A lot of private equity groups want to get into healthcare services. But all too often deal size makes it all but impossible for them to invest. If you set a minimum enterprise value of €250m you limit yourself to very few opportunities.

This leads to a dual structure with a few large players – think Cinven, Bridgepoint, HG Capital and Apax, now joined by uS outfits like Carlyle, Blackstone and KKR – chasing the mega deals across the continent and a plethora of smaller national players investing smaller amounts.

Recently, we have seen large private equity investors changing their tune. Advent has purchased small subscription healthcare provider CMU Unirea in Romania and Bridgepoint has launched a fund to invest in €20-200m acquisitions buying Swedish autism specialist Solhaga. Such deals make sense given the extraordinarily fragmented nature of the European market. For proof of what can be achieved, look at the daring merger of diagnostic labs Synlab and Futurelab carried out by BC Partners.

The bottom line? Private equity players who set high barriers will miss a host of opportunities. And, by not getting dug into smaller deals, they won’t expand their knowledge of the sector.