Pinipa @ #NHSClinEnt explained by the founder @faithforster and our very own @harryt2k

Harry Thirkettle (clinical entrepreneur) and Faith Forster (founder) explain Pinipa.

Faith explained her background of going into dangerous places and shared her experiences and lessons from being an entrepreneur.

Lesson 1: Take a user led approach

Lesson 2:product market fit is hard

Lesson 3:be careful what advice you listen to

Lesson 4:Team is critical

Lesson 5:Take care of yourself

Useful resources she has found for entrepreneurs:, saastr.Com, and

Then Harry took over to take us through the platform. Video link (

Roger Harcourt @shake_lawyer on legal issues that startups face #NHSClinEnt – Pitstop 1

Good legal governance leads to credibility. Helps us to maximise value and avoid costly disputes.

£130,000 to get to court

£600,000 to take a case through the IP court!


Good examples of Patents that have succeeded: Ermil who developed the can pull and then sold it to coca cola.Before long he was making a lot of money with his few cents take per can!

Is your idea actually YOURS? If it is can you obtain freedome to operate and therefore commercialise the idea. In order to do thsi it will need to be protected.

Learning from Lord of the Rings. Keep it secret. Keep it safe. Or more correctly keep it confidential, keep it safe.


As soon as you start to disclose the core of your stuff you need a NDA in place. As good practice you should still be trying to minimise the information you are giving (the secret sauce as it were). When you come to contracting make sure that there are things in place to stop people getting the full picture (drip feed the information).


Consider if it is needed, can you afford it, can you afford to defend it, is it patentable.

If you do need one write it yourself because someone else won’t know your idea as well as you!

To Incorporate or not?

Sole trader, partnership or PLC? What to choose. There are advantages and disadvantages to each. If you do incorporate you have protection but you have to decide:

  1. How you divide up the shares in the company.
  2. Creator, founder, entrepreneur, manager, funder. Look at the contributions now and future contributions and then decide how to divide up the stakes. You are looking to make up an equity split.
  3. Documents, articles, officers, directors etc. Lots of things to think about.
  4. What is the rule book – governance of the corporate structure.
  5. Shareholders agreements whill cover all of this. What are the rules. Who are the directors and who are the shareholders. governance, IP, how to transfer shares, dispute resolution, restrictions and leaver provisions are all in here.There needs to be a structure to protect the shares.

Its about building a contractual mechanism to resolve these disputes in order to avoid a court case later on.


Must have contracts but can have policies which fit everyone.

Your employess represent an operational risk. HR can be tough!

Confidentialitiy, IP ownership, Restrictions and Policies, One size fits all.

Our IP

National contracts do not talk about IP however, local policies might say that individuals do not own IP if they are working in the context of their trust.

Tony suggested potentially writing to the employer explaining that you are building something in your own time and that it is your own IP but also being willing to work with the NHS to make things better for patients.

Roger explained that it is a negotiation.

The whole room is massively engaged at this point

As a businessperson you should also sign up to an LPA just in case something happens to one of the founders. Make wills which tie in your shares, Assignment of intellectual property and other agreements.

Business Model and Contracts

SAP (standard operating procedures) and quality control – document this so you can demonstrate ‘due process’. Also trading contracts whether they be NDA’s, standard terms, bespoke contracts. Don’t sign it if you don’t understand it. and contracts

Bespoke contracts. key terms, compliance, reflect – make sure it fits with your business model and insurance cover. Negotiate.

Joint ventures are particularly important to get right. Define contributions, milestones, outputs. Licences – Get the scope and the outputs correct.

A contract should be a ‘living document’- it needs to keep up to date with the business!

Financing Options

Venture capitlists – are they scary? The key is to find the right VC. If they don’t fit don’t work with them.

The room is fully engaged. Well done Roger!

@RobChesters1 explains the NHS innovation mechasism #NHSClinEnt

This is broadly how it works:

Source: NHS England

nhs-innovation-journeyBecause the NHS is squeezed from all sides this provides a great escape valve for trusts if the innovation can be scaled and used across the board to improve efficiency. The AHSN’s and other groups have developed to help facilitate this and there are now various financial incentives appearing via NHS reimbursement schemes.

The Clinical entrepreneur programme has come about precisely because this need has been recognised. Late definitely beats never, and this in conjunction with the NHS accelerators will hopefully start to gain traction and lead to #development.

Toby Stone @theonlytoby explains accelerators #NHSClinEnt

Toby Stone just explains the what, how and when of accelerators.


In a nutshell they should be a good fit for your business before you join one. You shouldn’t do one if your main need is simply capital. They may take equity or some other parallel. They provide you with mentors who have been through it before. Ideally this mentor and your investors should have specific knowledge but also general knowledge that you don’t have and can benefit from.

An accelerator like an investor is way more than just the money and you should spend time trying to find a good fit. There are some specialised ones.

SeedDB is a great site that lists them all but they are constantly changing. There are some more specialised ones like Healthbox and TechStars

A note on Crowdfunding: Seedrs will manage the crowfuding investors for you, Crowdcube won’t.

One of the best ways to fill your funding round is to use different platforms at different times to lure in different kinds of investors at the right times. For instance Kickstarter is really useful to raise awareness if you have a hardware product. Then when, your round is filling up it gives you momentum and clout when talking to angels, however, this is only one example and every different situation will require a different strategy.

Thanks Toby.


John Spindler @capenterprise on the Lean Startup Method: Part 2 – The Customer. @ #NHSClinEnt

‘Make something people want’ – Paul Graham, Y Combinator

Avoid wasting too much time trying to change the ‘stuck’ middle who don’t want to innovate because they are very good at using the current system. Are your people your assets or your problem?

Before building your business ask: What problem would someone else solve for me?

Another thought: The number of secrets in the world is roughly equivalent to the number of startups we need.

How did the companies that are currently successful scale. When you scale big you win even if your product is inferior. Unless you can bring 10* value you are unlikely to be able to displace an incumbent. (As per Peter Thiel).

Design Thinking: He would thoroughly recommend we all do Stanford’s online course on design thinking (8-10 hours). Emphasise, define, ideate, prototype, test. Do it in groups if you can. Great course

‘Kick Ass’ products have evidence that they solve a customers problem in a big market. Focus on the early adopters. People you can beta test with. Commit 5 people. They need to know they are aren’t buying a perfect solution.

They are trying to find a home made solution. They want you to succeed, they will give you their time and honest feedback and you have a relationship of trust. Your mum is not one of these first customers!

Do you know the demographic? Needs and goals? Problems that need solving, Present behaviours? How do they go about solving those problems? Reference group? The behaviours and the psychology are key.

BJ Fogg. Head of behavioural theory at Stanford. B=mat. B=behaviours, m=motivation, a=pre-acquired ability, t=triggers (we are all contextual. We need external triggers to get us to change our behaviour. Every product is a behaviour change. Activation threshold affected by these three things, the triggers have to be enough to get them over the threshold.


Source: B.Fogg (Stanford) Site as per diagram.

Can you make something better than it already is, make something simpler. In an ideal world how would this problem be solved. Better, Simpler or emerging.

John suggests we build 5 actual profiles of people. The more specific the better. Motivation, Habit , Income, Age, Location, Status, Backstory.

Understand the full use-case lifecycle.

You need a hipster (domain insight), hacker (builder) and hustler (the first two work for him for free!).

Source: Capital Enterprise – John Spindlercap-enterprise-full-case-use-scenario

What do these personas do when ‘triggered?’

Entrepreneurship is a career. Startups are risky experiments. You don’t have to experiment full time. Start today with what you have.

Suggested reading: Moms test by Rob Fitzpatrick, Running Lean by Ash Maurya and Lean Startup by Eric Ries.

#NHSclinent. John Spindler @capenterprise talks about lean startup methodology – Part 1

Brilliant start to the clinical entrepreneur programme. @Tonyyoung and @theonlytoby introduce the programme (below)


Building a culture of entrepreneurial strength should be at the heart of what we are doing.

John Spindler @capenterprise – Lean Startup

Why bother starting a lifestyle business if you are a doctor. You have so much value and you want to share that with the world not just make your life easier. you don’t want a checklist business!

‘Big will not beat small anymore. The fast will beat the slow’ – Rupert Murdoch. Even he is aware of it.

Where can your business be in 12 weeks?

‘There are hidden gun’s in peoples garages which contain bullets with other companies names on them.’

‘Think big, act small, fail fast, learn rapidly’ – Eric Ries


As an investor, John Spindler finds the lack of background research by entrepreneurs to be one of the most commonly encountered frustrating problems.

2 columns:

Fact column- 2-3 facts you KNOW about what you about about do with this business.

Second column- Hypothesis. What things do I need to know to build this thing?

What is your OPPORTUNITY HYPOTHESIS. Build, Measure, Learn. Call it a project rather than a business because it is easier to fail fast. Like the psychology of this.

Experimental stage, metrics, evaluation leads to excellent execution.


Don’t build something nobody wants!

3 types of advice: validated and negative (in 8 weeks you can test it and see if it works. Good or bad it will help)

95% of advice is useless in the next 8 weeks. Shelve it because it’s useless.

Lean is just about organising the chaos, reducing waste and risk, providing more learning and a common language. IF your core assumption is wrong you need to test that FIRST. Then you will save yourself a lot of time.

It’s a common language. There is jargon and as soon as you learn it you can communicate with others – be ‘in the club’ as it were.

If you are going to build do a lot of thinking. Then build the thing that teaches you what you need to learn.

The number one thing an investor will look at is the team. If you can convince a quality person to join you that is a sign of successfulness. If you can recruit a quality army this is your number 1 asset!  What quality of ARMY can you recruit? Investors will care about this more than anything else as it is the biggest determinant of success.

Get OTHERS to validate your product. Your own validation is not that valuable but multiple external validations are.

A good hypothesis is simple & clear, written as a statement, establishes participants (who), variables (what’s involved) and prediction of an outcome (evidence).

The Pepsi Challenge type scenario is NOT the right first validation exercise. You have to assume that the first answer is wrong. Ask 5 why’s eventually & you might get to the nub of it. AVOID CONFIRMATION BIAS like the plague.

Most people are NOT early adopters in ANYTHING. Most people have habits that are very hard to break.

MVP is not a crappy version of the product. It is a prototype. Consierge MVP is legitimate. It can be a simple landing page, it can be a proof of concept, it can be something for people to engage with, it can be a paper prototype, a pitch, fake demo video, or something to help a developer to understand. It is just a way to answer the questions you need to answer.


Consierge means it is not scalable. It’s just there to allow you to learn. If your hypothesis is circular then its not a hypothesis.

Key assumptions: At least several other people are working on the same thing right now. How you think this your business idea will work is probably wrong. Your main job is to learn faster than the competitors. That is why the team is the key. It is the process and the people that win NOT the product itself.

The market is not stable and anyone who doesn’t keep moving forward will fall behind.

Call it a project, give it a name, sell something, convince someone else to join, set a goal that will inspire you, live 6 months in the future, fall in love with the problem and not your solution. Follow Peter Thiel’s philosophy as per ‘Zero to One’ (find it on Amazon its a good book.)

Don’t call it a business because you will overprotect it. Call it a ‘project’. Get people to devote time to your thing.

There are two types of teams. Napoleon team – they will follow your every command. The best teams however are people who are smarter than you and can do things you can’t and you bring them on the journey with you. They don’t want to just be footsoldiers for your army.

Paul Graham- You need three things to be a successful entrepreneur – a great team, proof that customers want it and a willingness to do it with minimal money!

Then questions:

Do you invest in startups who don’t use lean methodology? Yes but its rarer. Sometimes people just get damn lucky and hit a home run of first base but its the exception rather than the rule and it might not be repeatable.

Then he talked about financing and how ‘founders fit’ and how investors look at these things. Do you have someone resourceful, someone who can do x and y. The team you build now might well not be the team that takes it to the next level. Identify the task in hand and see if the team members can get you there.

Funders and investors must fit. An investor should never distort the function of the startup because this is your task. You have the hands on the controls. They are investing in you!

Thanks John.

Finally: My two favourites from Expo 2016

My Clinical Outcomes

As someone who was the first doctorpreneur I ever discovered and who is a genuine and honest guy. Tim Williams has helped me more than he realises at an early stage on my doctorpreneur journey. What he is doing with @myclinoutcomes is great and we need more of it. It’s only by measuring the metrics of health that we can feed back into the learning cycle and make sure we don’t waste effort (ie. think lean) but more importantly patients will be protected from harm. (Tim to the left). Lorie his analyst and Joe Mcdonald chair of the clinical CCIO network are to the right.

I want great care

In the middle is Neil Bacon. I had heard of Neil before and have even once for some reason been asked if I had founded! (apparently many have claimed to be the founder. If you are one of the other founders I would love to hear from you…)

Talking to Neil was like talking to an even more vivacious and talkative me! His passion for what he is doing shines through and I have to say what he is doing with is fantastic. I signed up straight away and so should all doctors. What you might think is just a ‘trip advisor’ or ‘checkatrade’ for Healthcare is actually a powerful feedback and analytics platform that enhances patient safety and outcomes. If you use it you WILL be helping your patients!!!

That’s it from me from NHS EXPO 2016. It’s been a great conference. Next up GIANT health con November!


More interesting tech at NHS Expo 2016


This is a really cool sensor system that is brilliant ad it is so simple yet massively effective. The founder Lawrence, is a legend and is doing great things via Southamptons catalyst programme. Watch this space! If I had money to invest I would invested in this.


Used by Shafi Ahmed in London this is a neat peice of kit using Google glass to transmit the wearers vision to a computer. The images can then be annotated or altered to be used in teaching etc. With the Google glass version 1 no longer available and a time lag for its successor and at £300/month this is potentially a very nice little training tool in the right context at the moment. It is certainly fun to play with.

PA consulting’s offerings 

PA consulting have introduced these products at the expo. This is a new probe for measuring Barretts oesophagus through the scope. It was next to the cytosponge but for some reason that had disappeared today. Both very promising innovations in my specialty (gastro) for Barrett’s surveillance.


TED has finally landed in the NHS. This proves people are gradually catching the vision. Bring it on…!

New tools to market at Expo 2016

This beauty could revolutionise the admission of chest pain. It can more accurately diagnose ACS AND unstable angina in just 3 minutes in the ED. It’s currently going through studies to validate it but I can see it being very successful as it’s price point is only around £100k and it could save NHS trusts millions.

Creavomedtech only just formed. Based in Leeds with a strong support structure, good corporate backing and strong technical expertise linked to the university I think this is one to watch!

Early Sense

This platform by early sense could be useful for patients with dementia as a way to monitor them remotely. However, there are lots of cheaper bed alarms. At £3500 a bed I think this products USP is the monitoring rather than anything else.


This is not a new technology but it’s beginning to scale. Portable theatres and endoscopy units could help some hospitals who have capacity issues. This polentally also has a role in major incident management.


This is a context based health platform. More advanced than a normal EPR (electronic patient record) system. This uses AI to filter the data and produce a useful record. This tool is FANTASTIC, but they have not yet broken into the NHS because their marketing strategy is wrong. It took me ages to get what they are actually doing and I think thats why they are struggling here. THIS IS A PATIENT SAFETY TOOL NOT A ‘CONTEXTUALISATION’ ONE. If you read this then get in contact because I think I can help you.

There are many more innovative solutions here but these ones caught my eye. To see more visit the EXPO website.