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2022 - GC5 “Doubling-Up”

Heya 👋🏽,

We’re the startup automating away admin tasks in Primary care. It’s been a while since I picked up the metaphorical pen, and oh boy has a lot happened ✍️ The last time I wrote to you, we celebrated hiring our Founding Clinician Dr Lydia (she’s great btw). I now write to you 3 months into the future with deep confidence that we’re going to build an incredible company. Before we start though, a small request; if you know a Senior JavaScript Engineer, please pass them to our careers page. This will be an opportunity like no other ✨

Growth Cycle 5 entitled “Doubling-up 👯”, covered the 6 weeks between June 20th & Friday 29th July. Recognising that transforming healthcare is a 10-year mission, this cycle focused on cementing the bonds between our founding team of 4:

GLOSS ✨

GROWTH

Growth was back on the menu:

  • 👋🏽 Onboarded 4 of 5 new practices: How?:
    • 1️⃣ On the 3rd of November 2021, I interviewed a practice to understand more about their registration process. They listed a set of product requirements as long as my arm - 🙋🏽‍♂️. Now, almost 8 months later, with requirements satisfied they became a paying customer - god that felt good.
    • 2️⃣, 3️⃣, and 4️⃣ came from referrals from existing happy customers. “Just linking you guys up… I’m absolutely loving it btw 😃”. Strong signals that we are building the right product.
  • 5️⃣ Onboarded our 1st University practice without a free trial period. Walking off stage at the Pitch Fest final in March, a tech-savvy GP partner from a University practice in Durham introduced himself. 2 days later we’d agreed on a deal. This is significant because the average GP practice in London will register 1,200 patients a year; this practice will expect 9,000 registrations, half of which happen in a single quarter 🤯 Normally, the practice staff would work late nights and every weekend till the end of the year to meet the demand. Even then, students would expect to wait 6-8 weeks to be registered. We made a series of product changes to accommodate their specific needs, and we went LIVE this cycle 🎓
  • 🤞🏽 Submitted 6 Grant applications. We’ve reached a wonderful point - we’ve got a long roadmap without the capacity to deliver it. We’re ready for a bigger team, with more mouths to feed. We applied for 6 grants in preparation:
    • Health Innovation Network (HIN), was awarding 10 65k grants to NHS organisations implementing automation within the NHS. We submitted 4 bids in partnership with 4 NHS organisations (we like to stack the odds)
    • Innovate UK give out match funding grants from the public purse for game-changing and disruptive ideas, through a regular, ultra-competitive cross-sector application process. We applied for 2 separate grants (1) 49k Fast Start & (2) 452k Smart Grant

PRODUCT

  • 💎 Implemented a big round of registration form changes. We’ve added new coded questions for gender 🏳️‍⚧️, disabilities 👨‍🦽, and university students 🎓. ”Every GP practice has its own way of doing things” - I’ve heard it said almost 50 times in the last 2 years. But it’s not true. There are about 15-20 different ways of doing things. The sum of those ways is one way - a diamond registration process.
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  • 🤝 Introduced Auto-Passovers. Having processed 7,064 registrations, we’ve figured out the known registrations exceptions that need human attention. Instead of manually reviewing each case, we now automatically pass these over to the practice. An example: a child registers at the practice without a person of parental responsibility - hello safeguarding risk.
  • 💚 Automations begin to self-heal. Remember, we’re automating registrations by simulating mouse clicks and keystrokes on top of a haggard clinical system user interface. It’s brittle, plagued by pops-ups, with long ‘not responding’ pauses and crashes. Previously, when the system crashed, our automations crashed too 😫 Now they’re a bit better at healing themselves without human intervention, increasing our operational capacity.

GRIT 😫

  • 🪥 Pete made the decision to let a vital company metric slip. The moment we remember: is Pete and I standing in our bathroom, teeth half-brushed, cheeks wet with tears. Two cycles back, knowing it would stretch him, we made the anxiety-inducing decision for Pete to take on operations in addition to product development, so I could focus on growth. He’d look after the internal, and I, the external. For months it seemed to work, but that morning, I’d discovered that our time-to-register a patient had slipped past our target of 24 hours to 72+ hours with some registrations as old as a week! The metric itself was upsetting but more upsetting was the surprise I felt; I had the impression all was in hand. Characteristically, Pete hates to be a burden on others. In his mind, taking responsibility for operations meant asking for help wasn’t an option. To the point of breaking, he’d protect my time. But with Neil joining a product largely documented inside Pete’s head, mistakes slipped through the cracks. Faced with fixing bugs and building for the future, he decided to let operations slide. In the bathroom, I understood Pete’s intentions but argued the method wasn’t right. We’d made a commitment to our customers and breaking it wasn’t a solo decision. How could I continue to pitch a same day registration service; when it was no longer true? That night, we developed an important principle. Work shouldn’t be split by role, but by company-level priority. We made a firm commitment that in the company we’ll build, C-Suites will serve the symbolic tea to the intern with critical work to do. We reprioritised, worked through the weekend and returned to our committed SLA, emphasising the importance of communication. Happily ever after? Not quite, - Pete’s forewarning that evening echoed within the bathroom’s walls “I’ve said this before taking ops, and I’ll say this again. It’s too much, we need to hire someone for operations.”

  • 🥊 Facing the competition Automation in Primary Care is in its infancy. Why? The easiest wins come from automating a high-frequency, simple process within one institution. In Primary Care, you’ve got 7,000 institutions (GPs) with relatively low-frequency transactions. Most automation players, perceive the cost of reaching these GPs in addition to the cost of serving them as less than the income they’d generate (CAC + Build Costs > LTV). When we entered the market in November 2021, we had no like-for-like competition. The market has moved and in this cycle, 2 competitors came out of hiding 🎭. Competitor 1️⃣ In March, off the back of Rewired Pitchfest we received interest from a practice looking to automate their registration process. Looking at their Linkedin profile, I rejoiced to see a Digital Project Manager with actual development experience! Enthusiastically, I outlined our product offering, and they asked lots of insightful questions about our process and tech stack. Perhaps too insightful 👀 Raj: “Really worth filling out a test registration form, if you haven't already :)”
  • “Thanks Raj. Will do! Sorry, I forgot to ask about your costing model. Before I have a chat with my GP Partner I need some costing information excluding any pilots of trials 😀”

    [Raj sends over pricing 😅]

    “That’s great! thanks for the information. I will put together the details and present internally!

    Of course, you will🤦🏽‍♂️

    I think you know where this is going, I got brain-drained 🧠🧃.

    Once out of hiding in May, the stealth company launched 3 products (Automated Patient Registration + 2 other automated processes), with the call to action: “Meet us at EMIS National User Group”. My stomach tied-up in knots 🪢.

    Not only had they automated registrations, but managed to launch two other products!

    In a single moment, I flipped from prideful to anxious about our progress.

    Were we even moving that quickly?

Competitor 2️⃣

During an NHS Clinical Entrepreneur Program (CEP) event, I became locked in a debate with two GPs. Each had their own company and more clinical experience than I had years of life! My mind felt like a sponge and I learnt something at each turn of the conversation.

Peeling one off for a drink - I began to introduce our company, but was cut off; “Ah you’re Healthtech-1. I was just on your website! You do automated patient registrations right?”

Complimented, I responded with a technical insight I thought he’d appreciate as a fellow founder, “There isn’t an available API for Patient Registrations, so we’ve using RPA to do go where other healthtech’s can’t.” He gave me a quizzical look. “Oh really? Our partner uses an API to automate registrations. They’re working with this University practice that gets 1000s of registrations. The practice staff just click a button and snap” he clicked his fingers for emphasis “they’re registered”. Like a magic trick, he just unpicked the core assumption of our company.

An available API for registrations? How in god’s name could we have missed this?!

Facing the beast 🦑

Pete and I have very different strengths and our ability to balance them is our superpower. Competition naturally makes me feel uneasy, but for Pete, it’s activating. Pete’s hopped from startup to scale-up collecting skills for this very journey. Beneath his calm and even expression is a deep confidence in our competence. “3 products…alright…but do they even have a paying customer?”. “Anyone can make a couple of RPA flows and film it, can they operate at scale?”, “They're using jot form, pfft - we’ve built a completely custom front end”. Neil’s the same; competitive and used to winning; he’s like a British David Goggins “Boy’s I’m fired up”.

I felt comforted by their confidence, but the knots wouldn’t loosen. Confidence alone doesn’t prevail. The facts hadn’t changed - we needed to know more. Both competitors were presenting at the EMIS National User Group Conference, so we booked 2 tickets to separate fact from fiction.

We sat smiling at Competitor 1️⃣’s talk and left still smiling. Spread thin over 3 products they could only automate 55% of the registration types (we were at 90%). They didn’t have a single paying customer, and the answers provided to the crowd's questions about clinical safety or registration complexity didn’t hold up to scrutiny. They looked to me like ‘all fur coat and no knickers.’ It compounded our direction: start by doing one thing really well.

The GP I met on the NHS CEP, introduced me to his partner and Competitor 2️⃣. They’d reached out once before on Linkedin; so I started with a candid explanation of why I’d ignored the message. “I’m still new to this space, and just wasn’t quite sure how to approach competition”. They shared their perspective - “maybe it’s stupid, but I’m really open - we’re all in this for the same mission.” I enquired about this magical registration API and he did me a great kindness, “come let me show you”. He pulled up his laptop and walked me through his product. “Look we’re only doing part of the process, practice staff still have to manually register a patient - we help them by using an API to code the medical information in afterwards”.

I breathed a sigh of relief, and the knots untied. Pete just kept smiling 😂

The takeaway? 🥡

Face the beast, separate fact from fiction, and know that time spent on reconnaissance is seldom wasted.

So what’s next? GC6 ominously entitled “Winter is coming 🏰” focussed on preparing for the university season, and the next stage of growth.