Allow GPs to manage insomnia at community level

Posed photo of a person with a stethoscope.
Posed photo of a person with a stethoscope.PHOTO: ST FILE

Under current Ministry of Health (MOH) guidelines, only psychiatrists are allowed to prescribe sleeping pills for long-term use to patients with insomnia.

In the latest case of a general practitioner (GP) being charged with prescribing "excessive" dosages of benzodiazepines, a class of drugs that includes tranquillisers, sedatives and sleeping pills, it is notable that the GP was not found to have malicious intent, but merely wanted to help patients with chronic insomnia (Doc fined, suspended for overprescribing addictive medication, Aug 3).

This is not the first time a GP has been penalised for such acts. In daily clinical practice, insomnia is a common problem. But many patients do not agree to be referred to a psychiatrist. Some patients cite cost and inconvenience as a reason, while others do not want to have the stigma of having seen a psychiatrist.

According to the Singapore Medical Council's Annual Report, there were 240 registered psychiatrists in Singapore in 2017. And according to a study of 2,565 elderly Singaporeans published in 2016, about 13 per cent reported at least one sleep problem.

The relatively small number of psychiatrists will not be able to cope with the large number of patients with sleep problems.

I believe that it is time for MOH to rethink its rules. It is better to empower GPs to manage insomnia effectively at the community level.

MOH can appoint the Institute of Mental Health to organise a course on effective management of insomnia at the community level.

GPs can be required to pass a qualifying examination at the end of the course to be accredited to manage patients with insomnia.

There could be auditing and monitoring of the prescribing history of accredited GPs to prevent abuse.

Insomnia is a common community problem, and would be managed more cost-effectively at the community level.

Desmond Wai (Dr)

A version of this article appeared in the print edition of The Straits Times on August 12, 2019, with the headline 'Allow GPs to manage insomnia at community level'. Print Edition | Subscribe