Home  /  GP Services  /  Long-term & Chronic Care

Chronic disease management

Steady, structured support for the conditions you live with.

Managing a long-term condition is a journey, not a one-off visit. Our family doctors provide regular reviews, careful medication management and practical lifestyle guidance — keeping you well and lowering your risk of complications.

Book a review Enrol in Healthier SG
One doctorWho knows your history
MediSaveFor chronic care (CDMP)
CHASChronic subsidies
AccessibleClinics across Singapore
A doctor reviewing chronic care results with a patient
A structured approach

How ongoing care keeps you well

Understand your condition

A thorough review and baseline tests to see the full picture and your personal risks.

A personalised care plan

Clear targets, the right medication and practical lifestyle guidance built around your life.

Regular reviews

Scheduled check-ins and monitoring so your treatment stays on track as things change.

Lower your risk

Early adjustments and coordinated referrals to help prevent longer-term complications.

What we manage

Ongoing conditions, expertly supported

We help you stay in control of the long-term conditions that need consistent care:

Diabetes

  • Type 2 diabetes
  • Pre-diabetes
  • HbA1c monitoring
  • Insulin & medication

Blood pressure

  • Hypertension
  • Home BP monitoring
  • Medication review
  • Cardiovascular risk

Cholesterol & heart

  • High cholesterol
  • Heart & stroke risk
  • Lipid monitoring
  • Prevention advice

Respiratory

  • Asthma
  • COPD
  • Inhaler technique
  • Allergic rhinitis

Other chronic conditions

  • Thyroid disorders
  • Gout
  • Chronic kidney disease
  • Osteoarthritis

Mind & lifestyle

  • Anxiety & depression
  • Weight management
  • Smoking cessation
  • Sleep & stress
What's included

Care that stays with you

Long-term conditions are best managed by a team that knows you — with everything coordinated in one place.

Regular scheduled reviews

Planned check-ins so nothing slips through the cracks.

A personalised care plan

Targets and treatment tailored to you, not a template.

Medication management

Prescriptions reviewed and dispensed on-site.

Tests & monitoring

HbA1c, blood pressure, lipids and more, tracked over time.

MediSave (CDMP)

Use MediSave for eligible chronic conditions under CDMP.

Healthier SG

A long-term health plan with your chosen family doctor.

Coordinated referrals

Smooth referrals to specialists when they are needed.

One familiar team

Continuity of care from doctors who know your history.

More affordable care

Support to help with the cost

Chronic care adds up over time — these schemes help keep it manageable.

Healthier SG

Enrol with a Bethesda family doctor for a personalised plan and subsidised chronic care and screening.

MediSave & CDMP

Use MediSave to help pay for outpatient treatment of chronic conditions under the Chronic Disease Management Programme.

CHAS & Pioneer / Merdeka

Subsidies on chronic consultations, medication and monitoring for eligible cardholders.

Good to know

Common questions

How often will I need to come in?
It depends on your condition and how stable it is — often every 3 to 6 months once things are well controlled, with more frequent visits when we are adjusting treatment.
Can I use MediSave for my chronic condition?
Yes. Many chronic conditions are covered under the Chronic Disease Management Programme (CDMP), which lets you use MediSave to help pay for outpatient treatment.
Will I see the same doctor each time?
We strongly encourage continuity — seeing a doctor who knows your history leads to better long-term care. Enrolling in Healthier SG pairs you with one family doctor.
Do you help with lifestyle changes too?
Absolutely. Alongside medication, we offer practical guidance on diet, exercise, weight, sleep and stopping smoking — the things that make the biggest difference over time.
What should I bring to my first review?
Your NRIC/FIN, any CHAS or Pioneer/Merdeka card, your current medications, and any recent test results or letters from other clinics or hospitals.

Take control of your long-term health

Book a review at any of our clinics, or enrol in Healthier SG, and let a Bethesda family doctor support you for the long run.

Book an appointment