Our Entrepreneurs: Dr Arjuna Imbuldeniya
Welcome to #OurEntrepreneurs, a series where we meet our innovators and uncover what inspired them to create change. Today, we’re delighted to introduce Dr Arj Imbuldeniya, joining us from Chelsea and Westminster NHS Foundation Trust.
Tell us a bit about yourself
I’m Dr Arj Imbuldeniya, a consultant orthopaedic knee and hip surgeon. Over the last two years, 8 in 10 patients I saw did not go on to surgery. That is not reluctance to operate, but knowing precisely when surgery helps and when it does not, and moving quickly in both directions.
I am building Orwyn, a surgeon-governed decision support tool for musculoskeletal frontline clinicians, starting with the knee and then the hip. It came from over a decade of watching the same thing happen. Patients wait too long to see the right person, and the decision that shapes everything afterwards gets made without the surgical input it needs.
I have been an NHS consultant at Chelsea and Westminster for over a decade. My work spans the full range of modern knee and hip surgery, from biological and regenerative treatments through to robotic-assisted joint replacement.
I also practise privately in central London, where I run OrthoLongevity, a personalised approach to treating knee and hip problems. Orwyn is a separate venture with a separate purpose. It is built for NHS clinicians, and I have kept the two deliberately apart.
Name: Dr Arjuna Imbuldeniya, NHS Clinical Entrepreneur Cohort 10
Occupation: Consultant Orthopaedic Knee and Hip Surgeon
My drive is personal. My father died at 50 and my grandfather at 42. Now, approaching 50 myself, with four children including a toddler and a baby, I am building a model of orthopaedic care that I follow myself, that keeps people moving, gets them to surgery quickly and precisely when they genuinely need it, and gives them a real plan when they do not.
What is the problem or challenge you are addressing in the NHS and why is it important?
Musculoskeletal conditions are among the most common reasons people seek care in the NHS, and demand is rising sharply. The clinician who sees them first is asked to make a decision spanning the whole pathway, from biology through to surgery, without ready access to the experienced surgical input that decision deserves.
That first decision is the one that matters most. Get it right, and the patient moves quickly onto the correct pathway. Get it wrong, and they may spend months in a conservative pathway while a treatable problem becomes permanent, or be escalated towards surgery they never needed.
North West London’s own commissioners have minuted a surgical conversion rate of only 17% for the existing pathway. Most people who reach an orthopaedic surgical clinic do not go on to have an operation. That is not a criticism of the clinicians referring them; they are being asked to decide without the input the decision requires. But two groups of patients lose at once. Those who need surgery wait behind people who were never going to have it, and those who do not need surgery spend those same months waiting to be told so, when their treatment could have started at the beginning. Fill those clinics with the patients who genuinely need or want an operation, and both waits get shorter.
There is a second reason patients end up there. Many want to hear it from the surgeon, even when the advice is word for word what the physiotherapist already gave them. That is not irrational. It is the whole problem in one sentence, and it is what Orwyn is built to solve.
So the challenge is access to surgical expertise, not the ability of the workforce. First contact practitioners and triage clinicians are skilled people doing a hard job at volume. What they do not have, and what the system cannot afford to place at every front door, is a consultant surgeon sitting alongside them.
Tell us about your innovation
The gold standard would be an experienced consultant orthopaedic surgeon assessing every patient early. At NHS scale that is unaffordable. Orwyn is the next best thing.
It brings a surgeon’s reasoning into the room alongside the clinicians already there, and it works with them, not above them. A working prototype already exists. During the consultation, the clinician answers a short set of questions, and Orwyn does three things.
It screens for what must not be missed, the septic joint, the fracture, the ruptured extensor mechanism, the truly locked knee, and states plainly what the consequence of missing it would be. It sets out non‑surgical treatment in the order the evidence supports, and tells the clinician which of those options this patient can actually access, free or funded, in this borough, and which they are not eligible for. And where a case genuinely does not fit, it says so and routes it to a human conversation rather than forcing an answer. The hard cases defeat flowchart logic, and a tool that pretends otherwise is not a safe one.
The criteria are mine, written down as explicit rules rather than hidden inside a model, and they are being reviewed by clinicians who are not me. There are no confidence scores. Every recommendation can be explained by pointing at the rule behind it, so a clinician who disagrees can see exactly what they are disagreeing with, and override it.
The second half is still to build, and it is the part that matters most to the patient. Before they leave the room, the clinician hands over a page they can keep, in plain language and printed if they have no smartphone. It sets out their plan, the programme and venue with a date already booked, what would change the answer, and when to come back. It includes a short video from a consultant surgeon at their own hospital, recorded alongside a consultant physiotherapist, because the plan is the physiotherapist’s. Nothing is asked of the patient in return – no app, no login, no password to remember.
A plan is only followed if it is believed, understood, and realistic enough to actually do.
Why did you join the programme and how do you hope it will support you?
I first heard about the NHS Clinical Entrepreneur Programme through colleagues on the intensive eight‑week BiteLabs HealthTech Fellowship, and from Dafydd Loughran, Chief Executive of Concentric. I applied because I am building something that only makes sense inside a health system like the NHS, and because I would rather change how thousands of patients are handled at the front door than only the ones I can reach myself.
I am a senior clinician, not a technologist or a commercial founder. I want to learn how to navigate regulation for a clinical decision tool, how to generate evidence that earns adoption rather than interest, and how to build the right team. I want to be challenged by people who have already taken health technology through regulation and adoption, the parts of the journey a surgeon is not trained for. I hope it opens doors to the data, the pilot sites, and the decision makers who determine whether something like this reaches patients at all.
What are your ambitions for the next year?
Over the next year, I want to move from concept to evidence and to a working prototype we can test. That means finishing the referral audit, writing the knee routing criteria down properly, and seeking a real‑world pilot at Chelsea and Westminster that generates outcome data rather than opinion. Knee first, then hip, co‑designed with the people who will use it.
I also need to settle the regulatory classification and the clinical safety case, because anything that influences a referral decision has to withstand that scrutiny long before it reaches a patient. If I end the year with early evidence, a clearer working first version of the product, and the right people around me, that is success.
Why do you think innovation is healthcare is important?
The NHS cannot meet rising demand by doing the same things harder. We will never have enough consultant specialists to see every patient early, so innovation is how we put that expertise within reach of the workforce at the front line.
I’m building software, so I need to be careful here. The software itself is not the innovation; the innovation is that a consultant surgeon’s judgement becomes available at the front door, in a community clinic, on a Tuesday morning, to a clinician who would otherwise be deciding alone. Everything else is delivery. It has to produce better decisions, made earlier, by the people already in the room, as well as plans that patients are willing to accept and able to follow. It has to work for people who are not comfortable with technology, otherwise it isn’t truly improving access. Get the first decision right more often, and we treat the right problem at the right time, use scarce capacity well, and prevent more patients from falling through the gaps.
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