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:

• between 2012 and 2015 we know that
  • the UDA system will be gone
  • the PCTs will be gone
  • Orthodontists are worried about what will replace the UOA
  • GDPs are wondering what on earth next?
  • CQC registration packs finally being picked up and read by long-suffering dentists, their spouses or their practice managers
  • there will be a raft of new compliance and regulation
    • all of the above will be replaced by new systems (as yet unspecified) that will focus on
      • the patient experience and
      • the quality of diagnosis and treatment planning
      • The CQC are searching for ways to identify fully private practices for registration and regulation (more difficult to find you than you might imagine)
  • the corporates are committed to getting bigger
    • IDH have announced a plan to grow from 300 to 1000 practices
    • IDH are reported as being ‘up for sale’ – this make zero difference to their plans – “the banker is dead, long live the banker”
    • Oasis and ADP appear to be gearing up for expansion
    • 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)
    • there are increasing numbers of micro-corporates, mini-corporates and mid-sized corporates springing up – privately owned – mainly NHS
    • 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
    • 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
  • the retailers may or may not have decided to take part – if they do – big change
    • Sainsbury – 4 practices now prospering by offering ‘cheap as chips’ private dentistry
    • Tesco – up and running in Slough with the same offer as Sainsbury
    • Tesco – reported as acquiring planning permission for in-store dentistry in Scotland, opening deferred until early 2011
    • Boots – new CEO expresses interest in ‘well-being services’
    • House of Fraser – developing in-store high-value dentistry by concession
• Strong reports that hygienists and therapists will be granted direct access during 2011
  • registration course under construction
  • GDC seeking opinion
  • first hygienists and therapists able to run their own businesses sometime in 2011 (or work unsupervised in dental practices)?
  • Smilepod working well in Covent Garden and planning to expand
  • in general dentistry, do therapists at 35% represent a good alternative to associates at 50%?
• Marketing systems in dentistry booming
  • modern branding throughout independent practices
  • web sites that capture date and encourage enquiries
  • social media marketing strategies
  • relationship based marketing being taken to new heights
  • local B2B networking rising in importance
  • print media and directories declining in importance
  • direct marketing declining in importance
  • radio and signage rising in importance
• Sales of certain products and services in dentistry are booming
  • whitening in all its forms
  • facial and medical aesthetics
  • veneers
  • Cerec crowns
  • Lingual ortho
  • Dental implants
  • Denture stabilisation
  • high value smile makeovers
  • high value recon and rehab cases
  • Properly branded membership schemes
  • new patient assessments with treatment co-ordinators (TCOs)
• Sales of other products and services are under pressure
  • new patient consults with clinicians
  • maintenance dentistry (check ups)
  • maintenance hygiene (S&Ps)
  • some capitation schemes are in net membership decline
  • Invisalign – very interesting
    • an Invisalign price war has started in London (latest Google search reveals Invisalign at £1450) and is spreading
    • signs of panic from dentists holding large stock
    • some dentists jumping off the bandwagon and offering ‘6 month smiles’
• changes in the people who populate dental teams
  • telephone and reception separated in practice
  • Welcome Team members trained to a much higher level
  • TCOs appearing everywhere
  • Values-based selling skills rising in importance
  • Payment plans now considered standard practice
  • Business Development Managers appearing everywhere – often no previous dental experience
  • Increasing recognition of the business case for therapists
  • And its getting harder to manage multi-site practice and be a dentist as well, unless you have a world-class management team
• Some demographics are buying dentistry:
  • 25-35 singles or DINKIES
  • 35-50 “Yummy Mummies”, “Desperate Housewives”, “Glamorous Grannies”
  • affluent over 50s (all social classes)
  • affluent over 65s
  • all gay men
• And some are not
  • ordinary families
  • teachers and other academics
  • engineers (except for higher-value treatment plans)
  • public sector workers
• Some price levels are selling well
  • anything below £120
  • anything over £3000
• Some price levels are difficult to get agreement on
  • anything between £120 and £3000
  • It is pretty obvious what’s going on here
    • patients are buying if its cheap
    • patients are buying if its paid for from capital/assets (might as well – returns on investment are lousy)
    • patients are not buying if its paid from discretionary income
• Some geographical areas are feeling the pain already
  • inside the M25
  • The Republic of Ireland (where there is now emigration of hygienists and dentists)
• Some geographical areas are felling fine
  • everywhere else
• 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:

• what do you need to live on?
• what does your business need to pay its way?
• 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