Abstract: The system for initial consultation in community-based healthcare settings is a key part of the hierarchical medical system.In Dongguan，the system for initial consultation in community-based outpatient clinics has been implemented since 2008.So far，it has obtained the following achievements：the mean annual workload shows an increasing trend during 2009 to 2016；the problem of "It is difficult and expensive to see a doctor" for residents has been addressed to some extent；the prevention and management of chronic diseases have been improved；the equity in healthcare use and healthcare efficiency have been enhanced.However，challenges such as significant differences in the operation status of this system across different towns（streets） of Dongguan，complicated referral procedures，high rate of referrals，intractable recruitment of health professionals and poor health workforce stability were identified.In order to promote the sustainable development of the system，we put forward the following measures：establishing community health centers in a unified manner，standardizing the referral standard for community-based outpatient clinics，developing scientific payment systems and promotion mechanisms for health professionals and guiding the residents to change the thought of seeking healthcare mostly in secondary or tertiary hospitals.

Key words: The system of the first treatment in the community, Referrals, Community health centers

摘要： 社区首诊制是分级诊疗制度的核心问题，东莞市自2008年开始实施社区门诊首诊制，现已取得一定成效。本文旨在对其运行现状进行分析，结果显示，2009—2016年东莞市社区门诊结算人次逐年递增，有效缓解了居民“看病难、看病贵”问题，有利于对慢性病的预防保健管理，同时兼顾了卫生服务的公平和效率。但在运行过程中，仍存在各镇（街）发展差异大、转诊手续繁琐、转诊率高、人才招聘和稳定性不足等问题。建议统一社区卫生服务中心的建立标准、规范社区门诊转诊标准、建立科学的薪酬体系和晋升机制，同时引导居民转变就医观念，以推动社区门诊首诊制的持续发展。

关键词: 社区首诊制, 转诊, 社区卫生中心