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Shared Care Partnership Office

Heading: Shared Care Partnership Office

Collaborations with GPs

The Shared Care Partnership Office (SCPO) works closely with primary care partners to co-create and implement various enablers and programmes that provide transitional care and support for patients and residents in the community.

Chronic Illness Screening (CIS) and Screen for Life (SFL) are campaigns driven in collaboration with Yishun Health, Health Promotion Board and GP Partners with the aim to encourage cardiovascular screening and provide health interventions to Yishun Health residents for better preventive health.

In partnership with GPs in the community, CIS and SFL will encourage residents to do regular screening and follow-up care with their preferred GP clinic close to their home. Yishun Health also aims to support GPs and residents with health coaching and lifestyle intervention advice conducted by Yishun Health’s Regional Teams for holistic preventive care.

Yishun Health collaborates with community partners and GP Partners to organise Community Screening events for residents living in the North who are deemed to be “hard to reach”. Following such Community Screening, Yishun Health directs the screening participants who require clinical follow up to our said GP Partners.

If you would like to find out more and/or partner us for upcoming screening events/initiatives, please contact us at partners@ktph.com.sg.

GPFirst is a national programme that encourages residents with non-urgent conditions to first seek treatment at participating GPs rather than at the acute hospital’s Accident & Emergency Department (A&E).

Should the participating GP assesses that the patient requires onward referral to either an Urgent Care Clinic (UCC) or A&E for acute interventions, the patient will receive a $50 subsidy off the prevailing attendance fee upon arrival at the UCC/A&E.

Joining GPFirst

For Group GPs, please complete this Clinic Sign-up form (PDF, 580KB)

For GPs, please complete this Clinic Sign-up form (PDF, 574KB)

Under shared care programmes, Yishun Health Specialists and our GP Partners co-manage patients with stable conditions for holistic, convenient and accessible care. Through such collaboration and close working relationship with the specialists, the patient still receives the same level of care as before, and ultimately be right-sited to the GP Partner.

The Shared Care programmes include:

  • Diabetes Mellitus
  • Heart Failure

Information Leaflets

Download to read more about our Shared Care Programmes.

Case Studies

Our Shared Care Programmes were featured in Aha magazine – Read more on Page 10-15!

Cover page of aha magazine featuring Shared Care programmes

View PDF

Please contact us at partners@ktph.com.sg to find out more.

The Diabetes Remission Collaborative aims to reverse diabetes in overweight persons living with early diabetes (within 6 years of diagnosis) via a curated initial 12 weeks total diet replacement phase, based on the Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT) study.

Primary care partners are able to better support their patients via 2 models:

  • Admiralty Medical Centre (AdMC) led model: primary care partners can refer patients directly to AdMC for shared care management
  • Primary care partners led model: with support from Yishun Health/AdMC e.g., Dietitian, community nurses and connection to physical & social activities

Key support for your patients:

  • Curated DM remission programme
  • Support from community resources (e.g. nurses and connection to physical and social activities)
  • Subsidised Very Low Calorie Diet (VLCD) for diet replacement phase
  • GP-led model option for better care convenience and familiarity with their existing care provider

Information Leaflets

Download to read more about the Diabetes Remission Collaborative.

Please contact us at partners@ktph.com.sg to find out more.

Contact Us

For enquiries, please contact our Shared Care Partnership Team at partners@ktph.com.sg