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Both sides of the fence

As a GP and entrepreneur, Dr Mark Greenhalgh has a unique view of the industry

Mark-GreenhalghI considered a number of career paths: medicine; engineering; business. I even flirted with becoming a professional musician. These interests remain today and explain, at least partly, where I am career-wise. Finally, in 1985, I settled on studying medicine at University College London and, in 1993, became a junior doctor. Keen on therapeutics, medicine and the use of medicines especially, I entered General Practice.

Life as a GP is rewarding, but I've always been interested in other things. So, in 2001, I joined up with a GP partner, working half time each, which gave me the capacity to take on other roles.

I became prescribing lead for West Essex Primary Care Trust (PCT), remaining in that role until 2006. I was also IT lead for the PCT for most of that time, working on information systems locally and nationally. This means that I was once very clearly on the purchaser side for the NHS, advising colleagues and making decisions about medicines we might use or promote. Today, for clients, I'm something of a gamekeeper-turned-poacher. They like to hear what it's like on the other side of the fence and the genuine insight I can offer.

In 2004 I became assistant director and deputy chief information officer at East of England Strategic Health Authority, bringing in new IT systems for the NHS National Programme for IT, later known as, and delivered by, NHS Connecting For Health – the multi-billion pound programme headed by Richard Granger.

Integrating social media

Junior doctors used to work famously long hours, sometimes 80 or 90 a week, so these simultaneous roles seemed OK to me, taking a comparatively shorter 60 hours or so. The long hours prepared me well for enterprise.

In October 2004, I became clinical lead with Connecting For Health (East of England), working with Sir Muir Gray, NHS chief knowledge officer. I championed improved and connected information systems for doctors across the NHS, realising the need to get professionals working together online. The NHS Connecting For Health programme failed, in part, because it didn't engage enough professionals. It took on many management consultants, but too few NHS practitioners and I'm convinced that social media – collaborative work with web tools handled jointly by medical professionals - would have been more successful. Of course, back then it wasn't obvious that what we now call Web 2.0 would take off. In fact, such a thing would have been counter-cultural in the NHS, which operated relatively large-scale IT systems, usually created from the top down, almost always without significant user consultation.

It seemed to me that if we could take the social media that were springing up everywhere and select their most relevant aspects, we could save money and create something that was usable because it would be influenced from the bottom up. I wasn't advocating cloning a MySpace-style site for the NHS, rather I felt that aspects of social sites, where people work together, could be chosen and built into a knowledge-sharing space for the medical community.

I had these ideas when I was still in Connecting For Health but they weren't well received. Though in increasingly senior NHS roles, all the while I was thinking I should start my own enterprise to make things happen in the way that I was imagining. It was Easter 2006 when I decided to create a business involving medicine and social media.

Creating a community
I planned to build a social networking community for doctors. The existing network,, was well known by doctors, but it had limitations. I know that social networks often migrate if the situation is right – no one can capture people for absolutely everything they want to do on the web. Also, more importantly, I wanted to challenge it by coming up with something fresh. I'm always keen for medical professionals to recapture something of the days when medicine was actually groundbreaking and challenged wider society. So, I created business plans and put my own money into something called Doctorati.

Meanwhile, I had another job with the NHS Institute for Innovation and Improvement, with Professor Bernard Crump. This was when I first put my ideas into action via NHS Collaborate, a network aimed at kidney doctors. It was somewhere for them to share knowledge, help one another and disseminate new ideas. It went live in October 2006 and enjoyed modest success, but the number of participants was small and it was never properly set free. That's to say, it was behind a firewall and users were by invitation only. This is the – admittedly understandable - problem with most NHS projects. They are limited by fear and constrained by the perceived risk of libel actions or the errors their users might make.

Around the time the design prototype was completed for Doctorati and the brand was successfully registered as a trademark, I met Carl Engelmarc, now a key business partner in Flutter + Wow.

Carl, a brilliant marketer, agreed to be the marketing director for Doctorati, which had become a limited company. We created a private share offer and spent time negotiating with investment vehicles. As a result, we decided it would be more useful, and ultimately more lucrative, if Doctorati could be funded without large investment. I set up a company called Socialnet and finally left the NHS Institute for Innovation and Improvement.

Socialnet was to be a digital agency with a focus on social media and its first client was the Department of Health, working on a project called the Public Health Desktop. It initially used Socialnet more as a consultancy.

Invaluable experience

With Doctorati on the backburner, Carl and I built an agency to deliver for our first big public sector client. My experience of the public sector and Carl's of the private sector proved – and still proves – invaluable and we soon brought in other work.

In July 2008, Socialnet was rebranded as Flutter + Wow and became a media and communications company, rather than a firm focused solely on Web 2.0, as Socialnet had been. We declined a safe, three-year master service contract with McCann, the global communications network, because we felt it would restrict our ambitions. Happily, almost immediately we won some mainstream work for the Red Bull F1 sponsorship team and were made agency of record for Napp Pharmaceuticals.

We kept delivering for the Department of Health, until the end of last year when the Public Health Desktop stalled, really for political reasons. But more clients have come in since, including Boehringer Ingelheim, which, alongside Napp, is one of the most flattering clients we could hope for.

That the CEO of an agency is also a working doctor with genuine clinical experience (I still work as a GP on Wednesday mornings) makes Flutter + Wow unusual. Our aspirations are to be a full-service agency and recently we delivered print media advertising executions and hard copy promotional literature to Napp for their new product Targinact.

Ethical stance
There's big money in the pharmaceutical world, of course, so while truly innovative new mainstream drugs are increasingly rare, the industry needs to 'evergreen' existing products. As a prescribing lead, I was acutely aware of this and now in a marketing capacity I've chosen to take a fairly ethical stance, only being involved in the upfront promotion of therapeutic products with real qualities. So far, I haven't had to make any close judgement calls, but I would probably make such a call – to the detriment of my own business – if required, simply because, philosophically, I'm opposed to marketing poor drugs and I know the medical profession is jaded by the exaggerated claims of some pharma marketers. Actually, I hope that, in working only with credible products and clients, Flutter + Wow will gain more than it might ever lose.

Healthcare practitioners are increasingly hard to reach. I think companies that use social media to reach them – in a managed way – will sell more and gain an edge over their rivals.

Flutter + Wow is breaking new ground in these areas, quickly establishing site visitor involvement and focus. In a social media environment, our algorithms behind the scenes accurately establish a healthcare practitioner's professional interests, as well as their personal preferences so that the information they seek can be presented in the best way possible. We're taking what advanced e-commerce experts know, refining it and applying it to therapeutic information. We think very hard about this 'closed-loop marketing'. Actually, we usually make it the science behind the creative and attractive websites and related applications we design and build for clients.

Although it sounds clichéd, I believe the secret of success in web is to create interesting and rewarding user experiences, not simply selling tools. This is done by presenting the most relevant information where it is needed and wanted. Great gains can be made simply through more accurate and sensitive targeting.

Everyone in the health service knows that the pharma industry is selling to them, or trying to influence them. Better, then, for it to be smart and reach the right people in the right way.

The Author
Mark Greenhalgh runs the communications agency, Flutter + Wow, named after an Elvis Costello song, and works once a week as a GP.
To comment on this article, email

27th May 2009


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