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SingHealth Delivering On Target (DOT) Right Siting Programme in SGH Campus

The SingHealth DOT Programme was launched on 20 August 2005 as a pilot programme to demonstrate a model for community-based chronic disease management in a local context. DOT aimed to create closer links between General Practitioners (GPs) and the tertiary care institutions, to enable the management of suitable patients from the hospitals at the community level.

The DOT Programme sought to actively facilitate and support the right-siting of clinically stable cases of diabetes to primary healthcare, so freeing up expensive specialist resources in the hospital Specialist Outpatient Clinics (SOCs) that were being utilised to manage clinically stable diabetics.

Drawing on the right-siting experiences of the DOT Programme, the Ministry of Health (MOH), in January 2007, launched one of its key health initiatives in the 21st Century: the MOH Chronic Disease Management Programme. This Programme was designed to strengthen and enhance the ambulatory care for the leading chronic diseases in the country, namely diabetes, hypertension, hyperlipidaemia, stroke asthma, COPD, major depression and schizophrenia.

In April 2008, SingHealth set up its Chronic Disease Management Office (CDMO), to oversee and drive full implementation of the CDMP in SingHealth institutions. The SingHealth DOT Right-Siting project included disease conditions beyond diabetes and CDMO continued to expand its partnerships with GPs island-wide, to manage clinically stable patients right-sited from SGH Campus SOCs and National Heart Centre Singapore.

CDMO Vision

Today, CDMO continues to drive integration, quality and cost effectiveness in patients’ care transition from tertiary institutions to the community by working closely with SOC specialists, GPs and allied health service providers. The programme is currently supported by a network of over 100 DOT GPs located island-wide.

Roll-out of DOT Programme in SGH Campus

As of 31 July 2014, the SingHealth DOT Right-Siting Programme encompasses the following disease conditions:
  1. Type 2 Diabetes Mellitus
  2. Ischemic Heart Disease
  3. Congestive Cardiac Failure
  4. Chronic Kidney Disease
  5. Asthma
  6. Orthopaedics
  7. Anti-coagulation
  8. Urology (Benign Prostatic Hyperplasia, Overactive Bladder, Elevated PSA, Lower Urinary Tract Infection)
  9. Rheumatology (Gout, ANA Positive)

Benefits for DOT Patients

Patients under the SingHealth DOT Right-Siting Programme enjoy benefits such as:
  1. Consultation charge at participating GP clinics capped at maximum $28
  2. Fast Track Referral to SOCs as Subsidised patients when their conditions deteriorate and require specialists’ care
  3. Medication at hospital subsidised rate and delivered to patients’ preferred address from SGH/NHCS pharmacy
  4. Subsidised Diagnostic laboratory and allied health test(s)
  5. Optional Shared Care model, ordered by SOC Clinicians, for patients who genuinely require yearly reviews at SOCs
  6. Follow-up support by SingHealth DOT Right-Siting officers (RSOs). RSOs are the point of contact between patients, GPs, allied health service providers and SOC specialists.
  7. Convenience of nearby GP

How does the DOT programme benefit GPs?

i) Promoting the important principle of “One Family Physician for every Singaporean”

As of today, more than 1000 patients have been successful right-sited to DOT GPs for their long term care. When patients choose to receive long-term chronic disease care from a DOT GP and realise the dedicated care by a named Family Physician with convenience of location and flexibility in making appointments, the family members will often choose to seek medical care from the same GP.

ii) The DOT Symposia

These CME-accredited symposia are held at regular intervals and involve speakers and trainers who are experts in community-based care for chronic diseases, discussing and sharing their specialised expert tips and experiences with the DOT GPs. DOT GPs receive up-to-date knowledge and information in key aspects of chronic disease management through these symposia.

If you are interested…

For GPs interested in finding out more about the SingHealth DOT Right-Siting Programme and/or signing up for this Programme, you may wish to email your personal particulars (Name, Mobile Number, Clinic Name and Address, MCR number and email address) to:

Ms Hilda Ng (Senior Manager, Clinical Networks)

Ms Emily Boon (Associate Executive, Clinical Networks)

Clinical Networks, SingHealth 
National Heart Centre Singapore
5 Hospital Drive Singapore 169609
Tel: 6702 5490
Fax: 6538 2830

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