Working in a busy accident and emergency department, Dr Julian Nesbitt saw first-hand the pressure mental health services were under.

There were numerous cases of attempted suicide or self-harm admitted to the hospital, but long waits to access follow-up mental health sessions to help patients manage their problems.

"I thought there must be a better way of doing things," says Swindon-based Nesbitt, who launched his business in 2017.

His aim was to allow those with mental health issues to access specialist counselling whenever they needed it, at the touch of a button. Enter Dr Julian, an app allowing patients to video call a therapist they choose from a list, agreeing a time and a set price beforehand.

It means users can see someone the day they need help and choose the expert suited to their particular needs, eliminating any postcode lottery that arises when an area only has certain therapists available.

"The main difference is that someone can see a therapist at 10pm from their sofa, which means they may open up a bit more because they’re in a more comfortable environment," says Nesbitt, adding that the app has a 100 per cent reuse rate and 480 users.

Prices start from about £45 per hour, which is low for the quality according to Nesbitt, and the app has 150 therapists registered. He is in discussions with NHS trusts in a bid to make the service free to patients.

"As well as complying with patient choice and faster access it will save them money because it’s a far more efficient system," he says. "It costs the NHS £190 per session when you factor in support staff and room costs, so that makes it a no-brainer."

dr

Nesbitt (pictured above), whose father was an entrepreneur, still intends to continue his medical career. He switched from A&E to become a GP trainee, because the more flexible placements will allow him to go part-time at the end of the year.

"My aim would be to do both and I think it’s possible to do that," he says.

The idea of doctors having commercial interests outside of their clinical role was considered "taboo" up until fairly recently according to London-based Abeyna Jones.

She says medics who may have found they weren’t suited to their chosen field would have previously suffered mental health problems or even quit medicine because they felt unable to speak out.

"There have also been health professionals that have started innovating on the side, seeing a problem they wanted to solve, but when someone caught wind of that there was the idea that they weren’t committed to medicine," she says. "They would often choose to go and continue their innovation and eventually sell it to the NHS."

It's the reason the NHS made a step-change when it launched its clinical entrepreneurs programme and why Jones founded Medic Footprints. With 9,000 subscribers and 3,000 attending events, it's a platform that uses tech to enable healthcare professionals to find out about the alternative opportunities open to them. Jones describes herself as a portfolio careerist.

An occupational health physician, she has also worked as a urology registrar and spent two years as a general surgeon in a hospital in South Africa, where her eyes were opened to the opportunities outside the NHS. Jones is currently looking for investment to scale the business, which she believes could be applied to other professions.

"Medic Footprints aims to help doctors transform their own lives and realise there are opportunities for them if they don’t want to work in conventional medicine,” she says. “If they’re unhappy, they could suffer from stress and then they’re more likely to make mistakes, which impacts on patient care. I know people who have left medicine and then choose to go back, and they’re able to bring skills they’ve learned in other sectors to their medical careers.”

dr

Birmingham-based Samandip Dhesi (pictured above) is one doctor choosing to step away from medicine for the time being when he finishes his two-year foundation training later this year. He says he has quickly realised that, as a doctor, he is unable to express creativity, and he believes his business will allow him to do that.

"As doctors, we’re naturally problem solvers and there’s more than one way to solve a problem, but everything in medicine is guideline based and you can’t deviate from that,” he says. “I’ve realised I want to affect more lives than I can as just a doctor.”

Like Nesbitt, his business idea came from his experiences on the frontline and will aim to solve staffing crises, although he is mindful of revealing full details yet. The business, set up with a colleague, has incubator space in Birmingham and he has been learning business skills as part of a Google digital leaders fellowship.

“I had the idea in the first couple of months of my training when a colleague didn’t turn up so I ended up looking after 400 patients – for a doctor who is two months into their medical training, that’s simply not safe,” he says, adding that working long shifts followed by building up his business idea has meant huge sacrifices socially. “I’d normally be choosing a specialism now, and I was a budding surgeon, but I’ve chosen to put my medical career on hold and pursue my business dream, which was one of the most difficult decisions I’ve had to make.”

Anaesthesia trainee Dr Chris Evans, of University College London Hospital, has his sights on combating anxiety and behavioural changes among young hospital patients with his business, Little Sparks Hospital. Children who go in for surgery are often given leaflets on what to expect beforehand – but Evans believed there was a better way to prepare them for the experience.

“When you’re anxious you have a big stress response and that produces adrenaline, which can affect how wounds heal after surgery,” he says. “After surgery, children can often experience symptoms like bedwetting, nightmares and separation anxiety, even with simple procedures like having tonsils removed or grommets fitted in the ears.”

His first innovation, funded as part of his PhD, is Little Journey, a virtual reality app that enables patients aged three to 12 to virtually explore the hospital they’re going to receive care at, see the equipment that will be used and learn more about their operation. It can be tailored to any hospital, which would provide images of wards and operating theatres to produce their own version of the app.

“Thirteen hospitals in the UK have said they want to use it and we’ve had really great feedback from the families using it so far,” says Evans.

There are also several spin-offs to the business, including Little Superstars – hospital gowns with capes to help children feel more comfortable, and Little Toot – an interactive app that uses gamification to help youngsters feel less afraid of breathing masks.

Evans is currently studying part-time for his PhD and the rest of the time as an intensive care fellow at a private hospital. “I do seven 24-hour shifts a month, which gives me money to live by and the rest of the time is for research and running Little Sparks,” he says. “I never really thought of myself as someone who was an entrepreneur but working in healthcare you see a lot of things that could be done better and, as tech moves forward, there are more opportunities to make improvements.”

dr

Dr Anas Nader and Dr Jing Ouyang (pictured above, right and left respectively) were among the first fellows of the NHS Clinical Entrepreneurs programme, attracted by the opportunity to continue clinical work and use tech to solve a problem.

Joining Chelsea and Westminster Hospital Trust, Nader was responsible for making improvements to the temporary staffing office, which was there to fill rota gaps in the hospital. With Ouyang, who was then working as clinical lead in digital health at Alder Hey Children’s Hospital, Liverpool, he developed LocumTap, software that aimed to make the process smoother.

 “We have a serious staffing crisis in the NHS,” Ouyang says. “There is increasing healthcare demand and reduced clinician supply, and that creates a perfect storm where there are lots of vacancies in hospital rotas across the country. The NHS spent £3.6bn on temporary staffing in 2016, a large proportion of which came from agency spending. You can save money if you find an internal clinician to do the shift instead of using an agency.”

LocumTap’s software aims to do this. Where currently admin staff wanting to fill a shift will cold call or email potential candidates – or use agencies – they can upload all available shifts onto LocumTap’s software. Clinicians can then view all available opportunities and sign up to fill shifts using a mobile app.

A pilot programme at Chelsea and Westminster Hospital NHS Foundation Trust resulted in 90 per cent of available locum shifts being filled by bank staff, compared with 30 per cent with the previous system. That represented a cost saving for that trust of £600,000 per year.

Ouyang and Nader are currently in talks with more than a dozen trusts, with one in London ready to adopt LocumTap. The business has its headquarters in the capital, with a satellite office in Liverpool, and 15 staff. The duo recently completed a seven-figure round of investment to fuel further growth.

“We’re in the early stages but it’s very exciting and we’re getting a lot of unsolicited approaches from the likes of dental practices and nursing homes, who believe it could work for them too,” says Ouyang, who is still in full-time training but intends to join Nader in the business in August. Although full-time with LocumTap, Nader also works as a locum and Ouyang says he intends to keep his hand in clinical practice.

“As clinicians we experience many pain points in the system and there are a lot of transferable skills,” he says. “I never thought I’d be able to do both but there are a lot of problems in the system that can be solved by tech and I want to be able to solve them at scale."

claire

Dr Claire Novorol (above) saw how her expertise could improve medical tech while studying for a PhD at Cambridge. She had previously worked in paediatric neurology at Great Ormond Street Hospital before becoming a registrar in clinical genetics. But it was only when she was asked to advise an entrepreneurship club at the university that she could see the potential for her to make her mark on the tech world. The health start-ups she assisted had previously had no access to doctors.

“I became really interested in tech and saw there was an opportunity I hadn’t considered before,” she says. “I started seeing examples of exciting ideas people were building to solve some of the problems in healthcare and I realised I didn’t want to go back to a full-time clinical position.”

She launched Doctorpreneurs in 2011, a non-profit organisation aimed at promoting health entrepreneurship, of which she remains chairman. But it is Ada Health, the AI-powered health app, which has had the biggest impact. The business she co-founded seven years ago raised $47m in funding in late 2017.

As well as improving the product, the cash will be used to open a US office, adding to its bases in London and Berlin.

The free app works like a chatbot, enabling users to give their symptoms and receive “approximate likelihoods” of what their ailment may be. They can also be connected with real doctors if they wish. “It’s much more personalised and sophisticated than a Google search, for example,” says Novorol, adding that a huge team of inhouse medics has built up the app’s knowledge over several years. “A lot of people don’t know what’s the right level of care for them to seek – they go to A&E when going to a GP or pharmacy would be better. Ada helps them make more confident decisions about what to do.”

Available for just over a year globally, three million assessments have been carried out. “We’ve heard stories about how Ada has recognised something serious like appendicitis, which has been later confirmed at a hospital, and how people have been reassured that something wasn’t serious,” Novorol says. The app has also correctly diagnosed those suffering from rare diseases, brought in to test Ada, within minutes of them answering questions about their condition.

Her own career has taken a back seat and, though it was the path for her, she doesn’t believe entrepreneurship is right for all doctors.

"A medical career has traditionally offered stability, prestige and a mapped-out path – entrepreneurship is the opposite of that," she says. "Healthcare is behind other industries when it comes to tech because it’s so complex and harder to implement new tech, but we’ll get there. I hear doctors talking about their clinical work and I do think it would be nice to go back.

"However, what we’re doing here has the potential to affect many millions of people around the world and I’d never have reached those people being a practice doctor."