Cautionary tales from the UK for the health reform in Singapore.

The 2022 White Paper on Healthier Singapore1Singapore Ministry of HealthWhite paper on healthier Singapore.https://file.go.gov.sg/healthiersg-whitepaper-pdf.pdfDate: 2022Date accessed: October 30, 2022Google Scholar provides an ambitious reorientation of the health system towards population health to overcome its fragmentation and respond to its rapidly ageing population.2Tan CC Lam CSP Matchar DB Zee YK Wong JEL Singapore's health-care system: key features, challenges, and shifts.Lancet. 2021; 398: 1091-1104Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar The plan is well aligned with the renewed vision of WHO3WHOUNICEFA vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals.https://apps.who.int/iris/handle/10665/328065Date: 2018Date accessed: January 12, 2023Google Scholar regarding primary health care in that it aims for the development of long-standing productive relationships between the population and primary care professionals through individualised health plans that are supported by community partners and enabled by information technology, workforce, and financial arrangements, including a capitation-based model.1Singapore Ministry of HealthWhite paper on healthier Singapore.https://file.go.gov.sg/healthiersg-whitepaper-pdf.pdfDate: 2022Date accessed: October 30, 2022Google Scholar The UK, one of the countries with the strongest primary care, has previously led the way in health policy development for quality improvement, including fundholding, revalidation, and pay for performance. The 2022 report by the Health and Social Care Committee4Health and Social Care CommitteeThe future of general practice.https://committees.parliament.uk/publications/30383/documents/176291/default/Date: 2022Date accessed: October 30, 2022Google Scholar on general practice therefore provides a timely perspective and relevant lessons for reforms in Singapore. After identifying insufficient numbers of general practitioners (GPs) as the main cause of current problems in the UK, a crucial aspect for the success of a healthier Singapore, the Health and Social Care Committee report makes relevant recommendations on access, number of patients per practice, continuity of care, funding formula, and professional status of GPs. Crucially, the report also recommends the abolishment of the Quality and Outcomes Framework (QOF). The criticism of this flagship initiative is not focused on its financial nature, but rather on it being a tool for micromanagement. Shaped by a condition-specific approach, the QOF has created perverse incentives that subordinate the core functions of primary care to the management of specific chronic conditions and public health interventions. Reminiscent of the selective approach that has previously impeded progress of primary health care in other settings,5WHOThe world health report 2008: primary health care now more than ever.https://apps.who.int/iris/handle/10665/43949Date: 2008Date accessed: January 12, 2023Google Scholar the QOF also conflicts with the whole-person orientation, which, together with the life-course approach, constitutes the core principles of general practice. The QOF is also inconsistent with multimorbidity being increasingly the norm among people with chronic conditions. Transferring policy lessons across contexts should be done with care, considering the nature of the policy, sociocultural differences and similarities, and careful adaptation for interactions between the policy change and the organisational and policy context. Nonetheless, in both the UK and Singapore there is a need to address the tension between protecting the core functions of primary care and ensuring accountability and high standards if primary care is to provide people-centred, integrated care. We declare no competing interests.