Neil Bacon is a former nephrologist (Oxford and Harvard trained) with a clinical and academic career spanning 18 years. In 1998 he founded the multi-award winning Doctors.net.uk, growing it to become the world’s largest, online, professional medical network. This pioneering work led to him being made a Fellow of the Royal College of Physicians in London.
After 12 years leading Doctors.net.uk, he successfully exited and launched iWantGreatCare.org. iWantGreatCare is the UK’s only open, independent service allowing the public to rate and review their doctors, dentists, hospitals, medicines and care homes. It provides patients and the public with unprecedented power to give feedback about the care they receive.
Neil strongly believes that the patient voice should be a central focus in driving quality improvement in health and social care. His view is that transparency is vital in driving radical change in healthcare services and he recently contributed to the inclusion of patient ratings and reviews as part of UK Government policy. In his own words, Neil describes how iWantGreatCare “breaks down conventional thinking and challenges professional preconceptions” and since it’s founding it has attracted widespread, high-profile, media-coverage. In 2008, Silicon.com identified Neil as one of its Agenda Setters. With his years of experience leading two pioneering healthcare businesses, Neil has also advised global companies, not for profits and public-sector organisations, on multichannel health strategies and using the internet to transform their businesses.
Absolutely. It all started really while I was practicing clinical nephrology in Boston, back in 1993. In the US at that time, the internet was really starting to happen. Everyone was using email and new technologies were emerging around me everywhere I looked. I could see it was going to change everything in healthcare, for both patients and doctors.
I came back to the UK after that period and embarked up a Wellcome-funded PhD. However, I had such a vision of what the internet and technology could do for healthcare and I just couldn’t stop thinking about it. I was restless. Obsessed! Thinking about it would keep me up at night. In the end, I knew I just had to do something. I had to just go and do it. So my wife and I sold our house and I used the money to start Doctors.net.uk
That must have been quite a leap of faith?! What gave you the confidence to just go and do it?
As I say, I was obsessed! I couldn’t think about anything else. I think obsession like that is a good thing for entrepreneurs. Along with a degree of arrogance, ignorance and a very thick skin!
I also absolutely believed I could do it. You do need that level of belief, to get others to follow you. And then you just have to take a leap of faith and throw yourself into it. How did I find the courage to take that leap? Well, to me it just felt like the obvious thing to do. I was really ‘in the zone’! There was a novelty value too – it was fun and exciting – that also helped to keep me going when things were uncertain.
Did you have any prior business experience?
No. I was just your average practising doctor until that point. No entrepreneurial experience. No IT experience. No close family or friends who’d done anything similar. When I told people I was giving up my job to start a company, most of them told me I was mad!
Some people get their startups going on the side, while remaining in employment either full time or part time. However, you chose to quit your job, invest your own money and just go for it, right from the outset. A choice I imagine many of us doctors would shudder with fear just contemplating! Can you talk a little about that decision?
I’m not a believer in doing things on the side – in dabbling. From my perspective, you can’t mess around if you really want to make something happen. If you want to really do something properly, change the way things are done, it takes all your time and effort. Half-measures won’t cut it.
So you sold your house, gave up your job, and invested all your own savings in your idea… tell us about those very early days.
I started off by talking to anyone and everyone who would listen about. Deans. The Royal Colleges. Government officials. Pharmaceutical executives. Absolutely anyone who might be able to advise me or help in any way! I literally walked all over town (money was too tight for cabs back then!), talking to everyone. I’d have got nowhere keeping the idea to myself – being secretive, getting people to sign NDAs (non-disclosure agreements). Those people then put me in touch with others. One of those people helped connect me with an angel investor and 3 months after our first meeting he invested. From there things really took off.
You founded the company by yourself, without a co-founder. Would you recommend that route to others?
Yes, it was just me at first. By myself. No team. For me that was the right decision, though of course that wouldn’t the case for everyone. I’d say to anyone thinking of starting something by themselves, that you do have to be prepared for what can feel like a pretty solitary journey at times. For every person who encouraged me and thought it was a great idea, there’d be 10-15 telling me I was mad! You need a lot of self-belief, motivation, drive and resilience.
How did you get to grips with building a web-based company, when you had no prior experience in Business or IT?
In terms of the IT – I paid someone to do that right from the start. I’m lucky as my brother is a graphic designer, so I already had that contact and could get his advice and through word of mouth recommendations I found someone good. In terms of my own input – I was literally making up the rules as I went! No-one else was doing anything like it in the UK so it was like starting with a blank canvas with free reign to create based on my vision of how things could work. No-one knew what to expect or how the internet would be used in healthcare. There really there were so few people doing stuff on the internet back then, that with a little bit of knowledge I found myself being considered an expert, being consulted by others even, from very early on.
So how did you take the business from startup to a successful and profitable business?
Of course early on I needed to take on more people, in order to grow. I first took on a single colleague – as an employee. Then as I had more cash I hired someone to do the admin. Then I took on a chairman. All employees had a stake in the company, with options. This is very much the way I think you should do things. I wanted great people working with me, and I wanted them to be sharing in the upside of the business as well.
And what led to your decision to exit Doctors.net.uk and start iWantGreatCare?
Doctors.net.uk grew and became profitable. After several years at the helm, I felt I’d done my job there. It would carry on being a great business without me. I was ready to do something different. I found myself waking up at night again, so I knew it was ‘time’! I realised someone needed to capture the patient experience and push for transparency, to give patients a voice and enable healthcare providers to better understand what’s needed and deliver better care. Again, I felt driven to do something about what I felt was a glaring need in healthcare. That’s what gave me the impetus to make the move and start again.
How did you get started with this new venture? Did you do anything very differently to before?
I sold my stake in Doctors.net.uk and at first I paid a few thousand pounds for a group of programmers in India to build an early version of the site. It’s now so easy to find people via the net, who can build you almost anything at a fraction of what it would have cost in the past. I then took on a partner who is a programmer. The site needs quite complex programming and I needed someone on-board and invested in the company to really drive that side forwards.
What are you aiming to achieve with iWantGreatCare?
We want to help shift the balance of power to patients – the customers. In every other industry, customers’ views are sought, listened to and responded to, but we still have a lot of catching up to do in that sense within healthcare. It’s been a fascinating journey so far, though I foresee it taking us about ten years or so to really achieve what we hope to.
You are doing something that’s really changing approaches and challenging the accepted ways of doing things. In any field, that can be a tricky road to tread. Can you talk about that and perhaps some of the challenges you’ve faced?
Certainly. We are aiming to revolutionise the patient experience and the issue of transparency. There has been some trepidation, although interestingly, only amongst doctors. A small number of medics who have been afraid of what it might mean for them personally and what we potentially represent, in terms of the shift in power.
However, the patients love it. Other professionals – nurses, physiotherapists – all think it’s great. They really like getting the feedback and say it helps remind them of why they do the job – hearing how grateful a patient is for the care they’ve received, getting positive feedback about their caring attitude or fantastic communication skills. More and more doctors are seeing the benefits as well and increasingly coming on board.
In truth, there’s plenty of opportunity for people to post maliciously or spread their opinions on the web if they so choose, and anyone can decide to write about their care or experience publicly in ways that leave doctors powerless to respond – via their own blog for example. By contrast, we have created a system that promotes fairness. Doctors have the ability to read and respond to views. They can post comments back in response to anything that is said about them, good or bad. They can alert us if they feel something has been inappropriately portrayed and we will look into it. They can ask their patients to provide feedback on the site and use that feedback for appraisal and revalidation purposes.
I didn’t ever expect it to be easy though. As a fellow healthcare entrepreneur and friend once said to me: “There’s a fine line between stimulation and irritation. If you’re not irritating at least some people, you’re not changing anything!” I’d also add to that and say that to make real change, you have to do something that’s causes an explosion. Otherwise, you risk just fizzling at the edges!
How do you deal with misuse of the system, such as malicious posts?
We spot unusual patterns of posting, via pattern recognition software on our system. For example, patients can only write a review about any particular doctors once every 6 months. We also pick up on, and look into, spurious reviews that don’t fit into the usual pattern. We are working hard to create a fair system that provides benefits for patients, doctors, other healthcare professionals and healthcare provider organizations.
What’s your business model?
We are paid for information. We collect data for healthcare providers – PCTs, hospital trusts and other organizations – and they pay for us to collect data relevant to their practice, analyse it and provide them with detailed reports. We have the ability to analyse data across trusts or other organizations and then give them individual feedback, including their comparative score (out of 50 or so trusts for example). Customers receive detailed information about their own relative strengths and weaknesses and can work on improving their service and the patient experience. We are able to charge the trusts less than their existing systems, so for them it’s a great way to access data, save money and improve care.
Starting a business is exhilarating. So many interesting opportunities come out of doing something pioneering. If nothing else, you won’t be bored!
Have you drawn inspiration from anyone in particular along the way, or had any business mentors?
I’ve had a lot of support and enthusiasm from Sir Muir Gray. He’s a healthcare entrepreneur himself, having started 3 companies. I also had exposure to various entrepreneurs in the US, before I started Doctors.net.uk. Not necessarily all medics, but people who were doing things in Boston while I was out there. At that time I was really inspired by a nephrologist out there who was working on ‘Up to Date’ a company based around publishing medical knowledge and information on the web. People like him were great examples and inspirations.
I’d also say that people I’ve known or known of, who gave up something solid and structured and reliable, to give something they believed in a shot. Who took a risk. Their example really inspired me to go for it. And, in a funny kind of way, those people who told me I was mad really inspired me to keep going. I was determined to prove them wrong!
What would your advice be for doctors who are interested in starting a company themselves?
I think one of the major problems for doctors in getting started is that we tend to be risk averse. It’s a cultural thing. It’s probably much to do with the hierarchical nature of medicine as well as, of course, the nature of what we deal with clinically. The thing is, in business it isn’t hierarchical like that. Young people, if they’re doing great stuff, are taken seriously. At a really young age, entrepreneurs can end up employing and managing people who’ve been working in the same field for years. It’s very different in that sense.
Another thing is that there’s no way I could have started IWGC from inside the structure of the NHS. The challenges would have been too great. To do something like that, you do need to be prepared to approach things in a different way, to take some risks and overcome the hurdles.
It does require a different attitude and way of looking at things. I find it interesting that many doctors ask me when I’m going to go back to medicine. From my perspective, I am still in medicine. I might not see patients myself, but I’m still making a difference, albeit on a different level – a population level. We’re attempting to change the culture in medicine.
Any other top tips?
- Don’t ask ‘why?’. Ask ‘why not?’
- Don’t fear that you won’t be able to get a job if you step off the trodden path for a while and definitely don’t let that prevent you from giving something a try
- The way I see it, if there’s something you’d like to do but fear that it’s too risky – probably the real risk is in not doing it. You may well look back once it’s too late, when someone else has done that thing you were thinking about, and wish it had been you.
- If you really want to do it – don’t skirt around the edges. Just jump!
Any final words of inspiration for wannabee Doctorpreneurs?!
It’s been a really exciting ride. Challenging, but so much fun! Starting a business and turning it into something is exhilarating in itself. Also, I have found that so many interesting opportunities come out of doing something pioneering and putting yourself out there. I’ve worked on projects internationally, advised EU commissioners on European health policy and done consulting work with a wide variety of organisations. Seriously – just do it! If nothing else, you won’t be bored!
Listen to Neil talking about iWantGreatCare and the need for transparency in the health service, during his address at the recent Conservative Party Conference 2011.