How Remote GPs Could Save the NHS | Julian Titz, CEO of Asterix Health

Speaker A: Hi, this is Steve Roost and you're listening to HealthTech Hour on UK health radio. Each week we give you the best news, views and interviews from the health technology world. From CEOs and founders to entrepreneurs and clinicians, the companies and people that are shaping the future face of healthcare,

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Speaker A: on the world's number one talk, Health Radio. Hello and welcome to this week's Health Tech Hour with me, Steve Reest. Each week we bring you the best news, views and interviews with the leaders, clinicians, CEOs, journalists, founders, the list goes on, who are changing the face of UK healthcare and beyond. As regular listeners and viewers will know, I am a CEO and co founder of a health tech business myself, which is called pocdoc. And pocdoc's Healthy Heart Check is now the number one tool being used outside of a GP surgery to check your, your heart health. And if you'd like to know more, please go to pocdoc Co. That's P O C D O C Co. Thank you to everyone who's listening live on UK Health Radio. We love, love, love the live platform. It goes out all across the world, 24 hours a day. And if you're not listening to us, please check out the other presenters because there's some incredible content on the show. Thank you. If you're listening on demand, we get downloads now across all of the podcast channels in over 50 countries every single month. So thank you so much for listening and for interacting and engaging with the show. We wouldn't be here without you and thank you very much. If you are watching this on our YouTube channel, which is ealthtechour, or if you're watching the best bits on my Instagram, which is everost. So that's all of the show admin out of the way and onto today's show. So today's show we've got a, uh, really exciting founder, co founder and business on Asterix Health. I've got Julian Tits with me, who's the co founder and CEO of Asterix Health. Now, just to say the scene, I'm not sure we've had a business like this on before, but this problem that Asterix solves has been around, well, probably since the beginning of the healthcare system, quite frankly, of any healthcare system which is really around workforce. Now, if anyone's been reading any of the news in the UK over, uh, goodness knows how many years, workforce in the NHS is a critical issue. We can't train enough doctors, we can't train enough medical staff to fill the gap with the Growing demand that patients are placing on us across all disease areas, it doesn't really matter. And the front line of this, the people that are under the most pressure are gps. So Julian, who comes from Germany, has actually come over to the UK to help us solve this issue. And it's a really interesting way that they've done it. So, Julian, welcome to the show. How are you doing?

Speaker B: Very good. Thank you very much, Steve, for having me.

Speaker A: And you came over quite early this morning, I understand.

Speaker B: Uh, yes, Yeah. I mean, I've been in the UK now for half my life. Uh, so I didn't just come over for asterisks, but, yeah, flew in this morning from Frankfurt.

Speaker A: And what, when you say you've been here for half your life, like, what, how did that happen?

Speaker B: I moved to Oxford when I was a kid, so when I was about seven, lived here for five years, um, then moved back to Germany, um, and then I came back for Union. Have been here since.

Speaker A: Cool. Um, we should catch up. So I grew up in Oxford, but we can do that after. We can do that after the show. So how would you set the scene for the problem that Asterix solves?

Speaker B: Um, what we are doing at Asterix, the problem that we're solving is really what is, you know, the biggest problem in healthcare, as you said. Right. It's the shortage of highly qualified clinical staff. The way that I like to think about it more is probably the system's ability to make enough qualified, informed, correct clinical decisions. Um, kind of started looking at this from a personal experience point of view. Um, myself and my co founder Max, they both kind of come from that personal healthcare background. M. So really from a patient angle. Um, and yeah, we've spent the last two years going very deep on, uh, workforce, seeing what has been there in the past, what has worked, what hasn't worked, um, and kind of moving on from there.

Speaker A: So it's interesting that you mentioned the patient angle. So one of the things that I feel really passionately about, about what we do at our place around heart health, um, is really driven from what happened from my dad. So literally, I had my birthday the other day. I won't mention what my age is now, but at this exact age I am now, my dad had a huge catastrophic stroke when I was 14 due undiagnosed cardiovascular disease. And I think that actually more. The more I do these shows and the more I interact with founders, the more I realize that a lot of people in health are driven by a personal experience. And that's. That's the same for you, isn't it?

Speaker B: Yeah, yeah, exactly. So, um, after I left previous business that I started, um, I kind of took some time out, did some preventative care, did, um, a couple of scans, um, and then figured out I have like a heart, um, valve problem, my cosmic aortic valve, which is currently really asymptomatic, besides some high blood pressure, um, but would quite significantly, significantly, you know, decrease my life expectancy had I not found it early. Uh, so I need to get surgery on that in the next couple of years. Um, so it's fine because I found it early. But, um, that kind of got me thinking. Um, you know, I was able to access that early because I was able to pay for preventative care. Um, and why is that not available, uh, in the NHS in public healthcare systems, when that is really what's on one hand best for patients, but on the other hand also best for the system in terms of a, uh, cost, a capacity, uh, long, long term.

Speaker A: And is the, your bicuspid valve, what was it called?

Speaker B: What's the bicuspid aortic valve?

Speaker A: Okay, bicuspid aortic valve. Is that something that you've had since birth and it was just a sleeper? Yeah, the new.

Speaker B: Yeah, yeah, exactly, exactly. So I did like, uh, I was at home, uh, one day, did a, did a blood pressure check, uh, just, you know, as you do, the machine was standing around. Turned out I had like very high blood pressure that day and then was kind of monitoring that. Um, and that, um, yeah, kind of opened up this world of the heart valve problem, which I, you know, I thought I was perfectly healthy. Yeah. But it turns out I wasn't.

Speaker A: You must have been like, pretty reasonable. I mean, you, you seem young now, so you must have been a lot younger. Right? You wouldn't have thought, you wouldn't have thought you would have had a potentially life shortening condition.

Speaker B: Yeah, no, absolutely not. There's nothing in the family. Um, yeah, I, you know, I still feel great. You look great. Thank you very much. So do you. Um, but, you know, it's there, um, and I was only able to access it, um, because I was able to access preventative care.

Speaker A: So there's always a kernel, I find, like an inspiration, like a light bulb moment. M with founders, particularly mission driven founders. Like I said, it often comes back to like a personal experience in your case. But the gap between that personal experience and what you've built is still enormous. So how did you even start on this journey? And then once you got started, how did you Sort of evolve into the solution that. Because you could have gone anywhere in health.

Speaker B: Yeah, yeah. Um, well, I joined Entrepreneurs first, um, so they have incubator program, um, I start. That's where I met my now co founder, Max. So he has seen, you know, previously the best and the worst, um, of the nhs. So from a gp, uh, seeing him with club fingers, so, you know, obvious cancer, uh, symptom, uh, and telling him that he's fine, he should just go home, it'll go away to then him, you know, making a full recovery, um, at the Royal Marsden. Um, so really the worst but also the best of the nhs. We started looking at the healthcare system, speaking to lots of gps, lots, lots of doctors. And I think that, you know, at Entrepreneurs first you are, uh, the kind of expectation is right, that you go into some sort of software technology using that to solve the problem. Um, we then, yes, spoke with lots of doctors, um, and I think we realized that doctors are incredibly innovative. Uh, they want to try new things, they like new technology. They inherently want, obviously what's best for patients. But the software market in healthcare has just not been that successful and I think it's also not really had quite the impact that, um, people really expected on the front line.

Speaker A: And why do you think that those things are? What's your hypothesis?

Speaker B: Well, I think that in particular in primary care there's just not enough money, uh, to go around. Um, so a business needs to be able to reach a certain size. Um, if your size is limited by the amount that the NHS can pay for you on a per patient basis, uh, then you quickly end up with markets that just aren't large enough to sustain the sort of investment you need into technology that actually changes the game. Um, but what we also quickly realized is that, you know, 70% of healthcare spend goes to the workforce, goes to labor. Um, but workforce has not really seen innovation in, you know, decades. I think the most exciting thing really on, um, workforce innovation, um, has been, you know, the introduction of teleradiology, teleservices. Of course you also have like, workforce diversification, bringing in clinicians with different, um, different qualifications into the workforce to try to grow it. Um, but that's really been it. Um, and so, yeah, we started going down this very, very long rabbit hole that we're still going down, which is, um, healthcare workforce.

Speaker A: Okay, but why? I mean even that in and of itself, workforce is just a massive area. So at what point did you sort of happen upon the hypothesis that actually, yes, you, you can innovate with pieces of technology like teleradiology or even, um, ambient voice technology, which obviously was like, championed by GPS to begin with.

Speaker B: Yeah, definitely.

Speaker A: Or you can try and solve the actual workforce issue, which is actually about plugging more people into the system to see more patients.

Speaker B: I think it's about like, ability to achieve impact right in the market. If, if we're able, if, you know, if Asterix is, is successful, then, you know, we're able to place another hundred, like hundreds or maybe a thousand gps, um, into the workforce. Which is, if you look at the numbers. So, you know, the workforce plan is now rumored and they say that, you know, we need something like 50,000 new GPS by, by 2035.

Speaker A: Is that what they say?

Speaker B: Yeah, well, that's the, the rumor.

Speaker A: How many do we have right now, roughly?

Speaker B: I'm not, um, I believe it's around 50 or 60. Depends on how you, how you quote from a full time equivalent.

Speaker A: So they're saying that they need to double nearly.

Speaker B: Yeah, yeah.

Speaker A: Less than 10 years.

Speaker B: Yeah. Um, and you know, that's not going to come out of nowhere. Um, and so Asterix is going to be able to play a role in that. It's a piece of the puzzle. Um, and there's, I think, many different pieces of the puzzle. It's around making doctors more productive, it's around, of course, using technology, but fundamentally we need to be able to grow the pie. Um, and that's really where we come in.

Speaker A: Yeah, I mean that doesn't even on a. I mean, I hope someone's done the maths in terms of like, how many new GPs are created each year. And I mean, I still struggle to believe we're going to double the GP workforce.

Speaker B: Yeah, I should know the numbers.

Speaker A: No, no, no, no.

Speaker B: Maybe I'll come back to you. But you're absolutely right. And the bigger issue, I think is actually GPS proactively choosing to leave the workforce. So you walk into the big primary care conferences these days and what do you see when you walk in? The first thing is a recruiter for Canada that offers you better quality of life at two or three times the pay. Um, and then you have lots of GPs who are structurally overworked, um, who are burnt out, um, where expectations are just rising, um, every single day, both from the government, also from patients. Um, that's just not a sustainable workforce.

Speaker A: So you started with an entrepreneur first. So we're a broad church, so there might be people that know what that is, there might be people that don't, but it's a really Big successful entity. Could you just give us like 30 seconds on what it is and why it's so important in the UK? Well, and now international, but started in the UK. The UK. Sort of tech ecosystem.

Speaker B: Yeah. Um, Entrepreneurs first, or eF, is an incubator, kind of a talent incubator. Um, and so what they do is they set up these cohorts, um, and they bring together anywhere between, I think 30 and 50 people per cohort, um, that they pick, uh, they think, uh, might make good founders, um, put you into a room, uh, give you coffee, office space, whiteboards, and then it's really about, okay, now go and, um, identify problems that are worth solving and figure out novel ideas, um, and ways to solve them. Um, there's some structural support around that. Um, but I think at its core it's really their ability to bring together people who wouldn't have otherwise met, um, to start working on problems that, that matter.

Speaker A: And what was their reaction, the EF guys reaction, when you, you sort of landed in this area? Because I, I don't know, but I suspect potentially some of their, the stereotypical reaction to the sort of NHS being the main customer group may not necessarily have been immediately positive, but I'd love to hear how that played out.

Speaker B: Um, yeah, it's a really good question. Um, I think the initial reaction was not overly positive, but I don't think it's because of the NHS as a customer, because there are fairly successful, um, health tech companies out of ef, Accurex, Tortoise, I think Sono, they all sell to the nhs.

Speaker A: Um, I didn't know those guys were ef. That's cool.

Speaker B: I, um, think the bigger problem was, or the bigger challenge they had was around how we're looking at solving the problem, which is fundamentally not tech first. Right. But what we really believe and what I really believe in is using a highly qualified GP to deal with an abnormal, complex, um, piece of, of like clinical, clinical decision making. Um, and today you're not going to have technology make that clinical decision. It's complex, it's risky. Um, there's patients, lives that are at risk. Um, and I think we're taking kind of a, uh, you know, an unusual approach compared to other, um, companies that come out of ef.

Speaker A: I think it's really interesting. So it's not exact. I mean, we're very different fields within health, but our view at POCDOC was always around how can you accelerate the delivery of existing clinical pathways? Yeah, because we already decided, or they already decided that this was the Right way to do things. How can you use technology to accelerate that to deliver a step change, increase in success or impact? And it seems like that's a similar, that's similar to what you're saying, which is instead of sort of our, uh, whole thesis is around replacing doctors with an AI doctor, which again is almost, it may happen at some point in some ways in some clinical pathways. But I don't think any of us think we're close to that really actually that, that AI taking over actual clinical responsibility instead of an actual doctor. I think that's a ways off.

Speaker B: Yeah, yeah, certainly. To be honest, um, there was the paper that came out like this week around uh, general LLMs better at clinical decision making versus like the specific LLMs that are made for the healthcare domain.

Speaker A: Is that right?

Speaker B: Yeah, yeah, well it's, there's some, there's some controversy going on on Twitter at the moment. Um, that's what the, that's what the paper said. Um, I think as you say, right, the technology will take us there. Like inevitably AI will be uh, doing some sort of clinical decision making in the future. And I think that's actually positive because it means that clinicians will be freed up from um, the, let's call them simpler decisions, uh, to deal with more complex patients. But that has to be done in collaboration with regulators, with patients, with doctors.

Speaker A: Um, it has to be completely co designed.

Speaker B: Yeah, exactly.

Speaker A: I don't believe that solution is going to be dropped on people from a tech company. I think it's going to have to be built together. And even if you look at what Tortoise has done to scale in the NHS around Ambient Voice technology, they had to go out and get that regulated as medical device. Yeah.

Speaker B: Ah. And they've done a great job at that. Oh yeah, like really leading with regulation, with safety, with um, you know, hitting those kind of proof points, um, where you have others in the market who are not doing that. Um, I think it's great that they kind of went that extra mile to go do that.

Speaker A: Makes sense. And then. But with your, with Asterix, it really sounds like it's about plugging humans through technology into those gaps. So I didn't realize until I was doing the research for the show that actually the NHS itself had signaled this move around using non UK GPS virtually to boost the workforce. They actually signaled that in the ten Year plan. Right?

Speaker B: Yeah, yeah. So non UK based gps, that's what I mean. Uh, working with UK registered, um, health professionals who have all of the right qualifications. So GMC registration, etc. Um, to support the workforce remotely. Um, I think the Ten Year Plan in particular talked about, um, things like productivity, increase, time zone coverage and general, um, you know, access to a global talent. Um, the kind of point I made earlier around people or GPs leaving the NHS. You, uh, know, those are doctors that have studied, trained and worked in the uk. We've invested a lot of time and a lot of money into, um, you know, getting them ready for the system and then now they've left. So this is also, I think, from the Ten Year Plan perspective, a way to, to retain some of the investment, keep some of that workforce, um, in the pool and yeah, it was super exciting for us to see that actually be in the, in the Ten Year Plan.

Speaker A: Yeah, it's huge. It's a huge signal.

Speaker B: Yeah. Which was super, super exciting.

Speaker A: Yeah. I mean, I actually think when, when I read that bit, it looked really pragmatic.

Speaker B: Yeah, yeah, it's surprising.

Speaker A: Slightly. I mean, slightly. So on that note, we're going to stop now for our first commercial break and then we will be back after our short break with the CEO and co founder of Asterix Health, Jo Julian Tits. We'll be right back.

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Speaker A: station that makes you feel good. Foreign welcome back to the second part of this week's Health Tech Hour with my guest, Julian Tits, the co founder and CEO of Asterix Health. So let's dig into the details. How does Asterix actually work? What actually happens if, uh, let's say I'm a GP and I want to work with you guys, what actually, what do I get? What happens? What do my patients see? How does it actually work under the hood?

Speaker B: Yeah, I mean, really what we do with Asterix is we make it really simple for GP practices and other NHS primary care providers to access vetted remote gps, um, in their surgery. Um, and so our doctors become, um, embedded members of the practice team. They work According to local SOPs, follow local guidance. Uh, sometimes our GPS will join weekly clinical meetings. Um, and really what we focus on is the clinical admin work, the abnormal, complex clinical admin work. So, example, you know all about this. Test results, um, interpreting, ah, test results of both pathology, but also, um, imaging, radiology results, um, and importantly managing those end to end. So I think what we see a lot is that you have a lot of technology now coming into primary care that deals with normals, that deals with like, slight abnormals. And as soon as something doesn't fit the, you know, the kind of guardrails, it gets tasked back into the practice. What really, what we're all about is freeing up GP time and to do that you need to manage that task end to end. So that means the interpretation of the test, any actions, like message, like text messages to patients, uh, referral letters, uh, managing prescriptions and then importantly also the, like the consultation. So a phone consultation.

Speaker A: So what you're saying is in many instances when test results are normal or just slightly borderline. Yeah, there's a sort of a system that kicks in that's automated or semi automated and there's no sort of, you know, no need to look here too hard, it just continues.

Speaker B: Yes. Yeah.

Speaker A: But the sort of red results or results that are outside of the range. Yeah, that is very manual.

Speaker B: Yeah.

Speaker A: Practice to deal with.

Speaker B: Yeah, that requires a, that requires a doctor. Right. So, you know, your blood, uh, test results might be different to my blood test results. Your normal might be different to my normal. And it really depends on the context of each patient. And, you know, only a human, a doctor can, uh, can do that. And what can understand that context and

Speaker A: before asterisks or, you know, for those practices that aren't using asterisks, how does it, what actually happens? What, what, what? In reality?

Speaker B: Yeah, I think in reality what we see a lot with practices is that the partners, uh, the gps or the members of staff that own the practice, they will log in evenings and weekends, um, to deal with this sort of clinical admin work. Because there will always be more test results as soon as you have a backlog. You know, it's. It's potentially a fairly significant patient safety concern as well, because you don't know what's in there. Um, and somebody has to kind of do the. Do the mopping up. Um, that work typically sits with, uh, like the practice gps at the moment.

Speaker A: Interesting. And they have very little time and a lot of the time, probably partners have been at this for a really long time, you know, scraped and fought and built their practice and things like that, and they just under a lot of pressure and.

Speaker B: Yeah.

Speaker A: Using weekends and nights to go through these things.

Speaker B: Yeah, Ah, yeah, exactly. Um, I think there's something like 15% less. Less, um, GP partners over the last 10 years. Yeah. GPS, you know, regularly leaving the workforce, moving abroad. Um, and so that pool is shrinking. The doctors that remain, they still have to deal with the same level of admin. Right. The patients didn't go away. Um, and so doctors are working, um, are longer hours, under more pressure and are kind of looking for. Looking for a solution there.

Speaker A: Because it's hard for them to hire new gps.

Speaker B: Yeah.

Speaker A: Because there aren't more gps.

Speaker B: Yeah.

Speaker A: So actually. And actually the abnormality around the results means that there's a certain level of qualifications that you would need anyway.

Speaker B: Yeah.

Speaker A: To be able to deal with that. So it's almost like an impossible problem.

Speaker B: Yeah, yeah, yeah, yeah, yeah, absolutely. Absolutely. I think this is. Yeah, it is quite an impossible problem. And as people age, the population gets older, healthcare needs become more complex. We're only going to be dealing with more clinical admin and test results is just one part of it. Right. There's also the kind of documents, the prescription management. Um, but really what we see is that test results is what practices, um, struggle with a lot. And it's really where the highest clinical urgency is as well.

Speaker A: And when we say test results, are we talking blood test results? Sorry, are we talking sort of pathology results? So someone's given a example of urine, blood, whatever, and those results are coming back. Or are we talking as well about MRI images and CT scans or what are we at? What's the range here?

Speaker B: Yeah, both really. So pathology on one hand and imaging results on, on the other. Um, the doctors that we work with right there, they're ex UK gps. They have studied, trained and worked here, they have moved abroad, they've done all of this work previously in a practice. Um, they left the workforce and now we bring them back into the workforce remotely. Um, and so their scope of practice is exactly the same, um, as, um, a local.

Speaker A: It makes you realize how much risk gps take on.

Speaker B: Oh, yeah, yeah.

Speaker A: So if they're being required to interpret and therefore make clinical decisions off of all these test results, that's an enormous amount of clinical responsibility.

Speaker B: Yeah, yeah, absolutely. And then you have, you know, you have other GPs who are maybe ill in the practice, they can't cover their own labs, suddenly everybody else has to cover for them. Backlogs start building up, you miss, uh, you miss a high potassium, um, or it sits there for too long. Um, it is really, really risky.

Speaker A: And did these results. We're going off into sort of slightly geeky territory here. But in general, when these results come back in from whoever, the pathology lab or whatever, do they come back in in a sort of stratified way or. You can't tell which result is abnormal, you have to open each one sort of thing?

Speaker B: Uh, yeah, that's, that's a really, really good question. And uh, I think the answer is, unfortunately, that you can't tell from the outside, uh, what's in there. So. So sometimes they might have, ah. Uh, they might be coded as like, green if they're normal, or they might be coded as like red if they're obviously abnormal. But even then, you know, there's a difference in how abnormal a result is. That sort of stuff is not.

Speaker A: And also because it could be abnormal, low, abnormal, high. It doesn't necessarily.

Speaker B: No, it doesn't say you have to go in, you have to understand it, you have to understand the, um. And then you have to make a judgment off the back of that.

Speaker A: Do you know, I think it's interesting about what your model is, is actually you don't necessarily, by the sounds of it, need your additional clinical teams to actually interact with the patient necessarily, although they might do, but they can actually take off all of this workload about looking at the results and then feeding back in, basically. M. So they're a workforce, sort of, they leverage GP time. Existing gp.

Speaker B: Yeah, yeah, yeah, yeah, certainly. I mean, I think where we see real time savings be generated is an own or managing that task end to. So where appropriate, then also kind of doing. Having the patient touch point.

Speaker A: Oh, nice.

Speaker B: What we see is about between 10 and 20% of results require, uh, like a callback. So GP picks up the phone, talks to the patient about their result. Um, everything else. Right. Can just be dealt with, uh, a text message, um, or just be marked as normal and then that's totally fine. But there are cases that are escalated even beyond, of course, uh, like phone consultations.

Speaker A: Makes total sense. How much of a challenge was it to. So whenever, for those of you listening, we're a broad church. When you build a health technology business in the United Kingdom that has the NHS in any form as a customer, it won't be very long before someone asks you about integrating with the patient record.

Speaker B: Yeah, of course.

Speaker A: It could even be minutes after your first press release. So how did you get. Because I know that you've integrated or have connections to all of the major platforms, which is required because you work in primary care. How did you. How was that journey? Like?

Speaker B: Um, so I. So the way that our doctors currently work is that they just work in the existing systems of the practice and so they were like, login to the system one, the email. So the patient record system of the primary care provider, um, which is, I think, a little bit simpler. Um, we are also, like, building out some technology, um, that is now integrated with the systems on the back end. Um, I think compared to the initial setup that we had to be able to do from a regulatory perspective to be even to even deliver this clinical service. Because in the end, you know, we now have GPs who are caring for like 250,000 patients across the country. Um, that was a much bigger lift. So we spent. The first year of the business was basically just, uh, Max and I and kind of the early team sitting there in this kind of seller at Entrepreneur first, uh, like, solving some of the regulatory issues. Yeah. Um, that was, yeah, probably a little bit of a bigger lift, but at least it wasn't out of control. The issue with integrating with the, with the tech providers is that that's not in your control. It kind of sits somewhere else and you have to wait for them to come back to you.

Speaker A: Yeah.

Speaker B: Uh, so it's probably a little bit more of a pain.

Speaker A: Yeah, yeah. I mean, it's, it's a weird, it's a weird situation that we find ourselves in in the UK around who controls access to patient records. Yeah, but it's been going on for a while and I don't know necessarily if there's going to be an end in sight, but, um, do you guys

Speaker B: integrate with, um, the patient record?

Speaker A: So where we came at this from was that if you bear in mind our sort of hypothesis, if you like, was that the gps do an incredible job of screening people proactively, preventatively for cardiovascular disease and type 2 diabetes if someone's in the surgery. So There are lots of clinical pathways and GPs do a great job and those results get sent from the pathology lab and the gps know their community and their patients the best. That's fantastic. Our hypothesis was really focusing on how can you reach all of the people that can't or won't or don't go through that process. And there's quite a lot of unknown about who you might reach in a community, in a community pharmacy, in a workplace setting, etc. Um, less so at home, because you obviously know who you're inviting into that home based program. But for those other areas, you have to have some ability to effectively, universally write back into the record. Um, and thankfully NHS England in their wisdom created something called GP Connect. So we're actually the only point of care testing provider to integrate with GP Connect. So that means we also have a. Again, sorry listeners, we're going deep into geeky.

Speaker B: This is now reading.

Speaker A: Yeah, it's super niche, but we have, um, an API integration into ods. So if I'm screening you in a pharmacy and you give me three or four pieces of information, I can do a live NHS number lookup, which means then I can push your result directly in through GP Connect, which is the same if anyone listening has ever had their blood pressure checked in a pharmacy. We use the same API to be able to do that.

Speaker B: That's great for transparency as well. Yeah. For the, for the primary care provider to see what, uh, what has been happening outside of the primary care environment.

Speaker A: We built. The reason I asked about stratification is we built a number of tools to be able to stratify those results that send back in. GP's really don't necessarily need to know that someone's cholesterol levels are completely normal.

Speaker B: Yeah.

Speaker A: They do need to know if their Q risk is over 10% and, or they might have certain other, other flags. Um, so how applicable is this concept that you've got to other markets?

Speaker B: Mhm.

Speaker A: Conceptually. Because I think that's another thing which I've noticed, which we've sort of consistently fought against, is that sometimes people assume that by focusing on the NHS as a customer, you haven't built something that applies everywhere else.

Speaker B: Mhm.

Speaker A: Which I think is a lazy thinking.

Speaker B: Yeah.

Speaker A: To be honest with you. But how have you sort of encountered this issue? Or what are your thoughts about this?

Speaker B: Look, I think that there is a shortage of qualified clinical staff pretty much globally. Um, and there are certain qualifications of doctors that are recognized, um, in other places than just the uk. Right. So for example, with The UK qualification in primary care on general practice, um, you can go work in Europe, you can go work in Australia, New Zealand, Canada, um, you know, around some African countries as well. Um, so that is kind of an obvious future step, I think. Um, and there's a lot of, I think, interchangeable workforce that broadly work in similar systems, uh, that can support each other. In particular, if you look at, for example, the ten year plan, looking at the time zone advantage. Right, so just being able to offer primary care services in, in a night shift, um, which is already happening, but it's incredibly expensive for the system and difficult to staff, um, that sort of thing is something that would work, I think, globally.

Speaker A: I think, again, I said it earlier, but it's an extremely, it's shockingly pragmatic.

Speaker B: Dare I say, almost like too simple.

Speaker A: Yeah, well, no, because I think where it sort of could evolve to, which is, as you say, there's a shortage of clinical staff in every country. There's not like a country where there's an oversupply of gps. Really. Where we could be evolving to though, is in effect in any given country, 30% of all of these clinical admin tasks are, um, basically delivered by a remote workforce, wherever that remote workforce happens to be based.

Speaker B: Yeah.

Speaker A: Which makes sense for everybody. So instead of competing for resources and things like that, actually you have almost a globalized clinical workforce with globally recognized accreditation that can work and solve these issues. Globally, yeah, I think it makes total sense if that's, that's the direction of travel. I don't know.

Speaker B: As long as everybody has the appropriate qualifications for their local system, the service is delivered with the right, um, you know, governance, audits, guardrails, um, and patients have a great experience and a safe experience. Um, I don't see why something like that shouldn't, um, happen. But of course, you know, that being said, that's a long way away, I think, from where we are today.

Speaker A: But I think it makes so much sense because it means it doesn't matter what system you work in because the same issues are systemic. Right, yeah, that makes so much sense. Have you actually had any. I mean, uh, obviously there's been a thousand, ten thousand challenges that you've had to overcome, but has anyone actually really deeply questioned the thesis? I'd be curious.

Speaker B: I mean, I think obviously when you go through that kind of a fundraising process, there's lots of.

Speaker A: I meant more like, like, like GPs or clinicians or patients, like not, not VCs, they question everything.

Speaker B: Um, I mean, I mean, certainly, uh. Right. But if you look at it from a, from a regulatory perspective, from ah, um, a governance perspective. Like how do you deliver something like this safely? Um, right. I think something that we did very early on is actually bringing clinical and like governance expertise into the team. Uh, because of course both myself, my co founder, come at this from a patient perspective. Um, that's super important. Um, but I think there's always uh, people that will ask the questions and doubt and um, want to preserve the status quo, um, and try to improve the status quo in other ways.

Speaker A: But that's why I think so clever about what you're doing is that you're making the practices more successful.

Speaker B: Mhm.

Speaker A: Within the framework that already exists. M so people m. End up just, you know, the incentive structures that exist. You're just making it easier for them to fulfill those incentive structures.

Speaker B: Yeah.

Speaker A: Which I think makes a ton of sense. As opposed to sort of saying trying to I think a lot of the time, uh, unfortunately M in particularly in businesses, I talk about this all the time. But businesses where they have a high level of technical sophistication, they've invented something or there's an innovation, there's this natural tendency to want to prove existing people wrong. Mhm. And to have them say, oh yes, we admit you were right and we were wrong. And I think that that's way too binary and generally ends up with very little progress.

Speaker B: Yeah, I mean, you know, we're everybody that works in healthcare. Right. You, you too. We're here to improve the outcomes for patients. You know, we're all rowing towards the same goal, um, in of course, with different ways, um, and kind of using different techniques. But in the end we all want to get to the same outcome.

Speaker A: Great.

Speaker B: So why like go against each other?

Speaker A: I agree. On that note, we're going to go for our last commercial break. We will be back, um, in two minutes for the last part of this week's Health Tech Hour with my guest, Julian Tits, the CEO and co founder of Asterix Health. We'll be right back.

Speaker B: UK Health Radio, the station that makes you feel good.

Speaker A: What if your worst dreams aren't your enemy? Falling.

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Speaker A: What if something goes wrong? I'm Theresa Chunk, dream expert, best selling author and co host of the Healing Power of youf Dreams. And in my latest title, Extreme Dreaming, I reveal a powerful truth. There are no bad dreams. They feel so real, but that's so you remember them. They're messages, signals, transformative gifts guiding you toward clarity. Click on the Extreme Dreaming discount banner link on UK Health Radio homepage and learn to decode even your darkest dreams. Extreme Dreaming Are you ready to listen. UK Health Radio, the station that makes you feel good. Welcome back to the final part of this week's Health Tech Hour with me, Steve Roost and, uh, my guest this week, Julian Tits, who's the co founder of Asterix Health. So what was it like, or, uh, what is it like working and building a tech business in the UK over the last couple of years? And what do you think it's going to be like in the next couple of years? Because it's, it's pretty, it's pretty up and down at the moment, you know. So where do you, where, where do you kind of come out on all of this?

Speaker B: Um, look, I love what I do. I love solving the problem that I get to work on. I love working with the people that I work on solving that problem with. Um, and I love that in the end we are doing something that I think is like, net positive for patients. Um, that will inevitably come with challenges. I think, you know, starting a company will always come with challenges. You'll know.

Speaker A: Oh, yeah.

Speaker B: But, um, I think, I think it's, uh, you know, a great, kind of a great position to be in and I, um, I really enjoy it.

Speaker A: What do you think about, like, there's this continuous perennial. I feel like it's highly European, which is frustrating, but it's like, which country has the best tech ecosystem in Europe? I feel like it's slightly sort of derivative and it's sort of like, why don't we try and all club together a little bit about, you know, but what is your take on the different European markets versus the uk, Particularly for people listening who may not necessarily have, like, an understanding of why you might build here or build there, or the pros and cons. What's your general view of the whole thing? Um, as a European.

Speaker B: Yeah, I'm German. Right. I, uh, think there is no place in Europe that I would choose to live to start a company besides London. Um, yeah, I just think, like, for me, I think London has kind of everything that you need. Um, from my perspective, I've spent some time like in Berlin, um, which is the kind of obvious point of comparison. But I think, you know, starting a company outside of the US is already, already, you know, probably behind on certain metrics. Uh, then you might as well, at least for me, be in London.

Speaker A: That makes, that's, that's the clearest statement I've heard in a while. You know, about why, why be here? What's the major difference in between Berlin and here? So Berlin, just everyone listening is sort of. It wasn't for a long time but. But I guess for the last 10 years it's sort of been the London of across the water. I guess if you want to say that.

Speaker B: If you ask the French or not.

Speaker A: Well, yeah, I mean I'm not sure. I know that a lot of VC money seems to get raised there, but I'm not sure necessarily it's the right environment, having done some work there in the past. But what's the differences do you think, between the German ecosystem and the UK tech ecosystem?

Speaker B: I think you kind of hit on the point there. It's capital or access to capital and then access to talent. Um, I think in London there's just a significantly like bigger talent pool. Uh, you have more like better technical talent, better technical universities. Um, and by speaking English you're already kind of in a, in an easier. You can access both the European market but also the American market. Like much easier, um, capital. Like obviously there's a lot more of it in London than in Berlin. Um, I think those are really the two biggest points.

Speaker A: I think the biggest thing that you have to give credit where credit's due. Osborne and I think it was Osborne on his own. Osborne and Cameron with the seis. Eis.

Speaker B: M. Yeah. Yeah, it's good.

Speaker A: 15, 20 years ago. I mean that was inspired.

Speaker B: Yeah.

Speaker A: Like that underpins everything.

Speaker B: Yeah, we did seis. Did you?

Speaker A: Yeah. I mean why wouldn't you?

Speaker B: Yeah.

Speaker A: So again for everyone listening, SEIs and EIS were tax incentives that were created that enable investors who invest in early stage businesses where there's the highest risk, obviously because nine out of, what is it? Nine out of 10 go under or whatever.

Speaker B: Some, some, some fun number like that.

Speaker A: Some fantastic statistics.

Speaker B: Let's not talk about that.

Speaker A: But yeah, let's not mention that. But um, have really super high risk investments. They can get, um, a tax break. I think it's 30 to 40% under EIS and then it's a bit more under SEIS.

Speaker B: I think it's 50% under SEIS that you effectively put at risk.

Speaker A: Yeah. Which became so successful that you actually have entire venture capital funds that are raised using money that is qualified under eis. So it really underpins the entire UK tech scene. And I don't think that concept exists anywhere outside the uk, does it? I don't know.

Speaker B: No, No, I don't think so. Um, I think I, I mean I'm a Huge fan of like SES and eis.

Speaker A: Yeah.

Speaker B: Um, I, I, I don't know how much that really drives like, like your ability to raise capital here. I think you can still put together like an angel round in Germany. It will be more difficult but a lot of like SES investors in the uk, you know, they put in a very small checks as well.

Speaker A: They, they do, they do tend to become high maintenance. Yes.

Speaker B: Um, but then again, you know, we love all of our SAS investors on the capital.

Speaker A: I mean, look, again, particularly if you're trying to get off the ground.

Speaker B: Yeah, yeah. You know, yeah. It's a no brainer if you're here. Yeah, absolutely.

Speaker A: Um, no, I think it's interesting when you look at kind of other markets and things like that when, yeah, when, when, when you don't have, when you don't have those things here. But let's talk, you've mentioned it a few times. Let's talk about the us. So I think I love the uk, obviously I'm British. We've built here, you know, we work with the nhs, we, we love the uk. But the reality is um, I don't believe that there's a founder of a, maybe any business, but certainly a health technology business that wouldn't want to go to the us, given the choice.

Speaker B: Yeah.

Speaker A: Do you agree or disagree?

Speaker B: Yeah, yeah, yeah, I think so. I mean it's the obvious, you know,

Speaker A: big, big market and do you think that like we should be more honest about how the UK is effectively a feeder market for the US or do we. Is it not that extreme?

Speaker B: I think it really depends on what it is that you're building. So if you look back like kind of the thing I said earlier around health tech businesses being constrained in market size in the UK due to the like the NHS's, you know, systemic, uh, systemic um, ability, um, to pay for innovation, um, for that side of things. There's not a massive business that can be built in the uk. But I think if you look at for example a business like ours which goes more on the workforce side of things, I think we can build a much bigger business in the UK than any other health tech. Um, but of course, you know, America is the kind of um, the big one that you want to go for in the future. But I think it depends on like where in the journey it comes and how big of a business you can build here in the first place.

Speaker A: Well, you also need to make sure you get under the skin of the incentive structure in the us.

Speaker B: Yes, yeah, very different.

Speaker A: We've Started our US journey and you know, baby steps and so on and so forth. And you know, I went on a trip recently and, and um, everyone just assumes that your product or service does what you say it does. So they skip that part where you explain all of the happy, joy, joy feelings about all of the great impact. And they're like, how do I bill for that? How do I bill for it? Tell me how I bill for it. And that's really the main. So if you don't understand the billing and the coding and the reimbursement and all these things are kind of actually, weirdly, they might be more familiar to a German sort of founder. Right. Because there's reimbursement stuff there and insurance.

Speaker B: Yes, yeah, yeah, it's a little bit

Speaker A: more like that for the UK is completely different.

Speaker B: No, it's very, very different. The incentives is really the thing that, that opened my eyes when starting to go into healthcare because I think incentives are so different than what I expected them to be. And it's just, it's just so, so interesting. Uh, as you look at nhs, as you say in the us, if you look at people building software, like who are they actually incentivized to build software for? 9 times out of 10 it's not the user. Right. It's somebody else. Um, I think that's something that really stood out to me as we started going, uh, into the healthcare system. Um, just understanding everybody's incentives has been super interesting.

Speaker A: Yeah, it's really, really difficult to get your head around. I remember there's been a few moments and I think what I found interesting is I've gotten more into health because I don't come from a healthcare background, but was the ability to interpret the media stories about different things. So for example, there's been one that's been bubbling away for a long time around prostate screening for men for, um, prostate, um, specific antigen and obviously lots of high profile men, um, with prostate cancer, ah, kills a huge number of men every single year. Um, and it sort of repeatedly. They've also got a really strong patient advisory group. So that the prostate, I think it's called Prostate UK or something like that, they're really, really, really strong and really vocal, but continuously it wouldn't make it onto the national screening register. And that was because they looked at the health economics, which is a whole different area that you get into when you get into health, which is we're not saying you shouldn't screen for it, we're saying that we, the system don't want to pay to do it. Which isn't the same thing. Yeah. Uh, like we're not saying that you won't catch people with cancer. What we're saying is we're not willing to pay the money to do that versus investing that money somewhere else.

Speaker B: Yeah.

Speaker A: Which is super. Was really difficult to get that into the public consciousness. Mhm. At large. Because it's, it's quite a nuanced thing.

Speaker B: It's different. I mean it's not obvious. Right. It doesn't. As a patient, which is how most of us look at it. It just doesn't make sense.

Speaker A: It doesn't make sense to Joe. Joe or Josephine, Punter on the street. It makes no sense.

Speaker B: Yeah, yeah. Ah, absolutely. What was it for you? So like going into healthcare for the first time, what was the thing that for you was like kind of the biggest, biggest eye opener you've spent?

Speaker A: Oh this, this, I say this all the time. So um, so when we've, when. So I've got lucky enough to have two scientific co founders and they were the ones that were doing all of the, developing the science and writing all of our research papers and doing all of that stuff. And I was more of a business sort of ops from a, a VC back tech sort of background. And um, one of the initial theses that we had, and I would say at the very beginning it was a very strong thesis was, and this was mostly driven by um, individuals that we spoke to. So before we started building anything, we did about three or 400 hours of patient research, clinician research. Yeah. We really, before we, before anyone put a spade in the ground, I particularly could see a number of medtech businesses that were continuously failing.

Speaker B: Yeah.

Speaker A: Because they hadn't done enough customer research. So they didn't know who their customer was. So I sort of did a bit of market scanning and I could see that businesses weren't failing because their tech didn't work. They were failing because they hadn't solved customer problems. So I was like, well I'm not gonna, I'm not wasting my time unless we figure out exactly what the customer problem is. So uh, our first thesis, everyone, our investors and you know, friends and family were like, oh my goodness, this would be so much better than, than when I go to the gp. I hate having blood taken out of my arm, I hate waiting for my results and da da da da da. It'd be so much easier if we just did a little finger prick and that would be great. And we thought oh yeah, that sounds like, that sounds great. Cause all the patients would really like it. That makes so much sense. So then we went off and we knew we were gonna do this, but we went off and talked to some GPS and um, that plan didn't even make it through the first three minutes of the first GP meeting for a very simple reason, which is, is GPS don't pay for pathology labs testing. So, and we didn't know that until we spoke to them and what that means, everyone is basically when you go to a GP and they take blood out of your arm, that the cost of that, the lab testing and the sample things, all that stuff that's paid by the local system. Whereas if a GP was to use Pocdock's kit, the GP would be buying Pock doc kit. So there's no incentive whatsoever, in fact there's the greatest disincentive ever for them to use our kit. Now latterly we figured out how there's some things we can do around helping them deliver more health checks and things like that. So in the community and stuff like that. But that was the biggest eye opener for me.

Speaker B: Incentives.

Speaker A: 100%. Exactly. And that particular thing, believe it or not, is that so every on the last Friday of every month I give up my day to help, um, anyone that needs help with stuff, I just give up my day and I take meetings and just talk to people that have business challenges. And that's the number one thing I hear from diagnostics businesses really is that the GPS will buy their test. And I'm like, but you know that GPS get that for free, so why would they. And they've just not necessarily even done that level of customer research. Uh, particularly innovative med technology businesses, they really there's, there's an unfortunate trend, not all by any stretch of the imagination, but some focus on building the innovation and then trying to sell it as opposed to trying to understand what the need is. So that for me was my big wide opening moment. I was like, oh wow. Yeah, there's a whole different layers to this that I've not quite appreciated. So now we need to go find out who does benefit and who will pay.

Speaker B: Mhm.

Speaker A: So yeah, what was it like for you guys?

Speaker B: Um, yeah, I think, I think it's also around the incentives and understanding the different, different levels, the things that, that everybody wants. Um, I think that continues to, to surprise me in particular now when you look at the ten year plan, you look at neighborhood, uh, care. You were also alluded to it like, you know, care being delivered in the community, how that's actually being implemented and who's incentivized to do what and how that is different, depending on, like, where you are in the country, you know, on every single town has different, like, local leaders. Um, it's just, just surprising. And it requires you to just be

Speaker A: thinking about this all the time constantly. And I think it also requires a huge amount of humility.

Speaker B: Yeah.

Speaker A: Which is to have a frame of mind which is I'm constantly listening, I'm constantly learning, I'm not telling people anything. You know, I'm willing to adapt and be flexible. And, uh, it's about helping them achieve what they're being. And so because also their incentives change all the time.

Speaker B: Yeah.

Speaker A: Contracts change, stuff goes in, stuff comes out. We're reaching the end of the show, though. So at the end of every show, I ask everyone that I talk to. You've obviously been through lots of difficult times. What is the kind of self talk or the motto that you use and that you go back to every single time that you kind of rely on that you would want to share with the wider world to help anyone out there?

Speaker B: Yeah, I think for me it's just like keeping going and like, keeping working away on. On, like the thing, you know, you might. Or I have been, you know, knocked down before. Um, and it's totally fine to, like, be there for a little while, but really, realistically, the only thing that's gonna kind of keep you moving is just like doing a thing, doing the next thing, figuring out your next move. Um, and just like. Yeah, keep it. Keeping in motion.

Speaker A: Keep in motion. Uh, stay busy. Right. Um, Julian, thank you so much for coming on the show.

Speaker B: Thank you very much for having me.

Speaker A: And if anyone wants to know about Asterix, where do they go?

Speaker B: Asterix Health.

Speaker A: Perfect. Thank you very much to everyone listening. We'll be back again next week with a new show.