THE INSIDE VIEW

éxito = success

When I founded Whitecross in 1998, it was the first high street, ground floor chain of branded dental practices, it was also the first to raise venture capital and the first to float on the stock market. When Whitecross was acquired by IDH at the end of 2000 there were 48 practices across England.

There have been many shapes and sizes of corporate dental chains since then, and many of the smaller fish have been swallowed up by the bigger fish such as Oasis or IDH.

When I took over CODE in 2001 is was a small association with few member services, I have developed it over the past 10 years into an established association that provides support and services to the owners and mangers of 2,500 dental practices. The majority of the work with CODE over the last decade has been intellectual, in that I mean creating management procedures, software and systems for our members such as Clinical Governance Made Simple and CODEplan’s low admin cost dental plans. That’s why I have square eyes after thousands of hours in front of a computer screen, drafting, writing and checking the management modules that put the knowledge of running a corporate chain into the hands of independent practice owners and managers.

By all measures CODE is a highly successful association, with a quarter of all practices as members and a great range of benefits, but for me this is just the beginning.

CODE seems to have reached a critical mass. The dental manufacturers and supply companies are falling over themselves to work with us (allowing us to choose the ones that will deliver the best value to our members), our presence in dentistry has never been higher, and the office is busy with helpline calls and new membership enquiries.

But the dental environment continues to change. Practices are embracing IT, more expensive elective treatments are available, but patients have less disposable income, visit the dentist less frequently and are opting for the less extensive courses of treatment. Although costs continue to rise, it’s the wrong time to increase fees. Additionally new challenges arise from employing generation Y, who have been brought up on computer games, social media and an education system that doesn’t let them fail. It’s getting tough out there, and these trends aren’t going to reverse in the short term.

I feel it’s time for a new approach, a new invention, a new way to look at dentistry, from the outside in, from the patient’s (customer’s) perspective. That’s why I have started a course at the Cranfield Business School, the ‘Business Growth Programme’. Which is designed for owner managers, such as dentists, to learn how to develop and grow their businesses. Some practice owners have already completed this course in fact.

So far the experience at Cranfield has been a real eye opener. I would have thought that I knew what I was doing,

Cranfield Business Growth Programme

having built Whitecross to a team of 500 in 48 practices, but there is no doubt that I knew a lot less about management than I thought I did. I have recently discovered that like dentistry, business is a science, there are tried and tested ways of doing things that give you a much greater chance of success, that help you avoid the pitfalls.

As a result of this, I am planning three things to happen:

1, CODE services will get better, we will add more value for members and hence you and I will be more successful.

2, I will start to integrate the new business skills and techniques I am learning at Cranfield into the Management Modules and other CODE services for your benefit, for your personal and practice growth against a backdrop of the recession.

3, I am developing the next generation, but this one is for you, for members, it’s not going to be a corporate.

Watch this space, there’s great things coming!

CODE has just finished three days at the British Dental Trade Exhibition. As an exhibitor I can say that some of those exhibitors who were at this year’s the BDTA seemed to have smaller stands, with the whole exhibition taking up less than one hall. It was fairly quiet at times, and some companies were saying that practices were not making purchase decisions this time. Our members tell us that income is down about 15% and has been for three years. The cumulative effect being that some practices are now facing debt/cashflow issues. It’s interesting to note that quite a few practices who are still doing well, are taking advantage of internet marketing – you can watch the first of some free CODE videos about internet marketing here:

But I think that there is more than just the economic situation causing the loss of interest. The newer exhibitions have a CPD programme, but the problem from an exhibitor’s point of view is that the educational programme, allows the delegates in the hall only during the breaks, creating long spells of inactivity. Is it possible that online and e-learning is nibbling away at participant numbers at these CPD meetings too?

I also think that the increasing corporatisation of dentistry may have an influence, if you aren’t making the materials or equipment decisions there isn’t a need to shop for them, add to this the growth in the use of own label dental products and the dental exhibition in its current format is beginning to look less interesting.

Every year we have the conversation “should we have to stand to have a presence or is it just not worth it?” and each year the answer is harder to find. This is probably the main topic of discussion between exhibitors in the quiet periods.

Like readers of this blog, I am a big fan of the Internet and all it can offer for communication, information and training etc. but there is nothing like meeting colleagues and old friends, moaning about our lot (a favourite pastime of dentist’s since I qualified back in the day) and gleaning snippets of information that can be incredibly helpful for my own business or for practice management. Not to forget picking up on the industry gossip, which is always fun but usually wrong!

So what’s the answer? I think we need to have more of the smaller local meetings with a fewer national meets that should be organised by the associations – like us! We need new web based social media CPD meetings and bricks and mortar exhibitions focused on dental technological innovation, business success, clinical success and customer care. Let’s leave the shopping for equipment on the Internet and lets meet to learn about the new stuff, how to do it and how to be more successful with it.

Next year CODE will be releasing an exciting new range of internet and ‘bricks and mortar’ courses and training. Watch this space!

No more Mr Nice Guy – its time to take off the gloves! The practice owners and managers who are members of CODE make up about 25% of the profession, and we are spending £40m a year on dental products, £30m on cars and £7m on holidays every year.

I would say that in terms of buying power, CODE has reached its critical mass. We have grown rapidly over the last few years, partly due to the popularity of our compliance solutions and contracts and also due to the expansion of CODEplan.

Now we have the muscle, it is time to flex it and the first recipients will be the dental manufactures. Although practice costs have escalated recently there has been a reduction in treatment uptake reported by members, who attribute it to the recession. That’s why I am launching the CODE Buying Group (CBG)

Last year Dentsply international made a profit of £265m and 3M UK made a profit of £46m. I wonder how many dental practices made a profit after paying the principal a reasonable salary? Not too many I would hazard.

Dental Directory have always been a great supporter of CODE and recently they have excelled themselves.  They have championed the CBG with manufacturers and have encouraged chief executives and marketing directors to the meeting table. DD have agreed to provide quarterly figures so that the manufacturers can see what products our members are buying and how their sales are increasing though CBG participation. The figures will also used to calculate the members’ cash rebate, but it be interesting to see the decrease in the market share of non-participating companies.

At the time of writing, Dental Directory and Coltene Whaledent have signed up to the CBG, 3M is interested and we are hoping to have them on board but some others are dragging their feet.

The CBG is going to grow and become a force in dentistry, but only if members participate and favour the manufacturers who support it. Now is the time to show your initial commitment by signing up online here!

If the average 2.5 chair practice grosses £400k per year and spends 24% on essentials such as materials, labs, electricity and insurance etc. CODE members have annual spend on essentials of £240m.  Let’s make this fortune work for us.

You can read more about the CBG and CODE members can sign up now on the CODE website here.

Join us at the CODE buying Group Launch Party

The CODE Buying Group Launch Party is on the 21^st October at the BDTA exhibition in Brimingham. You can  read more and book yourself a place (and your friends) to join the fun by clicking this link.

Is dentistry coming up to a summer hiatus? The news is fairly quiet, but I can’t help wondering if this is the calm before the storm. There are some worrying things on the horizon. On the mind of every practice owner is the first CQC inspection, will the inspectors ask for the irrelevant evidence (probably).

The ring fencing of NHS dentistry came to an end in March, there could be some drastic cuts from PCTs who are already making alarming clawbacks. What it will affect is new contracts or PDS agreements coming to the end of their time and having to be renegotiated. I have been told that all orthodontic agreements in Yorkshire will be put out to tender when they come to an end. In effect you will have to tender for your own business.

The new contract is being tested, whatever the outcome it seems likely that the next version will be more bureaucratic and less user-friendly than the current ‘dogs dinner’.

In order to avoid descending into suicidal thoughts though, I would like to think about some of the positive trends to brighten our day. Members tell us that discretionary spend on elective treatment is increasing back to pre-recession levels, although there is still some resistance to the ‘big ticket’ cases. Tooth whitening might actually get sorted out this time. According to Cockcroft the whole thing could be solved in a month or two, although assessing the reliability of his predictions is up to you.

Dental plans are doing well, CODEplan has seen a surge this year as patients choose to budget for treatments. And importantly most of us have finally registered with the CQC after all the strain and effort of reviewing and setting up compliance.

Prepare now before your summer holidays
Now is the time to plan for the autumn, traditionally the busiest and most profitable time for dentistry. The months are long, holidays few and the threat of toothache over Christmas brings our patients rushing in for check-ups and other delayed treatments.  That’s why September to November is the best time to advertise for new patients, but the best way to advertise for them is online.

Your website is the most important thing

Summer is the time to organise things, if we get chance between Disneyland and family commitments, the one thing I would recommend you focus on is internet marketing. Over the last few years there has been a massive shift towards using Google to find new services or products. If you are reading this blog then you will be one of the many who look first online to compare prices and benefits before making a purchase decision.

Most dental patients are now doing exactly that when looking for a new dentist. Word of mouth is still the main source of patients, but increasingly, people find their new dentist online. A typical Internet savvy practice will gain as many patients from their website as they do from word of mouth, doubling word of mouth referrals. If you’re not online, you’re losing out!

Here are the steps to a successful web strategy:

1, It starts with a good website, with lots of information, updated regularly with attractive offers on the home page

2, Web video is the way to keep people on your site longer and let them learn about you. Videos should be short and professional. CODE productions can create videos for you

3, Once you have the web site it should be optimised (search engine optimisation) so that it will appear early on in search engine listings

4, Next, you will need off page optimisation – that is mainly creating high quality links back to the site (back-links). These increase ranking and can put you at the top of the first page of Google searches

5, For fast results consider Google pay per click or Facebook advertising. They can be expensive and so need to be carefully managed, using an expert

Pay per click for fast results

6, Finally you may consider social media marketing such as Twitter, Facebook etc.

There is more that can be done but steps 1 to 4 are the starting point for most practices.

In all of your Internet marketing activities, the most important thing is your web site. CODE can create your website and manage your search engine optimisation, Google pay-per-click and even social media activities. Please contact info@codeuk.com for further information and visit the CODE productions website.

I am currently enjoying panchakarma treatment in Delhi, something I do every year or so for a complete rest and rejuvenation. I am at the Maharishi Ayurveda clinic and have been coming here for 10 years. The treatments consist of lots of massage with herbalised oils, herbal milk baths,  a special diet, ayur vedic medicines and very calming treatments such as having cool buttermilk poured onto the forehead for half an hour.

It’s interesting on these repeat visits to see how rapidly India is progressing, from the modernised airport terminal, to the new metro rail and the first Day’s Inn hotel that has just opened on the road between Delhi and Jaipur. Macdonalds here does a super McAloo tikki and I found a Costa Coffee in a trendy district called Green Park.

Over the years, the clinic has developed too, it is still basic by western standards, but the treatments are second to none and each time I visit there are improvements in service and the environment.

This year though there have been some rather dramatic changes because compliance has arrived with a bang! All of a sudden the staff (called technicians) are wearing a face masks and a surgical hats. Event the cooks are now wearing chefs hats, and as I write this blog the floors are being disinfected yet again.

The compliance activities are due to new government regulations for panchakarma hospitals. Their first inspection here is planned for mid-March, hence the staff are hopping up and down doing everything they can.  Does this sound familiar to you I wonder?

Maharishi Ayurveda Technicians

It has to be said that there are visible improvements but I have one major problem with all compliance standards – are they proportionate? For example the massage treatments are completely non-invasive and they are given in a room kept at 31.5 degrees for patient comfort. Is it really necessary for the technicians to wear a mask and hat when carrying out demanding physical work in a hot room. I would love to know if there is an evidence base for the decision to set this standard.

Closer to home this is one of the things that keeps me awake at night. Is compliance proportionate, where do the standards come from? HTM 01-05 is a case in point. That’s why the situation here in India has really got me thinking. It seems that UK standards are designed for hospitals or NHS trusts and then thrust onto independent practices with little or no modification.

In my rest time between treatments, I have been mulling over whether CODE should set up the ‘Proportionate Compliance Committee’ (PCC) by inviting experts in each field such as microbiology or radiography to join. The remit of the PCC will be to challenge some of the outlandish standards that we currently have to meet.

Please give me your feedback on this, because if there is a groundswell of opinion, we’ll launch the PCC and see of we can lessen some of the burden practitoners have to face you can contact me at this email address and please leave your comment on this post for others to read.

I do though think it may be a while until CODE challenges the Indian Government on compliance issues, but you never know how effective the PCC might be. You can read more about CODE here on the Website.

My massage with tumeric paste

I was in a fully private practice yesterday in East Yorkshire setting up the CODE Assure compliance system, when coincidentally the PCT called and said to the practice manager “Can you tell me if you are compliant with HTM 01-05’.  As with most private practices, there has not been contact from the PCT before so this came as a bit of a shock. Anyway the PM said “can I speak to the principal and get back to you”. The PCT said ‘no I need your answer now’. Luckily both I and the principal where present. We decided to say that we will be compliant with essential quality requirements in three weeks, which is the case as there were a few small things that needed to be set up,  and that a decontamination room is going to be built within three months so we are aiming for best practice by the summer.

The PCT said to this ‘thank you we will inform the Strategic Health Authority that you are not compliant with HTM 01-05”.

What does it all mean I ask myself, are PCTs going to start monitoring private practices too?

You can read about the CODE Assure hand-holding for CQC compliance here.