General practitioners or primary care physicians have done work more assigned to secondary care since long time ago. It was not a new concept when the UK Government initiated the appointment of general practitioners with special interests (GPwSI) in year 2002. This has helped to relieve access to specialties that traditionally have long waiting times for investigations and treatment.¹ It is being taken as the answer to the growing demand for specialist services which has shown satisfactory result in the breast physician², in public health³ and managing chronic respiratory disease.⁴ Similar happenings at the primary-secondary care interface are taking place in Europe and Australia. How about the situation in Hong Kong?

The health care system of Hong Kong is neither a National Health Service like in the U.K. nor a central billing system as in Australia. It is unique in having a public sector (Hospital Authority, Department of Health, the Universities) and a private sector. In the public sector, there are hospital specialty specialists and specialist family physicians. The primary care practitioners in private sector include family medicine specialists, general practitioners, specialty specialists, practitioners of TCM, chiropractor, etc. Let us concentrate on our specialty - the family physicians with special interest (FPwSI).

FPwSI is the growing trend in the private sector with a range of positive benefits. It is definitely an added value in fee-for-services market and might be considered as cost effective to a certain extent. Primary care doctors providing services, traditionally only obtained through secondary care, definitely help to decrease the workload, hence the financial expenses, in the public sector. But in U.K., according to the NHS report, the general practitioner with special interest service for dermatology is more costly than hospital outpatient care.⁵ Their cost effectiveness has been questioned but patients' views on the services were generally positive.⁶ Integration of primary care with certain amount of secondary care by the family physician or general practitioner with special interest could satisfy the needs of patients such as shortening the hospital specialty waiting time, alleviating patients' worries and may address previously unmet needs. Hence, the additional cost can be weighed against the health outcomes.⁷

Will the development of certain specialty roles compromise valued generalist skills? Family medicine is already one specialty dealing with a wide range of patients, from infancy to elderly of both sex, a wide range of problems from acute to chronic diseases, from early undifferentiated to co-morbidities or terminal palliative care. To be a competent caring family physician, we have to broaden our view, knowledge and skills to deal with all problems in the primary care. Developing a special interest could deskill our doctors and increase the workload by treating previously untreated conditions. On the other hand, improving and widening our competence and skill could be a way of professional development.

In 2005, the Board of Education of our College formed a Professional Development Subcommittee. Since then, various Interest Groups are added yearly. Now we have five "Interest Groups", namely Geriatric, Mental Health, Medico-legal Alert, Dermatology and Musculoskeletal. Questions have been raised about their usefulness. Some query whether it will develop into subspecialties for Family Physician with Special Interest.

Our Interest Groups are hoping to provide a platform for all our members in the public and private sectors to meet together and to share experience. Our aims are actually very simple:

1. To maintain our interest in the care of our patients holistically, to upgrade our standard, to raise our morale and increase job satisfaction.
2. To provide peer support, to share some problem cases with specialists or expertise for skill-mix and to bridge the professional gap.
3. Our goal is to promote early awareness, clinical governance and risk management in respect to different medical fields, to assure a better management and a high-quality health care for the public.

Our Interest Groups are not equivalent to subspecialties of family medicine and will not develop into subspecialties in the near future.

At the 2007 Annual Scientific Meeting of Hong Kong College of Family Physicians, Dr Natalie Yuen, our College Censor stated: "many higher trainees are looking for further training in their areas of special interest, like many general practitioners and family doctors in other countries who are developing special skills in areas such as psychological medicine, counselling skills, child-health in primary care, academic general/family practice, musculo-skeletal medicine, and research. This is a trend many family doctors are pursuing, and as a College we must take note of such trends in developing future family practice."⁸ He spoke the hearts of many - Family Physician with Special Interest is the way forward.

Mary B L Kwong, MBBS(HK), FRCP(Edin),FHKAM(Fam Med), FHKAM(Paed)
Family Physician in Private Practice

Correspondence to :
Dr Mary B L Kwong,
18/F, Crason Commercial Centre, 333 Nathan Road, Kowloon.