Fractional-first teams in life sciences: a private equity perspective

A fractional-first operating model uses experienced professionals for defined work before a company commits to a larger permanent organisation. For private equity investors in life sciences, its value depends on how the work is governed, how knowledge is retained and when the organisation will need to internalise capacity.

The choice is often framed as building a local affiliate early or remaining flexible for as long as possible. A more useful question is which capabilities are needed at each stage, and how the company will move between stages without losing continuity or control.

Define the model before comparing the cost

In this article, fractional-first means engaging senior specialists or a coordinated team on clearly defined mandates, with agreed deliverables, scope, timing and decision rights. It can support medical strategy, market access, regulatory coordination and commercial preparation.

The label alone does not tell an investor how the business operates. An individual adviser, an interim executive and a multidisciplinary team may solve different problems. Compare the actual work and responsibilities, not simply the day rate or the number of external people.

The trade-off: fixed commitments and organisational uncertainty

An early affiliate can provide continuity, dedicated capacity and internal knowledge. It also creates fixed costs before local demand and the access pathway are fully understood. In smaller markets, those commitments deserve careful testing against realistic scenarios.

External expertise can make capacity more adaptable, but flexibility has its own costs. Poor coordination, unclear ownership and repeated handovers can slow decisions. A model that appears inexpensive can become difficult to manage if important knowledge stays with individuals outside the organisation.

The investment case should therefore compare total cost and execution capability under several uptake and timing scenarios. A lower initial cost does not by itself demonstrate a stronger operating model.

Where focused senior expertise can help

Early market entry often requires judgement at specific moments: testing an access strategy, mapping the care pathway, reviewing evidence assumptions or designing launch readiness. Those tasks may need deep experience before they need a large team.

A coordinated group can help connect medical, access, regulatory and commercial perspectives. The benefit depends on how the team works together and how its findings reach the people making decisions. Adding several independent specialists without a shared plan does not automatically create a team.

Make governance explicit

• Ownership: name the accountable sponsor and the person authorised to make each material decision.
• Scope: define deliverables, boundaries, dependencies and escalation routes.
• Responsibilities: document the relevant regulatory and compliance roles for the product, country and activities.
• Knowledge: keep assumptions, contacts, decisions and working documents in systems the company can retain.
• Review: agree how progress, quality and changing requirements will be assessed.

Contract wording should match the real working arrangement. The appropriate allocation of responsibilities and employment or contractor status requires assessment for the specific situation; “fractional” is not a legal exemption or a guarantee of compliance.

Decide when to internalise

Plan the transition before it becomes urgent. Useful review triggers include a more stable access position, clearer recurring workload, an expanding portfolio, sustained demand for local execution or a growing need for continuous internal coordination.

These are prompts for a decision, not universal thresholds. Some specialist work may remain external while other capabilities become permanent. Define who will make that decision, which evidence they will use and how the handover will work.

Questions for investor diligence

• What would the operating model cost under delayed, base-case and faster uptake?
• Which costs are genuinely variable, and which commitments remain?
• Who holds decision authority and owns cross-functional coordination?
• Can the company retain the knowledge needed if a provider changes?
• What is the expected cost, timing and operational impact of internalisation?

In the Benelux, assess the work country by country while identifying where regional coordination is useful. Avoid assuming that a compact geography removes differences in access processes or stakeholder environments.

Flexibility needs a destination

A fractional-first model can be a deliberate stage in building a business. Its strength lies in connecting flexible expertise to a clear operating plan, with ownership and transition decisions made visible from the start.

Explore Health Devotion’s Business Setup & Implementation services or discuss the team and capabilities your next stage requires.

About the author: Ivo Vink, Health Devotion. This article offers an operating-model perspective for life sciences leaders and investors.