NationWide Primary Healthcare Services Pvt. Ltd. (NationWide) is an initiative of a team of Indian doctors, who have returned to India after having worked with the National Health Service (NHS) in the UK, for over 10 years. Co-founded in 2010 by Dr. Santanu Chattopadhyay, MD (PGI), MRCP (UK), MBA (INSEAD), a trained gastroenterologist and Dr. Shantanu Rahman, MRCGP (UK), CCTGP (UK), a qualified General Practitioner, the company is the result of social entrepreneurship aimed at creating a profound social impact.
The experience of working in the NHS was an eye-opener for both doctors, who quickly realized the importance of the primary care general practice in the British healthcare system and how it was driving better patient care, cost effectiveness, patient-doctor trust, and ensuring continuity of care. General practitioners (GPs) were the first point-of-contact for every individual and their family. Apart from proactively managing their patient’s health, GPs also formed the vital bridge between every day care and specialist intervention, leading to better compliance and health outcomes. A similar system was clearly lacking back home in India.
Several questions about the Indian healthcare scenario bothered the founding team when they returned to India in 2006. Why wasn’t there a significant change in the healthcare industry similar to the IT revolution in the 1990’s? Why were patients unhappy? Why was every doctor rushing to become a specialist? Why didn’t patients trust their doctors anymore? How do you bring about a much-needed revolution in the healthcare system that was mired in widespread patient discontent, unethical practices, growing costs of hospitalization, and lack of accountability? In terms of healthcare technology and expertise, India is on par with most of the developed countries in the world, yet we have some of the lowest healthcare indicators globally. Public spending on healthcare in India is less than 1% of our GDP.
Interestingly, as the team researched the above questions, they found that some of the European countries have much better healthcare indicators compared to the US, despite the fact that the US spends a much larger fraction of their GDP on healthcare. The difference is in the area of focus. While these countries have a very good primary care system and concentrate on family medicine, the US healthcare system is heavily skewed towards tertiary care. The implication is that if you had cancer, or any another major critical illness, you have a better chance of survival if you are living in US compared to these countries. But what about not having cancer at all or getting the cancer detected at early stage so that it can be completely cured. These European countries have consistently focused on primary healthcare including effective screening systems which enable them to achieve the latter!
So they realised that if they have to improve the healthcare parameters in India, it is important to concentrate more on primary healthcare facilities and preventive health strategies. Currently, all the focus in the Indian healthcare environment by private institutions, government agencies or NGOs is in secondary and tertiary care, viz, super specialty hospitals, critical care, and high-end investigations. There is a huge unmet need for easily accessible, everyday medical treatment and counselling aimed at preventing illness, detecting critical illness in early stages and effectively managing chronic conditions. At the same time, it is important to bring the trust factor back into the doctor-patient relationship, which sadly has seen a spiral downwards due to the rampant commercialization of healthcare. NationWide was started primarily to address the above unmet needs.
Health Biz India spoke to Dr. Santanu Chattopadhyay, Founder & Managing Director, NationWide, to dig a bit deeper into his concept. Excerpts…
Why the stress on bringing back the family doctor?
In all the developed countries of the world, the General Practitioner (GP) or Primary Care Physician (PCP) plays a major part in their healthcare delivery model. In India too, just 2 decades back, the ubiquitous family doctor was the person who used to play this role. Over time, we have systematically devalued the importance of Family Medicine in India, so much so that most of us run to the nearest super-specialty hospital, the minute we have a bad cough or an aching back. While 80 per cent of our ailments can be managed by a GP or family physician, we spend several hundred to thousand rupees consulting doctors and getting investigations done in tertiary care set-ups. The role of a family physician has been forgotten.
The family physician is ideally placed to practice preventive as well as curative medicine. He/she knows the medical history of every person in the family, from the aged grandfather to the youngest grandson. The family doctor knows what will motivate your mother to take her medication regularly, as well as why a particular treatment may not be acceptable to the daughter-in-law. Most importantly, a single point of medical counsel ensures continuity of care across time as the family doctor coordinates diverse treatments prescribed by several specialists if you have multiple diseases or chronic conditions.
Top 5 advantages NationWide has over other players in the industry.
- NationWide focuses on primary care – (GP/Family physician & Paediatric services) – alone. We do one thing only and we do it best.
- Our leadership team consists of highly qualified doctors with GP/family physician qualifications from reputed national and international medical organizations such as PGI-Chandigarh, Royal College of General Practitioners, UK and American Board of Family Physicians. They understand the primary care market well and are very hands-on with the day to day management of a pioneering healthcare delivery concept such as this.
- Our Doctor-on-Call Service provides patients with access to the doctor 24/7, backed by a robust electronic medical records platform, with software for reminders and ensuring compliance. There is also the added convenience of home visits for our patients
- Dedicated internal training system for family physician/GP training with emphasis on superior patient communication and patient-outcomes.
- A rewarding career growth for the doctors employed with us that is far ahead of anything offered by other players in this specific segment of the healthcare industry.
What is the business model of NationWide?
NationWide is a chain of Primary Care clinics providing primary health care and allied health services to individuals, families, private groups and corporate in the community. We offer personalized family physician and paediatric services, where the main focus is on proactive management of every day ailments and chronic disease conditions that can be managed and treated as an out-patient. When required, our family doctors also liaise with specialist doctors if any of our patients need to be seen by them for appropriate intervention.
All our services are offered through our clinics, which can be classified into 2 types:
- Full-service clinics – These clinics offers the complete range of services listed above and are open 6 days a week. They operate from our own leased premises, are manned by 2-3 doctors and have lab and pharmacy services provided under the same roof – a ‘one-stop solution’ for our patients’ healthcare needs.
- Satellite clinics – These are fixed-hour clinics operating in gated communities or within corporate premises, where a NationWide doctor provides on-site consultation and treatment. These clinics are open for predefined hours on specific days in a week.
Patients can avail our services in one of the following 3 ways:
- Non-Subscribed Members – Individuals and/or their family members can schedule stand-alone consultations with our general practitioners, or walk into any of our clinics if they need to be seen the same day. Walk-in patients are generally seen on priority if there is an emergency requirement for general consultation. Since we run a GP practice, any urgent condition requiring hospitalization is immediately channelized to the nearest appropriate tertiary care institution. Non-subscribed members get the same high quality of care as our subscribed members, but they do not have an electronic medical record and hence proactive management of health at a personalized level is not available for them.
- Subscribed Health Plan Members – The first step for enrolling as members with NationWide is to get a health-check done with us. In this process, one of our doctors takes a detailed medical history and creates an electronic medical file for the person, which is available online for both the patient as well as his/her doctor to access anytime. From that point, this doctor becomes the patient’s “Personal Physician” and health manager. The electronic medical record (EMR) ensures that the patient can seek medical advice 24/7 with NationWide without having to worry about whether he is treated by his regular “Personal Physician” or another on-call doctor in case the Personal Physician is not available due to sickness, vacation or in off-duty hours.
- Corporate or Private Groups – These patients (employees of the corporates or residents of the gated communities that have subscribed to our corporate plan) can avail consultation and treatment from our on-site doctors at NationWide satellite clinics
What strategies has NationWide adopted to increase its presence in India?
Our growth strategy is aimed at enhancing customer experience and building their trust across our clinics in Bangalore. We will avoid any random approach of opening isolated centres across India and instead focus on first consolidating our positioning in Bangalore. Over the next 2 years, we plan to open around 120 clinics (20 full-service and 100 satellites) across Bangalore. Apart from the usual marketing and PR activities consistent with any growing organization such as ours, we are very active on social media in an effort to create more awareness about the importance of having a family doctor and reducing healthcare expenditure through timely and appropriate primary care. Thereafter we plan for a pan-India expansion.
At a later period, we will also be looking to percolate the same services to the rural sector via public-private-partnership (PPP) initiatives. We feel that we will be the most qualified to do so due to our proven experience in the family doctor model.
If it is a non-profit model, how do you plan to sustain the business in future?
NationWide is a for-profit organization with a social agenda. We are not an NGO and strongly believe that for any social entrepreneurship, success is only possible if it is an economically sustainable model. Towards this end, NationWide has a very experienced team of doctors, backed by a professional management team and investors from the Silicon Valley. We have a very solid financial model with multiple streams of revenue flowing in from our walk-in consultations, member subscriptions, vaccination and diagnostics, as well as corporate services. All our clinics are well on track to break even at the individual-level within 12 to 15 months from starting clinic operations, which is very good by industry segment standards.
It's been almost a year since NationWide started. What are the positive signs you have received from the market?
We have actually been overwhelmed by the interest shown in our concept by the public despite the limited area of operations we have currently. Even without having done any overt advertising in the past 1 year, more and more people are getting to know about our concept and quality of service by word-of-mouth. Our customer satisfaction ratings are constantly above 4.5 on a scale of 1 to 5 (1= very poor, 5= Excellent), with most members commending us on our doctors’ communication skills, empathetic understanding of their concerns and systematic approach to treatment. While patients are very happy with our quality of consultations and comfort levels established with our family physicians, specialist doctors are also very positive about us because of our holistic approach and the ethically-driven evidence-based care we provide.
In October 2011, just 18 months after inception, NationWide had the unique distinction of being honoured with the “Most Innovative Primary Healthcare Services in Bangalore” award at the Brands Academy Karnataka Service Excellence Awards 2011, by the prestigious BIG Brand Research Group.
How has the business grown?
The company was incorporated in March 2010 and since we have a brick-and-mortar business model, much of the time till August 2010 was spent in getting the infrastructure in place, recruitment, and planning the service channels.
In the 18 months that we have been operational, since September 2010, NationWide has grown from a single clinic to 10 clinics (3 full-service and 7 satellite clinics) across Bangalore. We have several hundred subscribed members, several thousand patient episodes, 7 corporate clients and have grown from 4 to 37 employees. The company has completed 2 rounds of fund-raising so far.
What are the future plans of NationWide?
NationWide plans to scale up services and staff considerably over the next 2 years. We plan to consolidate our position and build a large subscriber base in Bangalore over the next 2 years, by opening another 20 full-service clinics and around 100 satellite clinics in strategic locations across the city. Having gone through 2 successful rounds of angel funding so far, we are currently looking for venture capital (VC) funding to fuel our rapid expansion plans.
While we are very aggressive in our plans, at the same time we realize that it is important to gain the confidence and trust of our subscribers as well as walk-in customers. Hence we will focus more on customer satisfaction, user-experience and convenience.