It’s like déjà vu all over again is a great line from a film I once saw and for those of you who saw Bill Murray in groundhog day where he is stuck for ages in a day that ends and begins again over and over, you will understand the sentiment of seeing the same thing happening over and over again.

I wrote an article for this magazine recently where I made reference to what I had seen across the water and how that might play out in Ireland and several of you here told me that it’s different here! Well, there are differences for sure but actually it’s not hugely different as you are all Dentists trying your level best to make a living from your patients. The differences become apparent only when we look at ways of being remunerated for that service. The State schemes are altered and are most likely gone for a long time! When States are prosperous, they can afford to be benevolent and we are not prosperous financially at present and Dental care is very low on the agenda. Even the public are not up in arms about their loss as they would be if hospitals or schools were being closed.

I say that the only person that can change your business is you. You are the only one that can influence change. To do nothing is really not an option or some of you will see your incomes slashed as patients who are stretched also will stay away to attempt to save money that they may decide is better spent on something else. Some of you will do nothing and exactly this will happen, some will tighten belts and cut down on spending and staffing and materials and will stand still or go back a little and some will use this opportunity to re assess their whole business model and may institute the necessary changes to grow their businesses and actually prosper. The world does not stop turning. There is still dental disease out there. People have pain, they break teeth, they want to improve their appearance, and they want health. Some even want to prevent small problems becoming big ones and are willing to pay for it.

We have however to work a bit harder than before to make our practices successful. There is no doubt that when things are good and there is money sloshing about, we do not have to think as hard about service as the business is busy anyway and patients are paying and all is rosy. When things are tight as they definitely are now, we are competing harder and need to work at it. So what can you do? The very best place to start is with what you have already. You have to communicate with the cohort of patients you already have. Look to reactivating those who haven’t been in greater than twelve months. Have you been harvesting e-mail addresses every time you update your patient records? It costs you almost nothing to send an e-mail as opposed a letter and it’s green! If you have spaces in your books, have you gone back over patients who were given treatment plans and who have not been in since? You know they have a need but have not come back. Contact them and make them an offer! Your overheads per hour are there regardless of whether you are treating someone or not. Do some analysis of your overheads; do you know what your business is costing? Change your opening hours; offer to see people earlier, later or on Saturdays or at lunchtimes!

Do something different to differentiate yourself if you are not busy enough because if you do not change then you get exactly the same result. If you are trapped inside the old same old same old then you are like Bill Murray in Groundhog Day who only escaped from the continuous repetition when he decided to change himself.

There are a host of other strategies to increase patient retention and one of the most powerful strategies is setting up your maintenance plan where the patients can see and experience the benefits of regular attendance, one of which should be the early detection of disease with a resultant increase in Dental health and reduction in Dental treatment. I like the concept of a practice with lots of reasonably healthy patients with clean monitored mouths who are looked after well when they do need treatment. They also are much more likely to accept treatment when they are part of a team who looks after them regularly and case acceptance goes right up.

The only one that can change your business is you and if you want the same results that you are getting now, do the same things. If you want different results do something different.

“The Poor are Suffering”

I sometimes wish that I had kept all of the articles that I was interested in and involved in, and occasionally promise myself that I will look them all up one day by harnessing the power of the web! One article that I shall never forget opened with that above highly emotive headline one Friday morning in the early 1990s in my local rag after I had the temerity to leave the NHS for fee paying adults. Some of you will have been working in the UK system then and will remember the situation well. The reality was that at that time I had a choice: to stay within a system that was dictating my income and reducing it, or leave it.

Now in Ireland, after the actions of Mr Lenihan and Ms Harney, the choice has been in the main removed from you and you are forced now to look very closely at your business models. The IDA and most notably Fintan Hourihan have done a great job of advising on the present state of the PRSI and medical card systems. As well as the pulling out of the comfort rug of the PRSI cheque each month, there is an almost perfect storm of the seemingly apparent shortage of money in everyone’s pockets post the tiger and bricks and mortar boom and its subsequent collapse.

However as with me in 1992 onwards, it is absolutely critical to take a pragmatic, practical and objective view of the reality of the situation you find yourself in. Your surgeries are generally well equipped, well staffed with highly trained, highly motivated, fiercely loyal staff who take pride in delivering very high standards of treatment to your patients. I will stick my neck on the line a bit by stating that in general, I feel that the standard in Ireland is probably in the main viewed as being well above European average as the method of delivery of the service has in general been one of leaning on the side of private provision over the years. I don’t think I am wrong when I say that in my youth, we had to pay for our treatment and I remember my mother giving a certain Phibsoro dentist £2 to do a filling for me when I was 7. On X-Ray now 40 years on that restoration is intact and measures 1.5 mm into Enamel only and seems to me to have been a prophylactic odontotomy! I wish he had heard of fissure sealant but it took me to third year BDS to understand the difference.

Anyway back to looking at the business of providing dental service to your patients. Having spoken at Croke Park on 17th January, it was my privilege to realise that some of what I was proposing resonated with a lot of colleagues and along with my team I have visited quite a few practices by request. I am delighted to see the standard of clinic here and the attitude of colleagues and their teams to the care of their patients. That is the key to this whole issue. I tell every dentist I ever meet that the only relationship that is important is the one you have with your patients. If your patients continually come back for care from you and your team, they will in the main continue to do so. There are many ways that you can make it easier and more attractive for them to keep coming and one of these of course is to help them to keep healthy by maintaining their gum and dental health. You can also of course help them to budget for this eventuality and you can keep in touch with them by informing them what you are doing to look after them. This is what we can help you with as we have been doing this in one shape or another for many years. It is not about insurance or third party interference in your business but it is about our experience of successful implementation of maintenance schemes that will help you stabilise your practices financially. We have now set up our office in Baggot Street in Dublin and we are devoting a whole team to Ireland led my me and Dr Kenny Barr and including our head of business development Paul Nelson with 22 years experience in Dentistry and our first practice advisor Dr Sanjay Hirekodi who we have been working with for the past 4 months in anticipation of these changes. Sanjay is practicising at Absolute Dental in Carlow and will also be supporting our Irish practices with his knowledge of the process. These are truly exciting times for the profession and a crystal clear opportunity exists for you to define what you are offering to your patients. It can be as simple as I have said by offering them a pure relationship. If they are willing to pay a little each month, you can offer them a lot! The “poor are suffering” headline was hurtful and damaging at the time but the interesting thing is that my patients were interested in care and care is what I gave them and not only did I survive but I prospered and have been fortunate to have made a strong living out of ethical dentistry. I like to call it “Profit with Integrity”.

Our job is to support you through the process and process it is; it is not a one off “here you are” set up but an ongoing process until you achieve a critical mass and then maintain it. Do not waste your time playing with this concept as the serious adopters will achieve huge business stability and growth if they are shown how by experienced implementers. Finally I had several meals out over the past few weeks in and around Ireland and there were still lots and lots of people out and about eating and drinking and nipping outside to smoke. They all appeared to have decent sets of teeth! In other words need and desire remain and there is still cash in the system.

Your patients will need you to continue to look after them no matter what. Why not make it easy for them and for you? Contact us to arrange a visit to your practice to progress your business future.

John Barry BDS Cork 1987 Operations Director of “The Dental Plan”.