LCQ4: General out-patient services under Hospital Authority
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Question:
At present, the general out-patient (GOP) services under the Hospital Authority (HA) are primarily targeted at low-income people, the elderly and chronically ill patients. Some members of the public have relayed that the services provided by general out-patient clinics (GOPCs) are unsatisfactory. For instance, consultation quotas are in short supply, the coverage of service hours is inadequate, and the clinics are unevenly distributed among districts. Currently, among the 73 GOPCs in the territory, only 23 of them provide evening consultation services (i.e. from 6pm to 10pm) from Mondays to Fridays, and only 13 of them provide, in addition to evening consultation services, consultation services on Sundays and public holidays. On the other hand, the Chief Executive indicated in the Policy Address delivered in October last year that the Government would allocate resources to improve the healthcare system and services, and the relevant measures included vigorously promoting primary healthcare, reducing repetitive admission of patients to hospital, and rectifying the phenomenon where accident and emergency (A&E) services were regarded by members of the general public as the first point of contact in seeking medical consultation. In this connection, will the Government inform this Council:
(1) whether it will allocate additional resources to HA to strengthen the provision of evening GOP services on Saturdays, Sundays and public holidays; if so, of the details; if not, the reasons for that;
(2) given that at present, while no GOP services on Sundays and public holidays are provided by HA in six District Council districts (i.e. Central and Western, Sham Shui Po, Kowloon City, Kwai Tsing, Sai Kung and Islands District), the aggregate population in those districts has all along been accounting for about 30 per cent of Hong Kong's total population in the past few years, whether the Government will allocate additional resources to HA to enable it to provide the relevant services in those districts, so that patients need not go to other districts for seeking medical consultation; if so, of the details; if not, the reasons for that;
(3) given that as GOPCs and the vast majority of private clinics do not provide consultation services in late hours, members of the public who are taken ill during those hours, albeit with relatively mild symptoms only, have no alternative but to seek medical consultation from the A&E departments of public hospitals, thereby exerting extra pressure on the latter and wasting public resources, whether the Government will request HA to provide round-the-clock GOP services; if so, of the details; if not, how the Government rectifies the phenomenon where A&E departments are regarded by members of the public as the first point of contact in seeking medical consultation;
(4) given that the ratios of the number of low-income households (i.e. those with monthly household income below $10,000) to the number of GOP consultation quotas in various districts are varied (with the overall ratio in Hong Kong being 4:1 last year, Sham Shui Po having the highest ratio of 5.6:1 and Islands District having the lowest ratio of 2.5:1), whether the Government will request HA to redeploy the resources allocated to GOPCs in various districts, so that the low-income households in various districts have equal access to the relevant services; if so, of the details; if not, the reasons for that; and
(5) whether it will allocate additional resources to the Department of Health for the provision of GOP services, so as to strengthen the provision of public GOP services and alleviate the pressure on the GOPCs operated by HA; if so, of the details; if not, the reasons for that?
Reply:
President,
My reply to the question raised by the Hon Regina Ip is as follows:
(1) to (4) The general out-patient (GOP) services under the Hospital Authority (HA) are primarily used by the elderly, low-income persons and chronically ill patients. Patients under the care of general out-patient clinics (GOPCs) fall into two major categories: chronically ill patients in stable medical condition, such as patients with diabetes mellitus or hypertension; and episodic disease patients with relatively mild symptoms, such as those suffering from influenza, cold or gastroenteritis.
At present, the HA manages a total of 73 GOPCs, of which 23 provide evening out- patient services and 13 provide out-patient services on Sundays and public holidays. GOP services are provided on the basis of hospital clusters and consultation quotas are pooled together for use among clinics in nearby area to achieve effective use of resources.
Given the current shortage of doctors, extension of service hours (e.g. the provision of additional evening GOP services on Saturdays, Sundays and public holidays) will create further pressure on the existing staffing. Besides, the two major categories of patients under the care of GOPCs are not in need of round-the-clock services, and GOPCs are not intended for provision of emergency services. To ensure effective use of GOP resources, extending GOP services into the late hours or providing overnight services is not cost-effective. At this point, the HA has no plans to provide GOP services at late hours or overnight GOP services.
To meet the rising service demand, the HA endeavours to improve its GOP services, including renovating and modernising the facilities of ageing clinics to streamline patient flow, improve clinic environment and increase clinical space. The HA also actively recruits staff to enhance service capacity. With the implementation of various measures, the HA has increased the number of GOP attendances by a total of over 600 000 attendances from 2012-13 to 2017-18, including those of the extended evening and public holiday out-patient services, and additional attendances provided during the winter surge periods and long holidays. To cater for the demand for GOP services, the HA plans to increase the GOPC consultation quotas by about 55 000 attendances in 2018-19.
On the other hand, the General Outpatient Clinic Public-Private Partnership Programme (GOPC PPP) was launched by the HA in 2014 for clinically stable patients having hypertension and/or diabetes mellitus (with or without hyperlipidemia) and being taken care of by HA to select a participating private doctor as his/her family doctor and receive primary care services from the private sector on a voluntary basis. In addition to facilitating patients to consider choosing primary care services from the private sector, the GOPC PPP also helps alleviate demand for HA's GOP and reduce the pressure on the public healthcare system. Since April 2018, the GOPC PPP has been rolled out to all 18 districts in Hong Kong.
In planning for the provision and development of public primary healthcare services, the Government takes into account a number of factors, including the service delivery model of primary healthcare services, the demographic changes and distribution of target groups, as well as the provision of primary healthcare services and the demand for public primary healthcare services in a district. Having considered the distribution of target groups and the future population growth in various districts, the Food and Health Bureau has set aside sites in some districts for the future development of primary healthcare facilities. Among them, three proposed community health centre projects to be developed in Mong Kok (on the ex-Mong Kok Market site), North District (on Pak Wo Road, Sheung Shui) and Shek Kip Mei (on the existing site of the Shek Kip Mei Health Centre) have been included in the Ten-year Hospital Development Plan and are now in the active planning stage.
The HA will continue to recruit staff actively to cope with the rising service demand. Where manpower allows, the service capacity of GOPCs will be further enhanced, including the provision of more evening consultation services and out-patient services on public holidays. Meanwhile, we will closely monitor the operation and service utilisation of GOPCs, and flexibly deploy manpower and other resources to provide appropriate primary healthcare services for key target users.
The Government is conducting a comprehensive review of the planning for primary healthcare services with a view to drawing up a blueprint. The first district health centre will be set up in Kwai Tsing District in the third quarter of next year, after which such centres will be progressively set up in all the 18 districts. The planned district health centre, with a brand new operation mode and funding from the Government, will make use of the local network to procure services for strengthening medical and rehabilitation services in the community, so that the public can receive the necessary care in the community and unwarranted use of hospital services can be reduced.
(5) To facilitate the integration of the primary and secondary levels of medical care in the public sector, and to introduce the practice and training of family medicine, all GOPCs were transferred to the management of HA in 2003. The management of GOPCs by HA would facilitate flow of information between the clinics and other HA units, hence improving efficiency and service quality. At this stage, the Government has no plans to provide GOP services through the Department of Health.
Ends/Wednesday, April 25, 2018
Issued at HKT 17:38
Issued at HKT 17:38
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