

  9. ACE Clinical Guideline; When to order CT/MRI for headache 

  10. Edlow, Jonathan A., et al. "Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE‐3): Acute dizziness and vertigo in the emergency department." Academic Emergency Medicine 30.5 (2023): 442-486. 

  11. Schaefer TJ, Panda PK, Wolford RW. Dengue Fever. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

  12. Elsevier, Dengue Virus Infection. In: ClinicalKey [Internet]. Publishing; 2023 July 10-. Available from: https://www-clinicalkey-com.libproxy1.nus.edu.sg/#!/content/clinical_overview/67-s2.0-bd7b1824-4575-4ec3-83a7- d6cf25f81615

  13. Ebell, Mark H. "Predicting pneumonia in adults with respiratory illness." American family physician 76.4 (2007): 560-562. Predicting Pneumonia in Adults with Respiratory Illness | AAFP

  14. Kilduff C, Lois C. Red eyes and red-flags: improving ophthalmic assessment and referral in primary care. BMJ Qual Improv Rep. 2016 Jun 29;5(1):u211608.w4680. PMID: 27493748; PMCID: PMC4964165.​

  15. Approach to a Patient with Suspected Pulmonary Embolism – The Society for Vascular Medicine (mypulmonaryembolism.com)​