Latest / No Appointment Necessary / Clinics, Consolidation and Bad Advice: An Investor’s Unfiltered View of MSK

Transcript

Clinics, Consolidation and Bad Advice: An Investor’s Unfiltered View of MSK · No Appointment Necessary

• 0:00
  Michael: So today on No Point, we have a very special guest.
• 0:03
  Michael: His name's Ben, or otherwise known as the boss, and someone who reminds me most days that he had to sell his kidney to buy my company.
• 0:11
  Michael: So welcome Ben, the new owner of HMDG.
• 0:14
  Michael: We're going to be talking a little bit about HMDG to start with, because I think it kind of touches on a few things within the market.
• 0:21
  Michael: And then we're going to start getting some insight into what Ben thinks about the market, what he's discovered, and so on.
• 0:27
  Michael: So I hope it'll be really interesting getting that sort of outside outside source and opinion on the world of NSK.
• 0:35
  Michael: So welcome, Ben.
• 0:36
  Michael: Do you want to give us a very brief background on you, who you are, and so on?
• 0:40
  SPEAKER_01: Absolutely.
• 0:41
  SPEAKER_01: Well, first of all, thank you for having me.
• 0:42
  SPEAKER_01: You know, it's uh great to see that even though we speak very much, I think, on average, an hour and a half every day, you still want to hear more.
• 0:50
  SPEAKER_01: So, you know, thank you for having me.
• 0:51
  SPEAKER_01: So, quick one about me.
• 0:52
  SPEAKER_01: Uh, I'm French, as you probably know and can probably hear.
• 0:56
  SPEAKER_01: Been in London for for about 10 years, started my career in uh in digital, working at Google actually in 2011, and then moved in the other areas of the the tech space, mostly in entrepreneurship.
• 1:07
  SPEAKER_01: So started a couple of uh software businesses and got very interested in the healthcare space in the UK for a variety of reasons.
• 1:14
  SPEAKER_01: One of them being that you know we have a lot of doctors in in our family.
• 1:18
  SPEAKER_01: My sister is actually uh a dentist, kind of like the the failure of the family for for not being uh for not being a doctor.
• 1:26
  SPEAKER_01: And my girlfriend, as as a lot of you know, uh, has to acupuncture clinics here uh in London.
• 1:30
  SPEAKER_01: And so, you know, I kind of was pretty involved in her starting the business, even though it's her business and the success is all yours.
• 1:36
  SPEAKER_01: I'm not trying to form the the credit.
• 1:38
  SPEAKER_01: But you know, I was very interested in in the space.
• 1:42
  SPEAKER_01: Uh, initially, my approach in the in the space was to look into acquiring and essentially building a group of uh physiotherapy clinics, and I think more broadly MSK clinics.
• 1:52
  SPEAKER_01: I think we can probably we'll talk a bit about it and because I think you yeah, I'll I'll tell you a bit how we how I wanted to do it and kind of like my view on on the industry and how I think it it could make sense.
• 2:04
  SPEAKER_01: Um so essentially I I went and across you know UK, went around, met about 25 clinic owners, so pretty much uh spent six months as a traveling salesman, meeting clinics, actually had like three or four clinics under LOI.
• 2:18
  SPEAKER_01: So we were yeah, I think I think we we would have found a deal with with maybe a couple of them, including uh uh a couple of HMDG clients.
• 2:26
  SPEAKER_01: And I decided not to move forward with that um that ID or that that yeah that project work where clinics, and then that's when a couple of um GMDG clients who had had built a relationship with were like, well, you gotta talk to Michael because I think you know you both come from a digital background, you both talk super fast, and uh and I think you'll get along and you'll have IDs and see what happened.
• 2:47
  SPEAKER_01: And I remember actually we had a call, I think the first call was pretty much exactly two years ago now.
• 2:52
  SPEAKER_01: Uh sorry, yeah, yeah, two years ago.
• 2:54
  SPEAKER_01: Yeah, two years ago.
• 2:55
  SPEAKER_01: It was around October, November 2023, and I think we had 30 minutes in our schedule, end up spending two hours discussing anything from like booking systems to how we would rebuild the CRN for clinics from the ground up to aggregator in the space and so on and so forth.
• 3:12
  SPEAKER_01: And then, you know, there's the option as well to to find a partnership around HMDG and essentially for you to sell the business and Hannah for you to for the two of you to sell the business while staying involved, and then one thing leads to another in September 2025.
• 3:27
  SPEAKER_01: We uh we we we trust the deal, and here we are about 13 months after that.
• 3:32
  SPEAKER_01: So yeah, that there's the journey.
• 3:34
  Michael: Yeah, it was really interesting.
• 3:35
  Michael: Um because initially we were talking about tech and and kind of thing, and then uh yeah, and then you just went down.
• 3:40
  Michael: I think you you found out some of our numbers, and you were like, hmm, this looks quite interesting and uh might be worth doing this, and and slightly more profitable than most of the um the clinics that you were talking to at the time.
• 3:51
  SPEAKER_01: Yeah, and I think so so I think you know there's there is an element obviously about you know the number, the profit, and so on.
• 3:57
  SPEAKER_01: But I think ultimately one of the reasons why I decided not to pursue the the the clinic acquisition path is like it doesn't feel like it or it didn't feel like it was something where it was ready to make an impact and essentially like deliver you know the the the results that I wanted to.
• 4:13
  SPEAKER_01: And I think ultimately like I was a bit uncomfortable with the idea to not be a uh a physiotherapist or a clinician myself, and essentially having the core decisions, if you will, um sitting with someone else because ultimately, you know, I could be in charge of the systems and which software we use and so on, and convince myself that I'm the boss because I'm making all these decisions about the accounting software we use.
• 4:39
  SPEAKER_01: Ultimately, the core of the service or the product that that you're offering is the treatment, right?
• 4:43
  SPEAKER_01: And so I'm not gonna be the one making the decision on the treatment plan.
• 4:47
  SPEAKER_01: And I think you know, in that model, quality of care and and essentially the care you provide is the most essential thing, right?
• 4:55
  SPEAKER_01: And so if you're gonna acquire and run businesses where you actually, you know, you're a step removed from the most important thing in the business, something I could only reconcile.
• 5:05
  SPEAKER_01: I think you know, some people are doing it, and I think that they have a uh a larger team and so on and so forth.
• 5:10
  SPEAKER_01: So I think you know they they they're probably gonna be very successful at it.
• 5:13
  SPEAKER_01: But I think it was almost like a mismatch of like meme, my ambition, and uh and the core aspects of uh of the business.
• 5:21
  Michael: So touching on that, because it's quite interesting.
• 5:23
  Michael: Uh I I we're gonna have a PE on quite soon talking about uh acquiring clinics.
• 5:28
  Michael: And I think one of the issues is always that um you get someone in that isn't a clinician, doesn't understand the industry fully.
• 5:35
  Michael: How are they capable of running a business like that?
• 5:38
  Michael: But moreover, there's also that question about profitability versus patient outcomes.
• 5:43
  Michael: And as we know, most clinic owners are interested in patient outcomes first and profitability second.
• 5:48
  Michael: And I think it it's kind of an interesting point when it comes to HMDG because we had built a company, myself and Hannah had built a company which was still is, but was incredibly ethical.
• 5:58
  Michael: Um and we really cared about clients, we really cared about the work we were doing, and we had a certain level of well, there was two things.
• 6:05
  Michael: We had a certain level of integrity.
• 6:07
  Michael: Um, I'm always out there shouting about things that that I don't like.
• 6:11
  Michael: Um, and I do that because I'm truly passionate and I care about what's happening, but then we also had a certain tone of voice, and I I'm interested to know how how you see HMDG now and how do you scale HMDG, keeping that level of integrity, but also keeping that tone of voice.
• 6:35
  Michael: Because I think sometimes you you find that companies become very corporatized.
• 6:41
  Michael: Uh you can't say the same things that you used to be able to say.
• 6:44
  Michael: Uh, you know, it's fine when it's a family-run business, but now we're a corporate entity and we have to be more careful.
• 6:49
  Michael: Um now I don't think that's the case actually with us.
• 6:51
  Michael: Uh, but I'm interested to to hear your thoughts on on how you do that and and how you keep that balance.
• 6:58
  SPEAKER_01: Yeah, and look, I think it's you know, it's super tough.
• 7:01
  SPEAKER_01: And if I had uh the absolute answer, I'd probably write the book and and and help a lot of business scaling, a lot of businesses scaling from 100 million to a billion, how to do it.
• 7:11
  SPEAKER_01: And I think ultimately it's a very tough bounce to find, right?
• 7:16
  SPEAKER_01: There is almost different stages in the life cycle of a business.
• 7:19
  SPEAKER_01: You know, there's the what you're gonna call the zero to one, right?
• 7:22
  SPEAKER_01: And the zero to one was you know, you and Hannah to start with, and then the first members of the team in your living room, you know, not really knowing what you were doing, but doing it well.
• 7:32
  SPEAKER_01: So, you know, happy days, it worked at it scaled.
• 7:34
  SPEAKER_01: And and I think there, you know, you don't necessarily have to think about the ton of voice and stuff because the business is my own Hannah so you know it's like, well, be yourself, and that's the business, right?
• 7:43
  SPEAKER_01: So that's kind of the zero to one phase.
• 7:46
  SPEAKER_01: Then there's the the one to ten phase, and I would say that's you know where we are currently.
• 7:50
  SPEAKER_01: And when I say one to ten, you know, it's not like millions of pounds or whatever, it's just kind of like uh uh an order of magnitude.
• 7:57
  SPEAKER_01: And I think here it's kind of like the tricky bit, but it's also where it's still quite manageable in the sense that like yes, the team grows.
• 8:06
  SPEAKER_01: Yes, you have more people, and yes, you know, some of your jokes or Mark's jokes, mostly yours, because they're actually the worst in the companies, like might actually uh offend people or like rub people the wrong way, and so on and so forth.
• 8:19
  SPEAKER_01: But we're still at a stage where we have a lot of agency, right?
• 8:23
  SPEAKER_01: Because we're hiring a lot of people, but we're not hiring 50 people a month that you and I don't know, haven't interviewed and haven't vetted.
• 8:32
  SPEAKER_01: So I think it's it's it's the it's kind of like the danger zone where like if you become complacent now, there is no coming back from it, or at least it's gonna be very difficult, but you still have agency.
• 8:43
  SPEAKER_01: And I think what becomes extremely tough, and I'm not saying it's easy at the stage we're in, but I'm saying, like, you know, and we do it all the time, right?
• 8:50
  SPEAKER_01: When we interview candidates and so on, we're like, well, look, on paper, they know a ton about SEO and they'd be super good and stuff, but it's just the feed, like they don't have it, and it you know, it's your it becomes difficult to articulate.
• 9:03
  SPEAKER_01: Well, is that it, right?
• 9:05
  SPEAKER_01: But then I think the problem becomes, you know, at the order of magnitude after that, so the scaling from 10 to 100, where literally you're seeing 10 people coming through the door every week, and you know, you're gonna get some people wrong, and it's much much more difficult to assess because you don't speak to them all the time, you have yeah less of a view on it.
• 9:24
  Michael: I I think that's yeah, so that's the internal side, right?
• 9:27
  Michael: So for anyone, well, most people work now how we do how we've always run things internally, but it's very relaxed, it's very non-PC, we have fun, we have jokes, we we treat each other as friends.
• 9:38
  Michael: Yes, it can get stressful and so on, but we have a very informal attitude.
• 9:42
  Michael: And I think there comes a point where you can't, you know, maybe tell some of the jokes that you can tell when you've got a much larger team and so on.
• 9:48
  Michael: But I'm interested also in the external point of view.
• 9:51
  Michael: So, you know, right now I'm still capable of saying this is bullshit, I think it's rubbish, and or or this person or this business or whatever.
• 9:58
  Michael: I I still right now have that ability to do it, and I can do it on the podcast, I can call things out that I don't like.
• 10:04
  Michael: You can't do that indefinitely, or can you?
• 10:06
  Michael: Like, we have a certain tone of uh as HMDG where we're very honest, we're very opinionated.
• 10:13
  Michael: At what point, if any, do you have to think about, well, we're now far too big a corporate entity, we cannot do the same thing anymore?
• 10:22
  SPEAKER_01: Yeah, I mean, look, it's uh it's a very good question, and I don't I don't necessarily have the answer like when that happens.
• 10:28
  SPEAKER_01: I think that happens when partly when you start to have clients that you work with or you're working with stakeholders that have interests in things that you know maybe your clients didn't have interest in before.
• 10:41
  SPEAKER_01: So it was much easier, for instance, for you to or for us to go against something we don't believe in.
• 10:47
  SPEAKER_01: But then as you grow, and maybe you know, the type of clients you work with is much more diverse.
• 10:51
  SPEAKER_01: Well, some people aren't actually like, you know, have an interest in what you're about to denounce.
• 10:56
  SPEAKER_01: And so, like, how do you approach that and and so on and so forth?
• 10:58
  SPEAKER_01: And say there's also a question around like when we go around like when we actually like have an opinion and want to be a bit public about it, like there's almost a first question that's like, well, does it make sense?
• 11:13
  SPEAKER_01: Is it just Mark, Michael, Ben, Hannah, or Gabby just having a strongly held, loosely backed opinion and going a bit banana about it?
• 11:23
  SPEAKER_01: Or does it actually make sense?
• 11:24
  SPEAKER_01: Like, if I wanted to write an article like about how MSK clinic owners prioritize quality of care and we think it's dumb, we'd probably be like, no, Ben, that actually doesn't make any sense, right?
• 11:37
  SPEAKER_01: And so I think it's it's then the question becomes okay, like it's perfectly fine to be controversial, but the more controversial you're gonna be and the more opinionated you're gonna be on something you know that can be either sensitive or polarizing.
• 11:49
  SPEAKER_01: Well, you better do your homework.
• 11:51
  SPEAKER_01: Because I think, you know, for instance, like we or Mark, I say we so so I'm taking credit for it, but it's it's Mark wrote an article about packages.
• 12:00
  SPEAKER_01: And I think you know, it could have been much more polarizing than it's been.
• 12:03
  SPEAKER_01: It could have there could have been some controversy and and so on.
• 12:06
  SPEAKER_01: And we had some interesting comments, but the thing is the article was very well researched, nuanced at times where it needed to be.
• 12:13
  SPEAKER_01: So, you know, it's an opinion that we express, and it's like if you're gonna come at us or you know, disagree with it, well, at least you know you can't remake the point that we haven't done our homework and that we have a lot of blindsides.
• 12:25
  SPEAKER_01: So I think it's that's kind of like the the easy path.
• 12:29
  SPEAKER_01: Because I think, yeah, if we had uh uh a huge client representing 70% of our turnover that was making his his money on packages, probably it would have been a bit of a more difficult conversation.
• 12:40
  Michael: You see, that's interesting.
• 12:41
  Michael: That's interesting because if I'd written that article, it would have been very different.
• 12:44
  Michael: I mean the the content would have been similar and many of my points are in there, but it would have been a bit more polemic.
• 12:50
  Michael: But I I think for me it's it's always been a case of I don't give a fuck.
• 12:54
  Michael: Like I will give you my opinion, and if you don't like it, don't like it, don't be a customer.
• 12:59
  Michael: I just don't care.
• 13:00
  Michael: And and I suppose as you grow and you have whether it's investors or PR or whatever, you've probably got to be a bit careful.
• 13:09
  Michael: And you see that in in all sorts, in all walks of life, right?
• 13:11
  Michael: And I think that's the nature of having a much smaller company where someone like me can say, I don't give a fuck if you don't like the fact that I think the chiropractors who have who do 200 x-rays a week are morons and shouldn't be let near patients, well then don't like it.
• 13:26
  Michael: But that's my opinion.
• 13:28
  Michael: And I think that that that has actually, because this is the interesting point, that has actually helped us to grow to the level that we got to because people trusted us.
• 13:39
  Michael: They may not agree with me, and I'm sure there's plenty of things that many people don't agree with me on, but they know that I'm always gonna give them my opinion, which is well thought out, and so on.
• 13:48
  Michael: And so then, you know, how do we continue doing that and maintain that integrity whilst probably being being a bit more careful?
• 13:56
  Michael: I think you answered it, which is be a bit more careful, right?
• 13:59
  Michael: Just think about what you're gonna say before you say it.
• 14:02
  Michael: But but one point I do just want to make.
• 14:04
  SPEAKER_01: Yeah, but I think but I think so, so there is being careful, but I think you know, like not having an opinion and trying to please everyone, then you essentially like it's very easy to do, actually, right?
• 14:14
  SPEAKER_01: You know, you're gonna chat GPT, you're very broad about the prompts, and you're gonna have some slot that you can post.
• 14:20
  SPEAKER_01: Great, happy days.
• 14:21
  SPEAKER_01: But I think you know, and it's pretty much a getting principle in you know how how I see it, or tonight of voice or brand, and so on and so forth.
• 14:28
  SPEAKER_01: It's like if something rewrites sounds like a LinkedIn leadership, like thought leadership post, like it's it's it's that's not us, like you know, and and and that's the easy bit.
• 14:38
  SPEAKER_01: So I think you know, it's if you take something like very controversial, for instance, uh I don't have an amazing example right now, but like, or you know, let's use packages, for instance.
• 14:47
  SPEAKER_01: Like, it would actually be pretty cool to have almost a debate or like two articles that are like why packages are great or why packages are wrong, one is by Mark, the other one by Hannah, and be like, look, it's it's a debate, it's a topic, and ultimately at HMDG, we're gonna tell you, uh tell you uh uh how we feel about it.
• 15:04
  SPEAKER_01: And maybe packages is not the right example.
• 15:06
  SPEAKER_01: It's actually something that we have a very clear opinion of.
• 15:08
  SPEAKER_01: But yeah.
• 15:09
  Michael: I want to make a point on that because you I don't think you know this.
• 15:12
  Michael: Um, most of what I have come out and said, I have invited people onto interviews, I have invited people to to to to um to debate it with me.
• 15:22
  Michael: Not one person in six years has ever had the balls to actually get on screen with me and say, Yeah, Michael, I'm gonna argue it.
• 15:30
  Michael: And and I think most of the time it's because they're either gurus who don't believe it in them themselves, they just don't have the balls.
• 15:35
  Michael: So it's not that we can just put that out there and go, well, this is the truth, because I would I am I'm the one person in this industry that is open to data.
• 15:42
  Michael: You want to prove me wrong on packages, a thousand clinics that um, you know, make 50% more revenue by doing packages, although I don't think revenue is necessarily be all an end, all but show me that, then I'll I'll happily I'll happily change my opinion.
• 15:57
  Michael: But it is interesting that um and I said this to a client yesterday who sort of and she had a bit of a point to be fair.
• 16:04
  Michael: She was like, you do get out there and and make a lot of noise and ruffle feathers.
• 16:08
  Michael: And I said, Well, that's because I'm passionate, and I don't believe, and I'll be happy, I don't believe there is another person in this industry right now that calls out things like I do.
• 16:19
  Michael: And and it's not for the sake of calling them out.
• 16:22
  Michael: I I actually care.
• 16:23
  Michael: I don't want people to be ripped off.
• 16:24
  Michael: I don't want people to buy bullshit technology that doesn't work, and and it is a bit strange and a bit silly that I am the only person that does do that.
• 16:33
  Michael: Um, you know, n none of the big organizations do it.
• 16:35
  Michael: When TM3 did their big grift of increasing their prices, who else was out there other than Klinikodes themselves?
• 16:42
  Michael: But who else was out there saying this is ridiculous?
• 16:44
  Michael: Like it wasn't okay.
• 16:45
  Michael: Um, and I think again, we've grown through that.
• 16:48
  Michael: And I think again, as long as we're careful and not just ridiculous and put stuff out there that's stupid, then I then I think for the time being we can keep going as well.
• 16:57
  SPEAKER_01: Yeah, and and and it's right there, but I think there's there's almost like two pitfalls that you want to avoid, right?
• 17:03
  SPEAKER_01: One is like the AI slop, like you know, pitfall.
• 17:07
  SPEAKER_01: The other one is like, well, I've kind of been controversial.
• 17:11
  SPEAKER_01: You know, we've been controversial historically, this has served us.
• 17:14
  SPEAKER_01: Let's find another topic to be controversial about and kind of like constantly stir the the part where it doesn't need to be.
• 17:21
  SPEAKER_01: And I think it's it's finding that balance, right?
• 17:22
  SPEAKER_01: And I think what's also very important, and going back to what we're saying about like maintaining that culture, that ton of voice and stuff, you know, it's like, and again, it's gonna be a very like you know, basic thing to say, but it all boils down to like the people you bring on board.
• 17:36
  SPEAKER_01: And I would say like a hundred percent of the people we have in the team at HMDG are the kind of people who would say without too much problem, yeah, no, no, you're right, you were right.
• 17:46
  SPEAKER_01: Actually, I was wrong on this.
• 17:48
  SPEAKER_01: And I think that's absolutely essential, right?
• 17:50
  SPEAKER_01: Like, if you're gonna debate and be like, at all costs, I'm gonna defend my position.
• 17:54
  SPEAKER_01: And you know, I think on HMDG Connect, I think it was Paul Goss or maybe one of our one of our other clients making a comment, kind of going against some of the stuff you were saying in the article, even though you know he the he still praised the article and so on.
• 18:06
  SPEAKER_01: It's like, well, that's a very healthy debate, and you know, it's like should be a very good point that moves the conversation forward.
• 18:12
  Michael: It was Paul Goss, and he had mentioned about the running thing and that he had given you a package, and I actually agreed.
• 18:16
  Michael: I said, actually, you're right on that.
• 18:18
  Michael: That is a totally appropriate thing.
• 18:20
  Michael: So, yeah, as long as you I think as you've got to be open to debate, you've got to be open to be proven wrong.
• 18:25
  Michael: But one point I do just want to make, you sort of made it earlier, um, or raised it earlier, which was, and you don't know this yet, but we still have a level of integrity despite obviously being uh I don't want to say more corporate, but certainly being a not a mum and pop business anymore.
• 18:40
  Michael: And the example of that is the other day, um, I told a chiropractor we weren't gonna work with them.
• 18:45
  Michael: And it was worth, you know, a reasonable amount of money, but I was really uncomfortable with what they were doing and what they were trying to get us to do, and I just said, look, we're not gonna do it.
• 18:56
  Michael: It's it's it's not in our interest to go down this route.
• 18:59
  Michael: And and and I think that that's something that people should know that we do still hold firm on.
• 19:05
  Michael: You know, if someone says I want to do something and we don't have opinions on it, and that's fine.
• 19:09
  Michael: But if someone says we we hypothetically drink babies' blood to make people better, well, I'm not marketing that crap, right?
• 19:16
  Michael: So so I think that that um that's still an important point that we we will retain that integrity and not just work with anyone or market anything just because there's money involved.
• 19:28
  Michael: Because one of the things that we that I truly believed, and I remember you were very much the same.
• 19:33
  Michael: I I think for me, create a great product or create a great service, and the money will come.
• 19:38
  Michael: There are too many people that think about how do I make money and then create a service outside of it, and that isn't us, and I don't think it will will ever be.
• 19:46
  SPEAKER_01: But I think it's also, you know, like in in every businesses, and I think it's a bit of a fallacy you see now, like because of you know, LinkedIn and the and get rich get rich quick schemes, and you know, you can be a trillionaire and Look at me on my you know business class flight to wherever.
• 20:04
  SPEAKER_01: It's it's like you gotta be in it for the long game.
• 20:07
  SPEAKER_01: You gotta like don't start a clinic with the hope to flip it in two years.
• 20:10
  SPEAKER_01: Like, don't start a marketing agency or buy one if you're gonna flip it if you want to flip it in 18 months.
• 20:16
  SPEAKER_01: Like some people do it, some people are successful at it, but I think that's never gonna be the the the game I play or we play.
• 20:23
  SPEAKER_01: And so I think ultimately what what that you know requires is reputation.
• 20:27
  SPEAKER_01: And reputation, whether it's personal, whether it's your business, it's literally the most important thing you have.
• 20:32
  SPEAKER_01: Like there is absolutely, you know, and we're very clear on that, and I think we didn't have too many occurrences like that, but there is absolutely no amount of short-term revenue that would justify us working with you know a you know, crazy doctor from Harley Street and and so on and so forth, or even with like someone who standards we don't believe in, and and so on and so forth.
• 20:59
  SPEAKER_01: And I think you know, we could very easily do it and you know build our website, not have you know, remove or not include a an HG footer at the bottom and so on and so forth.
• 21:08
  SPEAKER_01: But it's just it's not worth it.
• 21:10
  Michael: Yeah, no, I and I think again that goes back to that point of short-term money doesn't count.
• 21:15
  Michael: I think one of the reasons you're interested in business in the first place was that we have an incredibly low churn rate and people stick with us, and we have a uh you know a recurring revenue level.
• 21:24
  Michael: And making an extra 20 grand next month for a month, who cares?
• 21:28
  Michael: It's not important, right?
• 21:29
  Michael: It's it's that long-term customer relationship that is important.
• 21:32
  Michael: Um, right, let's move on to some non-hem HMDG stuff.
• 21:36
  Michael: Um, I'm kind of interested in some of the business stuff that you see.
• 21:40
  Michael: So you've been around a long long enough now, and you've seen lots and lots of clinics, and and obviously you saw clinics before you got involved with HMDG.
• 21:47
  Michael: But what do you see amongst, like, what are the patterns you see amongst the really successful clinics versus those that struggle?
• 21:54
  Michael: What are those key elements that you see?
• 21:56
  SPEAKER_01: Yeah.
• 21:57
  SPEAKER_01: So I think the the main one I'd say is essentially like whether you call it a vision or a clear goal or a clear like reason why they're in the business.
• 22:07
  SPEAKER_01: I think that's like one of the things I see as like the main criteria for success.
• 22:12
  SPEAKER_01: Essentially, you know, you have clinical, and we could essentially list a lot of our of our clients who know exactly what they want to do, how they want, you know, like the problems and the the the the the the conditions that they want to treat for, to who, and so on and so forth.
• 22:27
  SPEAKER_01: You know, you can call that a niche, you can call that a focus, because ultimately some of them who have a very clear view on what they are trying to achieve might have a very broad scope.
• 22:36
  SPEAKER_01: So to that extent, they're not very niche, but like you have, you know, we have neurophysios who know exactly what they're into and they're locked in, and and so on and so forth.
• 22:44
  SPEAKER_01: Well, I think you know, the opposite for clinics who don't have that is that you're kind of gonna rely on whatever self-help book or business book you read last, and whatever you know, last trend you saw on LinkedIn, and you're kind of like flip-flopping on every single decision you're making.
• 23:03
  SPEAKER_01: And I think you know, it's if you know what you're in for, and and the reason why you chose that path, the reason why you've decided to take the hard path of running a business, starting a business, which means essentially swallowing shit all day, every day for uh for years.
• 23:19
  SPEAKER_01: Well, I think you know, you make your life much easier if you know what you're trying to achieve and the reason why you're in it, because then a lot of the decision you're gonna have to make, and you know, God knows you have to make 20, 30 decisions a day, well, you have a you don't have to flip-flop, you don't have the mental burden of having to like overthink your business strategy in every uh in every um in every um yeah, in every decision you make.
• 23:42
  SPEAKER_01: And I think if you take, you know, there's a business, for instance, that I I love, I mean, not as a client, not as a customer, because really as a as a business that has like extremely clear principles and ways to operate, it's Ryanair.
• 23:53
  SPEAKER_01: Ryanair, like they know exactly what they're in for, who they care to.
• 23:58
  SPEAKER_01: They're just we're gonna cut prices in every single thing we do.
• 24:02
  SPEAKER_01: So that means that you know, whenever they open a new line or and so on and so forth, they're like, we know exactly what we need to do.
• 24:08
  SPEAKER_01: And when we have a decision to make, we're gonna take the one that like cost less at the expense of like the experience for the for the for the cloud.
• 24:17
  SPEAKER_01: But it's also very clear to the cloud.
• 24:18
  SPEAKER_01: And I think these businesses that have that clarity are always very uh, you know, essentially are much easier to run for the owners, which means that in terms the owner can focus on actually uh uh growing the business instead of flip-flopping on every decision.
• 24:32
  Michael: The flip-flopping is a big one, and and I think also when you have that long-term vision of where you want to be.
• 24:37
  Michael: And and for some clinics, it can just anyway for us, it was always monetary.
• 24:41
  Michael: It was we want to be at one million pounds or two million pounds, and and how do we get there?
• 24:46
  Michael: Um, but it also allows you to do long-term planning and forecasting.
• 24:50
  Michael: So one of the things we see that is incredibly frustrating in clinics is especially new ones that join us, they'll call us every three days going, oh my god, what's happened here?
• 24:57
  Michael: Or what's happened there?
• 24:58
  Michael: Should we change things?
• 24:59
  Michael: And like with any life, it's consistency, it's planning, it's consistency, it's measuring over a longer period.
• 25:06
  Michael: You know, you don't, if you're trying to lose weight, you don't well, you shouldn't weigh yourself every 15 minutes, right?
• 25:11
  Michael: You look at it over a quarter, over a six-month period, and so on and so forth.
• 25:14
  Michael: And and I think that's where what I see from the clinics that do incredibly well are the ones that have that long-term strategy, that aren't flip-flopping, and who know exactly the direction they're going and are willing to look at their numbers, whatever those numbers are, over a longer period of time.
• 25:31
  Michael: They I I remember last year, I think it was November, and it was a really poor month across the market, and everyone was panicking.
• 25:37
  Michael: And this one clinic owner, I haven't chat with him, and he said, I said, Are you okay?
• 25:41
  Michael: And he said, I've been in this for 20 years.
• 25:43
  Michael: I know we have up months and down months, and that's fine.
• 25:46
  Michael: And we work that in.
• 25:48
  Michael: And it's quite interesting.
• 25:49
  Michael: I do wonder how many clinics work in the fact that you have lower or high months and what that looks like across the year for net profit.
• 25:56
  Michael: And I don't I think not that many, particularly the ones that aren't that all not successful, but the ones that struggle a little bit more.
• 26:02
  SPEAKER_01: Yeah, it's like what is it that you're trying to achieve?
• 26:05
  SPEAKER_01: Like, do you actually is your goal to be a very like diversified clinic in your offering with 10 sites across your region?
• 26:13
  SPEAKER_01: Great, like you know, whether that makes business, you know, whether that's like sound from a business point or not, like you know, that's not for us to work, yeah.
• 26:21
  SPEAKER_01: It's hopefully something you've done your homework on, but at least you know it's like, or you actually want to be uh uh um you know, like a very different model where you essentially are very strong in the niche and expand that, or actually you're very you're you're fine with having one side or two, but it's almost like you're going on a run, and once you're out, you're like, okay, well, am I running 5k or am I running a marathon?
• 26:45
  SPEAKER_01: Well, you know, it's kind of a problem.
• 26:47
  SPEAKER_01: You don't really know that going out because obviously, you know, your nutrition plan and maybe uh, you know, the the the pace you you have on the first kilometer will have to be very different.
• 26:56
  Michael: Well, it's also it's way easier to communicate that then as well with the team.
• 27:00
  Michael: This is where we're trying to head to, this is what we're trying to achieve.
• 27:03
  Michael: And and obviously things change, right?
• 27:05
  Michael: It's not that things don't change and you don't have to sometimes switch things around a little bit, but having that long-term strategy and planning and so on, it just makes life so much easier.
• 27:16
  Michael: Whether it comes to, you know, as you know, when when you bought the business, you saw all of our forecasting across the year, you saw where we were planning to hire people, where we were planning to do various things.
• 27:26
  Michael: And you can only do that if you have a one-year, two-year, three-year kind of plan.
• 27:31
  Michael: Um, so that's kind of interesting.
• 27:32
  Michael: But uh moving on then to let's imagine let's take your average clinic or or or a clinic that you owned, let's say.
• 27:40
  Michael: Let's say you bought one tomorrow.
• 27:41
  Michael: What would be the thing, the one thing, or it could be multiple, multiple things, that you would prioritize in the first 90 days of owning that clinic?
• 27:51
  SPEAKER_01: Yeah, so I think I think the answer to that's very different if you're like actually a clinician, you know, buying a clinic, which obviously is not my case, but I think I would come in obviously much more as, you know, with a different background and so on.
• 28:05
  SPEAKER_01: I would really like immerse myself in the business to and the numbers, but I think you know it's it's both are equally important.
• 28:14
  SPEAKER_01: It's like understand, like, okay, what are the the drivers of the business in the world?
• 28:19
  SPEAKER_01: Like, where do our clients come from?
• 28:21
  SPEAKER_01: Understand, you know, like the acquisition, the retention, both from a number perspective, but also literally probably sitting at the reception for a day or two, and understand, like, okay, is there a problem and like the way we rebook patients and so on and so forth?
• 28:36
  SPEAKER_01: And it's really like essentially mapping the business almost as like you know, an equation or like a uh uh uh um you know flow diagram or flow chart, and understand like, okay, at what steps can we get better and to what extent can that drive you know the the main KPIs we we we have.
• 28:53
  SPEAKER_01: And so I think you know, obviously, like a major one is retention and and patient, you know, uh follow-ups and so on and so forth.
• 29:00
  SPEAKER_01: So that's I suspect that's probably one where we'd spend uh a lot of time, and so that's kind of like the the the autistic side of the business, and then there's the the much more uh personal view where I think you know you you spend a lot of time and then personal side of things where you spend a lot of time with with with everyone and um and both you know from with the clinical staff, the non-clinical staff, really understand like okay, how do they work?
• 29:24
  SPEAKER_01: And I think you know it's something probably that I could have done a better job at at HMDG.
• 29:30
  SPEAKER_01: I should have sat for a day or two next to Tom and Gabby and just be like, don't mind me, I'm just looking, which I didn't do and I kind of regret not doing, but I think that's that's that would probably be be my playbook in the alternate alternate universe where I actually ended up buying clinics.
• 29:46
  Michael: Yeah, I mean you've just given the most boring answer I think I've ever heard to that question, but it is exactly what you did because I just shows different people.
• 29:53
  Michael: I would have given a completely different answer.
• 29:55
  Michael: If I went into a clinic, I would go make either impact and effect change immediately and I'd do stuff.
• 29:59
  Michael: But for you, when you did it at HMDG, it was if I never see another fucking notion document or spreadsheet again, I I honestly.
• 30:06
  Michael: But you looked at every part of the business and examined everything, and yeah, it was really interesting.
• 30:10
  Michael: But I think that's what a lot of clinics don't have.
• 30:13
  Michael: They don't have that autistic kind of fixation on every last metric, every last number, and really understanding the business from from that point of view.
• 30:21
  SPEAKER_01: And I think the the and you know, I think it's it's one of the um the big like fallacy or shortfall I've seen uh with with with clinical owners and with Vicky, my girlfriend.
• 30:32
  SPEAKER_01: I definitely put it in that category.
• 30:33
  SPEAKER_01: It's like it's yeah, but I don't have the number for that specific metric.
• 30:38
  SPEAKER_01: So like you know, it's gonna take me ages to find and so on and so forth.
• 30:41
  SPEAKER_01: So I'm simply not gonna look at it.
• 30:43
  SPEAKER_01: Well, I'm not asking you to lie, or uh it doesn't matter a ton, you know, if like your average average patient visit number is 4.27 or 4.32.
• 30:54
  SPEAKER_01: What matters is like is it two or is it six, you know, and like obviously the narrower the the more you can narrow it down, the more precise your your view is gonna be.
• 31:03
  SPEAKER_01: But it's like, well, I'm pretty sure it's between you know five and seven.
• 31:07
  SPEAKER_01: Okay, great.
• 31:07
  SPEAKER_01: Like that's a great place to start with.
• 31:09
  SPEAKER_01: And one thing that I found is super interesting with you know small business owners, and I don't say small as like you know, something uh something patronizing, but it's much more it has a difference or to differentiate from like corporate businesses, for instance.
• 31:22
  SPEAKER_01: It's like most business owners have their numbers in their like veins, they know it because they're in the business all day every day.
• 31:30
  SPEAKER_01: So you know, they would know, for instance, almost like to to the very precisely how many patients they had this week, and that's even without looking at the dashboard.
• 31:39
  SPEAKER_01: But it's like, look, I've done this for uh for 1,000 weeks, so I have like my pattern recognition.
• 31:45
  SPEAKER_01: And I think it's it's a pro and a con because I think you can also like be pretty blindsided with like that more intuitive view of the numbers of your businesses, but of your business.
• 31:54
  SPEAKER_01: But I think it's it's just super important to like not be scared about numbers, and I think it's something that like I've seen a lot with clinic owners where the second it becomes business y number-y, they like get on the back foot and it's like I I don't know that, it's not my thing, and I'm scared.
• 32:10
  SPEAKER_01: But actually, you know, when you spend some time with them looking at it, like it's not a talent issue, it's not a smarts issue, it's not a scale issue, it's just like almost an attitude issue.
• 32:20
  Michael: Yeah, I think one of the issues or one of the problems that I've seen is that they can have all the metrics that you want them to have, but understanding them and then applying them is a whole different matter.
• 32:31
  Michael: And I think that's where people fall down.
• 32:33
  Michael: You know, we know I know plenty of people using uh data player, and they've got all these lovely dashboards, and you say, okay, what have you done with that data and what have you done to change the business?
• 32:41
  Michael: And they go, nothing.
• 32:43
  Michael: It's no different, for example, to the number of companies in the history of Google that have had Google Analytics on their website and have never looked at their data ever.
• 32:52
  Michael: Um and and I you know, I think it's a natural thing when you don't understand it or you don't know how to apply it, and sometimes not even not knowing, it's having the time.
• 33:01
  Michael: Go tell me to apply some things from Google Analytics on a website.
• 33:04
  Michael: I don't have the bloody time.
• 33:06
  Michael: I'm far too busy.
• 33:06
  Michael: Yeah.
• 33:07
  Michael: So I think that's one of the one of the issues.
• 33:09
  Michael: And I do wonder whether there is a potential service actually of looking at business metrics, helping business owners with those metrics, whether it's measuring them or applying them in some way.
• 33:21
  Michael: I have thought about that in the past of a of offering that kind of service, but I do think potentially there's some AI involvement now, right?
• 33:29
  Michael: It's not like you can't give those same metrics to AI and ask for recommendations.
• 33:34
  Michael: So maybe that could help in the future as well.
• 33:36
  SPEAKER_01: Yeah, and I think you you touched on something that's like is also very interesting to see.
• 33:40
  SPEAKER_01: And I think it's it's you know the case in across all industries, but it's like it's almost like death by dashboard overdose.
• 33:48
  SPEAKER_01: And it's like you go from either you don't have any numbers and you rely almost solely on that intuitive, like, you know, I know my business because I'm in it all day, or I have this fancy dashboard that like even a NASA engineer would need like 14 hours to even understand, and everything moves in all directions, and you're like, am I doing well?
• 34:08
  SPEAKER_01: Am I not doing well?
• 34:09
  SPEAKER_01: Well, I don't know, right?
• 34:10
  SPEAKER_01: And I think it's it's like the the most important thing, and and I think you know, tying back to what we're saying about knowing the kind of business you want to build and so on and so forth, like the thinking around like okay, where the I'd say between three to five numbers that actually matter, number of patients, retention, staff cost, and you know, maybe a couple of others, you know, and there's probably a couple more.
• 34:33
  SPEAKER_01: But it's like you have that, that's all you need to look at.
• 34:36
  SPEAKER_01: And then you want to actually like look into retention and so on and so forth.
• 34:40
  SPEAKER_01: That's when you go to like you know more detailed dashboards to understand the driver of each of them.
• 34:45
  SPEAKER_01: But I think it's like it's really not that hard, and you know, like a hundred percent of our clo of our clients and the clinic owners we talk to like have the capacity to do it.
• 34:54
  SPEAKER_01: It's just I think again, uh an attitude, like yeah, almost like issue.
• 35:00
  Michael: I think it can also be a product of not having a very good accountant.
• 35:04
  Michael: And I would say the majority of clinics don't have very good accountants.
• 35:07
  Michael: And I remember when we started the business, we had a terrible one.
• 35:11
  Michael: He just told us that we had corporation taxpayer.
• 35:13
  Michael: I was like, what is that?
• 35:13
  Michael: And then we found Brent, and uh, you know, what he did for us in terms of educating us and telling us what we should be looking at and so on and so forth, it really got us thinking about the numbers a lot more.
• 35:24
  Michael: You know, when you have a proactive uh accountant who's constantly on your case, uh that helps a lot.
• 35:30
  Michael: And I think, you know, because of margins within clinics, I I don't think that many have really great accountants who are proactive every month looking at net profit, how are things going?
• 35:40
  Michael: And I think that's one of the one of the problems that the clinic owners have because they really many of them only get a once a year snapshot of their business um when they're doing their PL and their year end, which I think is a bit of a shame, but I do understand it.
• 35:53
  Michael: You know, it's not their fault, it's just the nature of it.
• 35:55
  SPEAKER_01: Yeah.
• 35:56
  SPEAKER_01: I think you know there's there's also a bit of a danger when when we say like clinic owners, because again, I think if you take our 600 plus clients, you have people who you know could pretty much work in a hedge fund all the way to people who are like self uh or you know, yeah, fast or yes, self uh very self-aware about like the fact that there are not a number of people.
• 36:17
  SPEAKER_01: And so I think you know there's there's a huge variety in in that.
• 36:20
  SPEAKER_01: But I think yeah, generally, like, you know, it's it's expensive to be cheap with your accountant.
• 36:25
  Michael: Yeah, always, especially when you come to sell the business, because uh if you ever sell your business, you better hope you've got some good accounts and uh you've had a decent account around, which I know very well.
• 36:36
  Michael: Two questions.
• 36:37
  Michael: One is what could clinics learn from the corporate world?
• 36:42
  Michael: Like, what is the one thing other than data and and and metrics?
• 36:45
  Michael: What's the one thing?
• 36:46
  Michael: But I also want the the turnaround, what could cor the corporate world learn from clinics?
• 36:50
  SPEAKER_01: Yeah, so I think the probably the what clinics can learn from corporate is that idea of like, okay, like if you go, you know, if you work as an executive at like, I don't know, McDonald's, Starbucks, you name it, like I don't know why I'm using food examples, probably because like it's it's it's almost lunchtime, but it's like you know, you're gonna have like a lot of uh you know standard operating procedures and like the brand values, the brand guidelines, and so on.
• 37:20
  SPEAKER_01: So you have that consistency.
• 37:22
  SPEAKER_01: And I think you know, every like uh corporate business, like one of the main goals is consistency.
• 37:27
  SPEAKER_01: And if you think about it, you're not talking about McDonald's, the fact that a Big Mac is the same in US, London, India, and South Africa is is quite quite quite quite uh quite uh quite impressive.
• 37:38
  SPEAKER_01: And I think that comes from systems, and I think that's probably the one thing you can learn is like how do you like again, and it's something I discuss a lot with with Vicky with with her clinics.
• 37:47
  SPEAKER_01: It's like how do you stop making the same decision 10,000 times?
• 37:53
  SPEAKER_01: You stop making the decision because you kind of you you have a defined way to act in that in that example.
• 37:58
  SPEAKER_01: So I think that's that's system building and systematic approach.
• 38:01
  SPEAKER_01: I think is probably what what I would say clinic owners can learn from from corporate.
• 38:05
  SPEAKER_01: I think corporate what corporate businesses can learn from clinic owners is like or actually like yeah, thresh their memory on because they probably started like clinic owners at some point, being very passionate about what they're doing, caring immensely about the patient, the client, or whoever they're selling to.
• 38:25
  SPEAKER_01: And that stuff kind of dilutes, right?
• 38:26
  SPEAKER_01: Because like again, if you work in the head office of a large business, you've probably never even talked to a client ever.
• 38:32
  SPEAKER_01: So you're like ultimately it's a number in a spreadsheet.
• 38:34
  SPEAKER_01: And I think you know, I I I'm yet to find one of our clients or to meet one of our clients who actually treat patients like number in a spreadsheet.
• 38:41
  SPEAKER_01: And I think you know, it says a lot about the industry, and I think you could broaden that to like a lot, or at least the the yeah, most, if not the old uh the successful uh small businesses.
• 38:53
  SPEAKER_01: None of them like you know treat their clients or patients as uh as spreadsheets.
• 38:57
  SPEAKER_01: And I think you know, I've seen it firsthand uh uh uh in in larger companies where I've worked where yeah, when that sense is a bit diluted, it it's probably something where you need to find a way to refresh that sense of like purpose and care.
• 39:09
  Michael: Yeah, I think it's humanizing the customer, isn't it?
• 39:12
  Michael: I went into a shop recently on circus and I wanted to get out of there as quickly as possible.
• 39:17
  Michael: It was awful.
• 39:18
  Michael: They just you could tell they just didn't give a crap.
• 39:21
  Michael: But then you go to another shop and bought something in and I said, Oh, this button came off, I bought it three months ago, and they're like, right, let me take that to the tailor and fix it.
• 39:28
  Michael: And I think that when you are ultimately it's about delivering experience, and you're right, I think there's a lot of large companies now, even some luxury ones, and a good example of that is Rolex, treat you like absolute crap because they don't care.
• 39:41
  Michael: You know, they they they brand and you know, you get laughed at when you want to go and buy a watch in a shop.
• 39:46
  Michael: That isn't how any clinic would ever treat customers.
• 39:50
  Michael: And I think actually Rolex could learn a lot from how the healthcare industry works.
• 39:53
  SPEAKER_01: Yeah, and I think it's super inspiring to see like brands and businesses who actually manage to like come.
• 40:00
  SPEAKER_01: Back to you know the initial sense of care.
• 40:01
  SPEAKER_01: And I think I was reading an article, I think, a couple of days ago around you know the parcel delivery company.
• 40:06
  SPEAKER_01: I think they were called Hermes, Hermes, and then they rebranded to Every.
• 40:10
  SPEAKER_01: And you know, they they changed a lot of things, including like, you know, some cultural elements, the way they treated their stuff.
• 40:16
  SPEAKER_01: And the numbers are showing that like, you know, parcels stop disappearing, and you don't have videos anymore of like the guy literally like throwing the parcel that has a big, like fragile tag on it against your wall, and and and so on and so forth.
• 40:30
  SPEAKER_01: So it's you know, it's it's very inspiring to see brands or larger companies like seeing that yeah, they've kind of like feared uh or yeah, stirred a bit too far in one direction.
• 40:39
  Michael: Yeah, exactly.
• 40:40
  Michael: All right, so what about the MSK market in general?
• 40:42
  Michael: How do you see it?
• 40:43
  Michael: Because it is all change right now, and the obvious you know, big change is AI, but how do you see the private MSK market changing every next five years?
• 40:51
  SPEAKER_01: Yeah, so I think you know, I mean, obviously there's there's uh AI is like the elephant in the room, and I think you know, it's you know, if I if I qualify for a for a second visit on on the pod, I'll, you know, it's probably uh an episode that uh that it's it's probably a full episode that we should do around around AI.
• 41:08
  SPEAKER_01: So I'm not gonna like spend too much time on it.
• 41:10
  SPEAKER_01: I think there is a huge element, or I think, yeah, one one of the main trends that I think is is materializing is is around the idea of like consumerization.
• 41:20
  SPEAKER_01: And it's consumerization not of the service itself, but the experience.
• 41:24
  SPEAKER_01: I think what you see, and actually there's an amazing uh survey and and report by the IHPN around like essentially the attitude of you know Brits um regarding private healthcare.
• 41:36
  SPEAKER_01: And what you see is that younger people are fully at peace with the fact that you know private healthcare is a thing, it's here to stay, it's something I have to spend money on, and you know, versus you know, people who who are a bit older who you know have been I've seen the heydays of the DNHS and you know, or who DNHS is an institution that is you know pretty much at the same level as the as the monarchy, which I think you know is it's it's super inspiring to see, obviously, as someone who's who's not British, but realitically, that realistically, like you know, the reality is is is changing, right?
• 42:08
  SPEAKER_01: And so I think if you think about that and and that massive trend, and you have to keep in mind that like these patients who you know, and and to more patients are gonna look for an experience that matches what they have when they spend their money privately somewhere else, right?
• 42:26
  SPEAKER_01: And so I think you know, you you you really have to think about the experience that you offer, and that's you know, your website, your booking system, but but not even that, it's also you know, the look and feel of the clinic and so on and so forth, the way you you portray yourself as essentially a a consumer business.
• 42:42
  SPEAKER_01: And I think on the private side, because obviously, you know, if your clinic is is is working mostly on uh on NHS contracts and and PMIs, that's gotta be a bit of a different story.
• 42:51
  SPEAKER_01: But I think that's that is something that is is you know, I think it's it's absolutely essential and I think is is is materializing you know super quickly.
• 42:59
  SPEAKER_01: I think what's interesting with that is that I think there's a almost a law in the in the universe that innovation is not spread evenly.
• 43:06
  SPEAKER_01: And I think you know, if you you know go to maybe you know central London or some other areas in the UK, you'll see that it's already in full force and some because you have clinics now that that look like spaceships or nightclubs, but that might be a bit of an extreme.
• 43:22
  SPEAKER_01: And whereas, you know, in some areas in rural England, I mean I don't know Cornwall too well, so but that's but I'm gonna use that example.
• 43:27
  SPEAKER_01: That innovation, that kind of like disruption hasn't happened yet, but ultimately you get a bet on the fact that that it's gonna happen.
• 43:35
  SPEAKER_01: Think about like if you spend money privately on, like, I don't know, a hotel, for instance, and you email them because you want to make a reservation and they don't respond.
• 43:45
  SPEAKER_01: That never happens, right?
• 43:46
  SPEAKER_01: At least like if that happens, you really shouldn't go to that hotel.
• 43:49
  SPEAKER_01: Think about that like now, like for clinics and how many, you know, some of our clients, for instance, or how many clinical don't respond to me, or like essentially don't have a process that's like bulletproof in terms of like responding to a client in X hours after or a patient, sorry, X hours after they they they reached out.
• 44:07
  SPEAKER_01: Like, I think the expectations of people who are spending money on private health are only gonna get higher and higher and higher.
• 44:14
  SPEAKER_01: And so I think clinics have to match the the have to match that.
• 44:17
  SPEAKER_01: We've never been as spoiled in the history of humanity than we are right now as consumers.
• 44:22
  SPEAKER_01: Like you can literally get anything you want to your door in 24 hours.
• 44:26
  SPEAKER_01: We're getting so you know, if you're competing against another local clinic that has embedded that like almost like B2C mindset in the experience, and you haven't, you know, I think I think I think that's uh that's gonna be problematic for you.
• 44:40
  Michael: Be careful about Cornwall because we've got a customer called Andrew McCaulay who's got an insane clinic, but I get your point.
• 44:46
  SPEAKER_01: Again, as we were saying, you know, at HMDG, one thing that's very important is to recognize when we're wrong.
• 44:51
  SPEAKER_01: My apologies to anyone to to everyone in Cornwall.
• 44:54
  SPEAKER_01: I didn't mean it like that.
• 44:55
  SPEAKER_01: Just blame it on the fact that uh that's you know, that's my my my my my geographic knowledge of the UK is still limited 11 years in.
• 45:03
  SPEAKER_01: So sorry about that.
• 45:04
  Michael: We got about 50 in and around Devon and Corn.
• 45:06
  Michael: But anyway, no, it's a very interesting point.
• 45:09
  Michael: I um had a chat with my best friend yesterday on the phone, and I'm I want to get him onto the podcast because he's he's kind of my age, falling apart, and he's been to see physios, and and I said, I want to get your opinion on, as a patient, what you're experiencing and what you like and dislike.
• 45:24
  Michael: And he said, Well, it's really crazy.
• 45:26
  Michael: I went to this physio and he charged me 120 quid, but it felt like I was walking into Poundland.
• 45:31
  Michael: I got plastic chairs, everything just felt like it was cheap.
• 45:34
  Michael: It was the experience was terrible.
• 45:35
  Michael: And he said, I just don't understand it.
• 45:38
  Michael: And and I think there is a lot of that, and you're right, it's about delivering that experience.
• 45:42
  Michael: And I I made the example of I've got a friend who owns a Michelin-style restaurant, and one of the things they do, very simple.
• 45:49
  Michael: If you and I go in, grab a bottle of wine with a meal, they will write down what wine we had.
• 45:53
  Michael: The next time we're in, they'll say, Oh Ben, how are you doing?
• 45:56
  Michael: We've got your Pinon Noir here.
• 45:58
  Michael: And you immediately go, Oh my god, yeah, great.
• 46:00
  Michael: They they remember me.
• 46:01
  Michael: Now they bloody don't, but they've just written it down.
• 46:03
  Michael: And it's no different than when you go in, you know.
• 46:05
  Michael: My friend said he'd been to the same thing three times.
• 46:08
  Michael: Each time he had to tell the receptionist his name.
• 46:10
  Michael: Just remember what I look like.
• 46:12
  Michael: Remember my name, remember who I'm I'm gonna see.
• 46:15
  Michael: And I think I think that's definitely something that we've been pushing for a long time now, actually, is delivering that experience, whether it's uh because we were actually going to do a secret shopping product, which we may still do at some point, because you know, the amount of clinics that don't answer the phone, that that don't get back to people on forms, that don't get back to people by email, whatever the case might be, you've got to be responsive, you've got to deliver that experience.
• 46:38
  Michael: And we all know what we all like ourselves, right?
• 46:41
  Michael: We go to John Lewis rather than pound land because we know we get a better experience.
• 46:46
  Michael: And and I think clinics really have to focus on that over the next couple of years.
• 46:50
  SPEAKER_01: So think about it like that, you know, like you you want to book a restaurant, and you know, there are tweet on restaurants like that, you know, fit the bill, good reviews, looked at their Instagram, they both look good.
• 47:02
  SPEAKER_01: One of them you have to call to make a reservation, the other one has an online booking system, like guaranteed you're gonna go for the one with the online booking system, right?
• 47:11
  SPEAKER_01: So now the counterpoint that you're gonna make, because I know you is yeah, but like some super high-end restaurants like don't want to have that, and so on and so forth.
• 47:19
  SPEAKER_01: And I think that's perfectly true, and that's exactly the same for uh um Kleenix, for instance.
• 47:24
  SPEAKER_01: It's like your standards, reputation, and so on and so forth would have to be significantly higher for people to actually make the trade-off in terms of you know, like convenience and have to call you and so on and so forth.
• 47:37
  SPEAKER_01: So, you know, I'm not saying that there's like just one path where everything is like, you know, easy, convenient, and so on and so forth, but you really need to believe that you're offering something either very different, much higher quality than the next best option that provide that convenience.
• 47:54
  SPEAKER_01: It's like how you know, if if you had to like go pick up a pizza that that you've ordered versus getting it delivered, it better be like an absolutely amazing pizza that's like 10x better than the one you could you could get delivered.
• 48:07
  Michael: Yeah, and and it's it's no different to you know, let's take that same example.
• 48:11
  Michael: You've got two clinics, same Google review, same everything, but one has um a really nice painted interior with pictures on the wall and nice hue lighting, Philips Hue lighting, the other one's got fluorescent tube, nothing's been painted for 20 years.
• 48:24
  Michael: You know which one you're gonna go to.
• 48:25
  Michael: And and I think one of the interesting things, and this is what my friend said to me yesterday, and we'll get him on the podcast, that he said, I'm still paying£120 for a 35-minute appointment.
• 48:35
  Michael: That's actually a lot of money given that it's a 30-minute appointment, and yes, it's in London, but the point is you would expect a little bit more.
• 48:42
  Michael: You didn't even get a follow-up email, you know?
• 48:45
  Michael: And um and I think that's something that clinics have to move on from because they are a little bit stuck in the past, some not all, but some are a little stuck in the past.
• 48:54
  SPEAKER_01: Yeah, and I think you know, it's it's it's yeah, I don't want this point to come across as like, you know, are you have to like do all this stuff and be as convenient as like you know, like Netflix and so on?
• 49:04
  SPEAKER_01: It's just there's a lot of small stuff and you probably already know about them where you're like, yeah, realistically that could be a bit better.
• 49:11
  SPEAKER_01: And you know, a lot of them are easy fixes, right?
• 49:14
  SPEAKER_01: And it's like, yeah, maybe your waiting room needs a fresh coat of paint and have nicer pictures, and maybe you know, like that booking system you've been thinking about upgrading or updating for it a while.
• 49:25
  SPEAKER_01: Well, you know, maybe now is the time to do it.
• 49:27
  Michael: Well, I funny you say that.
• 49:28
  Michael: I went to um it was like a dodgy bar or whatever, and uh it wasn't very as as you do, as you as you do very often for people who listen to the podcast.
• 49:38
  Michael: My my friend took me, but I I was like, alright, we'll go in.
• 49:41
  Michael: Went to the loo, they had Patrick Bamford um hand soaps and and stuff, and I was like, holy shit, that's really good.
• 49:48
  Michael: And it completely, I mean it's crazy, but it completely changed my impression of that bar because I'm like, they actually put some effort into choosing some Patrick Bamford, if anyone knows it's sort of 30 quid for a little bottle or whatever, um, which is way too much for frugal me.
• 50:04
  Michael: But I I was just very impressed that they had gone down that route and had thought about it.
• 50:08
  Michael: And and it's funny how little things like that can really change how you view a business or how you how you kind of yeah, because I would probably go back now.
• 50:16
  Michael: I I come away from that bar with a you know what, that wasn't too bad.
• 50:20
  Michael: Whereas if they didn't have that, I probably wouldn't have the same opinion.
• 50:23
  Michael: So kind of interesting.
• 50:24
  Michael: Um right, let's finish on one last point, because we are running over a little bit.
• 50:31
  Michael: Um, I want to know, given that you're in the area of Mana to some extent, I want to know what your thoughts are on the consolidation happening in the industry right now.
• 50:39
  Michael: The the amount of acquisitions going on and the mergers going on and so on.
• 50:43
  Michael: What do you think?
• 50:44
  Michael: Do you think it's a good thing or a bad thing, or are you indifferent?
• 50:47
  SPEAKER_01: Yeah, so I think, look, I think there is on the way it's happening, I think it's super clear, right?
• 50:53
  SPEAKER_01: Like private healthcare is going up and to the right, it's gonna go up and to the right for you know decades to come.
• 50:59
  SPEAKER_01: I think you know there are a lot of trends that are playing into that.
• 51:01
  SPEAKER_01: And I think MSK generally is like super well positioned to you know benefit from that growth.
• 51:08
  SPEAKER_01: So why are people attracted to it, or you know, investors and so on are attracted to it?
• 51:12
  SPEAKER_01: It's very clear.
• 51:13
  SPEAKER_01: When it comes to aggregation, consolidation, and I think going back to what we're saying almost about like the three different steps of a business.
• 51:21
  SPEAKER_01: So you know, the zero to one, one to ten, ten to a hundred.
• 51:25
  SPEAKER_01: I think that generally, again, you know, like uh terms and conditions apply to to what I'm gonna say, but it's like you're gonna have different finance, different kinds of players with different kinds of playbooks coming in at different stages of the business.
• 51:39
  SPEAKER_01: So the zero to one, no one's very interested in that, you know, it's like the the grind, and you know, it's like the super hard work with a lot of uncertainty.
• 51:47
  SPEAKER_01: One to ten, you're kind of like appealing to to, or you start to be appealing to to some investors.
• 51:52
  SPEAKER_01: Here, in most cases, the playbook of the good ones at least is going to be like, okay, how do we grow?
• 51:58
  SPEAKER_01: How do we build these systems?
• 52:00
  SPEAKER_01: How do we uh stabilize the business, make it a bit less of, you know, like risky little, you know, a small little wooden boat on the on the in a storm on the ocean and make it something a bit more stable, right?
• 52:13
  SPEAKER_01: Like strengthen the foundations and so on and so forth.
• 52:15
  SPEAKER_01: So, here generally, the the investors at that stage are gonna, yeah, you know, obviously be cost conscious and so on and so forth, but at least the good ones are not gonna be like, okay, let's just like cut all the cost and just essentially act as like, you know, like corporate raiders almost.
• 52:33
  SPEAKER_01: I think this kind of this typology of investors, and I'm talking here really like about you know financial investors, because I think there's a lot of different, or there are quite a few different types of buyers who who who will be and might be interested in in businesses at these different stages.
• 52:47
  SPEAKER_01: The 10 to 100, it's like, okay, well, look, we've bought a business that's already big, already established.
• 52:53
  SPEAKER_01: Yes, there are a few more clinics we can open.
• 52:55
  SPEAKER_01: Yes, like you know, the systems can always be changed, but realistically, the people before us have already done that work, right?
• 53:02
  SPEAKER_01: So that's when generally you start to see the like, well, why does why do this patient come only six times for that kind of condition?
• 53:11
  SPEAKER_01: They need to come nine times.
• 53:12
  SPEAKER_01: And actually, you know what?
• 53:14
  SPEAKER_01: We're gonna revise the compensation structure.
• 53:16
  SPEAKER_01: And you know what?
• 53:18
  SPEAKER_01: Like that offside you had boom, gone, that marketing, we're gonna look at every penny and so on and so forth.
• 53:24
  SPEAKER_01: Because then you're in the game of optimizing your costs, not necessarily thinking about like growing your your yeah, you you have you have a ceiling on how much uh uh um revenue you can you can grow.
• 53:35
  SPEAKER_01: So I think you're gonna have very different kind of of investors.
• 53:38
  SPEAKER_01: And I would say like it's not always that simple.
• 53:40
  SPEAKER_01: And I think ultimately, like I think the the there's been occurrences of buyers who essentially have started to sacrifice the bit the quality of care.
• 53:49
  SPEAKER_01: I'd say it's realistically a bit early to tell given that you know a lot of the consolidation has happened and is happening at the moment.
• 53:56
  SPEAKER_01: I think it's uh it's a conversation that's uh that uh we'll we'll have many more data points about it, you know, when you invite me again to this podcast in 2027 or 2028.
• 54:07
  SPEAKER_01: So see how I'm like positioning myself for future episodes.
• 54:10
  Michael: Yeah, I I I sort of agree.
• 54:12
  Michael: I think it does depend on the entity buying a lot of the time.
• 54:15
  Michael: I do think though, and I don't know if you agree, I think most of them have been caught up in a bit of a whirlwind and are absolutely bananas paying the kind of multiples that they are paying.
• 54:27
  Michael: And I do wonder whether in a year or two they will realize that perhaps five, six time multiples on a hundred grand net profit is madness.
• 54:38
  Michael: Because we see a lot of and I've seen a lot about I know someone that's got seven from 120 grand or something, and I I just don't think that many of them are realistic in terms of how optimized they can make that business and how much growth they can actually get.
• 54:52
  SPEAKER_01: And I think look, I think it's I think it's a huge fallacy again, and it's probably one to be honest, that you know, I I I I fell into a bit when I was looking into like acquiring clinics, but then she's like I think that's spreadsheet view that like okay, I'm gonna change this, and this is gonna drive like X percent inefficiencies and so on and so forth.
• 55:11
  SPEAKER_01: And I think look, it's not that easy, and I think you know, the last thing you want is to work with investors or sell to investors who essentially like a haven't done their own work and don't really understand that like a chiropractor and a physiotherapist are pretty different beasts and and type of people.
• 55:27
  SPEAKER_01: So that's one thing.
• 55:28
  SPEAKER_01: And then the the second thing, it's like, yeah, it's essentially like people who essentially are like investors who think that like or operate under assumptions they've made, you know, like looking at a spreadsheet and reading industry reports rather than like the more bottom-up way to do it, which is going to clinics, learn stuff, talk to people who yell to three, four sites or clinics successfully, and understand how they've done it.
• 55:53
  SPEAKER_01: So I think that's that's kind of how I see it.
• 55:56
  SPEAKER_01: I'd say there's one thing that's like I don't see a lot of it happening in the UK, which is you know, pretty surprising because it's something that's very mainstream or like widespread in France.
• 56:05
  SPEAKER_01: And it's kind of like a bit of a different path or a hybrid path.
• 56:11
  SPEAKER_01: Where essentially, like in the UK, you either sell to someone, you know, someone that we would call strategic, someone who already has like clinics and want to you know have a footprint in your region or add some services to um to um to what they are currently offering, they're requiring you to essentially have that off the shelf.
• 56:32
  SPEAKER_01: I mean it's never off the shelf, but you know, saves them again the pain of the zero to one.
• 56:37
  SPEAKER_01: Or you have the financial investors who you know are buying your business, but ultimately they are buying a cash flow that either they want to grow to you know, like essentially harvest or resell the cash flow to to someone at a higher price.
• 56:50
  SPEAKER_01: There is really like uh a hybrid path or middle path that again we we see happening in and it's very common in France, it's kind of like the multi-clinician ownership model, and you would have a podiatrist, a physiotherapist, and so on and so forth, kind of come together and open like multidisciplinary uh uh um clinics and so on and so forth.
• 57:13
  SPEAKER_01: And essentially, you know, the structure is very light, they come together, essentially mutualize the reception, the front desk, a lot of the operations, and so on and so forth, the marketing and so on and so forth, even though you know healthcare marketing is a whole different beast in France.
• 57:29
  SPEAKER_01: But that's again for my next podcast invitation.
• 57:32
  SPEAKER_01: But yes, and so I think it's it's something that I'm very surprised to see, and maybe you have a uh uh uh view on like why that we don't see that happen all that much in um in uh in the UK, but I think it's it's it's something I've yeah, I've been pretty surprised to see.
• 57:46
  SPEAKER_01: Because here essentially what you see is like while you coming together, you have more financial firepower to acquire things and so on and so forth, but you also like stay among mostly among clinicians, so you kind of prevent the or mitigate the risk of like essentially completely like uh you know like degrading the the quality of care and and so on and so forth.
• 58:07
  SPEAKER_01: So yeah.
• 58:08
  Michael: So I can answer that question, but not today, because I have to run and you have to run.
• 58:12
  Michael: So we'll end it there.
• 58:14
  Michael: Thank you very much, and um yeah, it's been well let's see what the future operation did you have in the next couple of years as well.
• 58:21
  SPEAKER_01: Um thank you for having me.
• 58:22
  SPEAKER_01: That's great, super fun.
• 58:25
  SPEAKER_01: Yeah.