Doctors developing apps to try to modernise the NHSBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k685 (Published 22 February 2018) Cite this as: BMJ 2018;360:k685
- Anne Gulland, freelance journalist, London, UK
A new breed of doctor is stalking UK hospitals and clinics—young, tech savvy, and frustrated with clunky NHS processes, these “doctorpreneurs” are setting up technology companies in a bid to make the health service run more smoothly.
It’s impossible to say how many doctors are tinkering away on their laptops trying to develop an app, but Kit Latham, an emergency medicine doctor and cofounder of Dr Focused, whose products include an online rostering system, believes that doctors are becoming increasingly frustrated with the outdated processes they are using at work.
“Every time they book a holiday or buy travel tickets doctors are confronted with tech that’s well designed, easy to use, and doesn’t waste their time. But when they’re at work they’re confronted with tech that is out of date and makes their job harder,” he says.
Latham is a perfect example of the new breed: a digital native who worked as a systems administrator in his teens. He did a masters in technology entrepreneurship at University College London and decided to develop an exception reporting app (to record when your work has varied from your schedule) with his company cofounders. This app has now been downloaded by doctors in 74 hospitals around the country. He now wants to create a whole digital back office for doctors, bringing all their paperwork into one place.
“We built the app with the brief of making exception reporting as fast as possible: people can now do their exception report in 19 seconds. This got us into rostering—rostering is the lynchpin of the hospital but often it doesn’t work properly,” Latham says.
Lots of people have expressed an interest in the product, but trying to turn that interest into a sale is the hard bit, he says. “A hospital’s sales cycle takes about two years. One hospital said to us that even if it used our software for free we would have to get past four committees and it would take a minimum of eight months.
“There are lots of legitimate concerns around the privacy of people’s data but we have conned ourselves into thinking that using tech that’s 40 years old is a risk-free strategy. It’s not,” he says.
While Dr Focused may or may not be the answer to the NHS’s rostering problems, getting the NHS to take up an innovation is certainly difficult. The NHS’s travails with introducing new technology are well documented—the aborted National Programme for IT was described by members of parliament as a fiasco and ended up costing the taxpayer £10bn (€11bn; $14bn).1
Rebekah Tailor is engagement manager for NHS Innovation Accelerator (NIA), a programme supporting entrepreneurs and clinicians to spread innovation throughout the NHS. For entrepreneurs to get onto the programme, set up in 2015, they must have—in geek speak—a minimum viable product. That is, the product must have been tried and tested and be ready to be delivered at scale.
Tailor says, “It takes something like 17 years for an innovation to be adopted throughout the whole NHS. The point of our programme is to accelerate that adoption. We offer fellows the support of mentors, relationships with other peers, and introductions.”
Tailor says individuals who join the NIA are expected to share their learning and report on progress. They do not give up any intellectual property, and profit goes back to the innovator. Tailor adds, “Innovations must have evidence to demonstrate in practice significantly greater quality outcomes for significantly lower cost.”
“Being on the NIA does not offer innovators a preferred NHS supplier status,” she says, but 788 organisations across the NHS are currently using NIA innovations. The innovations are not just tech based and include models of care and products, such as a pair of episiotomy scissors.
James Somauroo, an anaesthetist by training, is programme director of the Digital Health London Accelerator, a project similar to NIA but focused on the capital. It is a partnership between London’s three academic health science networks and the charities of Guy’s and St Thomas’ and the Chelsea and Westminster hospitals. It's supported by the mayor of London. Somauroo rejects the idea that the NHS is anti-innovation.
“There are people in the NHS who are open to innovation, and there are problems in the system that need solving. The NHS is spending a lot of money on systems and processes that are inefficient. The NHS is under pressure in terms of time and resources and is not in a position to buy things that are nice to have,” he says.
Doctors who want to innovate need to have a robust business model, which shows how their innovation will drive up quality and reduce costs, he says. “You may have created a lovely app, but what we need are end-to-end solutions that solve real problems,” he adds.
And frontline clinicians are in an ideal position to provide these solutions, he says. “You only need to go to hospital or the doctors’ mess to hear people moaning about systems. What’s changed is that access to technology is so much easier and people can code an app from their bedroom.”
Latham believes that doctors have a responsibility to get involved in the tech world. “We have two choices—either we take on that responsibility and learn as a profession or we abdicate that responsibility and let tech companies have a go. And they may get it right or they may not,” he says.
Doctors don’t always get it right, either, though. In October a doctorpreneur’s idea to help solve NHS bed shortages hit the headlines. Dubbed “Carebnb,” the CareRooms proposal aimed to free up hospital beds by putting NHS patients who no longer needed to be in hospital in local spare rooms.
“Hosts,” to use Airbnb parlance, would receive £50 a night in return for providing a room, three meals a day, and “conversation where appropriate.” The story attracted lots of negative press coverage, and within 24 hours Southend University Hospitals Foundation Trust, where the pilot was initially based, poured cold water on the project, saying it had never been its intention to support it.
It is unclear what is happening to the project as neither the entrepreneurs behind it nor NHS England, whose clinical entrepreneur fellowship scheme is backing the project,2 responded to requests for comments.
Private business fears
Some of the criticism centred on the uneasy relations between the NHS and the private sector. Felix Jackson, a former anaesthetist who has been working in digital health for the past 10 years, says there is a feeling that making money from the NHS is somehow grubby. All doctors get paid salaries, but that’s different, he says.
“I’m a fan of health workers, and I want to help health and care workers do their job better. There are a lot of people who believe that making money out of the NHS is an immoral act. I’m trying to create a really good company that improves the care patients get. I think it is okay for this company to make money so we can do this really well,” he says.
Jackson, who is developing a messaging service for health and care workers called medCrowd, says there are a lot easier ways to make money than being an entrepreneur. “You invest a lot of time and energy into your idea [but] you don’t know if it’s going to work. Every entrepreneur works very hard. I don’t want to be an entrepreneur just making rich people richer. I want to go out there and help patients and the people who care for them,” he says.
Latham agrees that people are suspicious, and he struggles with the “guilt” of having left the NHS and wasting his expensive training. But he thinks attitudes are changing. “I haven’t come up against anyone saying ‘you’re a rapacious capitalist.’ Without my training and experience of practice I wouldn’t be able to see the problems that healthcare has,” he says.
“I can square what I’m doing with my conscience.”
Doctorpreneur case study: Quit Genius
“I go back to talk to students to promote a culture of enterprise within medicine”
When they were in their fourth year of medical school at Imperial College, London, Maroof Ahmed, Yusuf Sherwani, and Sarim Siddiqui did a research project looking at how gamification—the use of gaming elements such as challenges and rewards—could help smokers quit.3
“As students we saw doctors talking to patients about quitting smoking but [the patients] were given no help,” says Ahmed. “Around 70% of smokers want to quit, but only around 3% are successful and only 6% are offered any access to behavioural support,” he says.
When the research project was finished the students thought their idea of an app based smoking cessation tool had potential and spent every night and weekend of their final year at medical school working on Quit Genius. The app, which uses tailored cognitive behavioural therapy to help smokers quit and stay non-smokers, was launched on iOS last summer and on Android in November.
The students built the initial prototype themselves.
“It went through a process of iteration and improvement, and then about 12 months ago we secured a large funding round and it took off from there,” says Ahmed. They now have a team of experienced developers, designers, and psychologists who are helping to improve the app and launch new features.
Trying to launch a business while in their final year of medical school was difficult, says Ahmed. “We were doing exams but at the same time trying to raise investment from key people. But we managed to find a way around it and it worked out. It’s unheard of to launch a business as a medical student—one of the reasons I go back to talk to students is to promote a culture of enterprise within medicine,” he says.
Although they are pleased with the app’s success so far, they want to take it further and, with their parent company Digital Therapeutics, look at ways of using app based cognitive behavioural therapy for other addictions. They are also looking at promoting the app to businesses as part of staff health and wellbeing packages.
Ahmed and his cofounders have decided to delay foundation training while they concentrate on the business—but they will return to practice one day, he insists.
“We don’t see this as leaving medicine. You go to medical school to make an impact on people’s lives—with this app we could have an impact on the lives of millions,” he says.
Doctorpreneur case study: My Locum Manager
“It’s an extension of what we did on our training—problem solving”
Surina Chibber, a locum GP in London, had just had her second baby when she started filling in her tax return. Coping with two small children while trying to sort out her paperwork was difficult, and she thought that there had to be an easier way to do it.
“I felt I needed some kind of tool that was useful, intuitive, and would save me time,” she says.
With her husband Matt Beddoe, a general practice partner, they decided to build software that would help locums manage their business administration and paperwork. “When we had the initial idea we coded a Star Wars trivia app to learn about coding, functionality, and how the app store works. We launched it as an experiment and it did really well,” she said.
Beddoe built all the wireframes—the blueprint for the software—and then the couple joined forces with a tech company. They launched the site two and a half years ago, continually testing and refining it, with feedback from users.
Locums pay for the site and it’s free for practices. Once a locum is signed up it brings all paperwork together, such as work scheduling, tax, and pensions, and includes features such as automatic invoicing.
“When you’ve been in the NHS for a long time you sometimes develop a certain mindset that doesn’t let you do any creative thinking,” says Chibber. “When I was on maternity leave I started to read more widely and meet people doing different things. That led to me to start thinking about improving things in the NHS.”
She still works as a locum and says combining this with her business means life is very busy but fulfilling. “For most of us it’s an extension of what we did on our training—problem solving. We’re in an age where tech is part of everything.
“Being an entrepreneur is an opportunity to bring out your creative side, problem solve, and have some fun.”
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.