Why a Physio Who Lost 70% of His Revenue Started Buying Clinics

Ross Tomkins calls himself an accidental entrepreneur. He qualified as a physiotherapist in the 1990s, left the NHS quickly because he wanted an hour with each patient rather than twenty minutes, and started his own business in 2006 simply to be the best physio he could be. Because he was good at the job, patients came back, and the business grew to 35 staff without any plan to build one.

The turning point came a week after he published his first book, The Business of Health, when the business lost its biggest client and, with linked contracts, around 70% of its revenue.

It pushed him towards mergers and acquisitions as a faster way to grow without depending on one client, and after the first deal he realised you could double in an afternoon.

He has since done 29 deals, acquisitions and exits, and now runs Balmoral Partners, a healthcare holding company incorporated in the UAE and buying in the UK and the US.

Much of the conversation is about identity. Ross describes years of introducing himself as a physiotherapist while spending most of his time on contracts and hiring, cutting clinical days from five to two.

The switch flipped the day he told his wife he hadn't been the best physio he could be, because he had been thinking about a contract review while treating a patient. It took six or seven more years before he gave up his licence.

What helped was accepting he didn't have to be the best at everything, hiring people better than him, and seeing his impact through the businesses he owns rather than the patients he treats.

On AI, he sees older operators worried and younger ones excited. Across Balmoral the savings so far are in the back office, and he frames them as ten people doing the work of a hundred rather than cutting nine jobs in ten. Marketing AI hasn't delivered yet, and he is wary of self-styled experts who weren't experts three months ago. He remembers being the last person in his own clinic to move from paper notes to a practice management system.

Asked where the bar should sit for new technology, his answer is the patient experience. Minutes saved on notes become minutes spent with the patient, and better experience feeds retention and word of mouth. Looking ahead, Balmoral's three main areas are elderly care, mobility, and a ketamine clinic roll-up in the US.

His biggest lesson is to be more careful about who you go into business with. Entrepreneurs like shiny things, he says, and everyone pulls in the same direction until something goes wrong, so he now spends time with potential partners at dinner, on the golf course or at events to see how they treat people before deciding.

He sees consolidation as a real opportunity for clinic owners to find a partner to help them scale or to make an exit that could change their lives.