Doctors relieved as healthcare workers allowed to resume working across clinics, hospitals from July 17

SINGAPORE — The Ministry of Health (MOH) will allow healthcare workers to practise at multiple institutions again from Friday (July 17).

Doctors interviewed by TODAY applauded the “good news”, saying that those who have been under strain covering more shifts in the absence of locums or stand-in doctors may now find some respite, patients will not be shortchanged in their care, and locums will be able to get more work and earnings.

On Wednesday, in a circular issued by MOH to all registered medical and dental practitioners, and healthcare institutions such as general practitioner (GP) clinics and private specialist clinics, it stated that with the Covid-19 situation expected to be “drawn out” over a protracted period, it has reviewed the guidelines for cross-campus movement of healthcare workers. 

It is therefore easing the restrictions to:

• Continue delivering clinical care of patients

• Support the training needs of healthcare students, medical and dental officers, and other workers

• Support ongoing Covid-19 operations outside of the premises of these institutions

• Better enable deferred services to concurrently resume

However, movement restrictions will not change for those working in long-term care settings such as nursing homes, since patients in these institutions are more vulnerable to the severe effects and complications of Covid-19, MOH said.

The move is set to ease the workload of GPs because locums are no longer restricted to working in just three clinics.

In a previous report by TODAY, one GP said that the restrictive measures were “killing off” the private sector which accounts for at least 80 per cent of primary healthcare here. An adequate primary healthcare system is essential in supporting polyclinics and hospitals to prevent them from being overwhelmed, the GP added.

In February at the start of the Covid-19 outbreak here, MOH had imposed restrictions on the movements of healthcare workers across institutions to prevent cross-institutional transmission of the coronavirus.

This included mandating that healthcare workers work at only one hospital. Healthcare workers from private specialist clinics providing outpatient services were also limited to working at two clinics.

‘A SHOW OF CONFIDENCE’

A specialist doctor said that the relaxation of rules was a “show of confidence” by MOH.

At the time when the restrictions were put in place, a locum had questioned if the authorities thought doctors might be potential carriers and spreaders of the disease even though a 20-minute contact with patients is as “transient” as taking public transport with other commuters.

Dr Desmond Wai, 51, a gastroenterology specialist at Mount Elizabeth Novena Hospital, said: “It’s good news because it signifies that MOH is confident that the doctor will not pass the Covid-19 virus around.”

Dr Tan Chyn Hong, 46, an orthopaedic specialist at the same hospital, said that the move will allow specialists to carry out “normal” operations again.

However, he remains wary of a possible spike in Covid-19 cases in Singapore and is ready “to go back into lockdown mode” if required.

EASING MANPOWER CRUNCH

With the changes, some GPs are relieved that some of their workload at clinics can be eased as well.

Dr Wong Choo Wai, 48, a GP at Bedok Day and Night Clinic, said that the movement restrictions led to clinics having to resort to overworking their doctors.

Operating hours then had to be reduced and the "chronic fatigue" of doctors could have reduced the quality of care for patients. As such, Dr Wong called the latest move an "all-round win for doctors, patients and clinics".

Another GP who gave his name as just Dr Kumar, 48, said that GPs at his clinic had been "stretched" since February, because the clinic relied on locums to support the dedicated one or two full-time doctors there. 

"With the locum market being more fluid now, we should be able to fill any holes we have," he said, adding that those who work as locums stand to benefit as well.

Dr Pauline Neow, a GP at Mei Ling Clinic in Queenstown who worked as a locum at accident and emergency departments, said that her earnings had dropped by about 30 per cent since the restrictions kicked in.

She is thus “very happy” with MOH’s announcement as it will give her greater freedom to choose where she works, as well as help to supplement her income.

EASIER CHOICE FOR INPATIENTS

In terms of patient care, those who are hospitalised may now get their preferred specialist to visit them where they are warded, for example.

Dr Wai said that his patients sometimes prefer staying in other hospitals rather than in Mount Elizabeth Novena Hospital where he is based. This could be due to the convenience of the location or preference for certain types of wards or services offered by a hospital.

With the earlier regulations, patients had to decide on whether to stay in the same hospital where their specialist is based or forgo the specialist’s services should they choose another hospital because the doctors cannot move around.

As to whether the period of restricted movement and being limited to the facilities at one hospital had affected their practice, the specialists who spoke to TODAY said that it had largely not been disruptive. 

Dr Tan Ter Chyan, 50, a hand surgeon based at Mount Alvernia Hospital, said that while some newer hospitals may have more state-of-the-art equipment for surgery, the operations that usually require such equipment were not permitted during the circuit breaker period of restricted movement in April and May anyway.

On the two occasions when he needed access to such equipment to perform surgeries, he received permission from MOH, though that involved “a fair bit of emails and justification”, he recalled.

Sharing what he knows from others in the fraternity, Dr Wai said that due to the restrictions imposed, some doctors had chosen to work out of hospitals with better facilities, and where other specialists also are, so that they may immediately call on their colleagues to assist them in cases, instead of seeking approval from MOH to travel to a different healthcare institution. 

In an email response to TODAY, the National University Health System (NUHS) said that the latest guidelines will help to address the health concerns of patients in its institutions and they will now have greater access to specialist care.  

The NUHS counts National University Hospital, Ng Teng Fong General Hospital and several other hospitals as part of its grouping.

Healthcare students who are at NUHS for clinical training may at times have teaching sessions delivered by faculty from other healthcare institutions, so they will now be supported in terms of training needs, the spokesperson said.

Dr James Lam, chief executive officer of Mount Alvernia Hospital, said that to ensure the continual delivery of clinical care for patients, the hospital will strictly adhere to safety precautions such as by wearing appropriate personal protective equipment and following safe workplace management measures.