Onko Health

A two-person job that couldn’t scale

Two people ran the whole intake by hand. They triaged the inbox, copied patient details between systems, chased the legal acceptances and booked clinicians one calendar slot at a time. It held up to around 700 patients a month, and not much beyond that.

There was a clock on it, too. Onko’s Series A came with a condition: show that intake could scale. Doing that manually meant hiring another four or five full-time people on top of the two already there — the kind of headcount-led cost that makes investors hesitate.

One team, six months, live in six weeks

We ran a six-month engagement as one team — four of our engineers, a product lead and a delivery lead, working alongside Onko. The first fortnight was discovery, mapping the referral journey from end to end. By week six, the first version was live in production.

We built it in Node.js as a custom integration rather than forcing a fit with an off-the-shelf tool. Referrals from NHS Trusts now land straight in Onko’s intake systems, clear their legal acceptances automatically, and drop onto the right clinician’s calendar. No copying and pasting in between.

What changed

• Capacity rose from 700 to 4,000 patients a month — 5.7× — with no extra people on intake.
• Time from referral to first appointment fell from as much as 10 days to two at the most, and usually the same working day.
• Onko met the scalability condition and the $5M Series A came in.
• The four or five hires they’d otherwise have needed never happened, freeing that budget for the rest of the business.

Growth that no longer depends on headcount

Onko got the funding that hinged on this, stopped tying growth to headcount, and handed its team back the hours that used to vanish into admin. For patients, it’s the difference between waiting weeks and being seen in days.