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Accessing Mental Health Services Online with Julian Nesbitt

The Business of Healthcare blogs and podcast explores what healthcare leaders do day-to-day, the decisions they face and how they operate on a business level.

Dr Julian Nesbitt is a GP two and a half days a week and is in his final year of training. Julian was an A&E doctor beforehand and 4 years ago he founded Dr Julian. The business is an online mental health care platform that aims to improve access to mental health care services, and it does that through visual, audio and text appointments with therapists.

Julian created the platform because he was seeing a problem from an A&E and GP perspective. With the NHS, patients are on an incredibly long waiting list to get psychological therapy support and there was good evidence that online visual and audio and even instant message appointments can be equally, if not more, effective at delivering mental health treatment than traditional face to face treatments. Julian wanted to create a platform at scale with good quality governance behind it to use in the NHS and beyond.

It has been 4 years since the concept started, but 2 years since the real launch of the service and the business employs 6 people.

Please check out our conversation...

Who predominantly uses your platform?

Julian: My main passion is for the NHS to use it. We work within the Improving Access to Psychological Therapies (IAPT) Services in primary care. So, when you go to the GP, they refer you to the local IAPT Service. Those waiting lists can be up to 6 months. That’s where our service comes in. We utilise a network of therapists, even internationally, with the correct training and qualifications and train them to work online.

The patient can go in and choose a therapist they want to see, read their biography, have a look at their picture and match themselves. If they need a specialist in a certain area, they can get that specialist.

They can then book onto that person’s calendar. It means patients can find an appointment when they want it, how they want it and where they want it.

Not only can we improve access and allow patients to get it from home all hours of the day, and the therapist is working from home so they can put up the hours they work as and when they want to, it also means we can keep costs down because it’s a more efficient way of working.

The cost per appointment is a third cheaper and up to half cheaper than what the NHS would currently spend on a face to face appointment, so we can save them a lot of money, and also deliver better outcomes.

Our outcomes have been anywhere between 5-20% better and our recovery rates are up to 70-80% compared to 50% that the NHS currently has. So, we are hoping to have a more efficient way of delivering mental healthcare for a lower cost.

Did you always want to run a business? Or has this happened a bit accidentally?

Julian: My father was an entrepreneur, so I think I’ve got it in my blood. If I see a problem or a challenge I like to fix it, so I saw that there was a big problem with mental health and I really wanted to try and come up with a better solution for it.

I’m not saying that we should replace face-to-face because a lot of people need it, but what this service can do is provide an option for those that want it online.

Have you have seen the need for your services increase due to Covid-19?

Julian: Yes, 100%. We recognised that all the doctors, nurses and health care professionals needed to be supported at this very difficult time as well as patients, so we have provided a response service for them to use.

We have some big contracts in various areas of the country, and we are being approached with new ones. For our business, the most difficult thing is supply and demand. We’ve got to have enough therapists to meet what the demand is or likely to be, but if that demand drops off then those therapists are sat there idle. So you’ve got to make sure you map out things.

In the NHS things also might not be as quick as you want them to be, if they say they are going to give you a contract in a month, make that four or five. If they really need you then you will get it.

Demand is ever increasing, and I’m interested to see what happens after Covid-19 as online therapy is not for everyone. But for a large proportion of the population it does work really well, for example those who might not want to leave the house and find their home a safe space they may be more likely to open up there.

Let’s see what happens, but it’s an ever-increasing need.

We are also scaling up to offer the services to business and their employees. So, if you are a business and have employees, their employees will have access to this service. So that’s where we are heading.

I see that you are an NHS Clinical Entrepreneur. What support does this provide?

Julian: Yes, I am. So Professor Toby Young the National Clinical Director for Innovation at NHS England set up the Clinical Entrepreneur Programme where, any health care professional that has an innovative idea, business idea or a way to help support the NHS in finding solutions, can apply for support.

I think so far over 300 people or so have had great business ideas to support the NHS with this program. The people that work within it know what the NHS problems are, and the programme enables us to help support each other. We are healthcare professionals and have no idea on how to run a business, so it will give you an understanding of what that involves.

An important aspect of this programme is that it gives you that feeling that you are not alone, as it can get quite lonely as a clinician trying to do that as you can get resistance in the system. It’s nice to have that feeling of support.

Have you received investment into your business?

Julian: Yes, we had an Angel investment of £350k quite recently. That put us in a good place, but we are not talking millions.

Other companies might be raising or getting investments of millions and millions but that is a lot of money and is not always used efficiently. I think it’s a fine balance of what you do with it. You could take on loads but I think if you haven’t got the revenue to justify it at that point, I don’t think it’s a good idea because you’ll constantly have the investors chasing you.

For those unfamiliar with Angel Investment? What is your relationship with your investors? Are they involved in the strategic direction of the business?

Julian: I’ve got a few Angels, some of which are completely silent and some I get advice from. But they do not run the strategic direction. They let us do what we want to do but they give us advice.

Angel Investment means raising ‘money from high net-worth individuals willing to give their own money into your business.’ The way it normally starts is you have a family or friend type investment where you can prove the concept early on. And once you have done that you can go for the Angel Investment. Depending on how you want to run your business, an Angel can give you tips for business. It’s very useful to have angels.

Do you ever worry about growing too quickly?

Julian: Yes absolutely! I find it is a constant balance of maintaining quality whilst growing and scaling it up. I want to scale at a reasonable pace, but I have got other members of the team who want to slow everything down.

And it is something you must balance because what you can’t do is lose quality. If you lose quality then you will lose your reputation, and that’s very important.

We have a very thorough and extensive vetting process which takes quite a long time and causes therapists to drop off our list because they haven’t met the standard or are not able to get through. And in a sense that means we are limited in our capacity, and if we made that much easier we could grow much more quickly, but we are not doing that because we want to maintain the quality of our therapists with the training we provide. So that’s the balance that we are striking. I do believe you need to grow quickly, but not so quickly you lose quality.

Have you received any resistance in setting up your business?

Julian: Innovation and change can be difficult and that is the case with the NHS. However, having said that, looking at how we have responded to the Coronavirus crisis I’m incredibly proud of the NHS on how innovative it’s been. It has completely stepped up to the mark in responding and acting very quickly.

Also, a big issue with the NHS is that everything is done in silos. If there is something that can work nationally, you still have to negotiate with every single CCG because everyone does it their own way.

We worked directly with the IAPT Service to start our proof of concept and then we were able to work with IAPT and CCG together. I think in the NHS its very important to work collaboratively with them and not to completely disrupt as that is where things can go wrong.

You’ve got to work with the NHS collaboratively and work together to try and improve things. We work very closely with the health service as an add on to try and improve things for patients rather than take over everything because it doesn’t work like that.

So far, what is the biggest thing that running a business has taught you about yourself?

Julian: It has taught me so much and I’m learning all the time and still have so much to learn. I think it’s taught me, if you have an idea that can really be great and make a difference, don’t just think about it, do it. Go out and do it. Make it happen. You’ve got to work, start slow, prove the concept, get people around you. If it’s a good idea it will work. But there is still a hell of a lot to learn about how you run the business, how you manage a team all of that.

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Tara Humphrey is the founder of THC Primary Care, a leading healthcare consultancy specialising in workforce transformation and the host of the Business of Healthcare Podcast.

Tara and her team also work with GP federations supporting the implementation of clinical services.

Tara has over 20 years of project management and business development experience across the private and public sector and has an MBA in Leadership and Management in Healthcare, is published in the London Journal of Primary Care and is the author of over 150 blogs.

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