In 2014, Cypriot national Nicholas Andreou was a junior doctor at a busy South London Hospital, freshly released from the academic cocoon of Imperial College into the creaking machinery of the National Health System (NHS).
“You come out of med school, full of energy and wanting to save the world, and then you end up in the real world and the healthcare system. That’s where problems start interfering with the practice of medicine,” he tells me, before relating how, one night, he found himself alone on a chaotic gastroenterology ward. “Gastro wards can have very sick patients but no-one else showed up,” he says, remembering how he couldn’t help thinking “This is impossible; this is unacceptable,” as he witnessed the frantic choreography of rota coordinators, desperate to fill shifts, making calls, sending e-mails or using pagers to no avail. “Pagers? I only know those from Grey’s Anatomy,” I tell him. “Yes, they were using those,” he laughs. That night, Andreou felt something deeper fracture – not just in the shift system but in the NHS as a whole.
The following day, still burdened by the weight of his busy night, he heard a colleague mention she was heading out to a yoga class. “How do you book your lesson?” he asked. “Online,” she replied. That casual exchange proved to be a quiet revelation. This was the age of instant everything and yet the system responsible for human life was still held together with paper, phone calls, pagers and hope, stuck in the old analogue world. Something clicked. “’What if this could be simpler?’ I wondered. What if there was an app for advertising gaps and instantly finding doctors? This is a highly regulated profession, everyone has a registration number. Why couldn’t the hospital instantly ask its entire pool of clinicians: ‘Are you available?’” He immediately pitched the idea to Dr. Ahmed Shahrabani – a colleague, friend and soon-to-be co-founder. “It was a no-brainer,” Andreou says briskly.
Delving deeper into the system’s inefficiencies, the pair’s research indicated that the NHS was spending around £4 billion a year on recruiting locum doctors. That was enough for Andreou to feel that he had something solid in his hands and he took the gamble to focus on his idea. “We were highly trained and employable professionals. If a proposed ‘gap year’ really would be a year and not a 10-year journey, we could always go back. I was still working as a clinician but it wasn’t my full-time job – that was a calculated risk,” he explains.
“Well, you’ve just ruined my next question,” I complain and he smiles questioningly. “I was wondering how you reconcile your medical background, which is built on risk-limitation, with the life of an entrepreneur who thrives on taking risks.” “It’s a brilliant question!” he enthuses, “and it strikes at the heart of the decision making that entrepreneurs have to make daily. Risk mitigation isn’t one single thing – it’s a collection of many strategies. My personal strategy at that point was to accept that, on a daily basis, I had to accept some risk. With hindsight, we were actually taking a massive risk but it worked out for us. Everything carries risk but the overwhelming desire to innovate – something that doesn’t really exist in medicine because of its low-risk nature –trumped all the risk profiles. We made some naïve calculations, of course, but what’s life without risks?” he asks, smiling.
I envy his boldness for a moment and as I listen to the inventive man sitting across from me, I can’t help but sense a quiet poetic justice: a clinician saw a system sliding towards burnout and chose to intervene. Once committed to fixing the system, he became unstoppable. Andreou taught himself software user interface design, built an app prototype and walked into the Royal Surrey County Hospital HR department with the audacity that only comes with entrepreneurial fever. “HR departments in hospitals are massively influential,” he tells me, “so we asked: ‘How would this look if we developed it properly? Would you be interested?’ And serendipity played a huge role – the answer was yes.”
To get Locum’s Nest off the ground, the two doctors sacrificed both time and personal savings, while additional funding came from friends and family in exchange for equity, until formal investors eventually stepped in. It was far from a smooth ride. Housed initially in the hospital cafeteria after launch, technological problems soon appeared. “Many UK hospitals are housed in very old, almost dungeon-like buildings with walls so thick they strangle internet connectivity,” he recalls. “So, we had to go back and develop technology that allowed offline submissions. New challenges would arise constantly – we just had to move through cycles of development and keep building.”
When Locum’s Nest was adopted by two hospitals, something else – entirely unforeseen – unfolded. As use of the app expanded, it unexpectedly created a digital collective bank. “This is one of the biggest processes and tech innovations that we brought to the NHS,” Andreou states with pride, before elaborating: “You’d think that the NHS was a single unified space but, sadly, it’s not. Just counting hospitals, ιt’s a collection of 200 or more different employers. So, why can’t everybody plug the gaps across institutions? When neighbouring hospitals launched, we asked whether they would be willing to share their contingent pools of staff; we created a greater supply of shifts, a bigger pool of workers, and we allowed supply to meet the demand. That’s a very simple but beautiful idea – we we’re not trying to micromanage the process; we just let it happen and we were shocked by how well it worked.”
Locum’s Nest has truly evolved. What started as a way to address last-minute staff shortages and cost surges has effectively put a lid on market-price frenzy. “Our system now allows hospitals to set approved rates by day, time and grade – weekdays, nights and bank holidays,” he explains. “We’ve built in governance so senior managers can approve any necessary escalation. The other thing we’ve done has been to remove anxiety from the rota coordinator by building a very advanced system – the shift popularity index – driven by advanced machine learning algorithms, which can predict with scary accuracy whether a shift will be filled or not at the standard approved rates. Conversely, if you need a shift for Christmas, you may be told that the probability of filling it is 13%, so it’s better to do something about that today, rather than waiting until the last minute. That saves money and, when you add it all up – per hospital, per month – we’re talking about many millions of pounds.”
Thinking of Cyprus, I raise the familiar complaints: staff shortages, overloaded state hospitals, long waiting lists, surgery delays, outdated digital systems, etc. Can an app like Locum’s Nest really transform any of that? “Cyprus’ health system is younger and therefore potentially easier to mould,” Andreou says. “But the problem we’re addressing is universal – healthcare runs 24/7 with a low supply of highly skilled workers. How you approach the problem varies from system to system – but the answer should always be a digital solution that helps address that problem as well as other administrational issues.”
Recognising that in Cyprus, as in the UK and elsewhere, what he calls “bashing, policymakers” has become something of a national pastime, he admits that he feels for those in government. “They need to save money while funding free healthcare for an ageing population with expensive staff, buildings and equipment. But these innovative little solutions can bring even 1% savings here and there which ultimately add up to millions.”
Locum’s Nest recently, made headlines following its acquisition by Aya Healthcare – America’s largest healthcare talent software and staffing company – a move widely seen as a vote of confidence in its ability to scale nationally, reduce the NHS’s reliance on costly agencies and provide Aya with a UK foothold for international growth. However, “Locum’s Nest remains our baby and there’s a lot to do!” Andreou tells me, and I believe him.
The co-founders of Locum’s Nest have not only demonstrated all that and more but they have now been deservedly rewarded for their hard work and perseverance as they see hospitals and healthcare systems around the world becoming more efficient. Giving birth to something new often demands a touch of audacity, intelligence, careful planning and perhaps even a little naivety. One chaotic night shift was enough for Andreou to take action and begin his relentless pursuit of innovation, which has since proved its value many times over.
(Orginal photo by Michalis Kyprianou)
This interview first appeared in the December edition of GOLD magazine. Click here to view it.
