Developing a social enterprise company - Redesigning family health services in India

West Midlands GP Dr Niti Pall is committed to improving healthcare in India.

West Midlands GP Dr Niti Pall (centre) is committeed to improving healthcare in India
West Midlands GP Dr Niti Pall (centre) is committeed to improving healthcare in India

What does your work in India involve?

I am a practising GP in an inner city practice in Smethwick in the West Midlands and chairwoman and managing director of Pathfinder Health India, a business with a social intent. Along with partners, I invested in the organisation as an angel investor.

Our mission is to reduce ill health events for people in India by providing low-cost, high-quality family medicine, bringing in international standards and governance. Just as UK policy is focusing on community-led services, we are working in India to prevent hospitalisation and ultimately to save money and lives. We run training programmes to deliver the clinical workforce of the future.

We want to make healthcare affordable for the emerging middle class in India. We are based in urban areas and we're developing models for rural primary healthcare.

Did you have personal reasons for setting up Pathfinder Health India?

I qualified as a doctor in India and was driven to help improve the system when I saw how many women still die in childbirth and how many households are plunged into poverty because of unexpected hospital expenses.

I also suffered two types of cancer four years ago, which made me appreciate how the NHS looks after people without them having to worry about the cost of treatment.

How did you do it?

I set up Pathfinder Health Developments Community Interest Company (PHD CIC) in the UK in 2008 and Pathfinder Health India grew out of this in 2010.

PHD CIC is also a social business and provides a spectrum of primary care services, including award-winning management of long-term conditions and in-house clinics.

The company is run by a pioneering group of GPs working alongside top social entrepreneurs and other clinical professionals, based across four high-performing practices which work closely with patients and clinical professionals. We listen to what people want and shape services around their needs; we have redesigned the way our practices operate accordingly. The £1m we have invested in service redesign has already delivered more than £4m in savings, freeing up resources to be used elsewhere in the health service.

Pathfinder Health India was founded with the help of a team of highly qualified medical practitioners who have successfully set up and run family medical centres and GP practices in the UK. We go regularly to India to deliver training, set standards and look after governance. We also have a team in India and a corporate office.

Does your UK work relate to your work in India?

Pathfinder India is an extension of the work we do in the UK around asset building in communities. We are trying to bring the concept of family medicine back to India, with an Indian twist.

This involves organising existing service delivery in primary care, addressing the need for reliable health services in semi-urban and rural areas and developing new skills for the primary care clinical workforce. We are also working to make specialised home care services available to geriatric patients.

I find that my clinical work as a UK GP (five clinical sessions a week) keeps me grounded in reality.

There must have been challenges and proud achievements?

The healthcare sector in India is disorganised and 80% of spend is in the private sector. There is a lack of availability of doctors and nurses (it's difficult to retain nurses) and the traditional model is very doctor-centric. Patient data is not always available nor easy to track. There are also ethical issues with doctors often motivated by pharmaceutical companies and diagnostic service providers.

When we launched Pathfinder Health India, the main challenge was that the market was not ready for us. Most patients in India go straight to a specialist and there are no government systems to advocate otherwise.

My proudest moments have been when I feel we have touched people's lives, saving them from crippling hospital expenses. One example that sticks in my mind is looking after an elderly gentleman with a diabetic foot ulcer who was told he needed an amputation. We treated him at home and he is now well, with his leg intact, and still able to live and work independently.

Having Delhi chief minister Sheila Dikshit open our first clinic was memorable. Another high point was recently securing our first government contract to deliver screening for school children after three years of hard slog.

What have you learned from Pathfinder Health India?

We are developing solutions for affordable care in India that we would like to bring back to the UK. It is not just a one-way street, we are learning from India just as India is learning from UK health services.

On a personal level, I have learned how to innovate and how to be tenacious and not give up.

Working for Pathfinder Health India
Pathfinder Health India is interested in contributions from UK medical students and qualified doctors and nurses, particularly to help train and develop local teams. GPs who are interested can contact: niti.pall@nhs.net

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