The Case For Private Businesses In The NHS

As a GP and entrepreneur, with my own software being used in the NHS, I have found that my opinion has continually changed with regards to businesses in the NHS.

I used to think as a junior doctor that a lot of the private companies dealing with the NHS were evil for two main reasons: overcharging the NHS for their services and the unethical use of patient data.

I think these two points are still valid for certain companies.  If you read some of the reviews of some of the NHS software suppliers then it’s patently obvious that certain organisations like TPP who provide the electronic health records for around 30% of NHS GP practices have stonewalled themselves from criticism.  Their software is also very dated and horrible to use as a result.

But, there are some great things about private enterprise.  One of the greatest differences between government ran organisations and private enterprises is accountability.

We live in an age where when there is outrage at a private company, real change can happen.  Just look at how the CEO of a multibillion dollar company was recently ousted for unethical behaviour.

I think that the world is changing.  People and consumers have a voice now, because of the Internet and how connected we are.  We can raise our concerns when we’re not happy and take our business elsewhere, or in my case start a business which is more ethically sound (I hope! :p ).

I feel that this is quite different from government organisations.  As private businesses become more transparent and ethical due to consumer pressures, large government organisations are appearing more and more opaque as time passes by.  Due to the lack of market place pressures they are also very inefficient and lack the focus that private enterprises need just to survive – but this is the subject of another blog post! 🙂

Selling “Time”

I really think that this blog post is a must read for any business owner out there.  I was introduced to this concept a while back and it has been continually brewing in my mind.  It’s totally changed my outlook on my own businesses and how other businesses operate.

The big idea:  It seems that businesses nowadays are selling “time” rather than anything else.  No matter what industry, it seems that what companies are actually doing is selling “time”. 

This sounded really weird to me at first, but now it’s actually painfully obvious.

We may think that Uber sells taxi rides.  But what it really sells is time.  Before I’ve gotten off of a train ride, I’ve already called an Uber.  It’s selling me time.  Time that I would have wasted waiting around for a taxi if it wasn’t for Uber.

What does Amazon sell?  Retail goods?  Actually it sells time. It takes me a second to order a product and get it delivered the next day.

Does JustEat or GrubHub sell food?  Or does it sell time and convenience.

What about Instacart?

It’s a really interesting way of looking at things and has implications for my own health tech startup.  Yes, I am automating a load of medical work, but actually when I think about it, I’m selling doctors and patients their time back to them.

One of the things that I’ve been thinking about recently is why this is such a big deal.

I think it’s a big deal because technology has allowed us to tap into a whole market place that didn’t even exist just a decade ago: the market place of time.  And back of the envelope maths says that this new market place is worth trillions of pounds.

How To Tell When You’re Speaking To A Manager

“I’ll Try”

“I can’t promise”

“I’m not sure what my boss will say about that”

“That’s not possible”

“We can’t do that”

“It’s against policy”

“I can’t make someone else do their job”

Managers avoid accountability and often believe they are powerless to make an impact in the world.

Leaders however, seek out to be made accountable as they realise they can have a large impact in the world by working with those around them.

What You’re Not Told

Businesses that were created five years ago faced a different set of challenges than the challenges they would have faced today.  They also would have dealt with a market place which looks very different than today.

That’s not to say it’s easier or harder today.  It’s just different.

I think most people would be surprised by how level the playing field is for everyone.  Entrepreneurs who have been successful in the past will face the same challenges in the market place as first time entrepreneurs.  Sure, they may be better financed and have better connections.  But connections can be made and finance won’t save you when you don’t have something that the market actually wants.

What does this mean?  This means that there is only one “now” in business.  And as a result most books on business are irrelevant as they’re not talking about what the world looks like today, but what the world looked like when (or before!) the book was written.

As a result, realise that there is no guide to executing your idea and business plan.  There is no book that will tell you what to do next, there is no list of ingredients telling you the recipe for a successful startup, there isn’t a video that will tell you who to call next.

There is only “now”, you, your idea and your strategy.

And that’s all you need.

Flattening The Bell Curve

2014-10-03-blogbellcurveThe Bell Curve

This is a bell curve and is what the world used to look like.  People used to watch the same movies and TV shows as one another, listen to the same songs on the radio as one another and even talk about the same topics as one another.

Then the Internet happened.

All of a sudden people are watching all sorts of stuff online and listening to music that no-one in their immediate vicinity has probably even heard of.  It turns out that we’re all freaks when it comes to our wants and needs.

In a lot of respects the Bell Curve has flattened as technology has allowed people to become exposed to so many different ideologies, art and knowledge.

What has also flattened is The Market.  All of a sudden entrepreneurs have access to all sorts of clients from all over the world who like what they’re doing.

It used to be that large companies would make a product or service aimed solely at the middle of the bell curve as a strategy to please everyone.  Now this strength has become their weakness.  Small startups are continually eating away at the fringes and coming after more and more of the large incumbents profit margins.

Nowadays, something for everyone is actually nothing for no one.

Welcome To Entrepreneurship

Everyone is one Google search away from getting the information that they need, to start doing work that matters.

What is unfortunate though, is that lot of information isn’t a Google search away.  There’s a lot of stuff in business that people don’t write or talk about.

When I meet other entrepreneurs, we talk about things between ourselves that we wouldn’t ever dare utter in public, or write about in a public space.

I suppose the reason we don’t speak about certain things in public is simply because it would be too controversial and no one can be bothered to deal with the consequences.  I imagine this is the same reason why parents lie to their children when they start asking those difficult questions.  It’s just easier not to tell the truth.

This really sucks for anyone who wants to read about or learn about entrepreneurship passively from the back seat.

The unfortunate reality is that you can only really learn about entrepreneurship by sitting at the front, behind the steering wheel.  Don’t know how to drive?  Don’t know where you’re going?  That means you’re doing it right.  Welcome to entrepreneurship.

NHS Startup Part XVI – Thoughts On Integration

As integration with some of the large NHS IT suppliers comes closer and closer I am thinking more and more in-depth about what is the best way forward.

Integration when I first started my business seemed to be the holy grail!  It seemed to be the panacea to all of my problems.  However, as it was not feasible to integrate initially (most of the large IT suppliers don’t want to integrate as they want to own a monopoly, I didn’t have the contacts at that point to even begin discussions with the large suppliers to integrate and we still hadn’t tested out our assumptions / if our product would even work) I decided to take a massive leap of faith and build a stand alone system.

Being a stand alone system has loads of advantages.  The APIs for most of the legacy software in the NHS are hard to use, have poor functionality and limits what you can do.  It also locks you into a system which is inherently broken and can’t keep up with the demands of modern medicine – If the existing systems were so good, then my company wouldn’t exist!  It also prohibits you from using third-party apps which you want to incorporate into your service as they are not approved by the NHS.

Not being integrated allows you to be super lean, iterate, build new phases, do A/B testing and so on.  The flexibility and the speed simply wouldn’t be possible with integration.

This is the dilemma in my mind: We’ve managed to launch our product in several surgeries now and next month we’ll be launching our service to a massive 70,000 patient company.  This all occurred within a six month time period (our product first launched at the end of Dec 16/beginning of Jan 17).  This leads me to believe that it is possible to grow the business without integration.

So why integrate?  It will open up a massive distribution channel.  EMIS who are very keen to get integration going, own >50% of the primary care EPR market.  TPP who I should be able to integrate with as well own about 30% of the market.  This would mean that integration would allow us to scale enormously.  Integration also means that we wouldn’t need to worry about a lot of scaling issues which may arise otherwise.

Well this sounds amazing!  But what are the down sides?  The down sides is that you’ve essentially given over control of your whole company!!!!  Is that really the best way forward?

image28

A graph showing what happened to many websites after Google’s search engine update (Panda Update)

Giving over control of distribution is a big risk.  It’s like relying on google to provide all your web traffic or depending on amazon to sell your products.  One rule break, one update of an algorithm and you’re dead!

In effect, one of these big IT companies may just decide to kill my company for the hell of it.

I don’t think a strong foundation of a company can be built on someone else selling for you.  Entrepreneurs take responsibility for their own success, I am not prepared to give that over.

The other thing I’ve realised is that being an integrated app in someone elses system will really reduce the amount of money we may possibly be able to make in the long run.  In the short run it will provide a big boost in revenue, but not so much in the long run.

“Back of the envelope” maths is important.  If I solely rely on integration for distribution, I realised that hypothetically we would be making in the tens of thousands of pounds a month.  However, without integration and with control of our own distribution, we could be making in the hundreds of thousands of pounds a month.  Theoretically an order of magnitude difference!  Too hard to ignore.

So, here is the new strategy for my startup!

We integrate.  But, we provide very limited functionality with the integrated version so that people can get a taste of what we can do.  Want the full version?  Then you’ll need to dump your existing system which is garbage anyway and switch over to ours instead if you want to really increase your revenue and improve inefficiencies!

This seems like the wise move for the time being and the definite way forward in my particular case.

Integration no longer seems like the panacea I once thought.