Licensing Guide for Community Health Centre Aug 2013

Licensing Guide for Community Health Centre Aug 2013

Frequently Asked Questions on Community Health Centre (CHC) 1) What is a CHC? A CHC is a facility that provides auxiliary services* (such as diabetic eye/foot screening, dietary counselling, blood glucose monitoring, etc.) to support the General Practitioners to better manage their patients with chronic medical conditions. *Auxiliary services refer to services that support the medical care of patients and substantiated by conventional medical science. Traditional, complementary and other alternative health practices are NOT considered as auxiliary services. 2) What are the differences between a licensed medical clinic and a licensed CHC? The main differences are as follows:- S/N. Medical Clinic CHC 1 A Doctor is present in the clinic No doctor is present in a CHC. (A CHC is to provide medical licensed as a medical clinic but is consultation. exempted from the requirement of having a medical practitioner as the clinic manager.) Only auxiliary services are provided by nurses and/or allied health professionals. 2 Patient can walk-in and seek treatment. 3 Health screening services are allowed. 4 Clinic Manager must be a registered doctor / dentist. Patient cannot walk-in to seek treatment. Patient must be referred by a registered doctor (GP or specialist) of a licensed healthcare institution (HCI) to seek services in a CHC. Health screening services are allowed only if the patients are referred by a registered doctor for the tests (CHC should not initiate health screening exercises on their own). Centre manager can be any registered mainstream healthcare practitioner (i.e. nurse, allied health professional, pharmacist, doctor or dentist) and with at least 5 years experience in healthcare operations to oversee the CHC s day-today administration and management. An administrative person could also be considered for appointment as the centre manager provided the CHC licensee is satisfied that he/she is adequately trained and experienced to hold the centre manager post.

5 Medications may be prescribed by the doctor and dispensed/applied to patients. Medications which need to be prescribed (e.g. dilation eye-drops) by a registered doctor are not allowed to be dispensed or applied to patients in the CHC. Over-thecounter drugs may be administered if the need arises. 3) Who can set up a CHC? Established service providers with knowledge and experience of providing auxiliary services are permitted to set up a CHC. The CHC service provider must also establish and have legal documentation/records to demonstrate a formal partnership with a public hospital or polyclinic. 4) Does a CHC need to be licensed by MOH? If yes, what is the application process? Yes, a CHC will need to be licensed by MOH to operate its services. Details on the application process can be found at https://elis.moh.gov.sg/elis/. Alternatively, you can contact the licensing staff at Tel: 63252611 or 63251741 or email us at elis@moh.gov.sg for assistance. 5) What is the licence fee for a CHC? The licence fee for a CHC is as follows:- Licence Period Licence Fee Not exceeding 1 year $1,090 2 years $1,150 5 years $1,310 6) Will MOH officers be conducting inspections at a CHC? Yes, licensing inspection visits will be conducted at a CHC. 7) What are the operational requirements for a CHC? In addition to the requirements for a medical clinic that are also applicable to a CHC, e.g. waiting area, hand-washing facilities, safe keeping of medical records, etc., other requirements include the following:- i) A system to document and ensure that all patients visiting the CHC has a referring principal doctor in charge (be it a GP, polyclinic doctor or specialist). ii) All patients are referred by their principal doctor for the services in the CHC.

iii) iv) Equipment used in the various services (e.g. eye screening facilities) are to be properly and regularly serviced and maintained. The staff providing the CHC services must have relevant qualifications and training, e.g. nurse providing diabetic eye screening must be adequately trained in eye care. For more details, please refer to Annex A (Licensing Requirements for a CHC). 8) Are there any other legislation that a CHC needs to comply with? Yes, please refer to the following websites for the PHMC Act and Regulations at https://elis.moh.gov.sg/elis/info.do?task=legislation&file=act_phmc_act.pdf, https://elis.moh.gov.sg/elis/info.do?task=legislation&file=reg_phmc_regulations.pdf https://elis.moh.gov.sg/elis/info.do?task=legislation&file=reg_phmc_publicity_regulations. pdf.

Annex A LICENSING REQUIREMENTS FOR A CHC A) CENTRE MANAGER a) The Centre Manager can be any registered mainstream healthcare practitioner (i.e. nurse, allied health professional, pharmacist, doctor or dentist) and with at least 5 years experience in healthcare operations to oversee the CHC s day-to-day administration and management and must be employed by one of the public health clusters or private healthcare provider. An administrative person could also be considered for appointment as the centre manager provided the CHC licensee is satisfied that he/she is adequately trained and experienced to hold the centre manager post. b) The Centre Manager shall not be absent for any length of time, unless arrangement is made for the CHC to be placed under the supervision of a similarly qualified person to manage the CHC. B) PATIENTS UNDER TREATMENT a) The licensee of a CHC shall ensure that every patient in the centre is provided with adequate safety, privacy and comfort when the patient is undergoing consultation, examination or treatment. b) Screening facilities to ensure patient privacy shall be provided where appropriate. c) A suitable patient waiting area within the clinic premises shall be provided for the privacy and comfort of the patient. d) In the course of treatment, the centre shall not provide lodging or accommodation for a period exceeding 12 hours. C) FACILITIES a) A CHC shall have adequate and proper facilities for hand washing. b) The room where a procedure is performed shall be large enough to accommodate all personnel, fittings and equipment and to allow all procedures and movements to be carried out in comfort and safety.

D) PHYSICAL FACILITIES a) The internal finishes of the premises shall be of such materials which permits easy washing and cleaning. b) Every part of the premises shall be maintained at all times in a clean, tidy and sanitary condition and in a good state of repair. c) Adequate lighting and ventilation shall be provided for the premises. d) Aids e.g. ramp, grab-bar, hand-rail, to facilitate movement for patients shall be made available where appropriate. e) The premises shall be designed in such a way to ensure that the comfort, privacy and safety of patients are not compromised. E) RESUSCITATION FACILITIES a) The centre shall have at least one defibrillator or Automated External Defibrillator (AED) and other appropriate resuscitation equipment and drugs for emergencies and treating adverse reactions e.g. Injection Adrenaline, Injection Hydrocortisone, Injection Phenergan or their equivalent. At least one Basic Cardiac Life Support (BCLS) trained staff shall be available to administer the resuscitation process. b) The centre shall have the means to set up an intravenous infusion. This includes having intravenous drip sets, intravenous cannulas and intravenous infusion solutions. c) The centre shall have the means to maintain a clear airway. This includes having air-viva and airways of various sizes. d) All equipment shall be checked and serviced at regular intervals to ensure that they are in good working order. e) All drugs shall be checked to ensure that they have not exceeded the expiry dates. F) EQUIPMENT a) The centre s medical and surgical equipment, instruments, appliances and materials shall be functional and effective and they shall comply with established or recommended procedures for their maintenance and use. b) Surgical instruments used for invasive procedures at the centre shall be adequately sterilised after each use by means of steam autoclaving. Alternatively, sterile disposable sets can be used.

G) INFECTION CONTROL PRACTICES a) Hand washing and disposable hand towels shall be provided in all the consultation rooms, treatment and procedure rooms. b) Needles and other sharp items shall be placed into puncture-resistant containers before disposal. c) The centre shall ensure that all infectious and waste materials are properly disinfected and disposed of in accordance with laws such as those administered by the National Environment Agency (NEA) and the Ministry of Health (MOH) and any other existing laws. d) If the infectious wastes are not removed by licensed waste collectors, decontamination of the wastes shall be done by soaking them in disinfectants e.g. phenolics or 1:10 dilution of 5.25% sodium hypochlorite for 20-30 minutes before disposal. e) The centre shall have an isolation area/room to isolate infectious persons when appropriate. The isolation area/room does not need to be a room solely for isolation purpose, but it has to be an area/room which is easily converted for isolation use during an emergency. H) STAFF RECORDS a) The centre shall keep records of all persons employed with the following particulars: i) Name, sex, date of birth, NRIC/passport number & address ii) Qualifications and duties iii) Date(s) of employment I) MEDICAL RECORDS a) The licensee of the centre shall keep and maintain proper electronic or hard copy medical records in respect of each patient. b) The centre shall maintain a patient registration record, clinical notes of consultation, investigation and treatment given. c) The following particulars shall be included in the patient's registration records : i) Patient s name, identity card/birth certificate/passport number, sex, date of birth, ethnic group and residential address ii) Date and time of consultation.

d) All medical records shall be accurate, sufficiently detailed, legible, current, secure, complete and confidential. J) PERSONAL PROTECTIVE EQUIPMENT (PPE) a) The centre shall keep stock of at least 2 days supply of PPE e.g. disposable isolation gowns, N95 masks for emergency use. K) INFORMATION ON CHARGES a) The centre shall make available to the patient, prior to the consultation, information on charges, which are likely to be incurred for consultation, investigation and treatment. b) Information on fees shall be provided prominently (e.g. via display on boards or tent-cards) in the centre at the point of registration of the patient. c) Itemised bills shall be provided to all patients. L) DISPLAY & USE OF CLINIC NAME a) The centre shall not display or use any name when referring to the centre other than the name appearing in the licence. This includes the display of signboards, name cards and other centre stationery. b) The centre shall not display the Red Cross emblem, or any other emblem protected under the Geneva Convention Act in the signboard. c) The terms Community Health Centre shall be spelt out in full, form part of the name of a CHC and displayed clearly/prominently at the centre. M) PREMISES OF OTHER SERVICES (if applicable) a) The centre shall be physically separated from premises that are being used for the provision of other services such as cosmetology, traditional complementary medicines or alternative medicines. b) The centre shall have a separate entrance from those premises being used for the provision of services other than CHC services.