NHS Startup Part XII – Hustle

A lot has happened since my last update on this project.  I can’t believe it’s been over a month since I did an update.  I suppose in my mind I keep thinking “I just need to do this” and by the time I do it, there’s another thing that pops up which is just as important to do.  Before you know it you look back and realise how much ground you’ve covered.

In the last one month my software has started to really take off.  The benefits of using it have exceeded all of my expectations.  It turns out that it can cut costs for the NHS in a number of areas I hadn’t even thought of, as well as make things better for both patients and doctors.

We hit a key metric within one month.  The metric is 4%.  This may not sound like much, but the existing systems in place have taken years to reach 5%, so my initial hunch was right.  Within the next couple of months we will have overtaken all the existing services in the UK.

Right so I don’t just want to brag and explain how awesome I am – I am aware that startups have a tendency to blow up in your face whenever you think things are going right, but there are a number of things which will be helpful for any other early stage entrepreneurs out there.  So I’ll illustrate some points with some anecdotes and insights below.  I wish I had known this stuff before I started – so this is literally gold for anyone looking to do interesting things in the NHS.


MVP in the startup scene stands for minimum viable product.  There is a great book by Eric Ries (The Lean Startup) which talks about his approach to building a software product.  He essentially says that you should build a minimal product to test your hypothesis.  See what users say and iterate according to your findings.  If things go wrong either scrap it or “pivot” into something else.

However, I feel that this is more accurate for B2C products than for B2B.  If you have domain experience in a field your hunch is likely to be correct, particularly if you are creating something to “scratch your own itch”.  This is what I noticed with my product – I knew it was the right thing to build because I’m solving my own problem.  As a GP, I know that there are GPs around the whole country who will have the same problem.  So no real need to go so minimal.  Just build something to solve the problem!

Another thing I would like to point out is that first time entrepreneurs (such as myself) are absolute c#@p at establishing the needs of a market place.  I have met some amazing entrepreneurs recently.  One of them spent £25,000 on his side project and now makes a passive income of £2,000,000 from it.  He described himself as a “surgeon” when it comes to building products.  He can see what is needed in a market place and just monetise it.  He’s been an entrepreneur for over thirty years, so he has a really amazing skill-set.  I’ve noticed that first time entrepreneurs are really bad at finding out what the needs of a given market place actually are and then end up creating something which they can’t monetise.  A lot of the doctors I’ve met with startups have not been able to establish what the market wants and so basically have failed startups.  I think the only thing that has saved me so far is that I’m solving a problem that I’ve faced myself and incidentally a lot of  other people have as well.  So my advice is to definitely solve your own problems.  If you haven’t done a startup before you’ll have a much higher chance of success this way.

How To Get Your Product Used by the NHS

I spent three months of my life talking to all sorts of people to try and get my software used in the NHS.  The NHS is extremely slow and difficult to work with.  It took me three months to get a big fat “no!”.

Luckily there was a GP practice which was really interested in what I was doing and they were happy to go ahead and launch.

So we launched anyway.

I later found out that you don’t need permission from anyone in the NHS to launch your software product in GP practices if it is considered a “pilot”.  It’s actually in the NHS England documentation.  Beverley Bryant (more on this down below) showed me this and she said that if you have any trouble you should literally show people this document and explain they have no authority to stop you from piloting something if a practice is on board with it all.

I can now sleep a bit easier at night as it no longer feels like I’ll end up in jail!


Hustling is essential.  If you can’t roll up your sleeves and do work which is absolutely insane then don’t do a startup.  On my holiday I was calling hundreds of people a day to get their consent and sign them up for my services. I was thinking to myself if I really went to medical school for this, but it was essential to get my project off of the ground.

If you don’t push, it won’t take off.  People think that if you make something amazing people will just start using it.  This is not true, particularly for B2B software.  You need to get them to use it and see the benefits, listen to their feedback and iterate quickly.

If you don’t hustle, do the dirty work and do anything it takes to make your startup work, you’ve already failed.

One of the admin team was giggling at me when people were slamming their phones down on me during my call list.  I told her that I was “willing my startup into existence”.  I think this is true of most startups.  You have to do anything it takes and it’s only your sheer force of will which will make things happen.


I’m good at a few things.  Coding is not one of those things.  I have massive respect for people who are good at what they do and having domain experience in any field gives you a massive appreciation for experts in other fields.

Although I have basic coding skills (HTML, CSS, Javascript, PHP etc), I wouldn’t trust myself to make something which handles patient data.  Also, my skills are in medicine.  I am way more useful in my startup using my existing skill-set and doing everything a CEO needs to do, rather than doing what a CTO needs to do i.e. sitting in a room coding like nuts.

So how do you get people to come on board?  Where do you get a CTO from?

Here’s my privileged answer:  If you’re rich then it doesn’t matter.  A lot of really successful entrepreneurs I meet don’t get co-founders, they hire people when they need to.  If you’re poor and just have an idea, then you need to get a co-founder, otherwise you don’t.

I hired some really amazing people to build my software.  Since we’ve been getting traction we’ve had talks about joining formally as co-founders.  However, it’s likely that I’m going to get my first sale within the next 6 months or so.  Also, I’ll be a full time GP, earning over £100,000 from August of this year.  Do I really want co-founders?  Perhaps it’s best if I retain all the equity and then just hire people as employees down the road?

This is the conundrum most non technical founders face.  They can’t get their idea built.  And the only way to get people actively asking you if they can join your startup is to build something that gets traction.  But then things go full circle – once you get traction and if you’re profitable you don’t necessarily need a technical co-founder.  You can just hire someone if needed, especially if something you’re making is not deeply technical by its very nature.

If you do need a CTO, the way to do this is to make something awesome and get traction.  You’ll have people knocking at your door.

(As an analogy I always think of bands.  If you don’t like music analogies then you should stop reading this blog….  Essentially if you’re a guitarist and you’re good, you won’t struggle to find other good musicians to play with.  You’ll just meet people and want to play together.  Creating a startup is a bit like making a band – each musician is an essential part of the team with an essential, but different skill-set.  It’s good if you all grew up together and have really good chemistry, but there is also the option of hiring session musicians if you want and you’ll still be able to make amazing music.)

After Traction

The last two weeks have been nuts.  Because I now have some pretty impressive metrics people have started to take notice.

I have really great contacts now, including people like Beverley Bryant who is the head of NHS Digital.  And I’m sorting out formal meetings with some of the primary care software providers to talk about integration.  I was fortunate enough to meet one of the main IT suppliers’ CIO who is setting this up for me.

Again, hustling and willing your idea into existence, getting traction is key.  Doing the work is what’s important.  Nothing else.

It’s too easy to get distracted in a startup and being hyper focused is totally overlooked.  I cannot stress this enough.  I was honoured to have been called “a rocket” by the head of NHS Innovation when we met last week.  It seems like I’ve done a lot.  The only reason it seems this way is because too many other people are all talk and not enough action.


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