Dr Tan Wee Hian, Family Physician, Associate Consultant and Deputy Head at Pioneer Polyclinic, sees a patient in his clinic.

American entrepreneur and author Tim Fargo once said, “Who you are tomorrow begins with what you do today.” Indeed, steps taken today lay the foundation for the journey ahead and the outcomes of the future. Having a vision and purpose is thus important as they chart a clear direction for the organisation and its employees. This is especially so for new organisations such as the National University Polyclinics (NUP), the primary care arm of the National University Health System (NUHS).


As the integrated healthcare cluster for the west, the NUHS envisions a healthy community by shaping medicine and transforming care. In line with this, the NUP formed its purpose of Shaping Family Health, Delivering Value Care. “NUP looks after patients of all ages and is likely a person’s first touchpoint to healthcare. At the same time, we know that family members play a big part in influencing the patient’s readiness to make the necessary behaviour and lifestyle changes. This puts us in a position to shape family health – the way care is delivered to the family and community, and the way the family and community should be involved in managing their health. We will do this by delivering value care – care that is patient-centric, safe and clinically- and cost-effective,” Chief Executive Officer Dr Lew Yii Jen explained.


This is opportune in the face of an increasingly ageing population and a rising chronic disease burden. With primary care being the first line of care for the public, demands on primary care – both in volume and complexity – will grow correspondingly in the coming years.


Transforming Patient Care


As health needs continue to morph and grow, a care model that is multi-disciplinary and collaborative is needed, so that there are synergies that can be tapped on. The NUP will look for ways to improve the delivery of clinical care to its patients. This will be done by managing patients with chronic conditions holistically, empowering them in self-care, involving their caregivers in the process, and partnering institutions within the NUHS and relevant organisations to ensure that patient care is seamless and coordinated.


Some of the initiatives the NUP is undertaking include increasing patients’ activation, or patients’ ability to manage their personal health and care, so that they take ownership of their health, integrating diabetes care with other institutions to help patients manage their conditions well within the community, and developing community mental health programmes across the polyclinics.


For example, the NUP is working with the National University Hospital (NUH) and the Ng Teng Fong General Hospital (NTFGH) to help diabetic and hypertensive patients manage their chronic kidney disease (CKD) under the Holistic Approach in Lowering and Tracking Chronic Kidney Disease (HALT-CKD) programme. Patients with early-stage CKD will be taken care of by the polyclinics, while those whose conditions have deteriorated would be referred to the hospitals’ Renal Departments. Patient cases are discussed between the respective teams for continuity of care.


The Health and Mind Clinic in Jurong Polyclinic is another example where the NUP is working towards making lives better for our patients. The clinic looks after patients with common mental conditions and emotional issues. It started the Assessment and Shared Care Team (ASCAT) programme – a tie-up with NTFGH’s Psychiatry Department. In addition to discharging stable patient cases to Jurong Polyclinic, the Psychiatric Department also provides training for doctors at the polyclinic.


Said Dr Lew, “We also need to coordinate with General Practitioner (GP) partners and community health and social care providers to ensure the well-being of the community we serve. We can do so by working through the cluster’s Regional Health System to 

review and enhance current health screening programmes. We can also partner GPs, Family Medicine Clinics and Primary Care Networks to drive health screening initiatives and community outreach programmes on chronic management for the residents in the Western region of Singapore.”

Contributing to Research


Leveraging on the NUHS’ research expertise, the NUP will work closely with its partners to deepen its research efforts, especially in areas related to family medicine and chronic diseases, such as diabetes, chronic kidney disease, geriatric medicine and mental health.


“Being part of the NUHS means that opportunities abound to work with the Schools and Faculties under the National University of Singapore (NUS),” said Dr Lew, “and to establish partnerships to work together on patient-related collaborations and other projects, which may improve the overall productivity in the way we do things.”


Nurturing Future-ready Healthcare Professionals


A key priority for the NUP is to educate, train and develop its workforce, as well as the future generations of doctors, nurses and medical professionals, so that they will always be ready to meet the evolving health needs of the population.

In particular, the NUP is planning to train more family physicians in the assessment and screening of mental conditions for the community, and is working with the NUS Yong Loo Lin School of Medicine (NUS Medicine) and the other two local medical schools to train undergraduates.


Dr Lew elaborated, “We are working with NUS Medicine to pilot short attachments for the Year 1 medical students, so that they can gain more exposure to Family Medicine at an earlier stage. Similarly, we will help to enhance the NUHS Family Medicine residency programmes, and gradually ramp up the number of new Family Medicine residents we enrol.” Plans are also in place for the NUP to develop more post-graduate doctors to become proficient family physicians for the community.


Another upcoming NUP-NUS collaboration is with the Alice Lee Centre for Nursing Studies. It is hoped that through this collaborative effort, NUP is able to work on modules to better train Care Managers under its teamlet care model. “We’re constantly innovating and incorporating best-evidence pedagogies into the training of our staff,” added Dr Lew.


Creating Culture And Establishing Operational Excellence


To serve our patients well, one must also possess more than just clinical knowledge. Technology is a strong enabler in this regard, and the NUP strives to enhance its operations to deliver quality care and optimise its resources. One of its plans is to explore the use of robotics in the polyclinics, with a one-week robotic trial that took place at the Choa Chu Kang Polyclinic in June. “We will also harness new technology such as tele-treatment, tele-collaboration, tele-monitoring and tele-support,” added Dr Lew.


Creating an NUP identity and building a collegial and person-centric culture across the polyclinics and departments is also a key emphasis, as the NUP moves into its second year.


Dr Lew hopes that the Purpose Statement will permeate all that the NUP does. “Regardless of our job scope, all of us need to ask ourselves how we can value-add to the patient experience, be it through direct or indirect means.”