A contracted family doctor treats a patient at her home in Shanghai's Hongkou district. [Photo provided to China Daily]

Aug. 9, 2024 -- A downtown Huangpu district resident surnamed Qin in Shanghai suffered a minor calf injury a few months ago. Her condition worsened days later with bruises and blisters. Instead of going to a large hospital, she chose to consult Tian Taoran, a doctor from Dapuqiao Community Health Service Center, who had recently become his registered family physician.

Tian formulated a comprehensive treatment plan, and after three weeks, Qin's condition improved significantly.

Tian, who joined the community practice last April, said: "I soon realized the substantial demand for minor surgeries in communities. These procedures are straightforward, effectively addressing patients' needs while fostering close doctor-patient rapport."

The Dapuqiao surgical outpatient clinic, staffed by a doctor and nurses, operates Monday through Friday, serving 30 to 40 patients daily on average. Since launching a "surgery day" on Wednesday afternoons, over 300 minor surgeries under local anesthesia are being performed monthly.

The case is an example of Shanghai's ever-expanding contracted family doctor program.

About 44 percent of permanent residents in Shanghai have joined the program since its pilot launch in the city in 2011 as part of Shanghai's effort to strengthen its community healthcare services, according to the Shanghai Municipal Health Commission.

As per the program, patients sign health contracts with physicians at grassroots health institutions for basic medical needs.

Patients first seek treatment from their assigned enrolled family doctors for non-emergency issues, before being referred to secondary or tertiary hospitals, if needed.

As of now, over 11 million residents have enrolled in the family doctor contracted service. Significantly, the contracted service rate has reached 84 percent among key groups such as the elderly and those with chronic diseases, said the commission. The age profile is also diversifying, with more working professionals and students signing up.

Shanghai now has 248 community health service centers, 102 branch centers, 842 service stations, and 1,118 village clinics, ensuring 87 percent of residents can access a community healthcare facility within a 15-minute walk, said Yang Chao, director of the commission's primary healthcare division, to news portal ThePaper.cn.

Community health centers have upgraded diagnostic capabilities, with 58.1 percent having installed CT scanners and 48.4 percent equipped with non-invasive ventilation. Regional centers for electrocardiograms, medical imaging and laboratory services have also been established districtwide.

The scope of the service continues to expand, with centers now offering treatment for 121 diseases on average using Western medicine, 13 more than last year.

Over 60 percent can provide outpatient minor surgeries, while all centers offer traditional Chinese medicine treatments and herbal medicines.

Community health centers currently stock an average of 669 drug varieties, an increase of 53 varieties from last year, according to Ni Yuanfeng, director of the medical policy division of the commission.

"This year, we will guide community health centers to optimize drug formularies at least every six months based on their positioning, capabilities and residents' needs to better meet daily demands. We are also promoting formulary integration between community and higher-level hospitals for common and chronic diseases to improve overall consistency," Ni told ThePaper.cn.

Since April, all 248 community health centers can schedule priority appointments at 36 municipal and 116 district hospitals for contracted residents via an online platform.

Fu Chen, deputy director of the Shanghai Municipal Health Commission, said that empowering family doctors and general practitioners can better leverage expert resources from higher-level hospitals and refer patients upward when needed, enhancing overall care.

Official statistics show that 21,000 experts from municipal and district medical institutions have been dispatched to provide specialty clinics in communities this year, which have received over 403,000 patients.

Within the year, 1,000 community doctors will undergo training or practice at higher-level hospitals, with emergency medicine as a required component to bolster acute care abilities.

Complementing this exchange are efforts integrating community doctors into Shanghai's 55 regional medical coalitions and promoting cross-institutional staff mobility between higher-level and community medical practitioners.