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Making Money the Uncommercial Way - Innovation, and the Myth of the “Golden Goose” · No Appointment Necessary

• 0:00
  Michael: So, welcome to the latest instalment of No Appointment Necessary.
• 0:04
  Michael: Today we've got Adam Polter from Foundations Physio.
• 0:08
  Michael: I think one of our uh first NeuroPhysios as a marketing client for HMDG, and I do remember it was actually quite important because until I started working with neurophysios, I didn't realize that actually marketing for neurophysios is completely different because it's one of the only sectors, I think, where you are marketing to three different groups of people.
• 0:29
  Michael: You've got the case managers.
• 0:31
  Michael: I'd be interested actually, I know lots of people are always asking, like, how do I get in with case managers?
• 0:35
  Michael: That's probably a question we can ask.
• 0:37
  Michael: But you've got the case managers, you've got the patients, and it's probably rarely patients with some conditions, but then you have the caregivers as well.
• 0:45
  Michael: So I do remember going, oh my god, this is really interesting.
• 0:47
  Michael: It's much more interesting than just marketing directly to patients.
• 0:50
  Michael: So um I do remember that.
• 0:52
  Michael: Adam, you own uh foundation's physio, but you also literally just said to me, You're more of a physio than you are a director or CEO.
• 1:00
  SPEAKER_02: Yeah, yeah, no, I'd um so I'd I still I still work very clinically.
• 1:04
  SPEAKER_02: I still probably work nearly nearly five days a week clinically because I enjoy it and because the service service needs it.
• 1:09
  SPEAKER_02: And I think we we restructured our service around that.
• 1:11
  Michael: So, you know, we have we have uh a support team, like an administrative team and a business team outside of that, so that they can sort of take that's an interesting question because I think there's a trend at the moment for people who own businesses to remove themselves clinically and run the business.
• 1:27
  Michael: That always makes me wonder whether that's the best move.
• 1:31
  Michael: And I'm interested, you just mentioned support services.
• 1:34
  Michael: You are an incredibly successful clinic.
• 1:36
  Michael: How have you managed to stay clinical and yet still have such a successful business?
• 1:42
  SPEAKER_02: I think it's we haven't tried to, we we we've scaled very organically, like we haven't taken any sort of investment.
• 1:48
  SPEAKER_02: We have outsourced services that we we know we're good at what we're good at.
• 1:52
  SPEAKER_02: And I think that's really important is to realize what you're good at.
• 1:55
  SPEAKER_02: And we've used services like HMDG, but also like other, you know, we outsource other services because they're good at it, they're set up for it.
• 2:03
  SPEAKER_02: You you do a miles better job than than we would do trying to do the same thing ourselves.
• 2:06
  SPEAKER_02: I think there's a an element and of of of making a decision of saying, well, I'm a clinician first and foremost, and always have been for the last over 15 years.
• 2:14
  SPEAKER_02: Um part of the reason the business is successful on a clinical level.
• 2:18
  SPEAKER_02: Why would I change that skill set when I can bring in people who have other skill sets and use them for that?
• 2:25
  SPEAKER_02: You know, that will do far better than me trying to learn that and then be clinical still because there's no one else to head up the clinical side of things unless I pass that on to the other rest of the team.
• 2:34
  SPEAKER_02: So for me, it made more sense.
• 2:36
  SPEAKER_02: Um, but I think it depends on your your service.
• 2:38
  SPEAKER_02: Like I don't know, Neuros, a very complex patient group that requires quite a lot of support management.
• 2:44
  SPEAKER_02: You you mentioned about the families and also supporting them, you know, it's it's not just the individuals you're working with.
• 2:50
  SPEAKER_02: Whereas I think perhaps an MSK clinic is slightly different in that you are pretty much there for the patient.
• 2:55
  SPEAKER_02: So it it's maybe different.
• 2:56
  Michael: Yeah.
• 2:57
  Michael: It's interesting though, because uh as I say, there's this huge trend, and and and much of the time I disagree with it, particularly when you see a clinician who's bringing in 60% of the revenue, and then someone says to them, You've got to get out of clinical work and you've got to jump into running the business, and so they hire a load of new physicians or whatever, and and suddenly revenue nosedives, and you're like, Yeah, that's gonna happen.
• 3:17
  Michael: Um take yourself out of clinical work, you've really got to plan and prep for that.
• 3:22
  Michael: I think it's a year to two years of really thinking that through.
• 3:25
  Michael: Anyway, it's just interesting to hear someone who is running something successful saying that they can still work clinically and still make the business business work.
• 3:32
  Michael: I've got a load of questions, which I think will be really interesting.
• 3:35
  Michael: But before we do, one of the things I've always enjoyed, and we've had lots and lots of chats, is you've told me about lots of different things that you've done that are quite innovative.
• 3:42
  Michael: I just want to like let's let's look at some of those and talk about some of those.
• 3:46
  Michael: Things that you've done within the business, um, whether that's clinically or not, that have been quite innovative and a little bit different to others.
• 3:52
  Michael: Can you name a few and just talk us through?
• 3:54
  SPEAKER_02: Um, I think a lot of it we we've just tried tried different things and not been afraid to try it.
• 3:59
  SPEAKER_02: So I think probably the most recent version was we have a member of the team who is martial arts trained, for example, and he happens to work with his boxing gym.
• 4:08
  SPEAKER_02: So we decided that we would partner up with his boxing gym and he would run a martial arts class for four neuros, um, which is high level.
• 4:15
  SPEAKER_02: You or I would struggle with this class.
• 4:16
  SPEAKER_02: This is like a very, very high level.
• 4:18
  SPEAKER_02: It's press-ups, it's burpees, it's bag work, uh, four neural conditions.
• 4:22
  SPEAKER_02: We ran that as a trial.
• 4:23
  SPEAKER_02: We gave all our patients free access for three months.
• 4:25
  SPEAKER_02: They came once a week for three months, and on the proviso, we would take outcome measures so that we could see if it was viable, for example.
• 4:31
  SPEAKER_02: And this is martial arts.
• 4:32
  SPEAKER_02: There's a lot of work around boxing specifically, but there's nothing really around the martial arts.
• 4:37
  SPEAKER_02: I think the kicking is a really important part of it for single leg stand and stuff.
• 4:40
  SPEAKER_02: So we looked at that, we did some outcome measures, we got a roughly a 15% improvement across the board over 10 sessions, which was amazing for the patients that we had there and some really great functional improvements.
• 4:51
  SPEAKER_02: So we've now expanded that and run that.
• 4:52
  Michael: Yeah, I suppose also you're I'm a big fan of when I hear people gamifying rehab in some way.
• 4:58
  Michael: And I suppose you're you're gamifying it um by doing it through martial arts.
• 5:02
  SPEAKER_02: It's sport.
• 5:03
  SPEAKER_02: It's it's sport, you know.
• 5:04
  SPEAKER_02: It's it's you know, there's all sorts of accessible climbing and accessible sport, and it's getting people outside of clinical work.
• 5:10
  SPEAKER_02: And we're very non-clinical in that sense.
• 5:11
  SPEAKER_02: We're probably slightly slightly different in that we are probably a bit more functional and a bit more let's get you out and about.
• 5:17
  SPEAKER_02: We do gamify stuff, like you were saying.
• 5:19
  SPEAKER_02: We we worked quite closely with VR for upper limb and subsequently for their sort of lower limb module that they've now put on the program to look at gamifying it in a bit more detail for people, and also look at technology because we're community-based that they can take home.
• 5:33
  SPEAKER_02: Um, that isn't going to cost them the earth from that point of view.
• 5:36
  Michael: I remember years ago I spoke to a guy called Guyam from a company called Neurophenex, I think.
• 5:42
  Michael: Yeah, we we he had an amazing story.
• 5:45
  Michael: I think if I remember rightly, his uncle um had had a stroke or had a I believe it was a stroke or two, he found it really difficult to get decent care.
• 5:54
  Michael: I believe it was insane.
• 5:56
  Michael: And then I hope I'm telling the story right, but it's from as as I remember, and then he did a degree in maybe neuroscience, and then a degree in engineering, and then with this this really cool, I wouldn't call it a toy, but product um neurophenix.
• 6:09
  SPEAKER_02: Yeah, and it was the neuro ball, because we we met with him as well, and it was the neuro ball, and it was a sort of for for for hand and upper limb function, really.
• 6:16
  Michael: Yeah.
• 6:16
  SPEAKER_02: Um I don't know what's happened to that.
• 6:18
  SPEAKER_02: I haven't really seen it around.
• 6:20
  Michael: I I will have to get in touch with him because he I did see recently he had got some more funding.
• 6:25
  Michael: I I think they're still doing quite well.
• 6:28
  Michael: It's really interesting.
• 6:29
  Michael: There are, and we'll get onto the tech a a little bit later, but I think there's quite a lot of innovation within Euro with tech and a lot of bullshit too.
• 6:36
  Michael: Um and we'll get into that a little bit later.
• 6:38
  Michael: What about any other things that you're doing or that you have done that are kind of a little bit more innovative and different?
• 6:44
  SPEAKER_02: I think I suppose we've tried, always tried at the heart of our service to try and keep it as accessible as possible.
• 6:48
  SPEAKER_02: And I know we sort of we were touching on that.
• 6:51
  SPEAKER_02: So I think one of the things that we do really well is locally, and I think part of the reason for our success is we keep things accessible through partnerships with charities and through partnerships with sort of care providers.
• 7:01
  SPEAKER_02: So we're actually, you know, collaboratively working on quite a significant level to be able to keep people accessing our service.
• 7:09
  SPEAKER_02: And we're probably, I would say that 90% of the people that access our service self-fund.
• 7:15
  SPEAKER_02: So you were speaking to me, you mentioned about case management side of things.
• 7:18
  SPEAKER_02: We actually don't do loads of that.
• 7:20
  SPEAKER_02: And having been to a few conferences, I think we're one of the only neuroservices that don't have, you know, you know, that level of case management.
• 7:27
  SPEAKER_02: I think most of them have around 70-80% case management.
• 7:30
  Michael: I think that actually speaks a lot to your brand and and what you're doing.
• 7:33
  Michael: Because I think, and I I not that I want to criticize neuroclins who are using case management a lot because I think there's some fantastic ones doing that.
• 7:40
  Michael: But I think it's much easier to do it that way than I think build that local kind of collaborating with, as you say, care home to whatever.
• 7:48
  Michael: It actually it actually is really, really difficult.
• 7:50
  Michael: And I think you really have to build a great brand to be able to do that.
• 7:52
  SPEAKER_02: And we we put a lot of effort into working with those local services, whether that is care agencies or anything else.
• 7:57
  SPEAKER_02: And I think outside of that, the innovative side of things actually sometimes is is like the culture and how you how you operate within your community and providing that home feel community to people, you know, and it's it's about your priorities as a as a service, and I think sometimes it's about what you know going backwards, it's about why you started in the first place and keeping very true to that.
• 8:19
  SPEAKER_02: I think lots of people probably get sidelined on a finance level, or you know, you get really sucked into that business side of things and actually keeping keeping the reasons that you started the the service prevalent is really important.
• 8:31
  Michael: Do you do that?
• 8:32
  Michael: So I I I um we've had the same issue, right?
• 8:35
  Michael: Where your business grows and suddenly money becomes the overriding thing.
• 8:40
  Michael: And for us, it's very difficult to forget why we first did what we did, because you're constantly coming across small healthcare business owners that are struggling, that have been treated badly by other agencies or or businesses.
• 8:56
  Michael: And it's it's it's actually really easy every day to be grounded and you have have someone who says, I just I don't know what to do.
• 9:03
  Michael: And so it's easy for us.
• 9:04
  Michael: Is that similar to you, or how do you do it?
• 9:06
  SPEAKER_02: I think a lot of it has been down to like appropriate partnerships with people.
• 9:12
  SPEAKER_02: Before we met you guys, for example, we went through about three different marketing agencies.
• 9:14
  SPEAKER_02: And I think I came to you and said, like, I've just had a nightmare.
• 9:17
  SPEAKER_02: And I think some of it is about appropriate collaborative partnerships in order to keep things flowing.
• 9:22
  SPEAKER_02: And I think some of it is also about realizing that some of the work that you're going to be doing is not going to be monetized, it is going to be favours and support.
• 9:30
  SPEAKER_02: And, you know, I've been out to two self-employed physios who own my locally recently, and I've just done a joint session with them with one of their patients, like as a free of charge, because they don't have anybody to support them, they don't have that clinical support.
• 9:42
  Michael: Do you see that as a strategy?
• 9:43
  Michael: Because again, it's something that we do a lot of, which is helping people for free.
• 9:47
  Michael: I don't want to call it for free because ultimately for us, we're gaining something in the long run, um, whether brand or whatever.
• 9:53
  Michael: But is it a bit of a strategy of yours to offer a lot of help um and support, not monetizing it and reaping the rewards afterwards?
• 10:02
  SPEAKER_02: Yeah, I think it's about it's about building a community.
• 10:05
  SPEAKER_02: I think you try not to do it with sort of that reward structure in mind.
• 10:10
  SPEAKER_02: I think it's very hard because I don't think anyone does things sort of totally altruistically today from that point of view.
• 10:14
  SPEAKER_02: But I think you know, but I I do think that as best as you can, I think if you know if I was in their position, then it would be great if I'd had somebody like that that could do that.
• 10:23
  SPEAKER_02: And I think you know, I've spent the last 10 years building a business and I've had not really many people that have given me that support.
• 10:30
  SPEAKER_02: I've had to go and find it.
• 10:31
  SPEAKER_02: And I think that that being able to offer that to people who are uh starting their journey is really important.
• 10:38
  SPEAKER_02: And I think, you know, like the HMT connect stuff to brilliant, I think it's really helpful for a lot of people.
• 10:42
  Michael: No, I think it's important, and and I I've said before, it's very difficult in this industry and healthcare in general.
• 10:49
  Michael: Everyone's a silo and an island, and they don't want to share, and they don't want to collaborate with others, and they don't want to, they're always very scared of giving other people information.
• 10:57
  Michael: And and I think people are always quite scared of asking for it because they're gonna know.
• 11:01
  Michael: And I saw a brilliant Steve Jobs interview once.
• 11:04
  Michael: He was about 12 years old, and these are this are the days where you had uh uh yellow pages, and he called the chairman of Dell and said, I've got this project, and I wanna um I wanna uh I need some of your bits and bobs from from Dell.
• 11:16
  Michael: And the chairman said, Yeah, absolutely.
• 11:19
  Michael: I'll send them out to you.
• 11:20
  Michael: And he said, You're a clever little one.
• 11:22
  Michael: Um, when you graduate, come and give me a call and I'll give you a job.
• 11:25
  Michael: And Steve Jobs said, No one's ever said no when you've asked nicely.
• 11:28
  Michael: And I found that actually.
• 11:30
  Michael: No one ever says no.
• 11:31
  Michael: If you ask nicely and you give a good reason, and and it would be nice if there was more collaboration and people did ask more for help more from other uh other people.
• 11:40
  Michael: You know, we we something that's really pissed me off over the years is people started treating me as a guru, and I hated that because I know I know a lot about very specific things, but I've never stepped foot in a clinic other than being in a being a patient or being a quick visitor.
• 11:55
  Michael: I don't know how to run things, and that's why we introduced Connect because I want the people like you and and others who have been there and done it, they I want them to be the gurus, them to be the ones advising other people rather than you know asking me what the best way of creating a patient journey is.
• 12:10
  SPEAKER_02: I'm interested in there's so many variables.
• 12:12
  SPEAKER_02: I think like even within that, even with the guru setting, like I'm like by no means a guru, like I'm still learning, and ultimately I would never consider myself in a position to give people that level of advice without having a very in-depth understanding of what they're actually doing, like their local services, what they like, where are their partnerships, where are the connections, like what you know, it it's everyone's business is so individual.
• 12:33
  SPEAKER_02: I think at some point it's just about having the time to sit down and understand it, like what's your business?
• 12:38
  Michael: Yeah, and I think everyone's everyone's a slightly different business owner as well, um, and they have different needs, really need a lot of emotional support, and others don't need any emotional support, they just need help with metrics and numbers and understanding how to run a business in that sense.
• 12:53
  Michael: Um but it is interesting.
• 12:54
  Michael: I do I do hope for the future that people are more collaborative in the industry and and helping a bit more.
• 12:59
  SPEAKER_02: It's becoming a buzzword of mine.
• 13:01
  SPEAKER_02: A really big buzzword is collaboration because it just it needs to happen.
• 13:04
  SPEAKER_02: It's come across all of the conferences, it's now in like the N NHS tenure plan.
• 13:10
  SPEAKER_02: So it's like, you know, like we should be collaborating across sectors, not even just across, you know, we should be collaborating because you have more power as a group.
• 13:17
  Michael: Well, that's the thing.
• 13:18
  Michael: It's like, you know, what this disconnect between GPs and physios and whether neuro or not, and and consultants, and how there's always this battle, it just seems crazy to me.
• 13:29
  Michael: Really, there should be, and and maybe this exists somewhere, but some kind of store shopfront where you all put yourselves together and you can all can communicate and send people in the right direction.
• 13:40
  Michael: Yeah, if you've got a uh as an MSK clinician, you've got a patient that's a hundred kilos overweight with a with a knee problem, you probably need to go and find a nutritionist, right?
• 13:48
  Michael: Or a or a pro personal trainer or something.
• 13:50
  Michael: And and I think it would be really nice if if there were more relationships, but I think ultimately we're still in a bit of a situation where people are worried about holding on to money.
• 13:58
  SPEAKER_02: Yeah, but but there's such greater value in in saying to your patient, and if you put your patient at the center, like truly put your patient at the center of your care, like we are not set up to deliver MSK services, we don't.
• 14:10
  SPEAKER_02: We pass them on to very local MSK services.
• 14:13
  SPEAKER_02: We we do what we're good at because that's the service spec that we're set up for, and they're the people we've recruited, right?
• 14:18
  SPEAKER_02: The neurophysios.
• 14:19
  SPEAKER_02: And I think when you're looking at it from a purely financial level, there's not there's a there's a feeling that you might just go, well, I'm just gonna run this service and this service and this service, and we're just gonna have loads of different services, all of which have like small amounts of patients coming through them that add up to this sort of cumulative effect.
• 14:34
  SPEAKER_02: And I think sometimes being a generalist isn't always the best option for your patient and pro possibly for your filip, and actually having that network of services is probably better in the sort of long run, you know, the amount of neuropatients I have that have MSK problems, because they do, because it's comorbid disease, and vice versa.
• 14:50
  Michael: I think it's important and I I think patients respect that, and I do the same thing.
• 14:54
  Michael: If someone says I really need an accountant, well, there's an accountancy firm.
• 14:57
  Michael: Yeah, I need a whatever the case may be, I I will push people in the right direction.
• 15:01
  Michael: And and I think having that network makes you your business incredibly valuable because number one, they know that um well most.
• 15:09
  Michael: I was accused recently of taking money from people for recommendations, which by the way I've never done, even though people offer me money all the time.
• 15:17
  Michael: But they know that if I recommend a product or a service or a person that it's genuine because I believe it's that they believe in that product or that person, and it makes us quite valuable actually to people because they they they know they can trust our opinion.
• 15:31
  Michael: Whereas if we just say, Oh yeah, we can do this and we can do that, it's we can't, you know, you can't do everything.
• 15:36
  SPEAKER_02: It's enough just to run a good service within one particular aspect of physiotherapy, right?
• 15:40
  SPEAKER_02: Like I think you know when you start to branch out, it's it's it's very hard to put all that in and run the excellent service that you want to, which I think most physicians want to.
• 15:48
  SPEAKER_02: I think they do, like I think it's just time.
• 15:50
  Michael: I had a load of questions, um, which are a bit more neuro related, but I think will be really interesting because I think they'll cross over to a few different areas.
• 15:58
  Michael: But first one was uh, and this came up to my head because uh Hannah, my fiancee, and MD of HMDG is an ACPAP physio.
• 16:06
  Michael: And I thought to myself, if she wants to treat a hamster and call herself a battery physio or an animal vet or physio or whatever, she's gotta go on a post-grad course, she's gotta pay a lot of money, and there are certain standards.
• 16:18
  Michael: I find it crazy that any physio tomorrow could call themselves a neurophysio and start treating a child with a stroke.
• 16:26
  Michael: Uh should first of all, should neurophysio be a protected title?
• 16:30
  Michael: And then should there be postgraduate standards within that?
• 16:33
  SPEAKER_02: I think it's an interesting question.
• 16:34
  SPEAKER_02: I think um so you can't, there are post-grad courses you can go on, so you can do an MS MSC and neurophysio, for example.
• 16:42
  SPEAKER_02: I think a lot of what happens with physio and with the HCPC really comes down to competency and being able to demonstrate your competency.
• 16:50
  SPEAKER_02: When you look at it in depth, competency is a number of things, right?
• 16:53
  SPEAKER_02: It's experiential, um, it is documented often through reflective practice or or whatever else, and it is through things like external courses.
• 17:02
  SPEAKER_02: They're probably the main real ways in which you can demonstrate your competency.
• 17:06
  SPEAKER_02: And the HCPC, they probably audit what every couple of years.
• 17:08
  SPEAKER_02: So you sometimes get caught, sometimes don't.
• 17:11
  SPEAKER_02: Um, there's no real structure to there's not real frequency to you being audited around your competency.
• 17:16
  SPEAKER_02: But I do think that if you had a problem that insurers would want to see your competency.
• 17:20
  SPEAKER_02: So I suppose the insurance side of things also should mitigate some of that.
• 17:24
  SPEAKER_02: And even within the CSP insurance, there's there's one of the professional standards is working within your scope of practice.
• 17:30
  SPEAKER_02: I think you can call yourself a neurophysio.
• 17:33
  SPEAKER_02: I do think that sometimes patients and with the rise, you know, with Google and AI and stuff now, I think you can quite quickly get found out if you're not, you know, well trained as a neurophysio, because patients are experts.
• 17:43
  SPEAKER_02: They're experts in their conditions, they will know if the advice you're not giving them is is incorrect because it is everywhere on the internet.
• 17:49
  SPEAKER_02: You know, you can you can access a lot of information now.
• 17:52
  Michael: Let's go back to that though, because I think um if that were the case and you they're all being audited, and and I don't think it's particularly difficult to throw a bit of CPT together and say, look what I've done.
• 18:02
  SPEAKER_02: No.
• 18:04
  Michael: Then we would have a an incredible pool of neurophysio clinics with great neurophysios, which I don't think is the case.
• 18:11
  Michael: I think that there is definitely a problem with standards.
• 18:13
  Michael: I think there is although you tell me if I'm wrong, um, but I think there is a an issue with standards.
• 18:19
  Michael: I think that mediocrity is is quite rife.
• 18:22
  Michael: And that may be, I don't know, but it may be to do with just the amount of staff shortages there are.
• 18:27
  Michael: Um more acceptable, for example.
• 18:30
  SPEAKER_02: Yeah, I mean, I think professional standards are are a really difficult one because they're a difficult one to monitor.
• 18:34
  SPEAKER_02: And I think perhaps your perspective is that you are obviously getting these, you know, you see a lot of that within your marketing company and you sort of hear a lot of that, right?
• 18:43
  SPEAKER_02: And I think that that's natural.
• 18:44
  SPEAKER_02: I think, you know, for example, anyone, I was looking back, anyone can set up their own private clinic like from graduation if they really want to, which I I think is, you know, possibly needs some sort of regulation.
• 18:55
  SPEAKER_02: And and perhaps, you know, there's there's some work to be done around the private sector being slightly more regulated.
• 19:00
  SPEAKER_02: I think most people go into the NHS and there's you know, there should be, you know, things like in-service training and external courses and regular CPD opportunities, and that should be evidence as an employer.
• 19:13
  SPEAKER_02: So I think there's also it's also incumbent on, you know, for me, if someone said to me, What do you do for your team?
• 19:17
  SPEAKER_02: You would you would be able to give a list of like the in-service trainings we run and the external courses we've all we've all sorted out and the peer reviews and all of those things.
• 19:25
  SPEAKER_02: So I think it also has to it would be interesting because I think there is an incumbency there on the employer and the clinic to ensure that they're maintaining their standards.
• 19:33
  Michael: And there is, and I think maybe both of our data skewed a little bit because you are obviously surrounded by very, very good clinicians and private practice owners, whereas I will see an awful lot of nonsense going on.
• 19:45
  Michael: And I suppose one of the reasons it sort of bothers me a little bit is that the financial rewards within Europhysio are so extreme and so high compared to MSK or other things that I do wonder whether there's a level of exploitation going.
• 20:00
  Michael: on or uh people just accept slightly lower standards because they they they're chasing the the pound sign?
• 20:06
  SPEAKER_02: Yeah I mean it's difficult.
• 20:07
  SPEAKER_02: I think there's a perception that perhaps the rewards are higher.
• 20:10
  SPEAKER_02: But I don't like as a clinic I don't feel that.
• 20:13
  SPEAKER_02: I'm sure they are.
• 20:14
  SPEAKER_02: I don't work in the SK for as I said and I as I said to you we withdrew from the big insurers because they were you know absolutely hammering people's prices.
• 20:22
  SPEAKER_02: I think I think that maybe perhaps the MSK sector because it's so competitive maybe that this is sort of price battle there there aren't that many really good neuroclinics around still.
• 20:32
  Michael: I think I think one of the the a few of the reasons we're doing this survey the private practice barometers so we can find out more but I think like the average clinic has got five grand in his bank account um if you turn over more than 500 000 you're in the top one 1% of clinics in the country on the MSK side uh and I think that comes down to on you on the neuroside your lifetime value of a patient is incredibly um particularly if they um have Alzheimer's and you just get them in every day.
• 20:59
  Michael: I made that jig check for a physio one so you didn't laugh.
• 21:01
  Michael: I feel it's quite but um your retention rates are high.
• 21:04
  Michael: In fact I don't think any neurophysias have gone oh how do we improve retention it's just not even a discussion or a topic right so lifetime value of patients is incredibly high your average fees are much much higher than your average 50 quid for a for a physio appointment and so when you could those things generally and not all but generally um neuroclinics are just way more profitable way more financially successful let's say than than your average NSK clinic I think it's probably over and a bit less volatility in terms of the market certainly from from that point of view.
• 21:38
  Michael: That's another good point.
• 21:39
  Michael: I think you you don't have the ups and downs in your cash flow.
• 21:43
  Michael: You are not having to spend as much in terms of chasing new patients every five minutes and you're not on that hamster wheel and from what we can see and what I've seen I I mean it always surprises me when a neurophysic comes along and says I'm really struggling to make money it's like I mind blowing it's a bit like a pod that says I'm not making money because like you're like gold dust there are very few around um very few of you around really good ones around um and again you know you treat the right conditions you've got patients there for an awful long time so I think the financial rewards are far far higher I mean I do I I'm not gonna mention you but I know one clinic who started offering euro because they're able to double their fee.
• 22:24
  Michael: They were paying their physios uh an appointment fee or a fee per appointment were able to just add 50 quid on and suddenly make an extra now that's obviously not why you should be offering Euro physio but you get yeah I I think it's difficult.
• 22:38
  SPEAKER_02: I think I I agree with you in that the fees are higher.
• 22:41
  SPEAKER_02: I think the additional work that comes in to Neuro I think is you know my Neuro assessment might take me an hour for the appointment but it might take me two further hours probably unpaid to go through that.
• 22:54
  SPEAKER_02: I probably haven't completed an assessment in an hour.
• 22:57
  SPEAKER_02: I think you know there's a lot of investment in terms of the community and the time and the family side of things that you just don't do with the MSK stuff.
• 23:06
  SPEAKER_02: You know if you wanted to you could have 14 patients in a day we'd be lucky to get five.
• 23:10
  Michael: Sure but those five but but those five patients are worth£5,000 each over a certain amount they're regular patients but I think a successful MSK clinic if they're full all the time is the same.
• 23:22
  Michael: I don't think there's much different it is because each patient they have to go out and find a new a new every single part.
• 23:29
  SPEAKER_02: Yeah I I think each has their challenges but I I don't think it's as as I think that's perhaps the perception and the problem I have with the perception of neuro and perhaps why MSK clinics are going into Neuro is that they think that it's this pure like golden goose and actually if you're doing a good job it's not it's I I I think it's difficult to say that and and part of me is is is pushing back on it because there's a perception in the neuro world that people that move into private practice are doing it for financial reasons.
• 23:56
  Michael: And actually you know we're not what I would say actually is that if you think about it like you just mentioned and you are doing massively respectful and doing things the right way and you're doing lots of things let's call them free.
• 24:08
  Michael: But actually it's not it's marketing.
• 24:10
  Michael: It's marketing in its own right if you're seeing my grandfather and you're spending time with me and you're educating me and and communicating with me and you know that that in itself is marketing because if if that patient is worth let's just say£5,000 then yes you're upfronting a bit of work you're spending a bit of extra time but it is a marketing cost.
• 24:29
  Michael: It's almost a an acquisition and retention cost.
• 24:32
  Michael: Whereas an MSK clinic their average patient is worth£250.
• 24:35
  Michael: They'd have to find 50 new patients every month just to survive.
• 24:40
  Michael: And so their fee is actually having to put more money into marketing having to put more money into all sorts of things just to generate those appointments and you know it's the old Pareto principle right those retained patients are always going to make most of the money rather than finding new ones all the time.
• 24:57
  SPEAKER_02: It'd be interesting to do a comparison I think because I think a lot of it's and actually you know again spending extra time with patients and families for us is not intention is a bit with marketing and I think actually the intention is to do a good job rather than anything else.
• 25:10
  SPEAKER_02: And I think if you do a good job for your patient you get the right outcomes yes on a marketing level from a marketing person it is positive.
• 25:17
  Michael: But that's not the intention that is the secret of incredible marketing.
• 25:23
  Michael: You're doing something because you're providing an incredible experience doesn't matter what it is right it could be a shop it could be it could be anything you're providing a great experience and that's always the best marketing.
• 25:34
  Michael: And and normally it's unintentioned it's not that someone's thinking we should do X and that's going to make us more money in the long run.
• 25:40
  Michael: They're doing it because they want to do a brilliant job but that is always the best marketing.
• 25:44
  Michael: It's very difficult to kind of reverse engineer marketing and go, okay, these guys are shit it's like we need to make them look better and so on.
• 25:51
  Michael: So it is it is a if I I've been doing a lot of thinking on this recently I think we're gonna do a fair amount of content on it which is that that customer experience providing great service which allows you number one to charge an awful lot more which retains clients much more easily which gives you great word of mouth and also brand I'll give you an example of I bought something in a really nice shop not so long ago and I went back in I said there's a little issue with this thing and he said done I think if they fixed it in like two seconds and they said we're so sorry.
• 26:22
  Michael: It wasn't even a question of oh well show me a receipt or when did you buy it it was just we will fix that for you.
• 26:30
  Michael: And so I I then tell lots of people about that I will always be a customer of theirs it's just you know it it's so important to provide that.
• 26:37
  Michael: And but it I know you may not be doing it for that reason but it is still a most effective form of marketing yeah and you and you're right on that.
• 26:44
  SPEAKER_02: I think kids um I think it all goes back to what we were saying at the beginning about the why.
• 26:48
  SPEAKER_02: Why did you set it up?
• 26:49
  SPEAKER_02: Like why did you do it?
• 26:50
  SPEAKER_02: And I think you know why are you starting that new service?
• 26:53
  SPEAKER_02: Is it financially driven?
• 26:55
  SPEAKER_02: What is it?
• 26:55
  Michael: And and in some aspects there are reasons why you might financially make that decision but your why has to be really important because that is what you're achieving by staying true to your why right so that brings us on to an interesting one because it's again um sort of related to some extent you know that there are and and we you spoke to this way and you don't deal with insurance companies an awful lot so this is self-funded patients and families.
• 27:18
  Michael: When a patient comes to you you know that they're gonna potentially spend a huge amount of money often something isn't necessarily affordable.
• 27:26
  SPEAKER_02: How do you deal with that just personally I think it was yeah I think it is a challenge.
• 27:33
  SPEAKER_02: I think one of the conversations is we always have is that you know we are very clear and upfront about what what you know pricing etc etc before people even book an appointment which you obviously should be and we have that conversation on the phone as part of our process most patients will have an expectation already about what they can afford in terms of sessions.
• 27:54
  SPEAKER_02: So often we're guided by then I think the skill in providing getting good outcomes when you're dealing with people that maybe are only having one session a week one a month one every two weeks and I would say the majority of our patients are only having like maximum one a week which is now a week is how you fill their time in between in terms of their rehabilitation.
• 28:16
  SPEAKER_02: There are patients that spend a lot of money often patients who have the money to spend but for the vast majority that's not the case I totally agree with you.
• 28:23
  SPEAKER_02: And so our job my job and part of my job is to try and keep things as accessible as possible and work within their budget rather than them yes there's my clinical recommendations and if you gave me anyone with a stroke I would want them in an inpatient rehab unit for three months and we would do wonders with them.
• 28:39
  SPEAKER_02: Right.
• 28:39
  SPEAKER_02: But that doesn't work that doesn't work as a model it's impossible for people to fund that so you have to think about using things like tech and you know proper exercise planning and goal setting and motivational techniques.
• 28:51
  SPEAKER_02: And often they're motivated anyway because they're they're they're financially paying so you know you tend to only get people who are really motivated to improve generally because it's a substantial amount of money to be putting forward for people.
• 29:02
  SPEAKER_02: So I think we balance it well with that and then working with charities we have a variety of like different services so you know the charities subsidise some of our exercise classes for example.
• 29:11
  SPEAKER_02: Well I didn't know that you know Parkinson's UK they they probably subsidize the cost for each member of 65% of the value of each class per head every week and we take 70 people through those classes um every week um we work quite closely with charities to subsidize and they actually subsidize the initial assessment as well so we go and assess them before so um the the the model that we have is around collaborative working you were we collaborative we work with the NHS you know and we we sometimes forcibly get them involved when they're potentially discharging and we say no no no like we will drop off a session here for you to add in a session or or whatever you know having private physio does not you know negate the need for you to come in like you should still be coming in just because they've got private physio.
• 29:59
  SPEAKER_00: Did you reach out the charities or were they reaching out to you?
• 30:02
  SPEAKER_00: How did that work?
• 30:03
  SPEAKER_02: Uh a bit of both I had our Parkinson's referral actually came from a colleague of mine who runs a different clinic um who couldn't fulfill it um who's another private service that we could contact with um which was Yale.
• 30:14
  SPEAKER_02: So we get those contracts through partly through looking for them but I think also partly just you know locally you know that reputation and that sort of builds from there and and that outreach work that we do.
• 30:27
  SPEAKER_02: So I do my best to reduce costs as much as possible for people, which sounds like a strange way to do things but because most of our people are self-paid it's different.
• 30:38
  SPEAKER_02: You know if a case management comes to me and says right you know what can you do then I can give them advice on what we can do and then and then it's a conversation about you know what's appropriate you know what what what are you able to fund here and and that's a whole different conversation.
• 30:51
  SPEAKER_02: At the same time like you know we're we're keen on keeping our services accessible and also not one of the themes that came out of the brain injury conference I went to on Friday for Headway was the haves and the haves not's so there's people that have a brain injury and have case management because it was an accident but there are a load of people that don't and it's you know you they see these these other guys that have got this amazing funding and they're accessing exoskeletons and all of these things right and then you've got everybody else and you know my passion has always been for the everybody else almost that's what you know we've tried our best to do that within what's viable for the service.
• 31:24
  Michael: Yeah it m it must be really difficult.
• 31:26
  Michael: It just makes me think of uh being a uh I don't know in an AE in in America and seeing one patient come in with with great insurance and then next you like choose which finger you want to keep um kind of crazy I saw that on the show once but um yeah it must be quite difficult at times because I suppose it happens in all uh areas of healthcare doesn't it you know I can afford to go and get a private scan and get whatever I need um and others can't but you you're at the sharp end of it and and you see that and it must be must be tough at times.
• 31:56
  Michael: It must be tempting also to now of course you've got the some of the stuff you do but it must also be quite tempting just to go you know what I'm gonna treat you for free even if it's commercially completely inappropriate.
• 32:08
  SPEAKER_02: Yeah yeah it it it is um it's you know often I'm probably not your typical I'm probably not the best area that I think commercially like is always a secondary thought for me which I'm I'm getting better at it not being that because it's not always been smooth sailing when I've done that.
• 32:21
  Michael: So you know I've got a lot better at that um which is which is good but it is a balance and I think you know you know if you don't I think you could be very commercial by not being commercial I'll give you an example during COVID when we were still a tiny little company I remember we uh I was really worried about these clinics because you know we we deal with a lot of small clinics and and it's not like we're dealing with multinationals here.
• 32:43
  Michael: And I I said to Hannah and I said look we're gonna send out an email I'm gonna send out an email that says don't take the piss but if you can't afford to pay us and you're really struggling let us know I will stop the payments um and you can start we're gonna we're gonna keep going with the service but you can start up again when you're ready.
• 33:00
  Michael: About five six tennis counters to up on that and I got some amazing things like you no one's treating us in this way everyone's trying to get every last penny.
• 33:10
  Michael: Thank you so much for doing it was probably and I didn't mean it like this but it was probably the best marketing we'd ever done because once COVID was over oh my god they are and to this day they're still referring people to us like these guys they're not just out for your money and it was it was brilliant marketing and again it's an example of not being commercial but being commercial if you like I remember I remember the email um yeah I remember the email because I was I very much appreciated at the time I don't think we took off on it in the end but um yeah it gives more time for everybody.
• 33:37
  SPEAKER_02: Yeah.
• 33:38
  Michael: But I think it's important you know you've got to treat people in the right way.
• 33:41
  Michael: I I had a another clinic owner who had spent 12 grand on I've got to be careful and spent a lot of money on something else and they said look my business is going under I don't know what to do.
• 33:53
  Michael: So we did everything for free um because I just I you know that poor person was was basically screwed.
• 33:59
  Michael: And again fantastic marketing I I sound like um I'm not exploiting it because genuinely we all want to just help people you know good people um want to help good people and um but I do think it again is it's the best form of marketing.
• 34:12
  Michael: See my my situations are kind of a bit easier than someone who's got MS or Parkinson's who's who you're just looking at thinking I wish I could do so much more for that must be so so difficult sometimes.
• 34:24
  SPEAKER_02: It is but I think it's all about innovation right I think you can like it's like the VR headsets we were talking about like we send someone home with that.
• 34:31
  SPEAKER_02: Let's get into I I remember you mentioned this is a couple of years ago now you mentioned what you were doing with VR yeah I mean we've got approaches um NeuroVel the company that we we've been working with and we we work to help them sort of along with a lot of other clinics but we work to help them develop some of their games and software and stuff to be relevant for neuro rehab specifically stroke.
• 34:52
  SPEAKER_02: We did a few projects with them and and they've recently um we just helped them with their lower limb module um to sort of um release that as well the reason that we like it is we're a community based service yes we have a clinic but actually we could send people home with that and use that as an adjunct to physiotherapy and they're not using it to replace physiotherapy but what they are doing is saying you can take this home and do your physio as prescribed intensively.
• 35:15
  SPEAKER_02: So what it's some of these tech companies are thinking and I think rightly so is they're thinking about how can we add intensity at home?
• 35:21
  SPEAKER_02: How can we send people home with stuff people that maybe can't get out people that don't want to go to a gym because the gym's very intimidating for for people with a disability how can we get them to do more and I think a lot of it comes down to like I think good tech gets people moving more.
• 35:35
  SPEAKER_02: And I think that's the ultimate thing is that like does it do that?
• 35:39
  SPEAKER_02: And secondly is it plug and play?
• 35:40
  SPEAKER_02: Is it a faff to to use?
• 35:42
  SPEAKER_02: Because if it is no one's going to use it.
• 35:44
  Michael: Yeah I I I think tech in healthcare is incredibly important whether it's w wearables I genuinely believe the Apple Watch has saved many millions of lives if nothing else that then it just tells people that you know they've got to do a little bit more exercise a bit more walking or whatever.
• 35:59
  Michael: And I think the the right tech is is is incredible and can be really really useful.
• 36:04
  Michael: And it's interesting because I think neuro I think you get it in pod as well but I think neuro is one of those areas that's using tech more than more so than any other sort of physiospecialism.
• 36:16
  SPEAKER_02: Yeah I think I think the tech is in neuro is more appropriate.
• 36:19
  SPEAKER_02: I think there's a the tech in neuro is is mostly developed with the patient in mind.
• 36:23
  SPEAKER_02: I do I do think it's wildly expensive but I do think that it is at least developed with the patient and therapist in mind and they are doing a lot of consultation around the development of those products.
• 36:33
  SPEAKER_02: I don't necessarily think all of them are there yet.
• 36:35
  SPEAKER_02: I think there's a really heavy reliance on data and you may or may not disagree with me with this because you're you know quite data driven as an individual but I think I don't find it particularly meaningful for the patient and I think the reporting of the data needs to be better so that it is meaningful for the patient.
• 36:51
  SPEAKER_02: And I think that's where the disconnect comes in is and as a clinician I don't actually have that much time to be sitting down and looking at reams and reams of data.
• 36:59
  SPEAKER_02: You can save it you can keep it you can have a quick glance at it but actually you know I still fairly reliant on what I'm seeing in front of me you know within the session rather than you know I think biofeedback and data that's in real time is is more helpful in some ways.
• 37:14
  Michael: Yeah I suppose AI could come in here a little bit though couldn't it if you create a good template to interpret the data and make it patient friendly because that's always the issue is is data and giving it to a client and then saying there you go and you're like I don't know what this means or how it impacts anything.
• 37:30
  Michael: But I think a good bit of AI to kind of repackage it could be quite good.
• 37:35
  SPEAKER_02: So how does it relate to your goals like there should be some goal setting stuff in there that you can be inputting before so we can actually relate what's happening to your goals because actually you know goals are set on a functional level and data is not on a functional level because it it's it's it's different.
• 37:49
  Michael: I I think with a lot of the tech companies it feels to me that many of the MSK tech and health tech companies often are run with money in mind.
• 37:59
  Michael: And it's to me that a lot of the products in neuro and you sort of say yourself are are sort of with the patient in mind and then it makes the money.
• 38:09
  SPEAKER_02: Do you think I'm right I do I do think that um there's a lot of because of the RD that has to go into all the research and development that has to go into all these things like I think the cost base for most clinics I think I find that most tech for neuro is still pretty inaccessible.
• 38:26
  SPEAKER_02: You know even like I don't know a buy an S FES for foot drop which is better than you know works better than some of the the the more basic models that's still like 5k if you want to purchase that and like for most people that's out of reach.
• 38:39
  SPEAKER_02: I think it's not necessarily designed for the mass market and the other problem I have is that a lot of the bigger tech is designed on people coming to you to use it.
• 38:48
  SPEAKER_02: It's like a gym based it's like a more fancy bit of gym equipment do you know what I mean whereas actually so it's great for intense intensity but for most for 90% of the population that's not happening.
• 38:58
  SPEAKER_02: You know the reason we've invested in things like VR and we've got FES kits and stuff like that is and you know blaze pods we use loads because you can take them out and you can bring them back and you can leave them with people and you can it's gamification still and you know just on a smaller level because that's the tool service we are I mean there's plenty of amazing intensive outpatient physiotherapy clinics that have these wonderful robotic suites and and then they're brilliant and they probably get fantastic outcomes because of the repetitions that you can achieve but for most people that's still not accessible I still early days.
• 39:30
  Michael: Yeah no I I I think so and and going back to VR I think that's a a relatively inexpensive um thing to do.
• 39:37
  Michael: And actually I think a lot of MSK clinics learn from that I think if you're doing upper limb shoulder or whatever I think um it could be really interesting and I suppose it opens you up geographically as well from business marketing perspective you don't have to be in a certain location to see a patient.
• 39:52
  SPEAKER_02: It could be across the country we work with we worked with the the De Rovert company and we did a remote trial for someone in Leicester MS for the for the system.
• 40:01
  SPEAKER_02: They sent it out, they posted it out.
• 40:03
  SPEAKER_02: We did the monitoring remotely.
• 40:04
  SPEAKER_02: We did the we did the reassessments via Zoom because it was upper limbs, so you could get a good idea, but you also had the data coming in anyway.
• 40:11
  SPEAKER_02: And so I think that's where tech like that is going to sit.
• 40:13
  SPEAKER_02: And actually, I think with the NHS, like widely adopting something like that, you know, sending home someone home from a stroke ward for that with that for six weeks, you know, having been set up and trained on it in the ward would be a great like continuity of rehab, innit?
• 40:27
  Michael: Yeah, I don't see the NHS getting there, but um, it's definitely a business idea, whether it's whether it's in the neuroside or um or on the MSK side, but having a central kind of this is what we have off the top of my head, you partner with a shit ton of clinics who you approve of, you put your product in the center, you rent the thing, and then you can speak to any one of these clinics that you like anywhere in the country.
• 40:49
  Michael: This idea, keep coming up with them, I don't have the time to implement them.
• 40:52
  Michael: Talking of tech, so that there's also a lot of nonsense right in the neuro area as well.
• 40:57
  Michael: How do you sort of decide what's clinically reasonable and improves outcomes and doesn't?
• 41:03
  SPEAKER_02: It's very, it's very, it's interesting, isn't it?
• 41:05
  SPEAKER_02: It's I think a lot of tech falls into sometimes it's about there's lots of tech in the MSK sector that people try and repurpose for neuro also.
• 41:12
  SPEAKER_02: I think things get repurposed, which I think is not the right way to go about it.
• 41:16
  SPEAKER_02: We do a lot of trials, so we will do a lot of uh trials and thinking around what we're actually buying or recommending.
• 41:22
  SPEAKER_02: So for us, a lot of it comes down to being highly critical of what you're looking at and actually having a really depth knowledge of your patient group.
• 41:32
  SPEAKER_02: And I think that's where having a select patient group helps because if you're trying, you know, if you're getting a bit of tech and you've got multiple different patient groups across your service, it's really difficult to know what to have.
• 41:42
  SPEAKER_02: And we had um at vowed in the other day because I was interested, and I know they're predominantly in the MSK market, but I was interested more in their assessment kits and stuff, you know, the the the dynamics and false plates and stuff and how that might implement into our realm, which I think it does.
• 41:57
  SPEAKER_02: I think it's transferable.
• 41:58
  Michael: Well, they're very good.
• 41:59
  Michael: Um, and if they're playing sponsorship opportunity, you could vowed.
• 42:03
  Michael: Good.
• 42:03
  SPEAKER_02: Yeah, absolutely.
• 42:06
  Michael: Yeah, I think also it is it is interesting because when you are not because I I I doubt that you're just purely looking at it again from a commercial and ROI perspective.
• 42:15
  Michael: So that makes it a little bit easier to judge whether a product is going to provide good outcomes, something that you really want.
• 42:21
  Michael: And then I guess the secondary thing is can we actually afford it rather than how much money is this gonna make us?
• 42:27
  Michael: And it looks really cool, it works ish, but it's gonna make us loads of money.
• 42:32
  SPEAKER_02: It goes back to that experience.
• 42:33
  SPEAKER_02: We uh I've always used tech as an added value.
• 42:36
  SPEAKER_02: So, like we invested in our body weight treadmill that we have here, um, and we we obviously purchased that.
• 42:41
  SPEAKER_02: We don't charge anybody extra to use that, we don't charge anyone extra to borrow our FES devices.
• 42:46
  SPEAKER_02: We th we don't could, and there are clinics that do that, but we don't because we think that actually it's inclusive in the you go back to the fees that people are paying, chalking fees onto people, left, right, and center.
• 42:56
  SPEAKER_02: How annoyed do you get when you you buy, you know, you buy an airplane ticket and then you have to pay for baggage and then you have to pay for your seat?
• 43:02
  SPEAKER_02: And actually, it's an added value to your service, and that's why we're quite critical, because we just don't have the money to be throwing at you know all these things if they're not going to add value.
• 43:11
  Michael: See, that would I I think the central lesson actually from this podcast is that is that many of the things that would shock a business coach and just make them want to scream at you, like, oh my god, you're not charging extra for this, or you're giving free time here.
• 43:25
  Michael: And those those really non-commercial things actually turn into incredible marketing.
• 43:30
  Michael: Well, first of all, it provides a great experience.
• 43:33
  Michael: The patient is incredibly happy, which in turn is fantastic marketing, which in turn actually ends up being commercial rather than the neuroclinic where I turn up and they say, Well, it's gonna cost this, and you've thrown this cost and thrown that cost, and I want to have a chat with you for 20 minutes because I'm a bit worried.
• 43:48
  Michael: Well, you need to book an appointment, that's gonna cost you money.
• 43:50
  Michael: And it just doesn't kind of deliver the same experience, which again is terrible marketing, and but maybe it probably makes less money than than you do doing it all the right way.
• 44:00
  Michael: So I I think it's a central lesson because too many people I think, and I'm sometimes guilty of this of telling people not to do things for free all the bloody time, but I think that lots of people can learn that lesson of do things really well and create a patient experience and generate more money because of it.
• 44:16
  SPEAKER_02: I think it's yeah, it's it's taking, I don't do much on I don't do much on a short-term view.
• 44:21
  SPEAKER_02: Like most of the stuff that I make a decision on is on a long-term view, and I won't make a learn through mistakes in the past to be to be fair, that I don't make decisions on the day, I don't make decisions with people that rep or whoever's trying to sell me something sat in the room, you know, I will make that decision over then a you know a period of months rather than immediately on a long-term view.
• 44:41
  SPEAKER_02: And I think, you know, uh the conversation we had some time ago when we were redoing our site about SEO, and I had said to you, I think, why should I be putting money into SEO?
• 44:51
  SPEAKER_02: Right?
• 44:51
  SPEAKER_02: Like, what is it?
• 44:51
  SPEAKER_02: Why?
• 44:52
  SPEAKER_02: Because I don't I don't know, do now, but I I didn't at the time.
• 44:54
  SPEAKER_02: And you had said it's a long-term investment for the health of your site, right?
• 44:58
  SPEAKER_02: Like to to build things organically.
• 45:00
  SPEAKER_02: And for me, that's really important, and that's how I've always, you know, run our services on an organic level and and rather than these.
• 45:08
  Michael: I believe that actually you're you're number one or two in every location when you're doing search purposes.
• 45:14
  Michael: So it it worked out.
• 45:15
  Michael: Yeah, I suppose long-term view is it's always important.
• 45:18
  Michael: You've got to make sure things work in the short term, you've got to make sure you're financially responsible on things, I guess.
• 45:24
  Michael: Um can't just give things away for free.
• 45:27
  Michael: You've got to be commercial at times.
• 45:29
  Michael: But um, it is I find it fascinating that that you can run a business and probably ultimately charge higher fees, actually, because I think people will pay higher fees for for better service, no different to a four seasons versus a premier in.
• 45:44
  Michael: Like you're gonna pay more for a four seasons because of what you're getting from it.
• 45:47
  Michael: Um, but I I it it's kind of interesting because you're also in no way, well, I would not describe you as an entrepreneur, I'd describe you as a secret entrepreneur or someone that's like a entrepreneur, because I think you are incredibly entrepreneurial.
• 46:02
  Michael: I think there are so many elements of you and what you've achieved and what you do on a daily basis, which are incredibly entrepreneurial, nothing that could ever be taught, but you probably never see them in any way as entrepreneurial.
• 46:13
  Michael: I bet you've never described yourself as an entrepreneur to anybody in your life.
• 46:16
  SPEAKER_02: No, I'm a physio, I'm a physio.
• 46:17
  SPEAKER_02: I think I said to you at the beginning, like I'm a I'm a I'm a neurophysio, and ultimately I'm trying to do a good job.
• 46:22
  SPEAKER_02: And I've been to a few conferences recently and you know, I spoke to a few, you know, the sort of legal case management people, and they said, Oh, you've got a team of X and you're there, and how come no one's ever heard of you?
• 46:33
  SPEAKER_02: And I was like, Well, I'm just you know, I've been doing it for 10 years, but I just haven't either I haven't had the time because I've been too busy focusing on the people that are in our service that are using our service, and you know, that is probably not a great message if you're trying to trying trying to build a business, but you know, when I have time I use it to do that, but when I don't have time, patience and the service comes comes first, and then that that time to be able to do that is is secondary.
• 46:56
  Michael: Yeah, I I spoke to someone maybe a week ago who owns a he doesn't want to be named.
• 47:02
  Michael: I wanted to get him on the podcast.
• 47:03
  Michael: He owns a business, a very, very successful business.
• 47:05
  Michael: It's a it's a Savile Road type business.
• 47:08
  Michael: And I was chatting to him and didn't know I was chatting to him, but basically this guy runs the shop, he's in the shop every day, he does all the marketing, he does everything within the business.
• 47:16
  Michael: He's got like a couple of like companies that sort of help him out with with bits, you know, bits of pieces.
• 47:21
  Michael: And I said to him, Why are you um why are you not out there?
• 47:24
  Michael: Why don't you want to do a podcast?
• 47:26
  Michael: He said, because I don't want people to know who I am.
• 47:28
  Michael: I want to be the guy in the shop that sees customers' faces when they look at the product.
• 47:33
  Michael: I want to be the person at the end of the phone where they think they're talking with the customer service rep when they're unhappy, because I want to know that they're unhappy.
• 47:39
  Michael: But I don't want them thinking they they're speaking to a founder.
• 47:42
  Michael: And I found found that incredibly interesting.
• 47:44
  Michael: He said, I want to turn up at trade shows and be the person that no one recognises rather than oh my god, that's the guy that has millions of pounds and owns you know XYZ.
• 47:54
  Michael: And I found that really interesting and and and quite refreshing in a way.
• 47:57
  SPEAKER_02: Yeah, I don't I don't I don't think you have to be this this this extroverted person to be able to run a successful business and to found something that's that's truly valuable.
• 48:07
  SPEAKER_02: And I think that's it all comes back to me for why, right?
• 48:11
  SPEAKER_02: Like I think like you have to really be close to that and and why you did it and and why you started it and and keep those reasons very clear.
• 48:19
  Michael: That's very contrary to a lot of what people are doing at the moment.
• 48:21
  Michael: I don't know if you've uh heard of um Daniel Priest in four Ps, like complete nonsense.
• 48:27
  Michael: And but I see it being spattered around the the physio community where it's like be noisy, be shouty, be on social media, post on LinkedIn every day.
• 48:36
  Michael: You you're only gonna be successful by being the voice of the business and getting out there, which I think is complete nonsense because actually I think authenticity matters more than anything else.
• 48:45
  Michael: I think quality of what you put out matters more than anything else.
• 48:48
  Michael: Like I put some stuff out there, but I really work hard on making sure that what I put out is really good, and I'd rather have one decent thing than ten crappy things, and you've got to be authentic with it.
• 48:58
  Michael: So you're right.
• 48:59
  Michael: I I don't think it's about being, says me, the guy with a fucking podcast and always shouting.
• 49:04
  Michael: But but I don't think you do need to be an extrovert.
• 49:06
  Michael: I don't think you do need to be loud and and whatever to be successful in business.
• 49:10
  Michael: I think you can if you understand the business from the inside, you know what you're doing, you understand the the customers, the patients, and deliver a great experience.
• 49:19
  Michael: I almost feel like you can't fail.
• 49:21
  SPEAKER_02: Yeah, I mean, I think there are I mean there are decisions that I've made historically which could have gone either way.
• 49:26
  SPEAKER_02: Like I think there's like decisions there where you're like, you know, just just pre-COVID, we were looking at renting a space.
• 49:31
  SPEAKER_02: And it was fortunately it's a credit to my my wife, she said, listen, Adam, I really don't think that this is the best time to be doing it.
• 49:37
  SPEAKER_02: And then literally three months later it was a lockdown, and we'd have been locked into some sort of rental agreement that would probably have just we'd have probably gone under.
• 49:44
  SPEAKER_02: So you know, there is uh periods where you've made those decisions and you you're lucky or you're not, you know, in some ways.
• 49:50
  SPEAKER_02: And you know, that's that's a coin toss decision in some ways, isn't it?
• 49:53
  SPEAKER_02: It's you could have gone either way.
• 49:54
  SPEAKER_02: But so I think there is a bit of that, but I do think that authenticity sits at the center of what you do as if as a healthcare, you're in a healthcare business.
• 50:02
  SPEAKER_02: You're not in, you know, you're not working in Canary Wharf, it's different, it's you know.
• 50:05
  Michael: Yeah, no, I I agree.
• 50:06
  Michael: I was on a podcast recently when someone said, Michael, honestly, you're incredible, what you've achieved.
• 50:11
  Michael: You've sold the business, you've got this money, and you've got the I was like, mate, it's sort of there.
• 50:15
  Michael: Like, number one, 50% of everything is luck, the rest of it is just hard work.
• 50:19
  Michael: Um, the amount of things that could have sent us under a million times, the people that I met at the right times, you can't take in the same way, you can't beat yourself up when things go wrong.
• 50:29
  Michael: You also can't sit there and go pat yourself on the back going, Oh my god, aren't I wonderful?
• 50:33
  Michael: Look how successful my business is.
• 50:35
  Michael: I think you've got to accept that a very small portion of that is down to you.
• 50:40
  Michael: The rest is luck, other people, relationships, and so on, and timing a lot of the time as well, right?
• 50:45
  Michael: Yeah, it's a really interesting point.
• 50:47
  Michael: Listen, let's leave it there because um we've been on for almost an hour.
• 50:52
  Michael: I'm sure you've got patience to treat for free.
• 50:54
  SPEAKER_02: Probably.
• 50:55
  Michael: It's been really lovely chatting.
• 50:57
  Michael: I hope everyone finds it really useful.
• 50:59
  SPEAKER_02: So thanks for thanks for your time.
• 51:00
  SPEAKER_02: That's been great.