established to consolidate public sector activities that until now have been spread across several units, such as the Department of Health and the Hospital Authority. ‘Those governance bodies have many other things to take care of. The Primary Healthcare Commission will have only one mission and interest, which is to develop primary healthcare in Hong Kong,’ she said. A statutory primary care registry will also be established to assure quality. All family doctors and other primary care professionals will be required to register and will likely have to meet credentialing requirements. On infrastructure, a familycentric community health system will be delivered through District Health Centres (DHCs) to be established across all 18 districts. This will ensure family doctors can be part of multidisciplinary primary care teams within convenient reach of everyone and make things easier for the older adults, in particular, who often make long journeys to hospitals just for health check-ups or maintenance. A variety of primary healthcare professionals will be on staff at the DHCs to provide preventive services, rehabilitation, management of chronic diseases, health counselling and other health services, which will also help improve population health, hence reducing unnecessary demand on hospital and specialist services. Funding resources will be redirected through a healthcare voucher system that people can use to visit their own family doctor and buy chronic disease medications. A co-payment system will also be introduced to incentivise those of greater means to make use of private healthcare services under governmentsubsidised programmes. Information sharing between private and public doctors will be enhanced through better access to the electronic health record system – currently, private doctors can search patients’ records in the public system but not vice versa. Finally – and most importantly to Professor Lam – is the issue of training and manpower. ‘If we want everybody to have a family doctor, primary care needs to be supported by more health professionals, including but not limited to doctors trained in family medicine,’ she said. Until now, the training of nurses, pharmacists, and occupational- and physiotherapists has been mostly hospital-based. This looks likely to change given the emphasis on multi-disciplinary collaboration in primary care to achieve early diagnosis and early treatment, such as non-drug interventions for certain mental conditions. Nurses are expected to play an important role in communitybased primary care centres, while pharmacists may be called on to help people with multiple morbidities manage their medications, dispense drug advice for simple ailments and even perform vaccinations. Both the School of Nursing and the Department of Pharmacology and Pharmacy are assessing how to accommodate these demands in their curricula. For doctor training, the Hong FEATURE + A family-centric community health system will be delivered through 18DHCs ‘If we can put the Blueprint into practice successfully, it can change not only primary healthcare in Hong Kong, but the whole healthcare system. It will help to reduce unnecessary use and demand on the hospitals and make our system more equitable and sustainable.’ Professor Cindy Lam Lo-kuen 28
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