GPFirst

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 .

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, or emergency procedures/treatment

Minor Trauma/Mild Orthopaedic/Mild Musculoskeletal Conditions:

Simple lacerations less than 5cm for toilet and suturing
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

Stable Exacerbations of Chronic Disease:

Asymptomatic uncontrolled hypertension

Asymptomatic and uncomplicated poorly controlled diabetes mellitus (Random Blood Glucose <20 mmol/L)

Non-Urgent 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 to acute hospital

Head injury with no indication for Computed Tomography (CT) scan of the brain

Cervical spine injury with no indication for radiography

Suspected pulmonary embolism with low pre-test probability

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.

Roles and Responsibilities under the GPFirst Programme

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.

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.
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.
The cluster/hospital will monitor the volume and appropriateness of referrals received at their UCC(s) and/or ED(s) through the GPFirst programme.
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.
MOH reserves the right to change the terms and conditions of the GPFirst programme.

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.

Financing

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 will be applicable to both enrolees and non-enrolees, with no differentiable benefits between them.