Do you remember the doctor-patient scene from the yesteryear classic films where the family doctor walks in with his briefcase to attend to his ailing patient at his residence? Well, this has disappeared from the Indian healthcare scenario over the past decade or so. If not this exact scenario, NationWide Primary Healthcare Services Pvt. Ltd. (NationWide), founded in 2010, aims to revive the concept of a family physician in India. For Dr. Santanu Chattopadhyay, founder and chief executive officer of Bengaluru-based NationWide, the idea of starting a primary healthcare service came when he was practicing abroad. Comparing the healthcare system between India and the U.K., he says that although India has good hospitals there is a huge difference between the Indian healthcare system and the U.K. system. “This is because of the lack of focus on primary healthcare in India,” he explains. Everyone in the U.K. has a family physician, who maintains their records and in case of an illness refers them to a hospital and coordinates treatment. “A family physician helps detect critical illnesses at an early stage and also eliminates complicated or unnecessary diagnosis. In turn, this reduces the overall healthcare cost by 40 per cent to 50 per cent,” adds Chattopadhyay.

NationWide’s primary care clinics focus on bridging the gap between fragmented general practitioner (GP) services and the super-specialist hospital care by creating a single point of medical care for its patients’ daily healthcare needs. It has grown from a four member founding team to 40 people and now has nine consultation facilities, which include three full service clinics and six satellite clinics. The satellite clinics, with limited services, are operated either out of an apartment complex or from a corporate setup.

The modus operandi
The physician, who meets the patient for the first time, makes an electronic medical record (EMR) of the patient. And for subsequent follow ups, even if a particular doctor is not available another doctor will attend to the patient using this EMR, which stores medical history. NationWide also runs a hotline, which gives the patient a 24×7 access to the doctor. Apart from personalised GP services, there are certain specialists like pediatricians and diabeticians who operate from NationWide’s clinics as most of their requirements are aligned to primary healthcare.

Its consultation charges are either based on health plan subscription or on a walk-in-basis. In the subscription plan, there are certain entitlements like number of home visits and phone calls for treatment. “We have now treated more than 4,000 patient episodes and have more than 500 subscribers to the various health plans,” says Chattopadhyay. NationWide has also tied up with six organisations like Capgemini and Idea Cellular to cater to the healthcare needs of its employees.

NationWide’s clinics are equipped to do most of the common tests and this is its second stream of revenue. “In the future, all our clinics will also have a pharmacy,” adds Chattopadhyay. The company earns its revenues from nursing services too. Chattopadhyay says, “Supposing you had an operation and need dressing for seven days, it is inconvenient to go to hospital every day. So, a NationWide nurse will pay a home visit and take care of this.” It also provides necessary vaccinations.

Demand-supply imbalance
While NationWide’s patients have appreciated its concept, the real challenge it has faced so far is getting good doctors. “There are not enough doctors who want to be a GP. If this needs to work out, we need young doctors to come in,” says Chattopadhyay. And its recruitment strategy is to target doctors who work in hospitals as duty doctors, tie up with institutes that offer a diploma in family medicine, recruit doctors who come out of the army or air force after serving a few years and do not have other opportunities in the clinical world, and to follow job portals. “Besides this, there are many Indian doctors abroad who are GPs and want to come back to India. We are trying to address this market,” shares Chattopadhyay. So far, NationWide clinics have nine full time doctors and six to seven consultants.

NationWide also offers its doctors an opportunity to become a partner in the company over a period of time. “This is as good as setting up their own clinic but at no cost,” he adds. In most hospitals, the GPs work on a revenue sharing basis and it might be difficult for them to sustain this during their early days. “We give them fixed salary plus quality-driven performance incentives,” says Chattopadhyay. In NationWide’s system, each patient is asked to rate the doctor on certain parameters which gets converted into a performance incentive bonus. So, the variable part of the salary depends on this feedback.

“It is not good enough to qualify once and encash on that knowledge for the next 30 years. In our setup, there is tutor modelling, where doctors get high quality medical education,” says Chattopadhyay. When the GPs practice alone they do not have a platform to continuously avail this training.

Tough spots
Another challenge for NationWide is getting good quality investors. “This is a business model which needs to be proven and most investors want to invest only in growth companies,” says Chattopadhyay. The company has raised around US $1.2 million dollars so far from US-based HNIs (high networth individuals), who want to fund great ideas. “We hope to raise another US $ 3 million to US $ 5 million,” he adds.

Rents for real estate is the company’s biggest cost. “The ideal rent to revenue ratio should be around 5 per cent to 10 per cent but in India it is around 35 per cent to 40 per cent. If manpower and infrastructure cost is added, the margins remain small at 5 per cent to 10 per cent,” says Chattopadhyay. To maintain a margin of 25 per cent to 30 per cent, the rent to revenue ratio should not be more than 10 per cent.

Building the future
The company is using social media to actively promote its services and also conduct health camps. It plans to set up around 20 to 25 full service clinics with each having five satellite clinics in the next two years in Bengaluru. In the next five years, it aims to enter other cities and is open to a public-private partnership to make this work better. It also hopes to give telemedicine support to the rural population soon and is looking for partners in that area.

“Today, every medical student aspires to be a specialist and patients do not have a choice but to go to a hospital for every small ailment and spend a lot of money in doing unnecessary tests,” says Chattopadhyay. While patients are not happy, they do not have a choice. NationWide has tapped into this opportunity. India, with her population of 1.2 billion, is a huge market and the primary healthcare market is more than US $ 40 billion or US$ 50 billion. Chattopadhyay is certain that NationWide will bring the family doctor concept back and build the family medicine career vertical for doctors through its training programmes and employment opportunities.

Concept in brief

NationWide Primary Healthcare Services aims to revive the concept of a family physician in the country. Its clinics focus on bridging the gap between fragmented general practitioner services and the super-specialist hospital care by creating a single point of medical care for its patients’ daily healthcare needs. It has multiple revenue streams – consultation charges, laboratories, pharmacy, nursing services and vaccinations.