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Let's make the NHS the most advanced healthcare system in the world

The world's best healthcare, for free. It's not a new idea, it's called the NHS. But the largest healthcare provider is fundamentally broken. So we're on a mission to fix it with technology that actually works.

We love the NHS because it's accessible to all, free at the point of delivery and employs millions up and down the UK. But we've all read the headlines. It's under intense pressure with rising costs, GP strikes, budget uncertainty and an ageing population. Which means longer wait times, fewer appointments and lower quality care for the people who need of it most. The NHS is beautiful, but broken.

The largest cost (£66bn+) is staff, who spend a ridiculous amount of time on mundane admin. 35% of NHS staff are employed to complete administrative work all day, every day. And that's where we're making a difference.

We're focused on relentlessly automating repetitive processes within the NHS. And we've had great early success. Our first product, Automated Registrations, is already used by 24% of GP practices in England. With this wedge in the market, we're now building more powerful tech that unlocks access to healthcare for the entire nation. Check out bookable.health for a sneak peek.

Our Principles

Exciting challenges lie ahead-guided by our principles, we'll meet these challenges with a thoughtful and caring approach to support our community of NHS GP practices. These principles drive everything we do at Healthtech-1:

1. Care deeply
2. Work hard
3. Be your word
4. Trust in radical truth and transparency
5. Do your life's best work
6. Find the fun

Read more about our principles in the Healthtech-1 Handbook.

We have an ambitious mission: to unlock access to healthcare by getting patients to the right appointment the first time. We are hiring a senior backend engineer to help us build secure, reliable systems for patients and clinicians and help us integrate the latest AI models into the patient care navigation experience. Check out bookable.health to see what we're building.

This is a place to do your life's best work.

You'll report to Laurence (Engineering Lead) and work cross-functionally with our product teams. The right person will have the potential to grow into a Staff Backend Engineer.

Hear Laurence talk about the role, p.s. he does smile!

The North Star the entire company is shooting for is 50,000 Weekly Appointments Booked (WAB) by September 2026. Whilst the product team that you're in might change during your time here, your goals at a high level will remain the same. These will look like:

1. Build something great, that patients and practices want. This means being a product engineer and seeking to understand the problem you're solving by working closely with product (designer/PM) and talking to users to deliver the right solution. When incidents occur, you seek to ensure they don't happen again.
2. Oil the technical engine. Technical debt is easy to build at a startup and scaling problems are easy to hit. You'll help us pay down existing debt, identify scaling problems ahead of time and propose new areas in the tech strategy.
3. Ship at pace. Your code should be high quality and delivered quickly. You should use AI and other tools to make the whole company faster. Your code reviews should keep our collective bar high.

You fully own:

• The quality and speed with which you deliver tickets
• The quality of your code reviews

You co-own (with product and engineering):

• Technical roadmap/technical investment items
• Reliability of the system
• The design of the solution

You influence (but do not own):

• The product roadmap
• Tooling and software that the company pays for to improve developer productivity

This role is not for everyone

This is a high-ownership, high-expectation role. You'll be working in a fast-moving healthtech environment where correctness, reliability, and speed all matter at the same time.

You probably won't enjoy this role if you:

• Prefer highly specified tickets over ambiguous problem spaces
• Need significant direction to make technical decisions
• Optimise for elegant abstractions over simple, robust solutions
• Are uncomfortable being on-call for the systems you build

You will enjoy this role if you like owning problems end-to-end and raising the technical bar around you.

By day 30: Understand our team and stack, and deliver early impact

• Spend your first week inside a GP practice to understand our users' world
• Understand your product team's goals and ways of working
• Understand our tech stack and the backend architecture behind it
• Deliver small and medium sized tickets, with some help/pairing
• Give code reviews in areas of code you become familiar with

Outcome: You've understood our context and shown ability to contribute to the team

By day 60: Building a reputation for reliability in the team

• Regularly shipping larger items with no significant issues or changes needed in pull requests
• Identified a meaningful area of technical debt or scaling risk, written a short proposal, and started delivering on it
• Able to understand warnings and errors and monitor the system for bugs

Outcome: You've proven your technical ability

90 days: Become a trusted voice and executor

• Delivered one larger user facing item which improves the product experience for patients or clinicians
• You've materially reduced risk or complexity in a core part of the system
• You are a trusted technical voice in product discussions
• Other engineers seek out your reviews and input
• The team ships faster and with more confidence because of your influence

Outcome: The team is moving faster and better because of you. You've shown ability to take a vaguely defined problem and turn it into a shipped, reliable solution

• High ownership: You feel personally responsible for the systems you build in production, including incidents and long-term maintainability.
• Strong engineering fundamentals: You have deep understanding of data modeling, API design, concurrency, and failure modes-not just frameworks.
• Product judgment: You can balance speed vs. quality and make sensible tradeoffs without waiting for permission.
• Strive for simplicity: You consistently choose boring, well-understood solutions over clever ones unless there is a clear reason not to.
• Comfort with ambiguity: You can take a vaguely defined problem and turn it into a shipped, reliable solution.
• Product care: You care deeply about building delightful and thoughtful product experiences, and are excited by the idea of speaking to practice staff.

Desired traits

• Strong TypeScript proficiency in large, long-lived codebases
• Designing and maintaining APIs used by multiple internal or external consumers
• Production experience with relational databases (Postgres preferred), including:
  • schema design
  • migrations
  • performance tradeoffs
• Experience operating backend systems in production (monitoring, alerting, incident response)
• Familiarity with NestJS or similar backend frameworks (e.g. Express, Fastify)
• Experience with data pipelines, analytics, or ML/AI system integration
• Experience working in regulated or high-stakes domains (health, finance, infra)

Required experience

• 3+ years as a software engineer
• At least 1 year at a startup/scaleup

A bit about us

We're all NHS staff. We're inside-outsiders. Trusted with one of the biggest datasets in the world.

Our office is within a GP practice. This is our unfair advantage. Got a question? Pop down the corridor. Want to learn how your work affects real patients? Pop downstairs to reception.

3-4 days in the office depending on your team. We highly prioritise in person communication. Our anchor days are Mon, Tues and Fri; and our flex days are Wed or Thurs. Homemade breakfast and lunch are on the house every day when you're in the office, ensuring you're fuelled for success!

We work in growth cycles. Every 8 weeks we do the same set of activities. 1 week outside of Business-as-Usual to research, strategise, plan our work. 7 weeks to knuckle down and deliver it.

We're highly collaborative. One of the benefits of a high trust team is we often work autonomously, but as a team we're very collaborative by nature. Two heads are often better than one, and we frequently lean on each other to solve problems together.

We're backed by industry leaders. We're on the DigitalHealth.London Accelerator, backed by the NHS Clinical Entrepreneur Program, winners of the London Business School Healthtech Challenge, Innovate UK, and Y Combinator (S23).

Paid volunteer days. We offer an additional 2 paid days off per year where you can give back to your mission of choice.

Every 8 weeks we take a day off to socialise as a team. In the past we've hiked box hill, raved at All Points East and spent one rainy day at Thorpe park. This works out as 6 working days a year.

Learning budget of £250 annually and time off to spend it - we care about this; this is flexible and based on need but everyone will receive a yearly allocation towards their continual growth.

Homemade breakfast and lunch are on the house when you're in the office, ensuring you're fuelled for success!

Health and fitness budget of £60 per month - see more here

An additional 7 days of paid leave is available if you want to take time to learn how to meditate.

Pension - We operate a standard 3% employer contribution and employees auto-contribute 5% of their salary. We use Nest as our provider.

Local living benefit - A one-off benefit to support living closer to the office: £5,000 if you live within a 30-minute walk, or £2,500 within a 30-minute bike. It is optional, available immediately on signing, and not linked to performance or progression.

If you choose to work late in the office, you can expense dinner after 7pm and an Uber home after 9pm, or earlier if you feel unsafe travelling in the dark. This is optional and about wellbeing, not performance or expectations.

⛵And of course, an adventure of a lifetime!

Inclusive & Diverse by Design

We care about building a product that is loved and a culture that is rich in perspectives, experiences, and backgrounds.

Our team represents more than ten different cultures. We come together every lunch time for a home cooked meal, rotated among team members!

We want everyone in our team to know that they belong. We are purposeful about this and are proactively building a company that is inclusive of all people; from race, religion, sex, sexual orientation, gender identity, age, neurodiversity, disability, colour, and national origin - essentially every type of diversity. We don't just want people who fit in, we want them to fit together. We're active in continually improving the way we make this happen.