Training for a Marathon? You Had Better Be…

As Christmas approaches I am nearing the end of three months of relentless travelling around the UK and Eire, speaking to audiences, listening to clients and in conversation with those who can influence the future. If you have been following the ezine, the blog and the social media streams you will know how mad and inspirational it has been. Summarising the ‘state of dentistry’ as is stands at November/December 2010:

1. between 2012 and 2015 we know that
   

2. the UDA system will be gone

3. the PCTs will be gone

4. Orthodontists are worried about what will replace the UOA

5. GDPs are wondering what on earth next?

6. CQC registration packs finally being picked up and read by long-suffering dentists, their spouses or their practice managers

7. there will be a raft of new compliance and regulation
   

8. all of the above will be replaced by new systems (as yet unspecified) that will focus on
   

9. the patient experience and

10. the quality of diagnosis and treatment planning

11. The CQC are searching for ways to identify fully private practices for registration and regulation (more difficult to find you than you might imagine)

12. the corporates are committed to getting bigger
    

13. IDH have announced a plan to grow from 300 to 1000 practices

14. IDH are reported as being ‘up for sale’ – this make zero difference to their plans – “the banker is dead, long live the banker”

15. Oasis and ADP appear to be gearing up for expansion

16. J D Hull demonstrates the characteristics a rudderless ship, nobody outside can tell if the ship is taking on water or not (I sometimes wish somebody would call and ask me to run it)

17. there are increasing numbers of micro-corporates, mini-corporates and mid-sized corporates springing up – privately owned – mainly NHS

18. the major corporates are still primarily interested in buying NHS-only – they see great future risk in buying private because of overall economics and the difficulty in recruiting good private associates

19. Gary Chapman (former JDH acquisitions manager) is buying private and specialist practices on behalf of Portman Healthcare – looking to replicate the bits of JDH that worked

20. the retailers may or may not have decided to take part – if they do – big change
    

21. Sainsbury – 4 practices now prospering by offering ‘cheap as chips’ private dentistry

22. Tesco – up and running in Slough with the same offer as Sainsbury

23. Tesco – reported as acquiring planning permission for in-store dentistry in Scotland, opening deferred until early 2011

24. Boots – new CEO expresses interest in ‘well-being services’

25. House of Fraser – developing in-store high-value dentistry by concession

26. Strong reports that hygienists and therapists will be granted direct access during 2011
    

27. registration course under construction

28. GDC seeking opinion

29. first hygienists and therapists able to run their own businesses sometime in 2011 (or work unsupervised in dental practices)?

30. Smilepod working well in Covent Garden and planning to expand

31. in general dentistry, do therapists at 35% represent a good alternative to associates at 50%?

32. Marketing systems in dentistry booming
    

33. modern branding throughout independent practices

34. web sites that capture date and encourage enquiries

35. social media marketing strategies

36. relationship based marketing being taken to new heights

37. local B2B networking rising in importance

38. print media and directories declining in importance

39. direct marketing declining in importance

40. radio and signage rising in importance

41. Sales of certain products and services in dentistry are booming
    

42. whitening in all its forms

43. facial and medical aesthetics

44. veneers

45. Cerec crowns

46. Lingual ortho

47. Dental implants

48. Denture stabilisation

49. high value smile makeovers

50. high value recon and rehab cases

51. Properly branded membership schemes

52. new patient assessments with treatment co-ordinators (TCOs)

53. Sales of other products and services are under pressure
    

54. new patient consults with clinicians

55. maintenance dentistry (check ups)

56. maintenance hygiene (S&Ps)

57. some capitation schemes are in net membership decline

58. Invisalign – very interesting
    

59. an Invisalign price war has started in London (latest Google search reveals Invisalign at £1450) and is spreading

60. signs of panic from dentists holding large stock

61. some dentists jumping off the bandwagon and offering ‘6 month smiles’

62. changes in the people who populate dental teams
    

63. telephone and reception separated in practice

64. Welcome Team members trained to a much higher level

65. TCOs appearing everywhere

66. Values-based selling skills rising in importance

67. Payment plans now considered standard practice

68. Business Development Managers appearing everywhere – often no previous dental experience

69. Increasing recognition of the business case for therapists

70. And its getting harder to manage multi-site practice and be a dentist as well, unless you have a world-class management team

71. Some demographics are buying dentistry:
    

72. 25-35 singles or DINKIES

73. 35-50 “Yummy Mummies”, “Desperate Housewives”, “Glamorous Grannies”

74. affluent over 50s (all social classes)

75. affluent over 65s

76. all gay men

77. And some are not
    

78. ordinary families

79. teachers and other academics

80. engineers (except for higher-value treatment plans)

81. public sector workers

82. Some price levels are selling well
    

83. anything below £120

84. anything over £3000

85. Some price levels are difficult to get agreement on
    

86. anything between £120 and £3000

87. It is pretty obvious what’s going on here
    

88. patients are buying if its cheap

89. patients are buying if its paid for from capital/assets (might as well – returns on investment are lousy)

90. patients are not buying if its paid from discretionary income

91. Some geographical areas are feeling the pain already
    

92. inside the M25

93. The Republic of Ireland (where there is now emigration of hygienists and dentists)

94. Some geographical areas are felling fine
    

95. everywhere else

96. But you do need a location that exposes you to the demographics above who are buying

I could probably go on – but by now you must have the picture. The best are getting better. The weak are getting worse. The middle is dropping out of the middle. Let me repeat. The middle is dropping out of the middle. Its the most dangerous place to be. My biggest source of new business enquiries (for business coaching) right now? “Hi Chris, I’ve been reading your stuff for some time now. I’m setting up a private squat with family money. We have the location, the property, the planning permission and I want to open in 6 months. I need you to co-ordinate the launch and the successful establishment of the business.” Im astonished at how often a version of that email or voice mail arrives – perhaps once a week at the moment – all over the UK. My second biggest source of new business enquiries? “Hi Chris, my practice is successful but we have stayed the same in terms of sales and profitability for three years now – I need you to come in and show me how to break through to the next level. To help me re-brand, retrain the team, re-edcuate the patients and establish new models of business that will secure me in the next 10 years.” My third biggest source of new business enquires? “Hi Chris, I’m thinking that in the next 5 years I’d like to have the option of either slowing down or getting out of the rat race altogether. I need you to help me figure out my end game and clarify for me how best I can create a succession plan for the business that benefits me and my family but also ensures that the team and the patients have continuity of the care and service levels that have always been our core values. I don’t want to sell to the quickest/highest bidder and sell the team and the patients down the river.” So here is a message for all independent practice owners – right now. Take stock. Take the time out to think. Decide exactly where you want to be by 2015 in the face of the changes outlined above. I’m advising my clients to take a short term view as well. After Christmas and New Year there could very well be a major reduction in everybody’s discretionary income spend an all goods and services. So create a cash flow forecast for your business and your life from 1st December 2010 to 31st May 2011 – 6 months. Figure out exactly:

1. what do you need to live on?

2. what does your business need to pay its way?

3. what sales do you need to achieve to finance the above?

And set those sales targets for the next 6 months – communicate them to all the team then watch the numbers like a hawk. The start of 2011 could be a very tough place. Be prepared. Most importantly of all – get away from the middle. Do something very cheap or….. Do something much more expensive. And thus positively differentiate yourself. Then get ready (and get your team ready) to work harder than you have ever worked in your life. You had better take a rest over Christmas because like me and my team, you and your team are going to need every ounce of energy, passion, enthusiasm, commitment, drive, relentless stickability, innovation, leadership, management and communication skills that we possess. And then we will win – because winners win. First published in the Confidence Club ezine on 19/112010