Preactiv, an innovative platform optimising patients before surgery

What was the catalyst for launching PreActiv?

[Alec] As NHS clinicians we saw first hand the effects of a lack of preparation before surgery. 30% of patients undergoing major surgery suffer a complication whilst a third of operations cancelled on the day are because patients are not fit enough for their procedure. Patients are also much more likely to stay in hospital for longer occupying a bed, which has implications for waiting lists. As clinicians we place an enormous amount of emphasis on the patient’s physical function when making decisions about their care as it influences outcomes so markedly. Some patients are not offered surgery or are offered different treatments based solely on this measure.

Prehabilitation optimises a patient’s health before surgery through exercise and lifestyle changes. When it is individualised to the specific patient it halves the risk of complications and reduces a patient’s hospital stay by an average of two days. This effect is a magnitude more than most drug therapies and yet we place much less emphasis on it! Access to prehabilitation is limited, patient’s are either offered nothing, generic paper versions or expensive face-to-face or telemedicine options costing up to £1,000 per patient.

[Rebecca] Seeing this gap, we knew we wanted to do something about it. There was a real need to create cost-effective, individualised prehabilitation courses to improve different patient’s health and surgical outcomes. We decided to develop a product for the NHS that could bring widespread change. We formed a team of motivated healthcare professionals and experienced developers, and that's how PreActiv was born.

Tell us about the business – what it is, what it aims to achieve, who you work with, how you reach customers and so on?

[Rebecca] PreActiv is a digital platform that harnesses technology to create dynamic, individualised prehabilitation programmes. By curating an entirely digital and remote service we have ensured our platform is highly cost-effective, this widens access to effective prehabilitation so allowing the benefits to be realised at scale and reducing health inequalities.

[Alec] We work closely with healthcare providers, such as the NHS. We know first hand the barriers that healthcare providers experience when implementing innovation. We speak of our own experiences and truly believe implementation is a collaborative effort. We work closely with perioperative departments to ensure success in their particular pathway. The staff have to really value the benefit as well as the patients and should not increase their day-to-day workload. Our platform is designed to mitigate as many barriers to use as possible from both staff and patient users.

How has the business evolved since its launch?

[Alec] We started our journey in 2020, just in the midst of the Covid-19 pandemic when the UK was under lockdown. As a result of our medical background we are very much motivated by producing a high quality product that is backed up by rigorous evidence. With that in mind we ran a clinical trial at the Royal United Hospital Foundation Trust, Bath in collaboration with the University of Bath. The results have been transformative, clearly demonstrating the positive impact our platform can have on both patients and healthcare providers. What is really exciting is that we are now at the point of scaling the platform in both private and NHS healthcare providers meaning it is having a widespread impact.

[Rebecca] The recognition of the value of prehabilitation has increased significantly over the last year which is reflected in NHS England’s perioperative guidelines stating all trusts should incorporate prehabilitation into their perioperative pathways. When talking to healthcare providers there is real excitement about PreActiv and a larger understanding of the meaningful impact we could have on patients and healthcare providers.

Tell us about the working culture at PreActiv

[Rebecca] We feel people are most passionate when they feel heard so we have a real focus on collaboration and embracing new ideas. One of our goals as a company is to support women in tech, offering opportunities, training, and mentorship to help them advance into senior positions. As parents ourselves, we understand the importance of flexible working and promote this within our workforce.

[Alec] Our team is absolutely central to what we do. They are all extremely talented individuals and are passionate about what we are trying to achieve. Our working culture is centred on innovation and in fostering a supportive workplace culture, where employees feel valued and part of the journey as PreActiv grows.

How are you funded?

[Rebecca] We have just finished our pre-seed investment raise, raising £600K, securing Exceptional Ventures as our lead investor. We are also incredibly lucky to have ongoing support and follow-on funding from Bethnal Green Ventures alongside Angel Academe and a group of experienced angel investors.

[Alec] We are very fortunate that our investors are not only hugely experienced leaders but also understand our vision and what we are trying to build. Their mentorship and experience has been critical to our success so far and will be in the future.

What has been your biggest challenge so far and how have you overcome this?

[Rebecca] Getting over my sometimes overwhelming imposter syndrome. To help, I remind myself that we are creating a highly effective and needed product that will impact numerous patient’s lives and is a force for good.

[Alec] A startup is such a big challenge and tests your skills at every turn! I think that the biggest one is managing rejection. We have been relatively fortunate in that we haven’t had as many of these instances as the majority of startups but they can be difficult to pick yourself up from when you put a lot of effort into something. I have learnt that when this happens it is usually due to factors outside of your control such as what an organisation’s priorities happen to be at the time or what a specific grant scope is. As a result we are much more focussed on information gathering at the start of a project to check both parties are aligned. If this criteria is met we are invariably successful but you must be ruthless about where you focus your resources.

How does PreActiv answer an unmet need?

[Alec] PreActiv meets a crucial gap in preventative care. Across most of the UK prehabilitation options can either be generic or non-existent. PreActiv is a remote and scalable solution that revolutionises access to individualised prehabilitation, giving patients the tools to enhance their treatment outcomes. Through automating the customisation of courses and costing 88 percent less than traditional programs, we help healthcare providers realistically meet NHS England’s guidelines and so realise the economic and health benefits of this intervention.

What’s in store for the future?

[Alec] Our goal is to become the UK market lead in digital prehabilitation in the first instance. We are currently launching our platform across multiple healthcare providers and continuing evidence generation alongside further development. The platform and its technology has multiple other related applications which is really exciting so watch this space!

[Rebecca] There’s been a real buzz about PreActiv and the energy around prehabilitation has made us look forward to what is in store for the future. We’re also looking at preventative care as a whole and how PreActiv can have further positive impacts.

What one piece of advice would you give other founders or future founders?

[Rebecca] My mantra is ‘if someone is going to succeed, why can’t it be you?’ Becoming a founder isn’t always an easy road, but it’s about pushing through and having the grit determination to keep going.

[Alec] As Rebecca says, in my view grit is the biggest determinant of success if applied in combination with a reflective and adaptive approach. If you are adapting your methods by reflecting on successes and failure and you have the determination to continue, you will succeed.

And finally, a more personal question! What’s your daily routine and the rules you’re living by at the moment?

[Rebecca] I would love to say we have a really clear routine, however with two young children on top of running PreActiv, that is not always the case. Our routine is flexible and changeable day to day. We organise our days with balance where we can!

[Alec] For me the rules that are non-negotiable are spending time with my family, especially my kids, and friends alongside daily high-intensity exercise. Without these elements in my life I find my stress levels increase, my sleep worsens and my focus decreases.

Dr Rebecca Allam is the cofounder & CEO and Dr Alec Snow is the cofounder & COO of PreActiv.