INTRODUCTION

Over the years, I have witnessed the development of primary healthcare and community pharmacy in Hong Kong. The Government’s policy in developing primary healthcare could be traced back in 1990 with the release of document “Health for All, the Way Ahead: Report of the Working Party on Primary Health care”.⁽¹⁾ Since then, the Government has released several consultant reports, including “Your Health, Your Life Consultation Document on Healthcare Reform” in 2008 and “Our Partner for Better Health – Primary Care Development in Hong Kong: Strategy Document” in 2010. ^{(2, 3)} However, the involvement of pharmacists was limited in these discussions, as there were no representatives from the pharmacy profession.

 

BREAKING NEW GROUND FOR PHARMACY SERVICE IN PRIMARY CARE

The turning point was the Hong Kong Pharmacy Conference in 2014, themed “Breaking New Ground for Pharmacy Service in Primary Care”. A press conference was held during the event to feature and introduce the role of primary care pharmacists and various services models (e.g. Pharmacist supervised monitored dosage system, Visiting pharmacist service, Medication Management for the Elderly, etc) to the public. The media response was positive with more than 10 newspapers and media coverage reported the press conference. The success was the joint effort from the three professional societies (The Pharmaceutical Society of Hong Kong (PSHK), The Society of Hospital Pharmacists of Hong Kong (SHPHK) and The Practicing Pharmacist Association of Hong Kong (PPA)), the two universities (The University of Hong Kong (HKU) and the Chinese University of Hong Kong (CUHK)) and the two chain store pharmacies (Mannings and Watsons). Following the press conference, subsequent meeting was held with the Head of Primary Care Office, as our continual efforts to advance the development of primary care pharmacy.

Photo 1. Press Conference at the Hong Kong Pharmacy Conference in 2014

From 2015 to 2017, it is my honor to serve as the President of the PSHK. One of the objectives of PSHK is to promote the pharmacy profession in Hong Kong. We engaged and lobbied with various stakeholders including Food and Health Bureau, Drug Office, member of Legislative Council, patient group, etc. In addition, we participated in every year’s Government budget consultation and policy address consultation, sharing our views and recommendations with the Chief Secretary for Administration, the Financial Secretary and the Secretary for Food and Health. We continued to liaise with the Government, on one hand to support the development of primary healthcare, and on the other hand to emphasize the importance of involving pharmacist profession in the development.

 

THE STEERING COMMITTEE ON PRIMARY HEALTHCARE DEVELOPMENT

The Chief Executive's 2017 Policy Address highlighted the focus on primary healthcare development, including establishment of a steering committee on primary healthcare development to comprehensively review the existing planning of primary healthcare services, and provide healthcare services via district-based medical-social collaboration in the community, and plan to set up a district health centre in Kwai Tsing District under a brand new operation mode.⁽⁴⁾ The Steering Committee on Primary Healthcare Development was subsequently established on 1 December 2017.The membership list of the Steering Committee on Primary Healthcare Development is as follows:
 
Chairperson
Professor Sophia Chan Siu-chee (Secretary for Food and Health)
 
Non-official members
Mr Philip Chiu Kwok-leung (President, Pharmaceutical Society of Hong Kong)
Mr Chua Hoi-wai (Chief Executive, Hong Kong Council of Social Service)
Dr Lam Ching-choi (Chairman, Elderly Commission)
Professor Cindy Lam Lo-kuen (Head, Department of Family Medicine and Primary Care, University of Hong Kong)
Professor Gabriel Matthew Leung (Dean, Li Ka Shing Faculty of Medicine, University of Hong Kong)
Dr Donald Li Kwok-tung (President-elect, World Organization of Family Doctors)
Mr Shum Ho-kit (Chairman, Yuen Long District Council)
Professor Hector Tsang Wing-hong (Professor and Head, Department of Rehabilitation Sciences, Hong Kong Polytechnic University)
Professor Frances Wong Kam-yuet (President, Hong Kong Academy of Nursing Limited)
Professor Samuel Wong Yeung-shan (Head, Division of Family Medicine and Primary Healthcare, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong)
Dr Zhu En (Chairman, Hong Kong Registered Chinese Medicine Practitioners Association)

Ex-officio members
Permanent Secretary for Food and Health (Health)
Permanent Secretary for Labour and Welfare (or representative)
Director of Health (or representative)
Director of Home Affairs (or representative)
Head, Primary Care Office, Department of Health (or representative)
Chief Executive, Hospital Authority (or representative)
Chief Manager (Nursing), Hospital Authority (or representative)
 

The membership of the steering committee consisted of medical doctors, nurse, allied health professions and for the first time, pharmacist was also included in this Government-initiated steering committee for future primary healthcare development. The first meeting of the steering committee was held on 9 Dec 2017.

 

Photo 2. Members of the Steering Committee on Primary Healthcare Development

The steering committee had four subgroups: Community Engagement, Manpower and Infrastructure Planning, Collaboration Model, Planning and Evaluation Framework. One of the committee’s key focuses was establishing a District Health Centre (DHC) in Kwai Tsing District, under a new operational model. As a pharmacist representative, I shared my insight on the role of pharmacists in primary healthcare and services that we can support the patients in the community.  Pharmacists became core team member in DHCs and it is a tender requirement to recruit pharmacist for every DHC. The first DHC in Kwai Tsing District was opened on 24 Sep 2019. Subsequently, other DHCs and DHC Express were established in all 18 districts.

 

Photo 3. The Opening of the first DHC in Kwai Tsing District on 24 Sep 2019

Another major role of the steering committee was to conduct comprehensive analysis of the structural situation of our primary healthcare system and to provide constructive recommendations to the Government for developing a blueprint for the sustainable development of local primary healthcare services. From 2020 to 2023, the COVID-19 pandemic impacted all of us and also our healthcare system. This further demonstrated the importance of setting up a robust primary healthcare system in Hong Kong. During the pandemic, community pharmacists played a crucial role in the primary healthcare system by providing delivery of medications and drug counseling to Hospital Authority patients. Community pharmacies also supported the public during pandemic by supplying and educating on hygiene products, COVID-19 test kits, OTC medications, etc. All these contributions were shared in the steering committee meetings. I believe the pharmacy profession can strengthen our role in the primary healthcare system and this should be reflected in the blueprint.

 

GOVERNMENT RELEASES PRIMARY HEALTHCARE BLUEPRINT

The release of the Primary Healthcare Blueprint in 2022 by the Government marks a significant milestone for the pharmacist profession in Hong Kong. It outlined five major directions of primary healthcare reform: Developing a community-based primary healthcare system, Strengthening primary healthcare governance, Consolidating primary healthcare resources, Reinforcing primary healthcare manpower and Improving data connectivity and health surveillance.⁽⁵⁾ The Blueprint specifically highlighted the Government support for community pharmacy development in Hong Kong, detailing the role of pharmacists in primary healthcare, such as providing medication advice and counseling for polypharmacy patients, drug refill and counseling support, smoking cessation, health promotion and disease prevention services, etc.⁽⁶⁾  The Government will prioritize developing sub-directories for pharmacists in primary care register. A certificate course in primary healthcare for pharmacists was later developed by the University of Hong Kong in 2023, to enhance pharmacist knowledge and skills to support the development of future primary healthcare services.

 

 

Photo 4. Primary Healthcare Blueprint

As recommended in the Blueprint, the Primary Healthcare Office under the Health Bureau was transformed into the Primary Healthcare Commission (PHC Commission) in July 2024. The PHC Commission oversees the strategic planning and provision, standard setting and quality assurance of primary healthcare services, training of primary healthcare professionals, as well as service planning and resource allocation through strategic purchasing supported by the Strategic Purchasing Office of the Health Bureau. Upon completing my six-year term and stepping down after my last steering committee meeting on 18 Apr 2024, I am pleased with the appointment of Professor Ian Wong as the member of the Primary Healthcare committee, to represent the pharmacy profession and assist the Commission in performing its functions.

CONCLUSION

The Primary Healthcare Blueprint serves as a strategic roadmap for the future development of primary healthcare in Hong Kong. The PHC Commission is actively implementing the Blueprint’s recommendations. With the leadership from Professor Wong and the support from the pharmacy profession, I am confident in the future development of community pharmacy in Hong Kong primary healthcare system.

Reference:

1. Health Bureau [Internet], HKSAR Government [cited 2024 Nov 21]. Available from: https://www.healthbureau.gov.hk/download/press_and_publications/otherinfo/231000_primary_health_care/Health_for_all_the_way_ahead_1990.pdf

2. Health Bureau [Internet], HKSAR Government [cited 2024 Nov 21]. Available from: https://www.healthbureau.gov.hk/beStrong/files/consultation/exsummary_eng.pdf

3. Health Bureau [Internet], HKSAR Government [cited 2024 Nov 21]. Available from: https://www.healthbureau.gov.hk/download/press_and_publications/otherinfo/101231_primary_care/e_strategy_doc.pdf

4. The Chief Executive’s 2017 Policy Address [Internet], HKSAR Government [cited 2024 Nov 25]. Available from: https://www.policyaddress.gov.hk/2017/eng/highlights.html

5. Press Releases [Internet], HKSAR Government [cited 2024 Nov 25]. Available from:  https://www.info.gov.hk/gia/general/202212/19/P2022121900561.htm

6. Health Bureau [Internet], HKSAR Government [cited 2024 Nov 25]. https://www.primaryhealthcare.gov.hk/en/index.html