Balmoral Partners: £1B Track Record, 0% Fees, and a New Model for Healthcare Investment

Discover Balmoral Partners, a healthcare-focused investment and advisory firm with a $1B+ track record, zero management fees, and a unique model that returns 85% of profits to partners. In this exclusive interview, we explore their strategic work across domiciliary care, nutrition, and healthcare services — as well as their global structure with UK shareholders and a Dubai base of operations.

✅ Topics Covered:
– How Balmoral delivers strong investor returns
– The firm’s unique no-fee structure
– Their strategic focus on healthcare efficiency

📍 Learn more: www.balmoralpartners.global 

⏱️ Timestamps / Chapters:

00:00 – Welcome & Introduction to Balmoral Partners
00:34 – Ross Tompkins' Background in Healthcare & Entrepreneurship
01:53 – First Exit & Entry into Healthcare M&A
02:14 – 20+ Healthcare Deals in the UK & Australia
03:01 – Expanding to the U.S. & UAE Market Focus
03:40 – Embracing AI in Healthcare Operations
05:31 – What Sets Balmoral Apart: Empathy + Expertise
06:44 – Sector Focus: Care Homes, Med Spas, Peptides & Hormonal Health
09:03 – Ideal Deal Size & Acquisition Sweet Spot
12:28 – Zero Management Fee Model Explained
13:02 – Red Flags: What Balmoral Avoids in Healthcare
15:38 – "You're Not a Businessman": The Balmoral Culture
17:16 – $1B+ in Transactions: Real-World Track Record
18:43 – How to Contact Balmoral Partners


#HealthcareInvesting #PrivateEquity #DomiciliaryCare #BalmoralPartners #HealthTech #InvestmentStrategy  #UKInvestors

Transcript

Welcome, everybody. My name is Richard C. Wilson, founder of the Family Office Club,
and we're excited to have with us here today Ross Tompkins, who is the head of
Balmoral Partners.
Interestingly enough, they're one of the few members of our investor club focused on
healthcare. Many times we have real estate firms, manufacturing companies,
private equity groups that are diversified across many industries, football mall is
focused on healthcare and they're based out of Europe and I have with me here Ross
is going to introduce their team a little bit, their strategy. Welcome Ross. Thanks
very much. Have me Richard. I'm looking forward to it. Yes. And I know you have
over 35 years of experience in healthcare and you've helped close a couple and
transactions in the space. Can you talk a little bit more about your background and
how you first got into the space to begin with? - Yeah, sure. So by background, I'm
actually a physiotherapist. So I trained in the nineties or a physical therapist. I
think you call me on that side of the world.
Started off in the NHS, which is our free healthcare system over here in the UK.
And after only 18 months, I realized it wasn't for me and I wanted to be a little
bit more, I want to spend a bit more time with people and really make a
difference. That quickly led on to me realising I needed to be my own boss.
So I started my first business back in 2006, which was an occupational health
business. So OSHA on the thing on your side of the world, we employed doctors,
nurses, physiotherapists, and helped large employers keep their staff healthy and at
work. Now we grew that up quite steadily over a number of years until eventually we
sold that business and that really was the catalyst where I realised that you could
buy and sell businesses and you could see exponential growth in an afternoon as
opposed to you know decades of hard work and going through that same sort of growth
period So since then, as you alluded to before, you know, we've done over 20
transactions in the UK and Australia and I'm looking to continue that through into
the US and further afield. Okay, great. What's the regulatory framework like there in
the UK? Because, you know, in the United States, there's certain rules and about
owning medical practices or certain types of medical businesses. How complicated or
challenging? Is that for you?
It's different all over the world. So everywhere's got its own version of the
legislation and red tape. But as long as you're comfortable with it and obey with
it, it doesn't really generate too much of an issue. Same as in the US, where you
might have to have a physician that oversees prescribing protocols, or a pharmacist,
it's the same in the UK. We just have a regulatory body, we have the MHRA as
opposed to the FDA. Okay, got it. And then what about your geographical focus? Where
are you really looking for acquisitions or investments? So up until this year,
all of our acquisitions had been in the UK. And this year, we've placed our first
investment into an Australian bariatric company, looking quite heavily at the US for
a number of years, haven't quite got a deal over the line yet, and Balmoral
Partners we actually incorporated in the UAE in December of last year,
so we've got a much stronger focus on the Middle East as well. Okay, and what
about healthcare related artificial intelligence or robotic investments? Is that an
area that you're excited about or are you avoiding it for some reasons? Super
excited, excited. I think any company that doesn't embrace AI right now is probably
making a mistake. You could be fearful of it, or you can embrace it. And I think
if you embrace it, you've got a choice. You can either say acquire a company that
has 10 staff and get rid of nine of them, because one of them could probably do
the work with AI, or you could take that same company and make those 10 people do
the work of 100. And we're definitely looking at the latter than trying to enrich
people's lives, grow companies, grow the headcount rather than call people. I think
you can do both. Right. Right. Yeah, it makes sense. And I know when we connected
a few weeks ago, you're giving examples of some minority equity deals. Sometimes when
people think of private equity, they think of buyouts, 50 % more equity. So they
control the exit, then maybe you can control the hiring and firing and strategy with
with a strong hand. Why have you gone the minority route and then how do you
influence the exit and what happens after the investment as a minority investor?
So our typical structure is somewhere sort of between 10 and 50 percent where we
come on board more of the strategic advisors. So it's companies that know they are
destined for more but they don't quite know how to do it. So they're looking for
access to capital or they're perhaps looking for expertise, networks,
relationships, and that's what we've realized over the last few decades that we're
good at. Okay, makes sense. And then what about unique edge in terms of what makes
you different than other healthcare investment firms? Obviously, being open to minority
investments separates you from some. What else really sets you apart when you look
around at others in your space? The biggest thing is actually the intimate knowledge
that we've got of the healthcare space. Healthcare is for many people seen as a
recession -proof business. So a lot of funds invest in it because they see it as
quite a safe haven for their funds. But we have a slightly different view.
One, yes, it's a safe haven in recession because we're all getting older despite the
fact that we are technologically advanced with the most infirm we've ever been so
you know it's a growing business for sure but we've also got that intimate knowledge
as well so that means that we can not only talk about this from a financial
perspective but also from a plate of empathy so we actually put the person first
the patient at the end of the day And we think there's a very good way that you
can actually grow a business at the same time as doing right by the patients. And
I think that's where we really separate us up. Okay, sure. And then we've done some
investments into like, you know, dental practices, med spas, you know, and what we've
found is that, you know, a health tech company is obviously very different than a
dermatology clinic or a, you know, um,
you know, improvement process you do in a dental clinic. So what what sectors are
you focused on? Because I've just found that some operate very differently than
others. And there's a whole new learning curve in some of these subsectors. It's not
like every healthcare business runs like every other one in my experience. So what
what's been your your path on that or your your focus on that right now? Yeah, so
we put a number that we're quite excited about. So one is the the care home
sector. James, the co -founder, he was 10 years at PWC,
he is an accountant, then he went on to be the head of Mergers and Acquisitions
for HC1, who were the largest healthcare provider private in the UK. They have 20
,000 employees, 800 million in revenue and he did 500 million in transactions for the
last few years. So we've got a great knowledge of the care home space And that in
that space alone, we know by 2050, there's 200 ,000 too few beds available for the
amount of people that are going to be over 65 and in need. There's a huge area
there of growth. Also, a passion of mine is you mentioned med spas,
hormonal health. This I think is a real growth area, particularly with, you know,
GLP1 sweeping the world over the a couple of years with the weight loss medications
and peptides, the huge strides being made there. And I think the peptide therapy
combined with now the next frontier of medicine being psychedelics as well, there's
going to be a lot of big changes happening in medicine over the next decade or so.
Right, yeah, I think that cannabis got legalized in many states, in the United
States, and I feel like psychedelics are, you know, on that same path over time,
sometimes moving faster than other years it seems, but it seems like it's on that
path here in the US at least. And in terms of your deal sizes,
what do you do to get around the fact that most of the time when someone has one
to three million or especially three to five million of EBITDA or profits, you know,
they're getting offers every month from someone. You just win them over with the
advisory approach and you're obviously providing way more than capital. You're really
providing that those insights and opening doors of distribution etc. Or how do you
compete out there in the marketplace? Very much the latter there. So it's this full
complement of services that we offer where it isn't just access to capital but it
is access to networks, to supply chains and to all of our existing network and
that's what really really does separate us I think from the other people that are
out there. Okay and what about deal size do you work with startups mostly or you
know five million plus in EBITDA what's the focus? So one to five million revenue
sort of half a million to two million EBITDA seems to be about the sweet and
before the multiples become too high, which are too large for us, it's current stage
of our own evolution. And too small, then it's just too much for headache.
I don't think they're quite ready to grow. - Right, right, got it.
And are you approaching it as kind of a, find a platform company and then little
bolt -on, you know, companies in the same industry, or if you have 20 or 30
holdings of bone marrow partners are they are you looking to have them all be very
diverse in nature it was kind of in your approach strategy wise. So so far you
know we've we've bought a medical supplies and pharmaceuticals business a medical
device company a dinosaurry care or home care company we're just in the final stages
of a care home business we then have a biotetics company, we have the men's health
company, and each one of those can be acquisitive. So the goal is that Balmoral
partners will have 25, 30 verticals, all of them broadly under that health umbrella,
and each of those will be acquisitive. So it should very much be an accumulative
thing. So with this first year, we're going to look to do 10 acquisitions with on
six in the first half. And year we'll have the 10 from this year but we'll all
hope you do another acquisition and then we'll have the new ones from next year. So
the returns for our shareholders should just grow exponentially. Sure. And then what
about the timeline? So if you meet somebody today, like let's say that one of our
listeners is in the healthcare space and they'd like to work with you, what's kind
of the general timeline they should expect to, you know, meet with someone like
yourself and then actually negotiate and close the transaction is that nine months,
three months, two years, what's the general timeline?
I don't think there's a hard and fast rule that we've discovered. I wish there was.
Probably the quickest we've ever done something is probably three months. And this
last deal we've just done, which we just signed back end of last week, I started
talking to them in
And so that's six years. Right. Right. Right. Yeah. What about deal structures or
anything unique that you offer to CEOs that you invest into their companies or
anything unique you offer to investors on the deal structure side of things? I think
again, it comes down to the fact that we're quite dynamic. So there isn't just the
one -size -fits -all. We're not a cookie cutter solution where it's going to be X, Y
and Z and you're going to get what you're given. We really do work with the
founders, work with the senior management to make sure there is a good fit. So in
some instances, it might be we come in with 10%, some people that it might be
more, sometimes the senior management maybe want to take a stake or others they want
to take a step back. So we can really be, as I say, why diverse in our approach.
- Sure. And what about fee structures to investors? What did you come up with there
and why did you take that approach?
- So yes, both James and I felt quite strongly that there shouldn't be great big
fees coming out of Balmoral, which we've seen quite often over the years. And I
think it's best to see through that quite quickly as well. So we have a management
fee, a basic management fee that comes from the company and that pays for for
HeadCamp and then all of the proceeds go back through to Shells. Okay and then in
terms of areas you're avoiding in healthcare or types of CEOs you're avoiding, are
there some red flags or some sectors you just really don't want to waste any time
on yourself?
Definitely found that home care is a difficult sector to be in after doing four
acquisitions in that space, it's probably not one that we would go into again, and
for sure. In terms of who we want to work with, really, we're looking for growth
-minded individuals, not those who already think they have all of the answers,
and certainly people that we get on well with, because for us, you know, we feel
business should be fun as well. You've got to enjoy going to work, and then I
think you can really make a difference that way. Right, right. What would be, you
know, after 30 plus years in health care, what would be like a number one insight
or some sort of counterintuitive lesson about the health care industry, investing in
health care, that maybe an investor who wants to allocate to five or ten different
groups like Balmoral maybe doesn't realize from the outside looking in is just
getting started on how to invest in the space. I think one of the things I learned
quite early on and probably because I am a health care professional at heart and
that's how I started and most health care business owners are heart led they're not
finance led and that will completely change how you have a conversation with someone.
So if we go in there on day one and start asking for forecasts and EBITDAs and
multiple multiples of XYZ it can make them feel quite threatened. And actually,
that isn't why they started the business. They started with the business to change
people's lives. And I think as an investor wanting to get into healthcare, it's
really relevant that you appreciate that because it will change how you build rapport
and how you open a conversation with someone. - Yeah, that makes sense. Here in the
United States, private equity has acquired so much of healthcare already that a lot
of doctors do not like it because of what you said. It changes that dynamic. Now
they're thought of as productivity measures in KPIs and as a machine, and they have
to see 90 patients every two hours and just a bunch of things that make it so
it's harder to deliver that care. And so a lot of times, some people in the
healthcare space are wanting to make sure that the zone actually cares about the
actual delivery of value to the patient is left in charge after a firm like yours
makes the investment. That's not completely swapped out for some suit from private
equity that just wants to grind everybody down, right? Yeah, exactly. As you can
see, I never go anywhere in a suit. I've got teacher shorts and a cap on most of
the time. And actually on a number of occasions, and this happened on more than
once, more than one occasion, and it took me a while to figure out it was actually
a positive because early on a number of people said we like you Ross because you're
not a businessman and it took me a while and eventually I thought you know what
that's actually really a real compliment because they mean that I'm not there
pretending to be someone I'm not in a suit you know just going to rip everything
out of the company and drive profits we do care about the people at the end of
the day. That's that's so funny. Yeah, I had my Lululemon v -neck shirt on before
this. And I was like, you know what, I better put on a suit shirt in case Ross
is a buttoned up, you know, tuxedo cummerbund guy. So that's,
I can relate to that. I live, I live out in Hawaii. And it's not the most formal,
formal culture in the world, in the Hawaiian islands, as you can imagine. So I
think that at the end of the day, sometimes people that where the fanciest suits
are the lawyers and attorneys or somebody trying to sell you something from an
investment bank. And it's kind of like the way overdressed are usually trying to
sell you something from a big corporation is my experience.
What else should I have asked you that I have not yet about your model,
about health care, about investing in investing in healthcare, et cetera.
- To be honest, Richard, I think we've covered most things. I think the one thing I
really wanted to get across is firstly, it's our experience, our deep experience in
healthcare. We're not just there talking about it. We've lived it. We've been in it
for 30 odd years. Myself, James and our senior advisor, how one of our board
members have done over a billion dollars of transactions in the last three, four
years alone. So we're not brand new to this space either as a provider or as a as
a fund manager as well. So that's probably the most important thing. And then the
second part, which again, we talked about was the fact there is this big difference
between being heart led and being putting the patient or the client first and still
still having a profitable business as well. Right. I think one thing that stood out
to me review on my notes here before we started was just that so many private
equity companies used to only look at 5 to 10 million EBITDA. And then if they
were lower middle market, 3 to 5 million EBITDA, it seems like with your focus on
1 to 5 million in revenue, you're maybe catching some of these platforms before they
get on the radar of the private equity firms that at a very minimum usually look
at 1 to 2 million EBITDA to even be worth their time to look at. It seems like
that's a pretty unique feature that combined with the minority equity stake approach
that you're open to. Those two things to me, just from running our investor club
for 18 years, I don't think I've met someone else in healthcare that really has
that type of a focus. So that kind of stood out in my notes while getting ready
here. What's the best way for someone to reach out and get a hold of your team?
Maybe they have a business that they invested in or they were involved in a startup
and now they're ready for private equity capital from someone like yourself. Maybe
they're a doctor, dentist or a family office investor and they want to invest back
in the healthcare and they liked what you said. I mean, what's the best way for
them to get in touch with you and your team? - Obviously through your directory
would be one straight to our website, which is Balmoralpartners .global or from a
social media perspective that I really am most active on LinkedIn. So just my name,
Ross Tomkins. See how I post on there several times every day. And so that's a
good place to get me as well. - Great, sounds good. If anybody listening is already
in an email conversation with myself or you see me at one of our investor club
events, just let me know if you need an introduction to Ross and happy to do so.
So I appreciate your time here today, Ross. And thanks for all your insights.
- Thanks, Richard. Have a great day. Take care. Thank you. Bye.
All right. I'll have mine. That was great. I think it was good. We covered a lot
pretty quickly. You had nice, relatively concise answers, usually to get through that
many questions. It takes us 35 minutes, sometimes 40 minutes because people talk for
a long time after every answer. I was aware you said you wanted to try and keep
it quite concise because I do sometimes have a habit of waffling on so I thought
I'd get it short. No, you didn't at all. At one point I looked down and it was
only 13 minutes in or something and we had covered like more questions than expected
in that time and so that's great. And when we get it done, you know, I didn't
hear anything that sounded bad at all but you know as you think it over if you
want us to cut out a question or two that you thought were half boring or like
repetitive or something then you then just let me know and it's super easy for our
we've got like full -time video editors that can just tweak things easily. Maybe what
it could ask them to do as well is look at the materials we have for you and the
pitch deck and see if we can edit in some visual pulls of some of the investments
that you've done or maybe show a picture of James etc when you're talking about him
and then have that kind of so it's not just a little bit more dynamic and it's
not just us speaking the whole time perhaps. - Yeah, sure. And we've got our founder
videos being created tomorrow on Friday, so a video joining us from London tomorrow
and Friday. So that should be done by next week. - Okay, hopefully James is feeling
better for that. It's not fun recording a video for feeling sick, right? - Yeah,
definitely not. I've been out of the country for the last four weeks. So it's
already taking a while to get that done. I literally got back to my house about 45
minutes ago. Oh my gosh. Yeah.
Well, I started in about five weeks ago when I was in Alaska, went to climb Denali
and then I altitude sickness. So I had to be flown off the mountain and I went to
India to a longevity centre out there. I had every kind of test known to man to
try and accelerate this healing and 40 % of my right lung has a dimmer in it
still. Left there, started treatment, went back to Dubai, which is off to our new
base, spent a week there, very variety of meetings and I was out in St.
Louis and Denver for a week and then last week I was in Mexico with my wife,
she came over and we met for a week on holiday. - Wow. - It's switched from the
night. Yeah, it's switched from night. I had a temporary residency from Mexico, but
I'm now a permanent resident there, so. - Oh, cool. Okay, we did one of my investor
friends in the medical space, he sold his dental practice, was here yesterday with
14 of his family members at my house here in Hawaii for the day, and he did
Everest Base Camp with me, and we did like a 10 day trek up there, and I got
really bad altitude sickness at Everest Base Camp. And we tried to fly in like a
rescue helicopter for me, but there was a blizzard. So I couldn't get taken down.
So I had to spend the night in a seven degree lodge with no heat. And it was
like a worst night of my life. I didn't have like fluid in my lungs, but anything
else you can imagine of bad altitude sickness. It was pretty extreme. But yeah,
so I know a little bit about what some of that feels like, you know, but yeah,
interesting that we do, we do a group of friends, we go to like Machu Picchu, we
do like the Narrows in Utah. We've done the Grand Canyon 11 times and we did rim
to rim to rim and did a 43 mile trek without stopping and stuff.
We like doing stuff like that. We don't do technical mountain climbing or like K2
summit or Everest summit, but everything else below that we enjoy. Yeah. Fantastic.
We never know, maybe we'll get to do one together one day. Yeah, yeah, yeah, for
sure. So all my team work on this and then we'll get in touch and let us know
and then hopefully we'll see you at one of our events this year. You know, our
Beverly Hills event is in September. We have our annual event in December in Fort
Lauderdale. We'll see if one of those line up with your schedules. Yeah, definitely.
I think change is going to come to the Beverly Hills one. I think both of us will
probably come out in December. Okay, awesome. Yeah, that's our best one of the year.
It's the biggest one. Excellent. Oh, Richard, it's been a real pleasure. Thanks for
taking the time to ask me these questions today and looking forward to working
together. Yeah, you too. Glad you're feeling better. Take care. Thank you.