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The Great Physio Shake-Up with Katie Knapton and Physio First · No Appointment Necessary

0:00
Michael: Welcome to the latest episode of No Appointment Nessary.
0:03
Michael: This is actually my second uh podcast today, and me and Katie have also just been talking for about 20 minutes about stuff.
0:08
Michael: Um, my my brain is already shredded.
0:11
Michael: Today we've got Katie Napton, who is chair of Physio First.
0:14
Michael: I've known you now probably for about five years, um, in in in different things, and I thought it was really interesting to get Katie on because um uh and I'll put this out there, in my mind, Physio First was a pretty terrible organization when we first came into the industry.
0:31
Michael: And I think Katie's done really well and wonders to some extent to try and change the organisation.
0:37
Michael: She may disagree with me on how bad it was, but um uh I think you have a lot of access, like we do, to private clinics, to private clinic owners.
0:46
Michael: So I think it's really interesting to have you on and interrogate you a little bit about physio first, but also about the market in general, um, and see where we can have a good debate and argument.
0:54
Michael: So, welcome, Katie.
0:56
Michael: Do you want to give me a quick, quick, quick background on who you are?
0:59
Katie: Yes, thank you, Michael.
1:00
Katie: So, yes, chair of Physio First, I'm also a practicing clinician, so I have a soul clinic, and I also run a video physiotherapy clinic where um I have a number of physios and we do predominantly B2B work.
1:14
Michael: Yeah, so that's where I'm just on that, on the video side, um, because I I remember we chatted during COVID, and I remember it being incredibly difficult for clinics to crack that virtual consultation nut.
1:27
Michael: Very few actually managed to do it, but you did, didn't you?
1:29
Michael: You did a bit of the weird stuff.
1:31
Katie: Yeah, I mean, I wouldn't say it's still easy, but um, it was set up pre-COVID, um, you know, an innovator.
1:38
Katie: But it is getting getting some traction, mainly just as I said, it works really well on that B2B, that quick immediate advice and education benefits.
1:47
Michael: It's really interesting because as someone now, so pre-me getting into the industry, I would never have a video consultation with a physio because I'd expect you to press my back better and everything would be great.
1:57
Michael: Now, um, I don't think I'd go and see a physio unless I absolutely had to.
2:02
Michael: And I'm always having obviously I get them for free, but I'm always having video consultations and it's there's huge value.
2:08
Michael: Same, same with with the team.
2:09
Michael: I wonder whether or what's needed to convince and educate the public that actually video consultations are a a definite option.
2:18
Michael: Um to some extent, whether the more AI triage there is and the more AI that comes in, whether that will help a little bit with that.
2:27
Katie: It probably will.
2:28
Katie: I mean, I I don't think you'll ever lose that some will need some manual treatment that potentially will benefit for we can argue about what what helps, but it certainly facilitates movement, gives empathy, felt makes people feel better.
2:42
Katie: And you're never going to remove those people who that is what they choose to do.
2:46
Katie: If you've got a clinic 10 minutes down the road, why wouldn't you go to it?
2:49
Katie: So I'm I'm not really into that argument.
2:51
Katie: Mine is it's getting to people who aren't getting the help that they need.
2:54
Katie: And a video is a really good way of offering standardized care.
2:58
Katie: And you're right, yeah.
2:59
Katie: So some really good AI triage that like the flock health that's out is is a great stepping stone.
3:05
Katie: But there's always going to be people who potentially need more.
3:08
Katie: And again, it's about quality if we're really talking about it.
3:11
Katie: So there can be just like any phone consultation that you might have with a GP, it can be good, bad, indifferent.
3:16
Katie: So I want people to go away with whatever way they've reached their physio, whether it's via video or they've driven to it, is that they've gone away knowing what they need to do, what's what what we think is wrong, and that that plan.
3:28
Katie: So that's my sort of passion, is that people are informed and I don't really care how it's delivered, if I'm honest.
3:34
Michael: Yeah, I think for me, having video consults, just like now we had it with uh Babylon, and I know that failed, but there's so many people now having video consults for all other areas of of of healthcare.
3:46
Michael: I think people still think that all physiotherapy is manual rather than initially being education.
3:51
Michael: And I know for myself, the first thing I would do is go and have a chat with Mark or or or give Jack a call and say, Is my is this an issue?
3:58
Michael: And probably have video consultation.
4:00
Michael: I think um it just makes it much more accessible to people because they don't have to take time out of work, have to find their way to a clinic, particularly if they're hurt.
4:08
Michael: Um and probably to some extent takes a fair amount of pressure off the NHS, um, whether that's GP surgeries or AE.
4:14
Michael: One of our team fell over or something and he hurt his knee and he was like, I've got to go to AE.
4:20
Michael: And of course he spoke to one of physios, and they're like, You don't need to go to AE at all.
4:23
Michael: You're absolutely fine.
4:24
Michael: But I do wonder how how whether the general public will go move to more towards video consultations in the future.
4:31
Michael: And is it a demographic issue or an age issue?
4:34
Michael: Like, do you find people, younger people, are more likely to have a video consultation?
4:38
Katie: Uh my experience, in fact, one of my physios has just texted me to say she had a 95-year-old just on a video consultation.
4:44
Katie: So I actually don't think you're right in terms of that.
4:47
Katie: I just think it's it's that human factor.
4:50
Katie: And if we get to people earlier, then a video consultation has a a a better outcome in general.
4:56
Katie: But if you're getting comorbidities, complications, system pain, then sometimes that empathy, that real human contact is actually really useful.
5:04
Katie: So I think it does vary with the patient, but it's certainly a good adjunct or a good thing to have.
5:10
Michael: So yeah, I mean it's sorry, that was a side note, because I I think it's a really interesting topic, and I I wish more clinics were doing video consults, but I just don't think the demand is there, and we've seen that, we've we've tried it a lot.
5:22
Michael: And um, right, let's get into physio first.
5:25
Michael: I'm gonna start off with something very controversial, which is uh and I've spoken about this to you before, but I I I feel as if there's a lot of private clinic owners that just don't see the value in physio first.
5:34
Michael: Um, I think they feel it's a little bit out of touch, and that may be for historical reasons, but a little bit out of touch, not particularly supportive, not value for money, and somewhat invisible.
5:44
Michael: Um, what do you say to those?
5:46
Michael: And this is your chance to plug uh physio first and why people should join.
5:50
Katie: Obviously, it's up to the individual, but I always like to, as I tell all the team, I like to think forward.
5:56
Katie: So I don't, you know, so the past is the past, but I think physiotherapists need support, they need help, and they need appropriate people to go to who know exactly what to tell them.
6:07
Katie: So my idea is that we've got a forward thinking, or we've turned it around.
6:11
Katie: I've streamlined the leadership, we've got a different approach, we're pretty agile, we're bringing in new things all the time, and we're receptive.
6:18
Katie: So I've just been to Manchester last week, and we got another business course in London, we've been up to Edinburgh, you know, so we're doing lots of things, we're traveling around, doing business courses, trying to get people to feed in what they need and what they want.
6:32
Katie: And my my question to clinicians is if there's something they need, they just need to let us know because we'll do our best.
6:39
Katie: So that's why we've put in that 24-7 um help line, legal line.
6:43
Katie: You know, I'm always talking to the PMIs, I go to most of the healthcare summits and all the private independent sector big conferences, and I'm talking to the Independent Doctors Federation, I talk to Finn.
6:54
Katie: So I think there's a lot of work going on that people don't know, perhaps, and you're right.
6:58
Katie: Maybe we don't shout out it.
7:01
Michael: Isn't that the problem?
7:02
Michael: So you've told me a load of things that even I had no idea about.
7:06
Katie: Okay, well, I mean, it does go out normally on LinkedIn.
7:08
Katie: We have 16,000 followers on our LinkedIn page.
7:11
Katie: So, yeah, I'm I'm not a marketeer.
7:14
Katie: So I'm just a working physio that's trying to run an organization to support other physios.
7:19
Katie: So, yeah, we could probably do with all the help we could to get it out there that we're progressive and we're looking forward and we're changing and we want to be there to help people.
7:29
Michael: And and I've had lots of past criticisms who are my to criticize, but I I have had them.
7:34
Michael: Uh, and I suppose I see clinic owners who have not had necessarily the best experience, or sometimes advice actually, from physiophys, in my opinion.
7:41
Michael: But I think that is changing.
7:43
Michael: Um, and obviously you, and I said to you before, you know, massively respecting you.
7:47
Michael: I think you're doing a great job, as do many other people I respect in the industry who who you know.
7:51
Michael: Um, so why don't you give me, let's say, five things that are really just things you're really proud of that have been implemented that clinic owners should know about.
8:00
Katie: So you've got a legal helpline, you've got clinic now membership, so everyone has access to our CPD, which is via physio matters, and including our physio first webinars as well, which are business oriented.
8:13
Katie: We do monthly webinars, we're doing business success clubs, and we're hoping to bring on um we've got a graduate um development program coming up as well.
8:22
Katie: Oh, cool.
8:22
Katie: What's uh talk to me about that?
8:24
Katie: Well, I'm still doing some work.
8:25
Katie: Okay, bear with me.
8:27
Katie: Yeah, so A, we've got a graduate membership that we're just just fine-tuning that I hope would be £100 for initial graduates for their first 12 months and physio first, and we'll be supporting them.
8:38
Katie: But we're also putting in a mentorship scheme.
8:41
Katie: And so that will be to develop them through as they work into private practice.
8:44
Katie: But the idea is to support them as well as the clinic owners and have some standardized paperwork so that you know everybody knows where they're at.
8:52
Katie: So we're hoping to work on that.
8:54
Katie: We've got some people involved, some leaders of various universities are offering to help, and we're gonna really roll that out.
9:01
Michael: I I really like that because I think a lot of um grads, well, first of all, we've got the big problem of very few, if any, NS NHS jobs.
9:09
Michael: So I think more and more grads are gonna have to go into the private sector straight off off the bat.
9:13
Michael: But I think that the there's there's been very little support for grads actually.
9:16
Michael: There's lots of people shouting at them, telling them you know nothing, you're rubbish, you know, your education is crap and and whatever, but very little support there, which are so I think that's that's really good.
9:26
Michael: Have you thought about, just out of interest, have you thought about um because I know a lot of clinics will take on grads in their final year uh to kind of bring them in, train them, and then judge which ones are the best ones to then go on and employ.
9:39
Michael: Are you doing anything alongside clinics where maybe you're placing those first two grads?
9:44
Katie: Yeah, so we do some work with Karis Roberts who places students.
9:47
Katie: So we do a um she helps us organize a three-to-one model, um, so you can actually have students in your practice that actually still means you don't make a massive income loss.
9:56
Katie: And so we have that in place, and if you're a physio first member, you get that on reduced rates, and she really sorts out the program and it's been fantastic in that.
10:03
Michael: We're really supportive of there's so much cool stuff, and like very few people know about it.
10:09
Michael: We definitely need to sort of I think you definitely need to shout about it a little more because I think that's that's very cool.
10:14
Michael: Um Right, a gripe.
10:16
unknown: Okay.
10:17
Michael: We've got some very cool partners.
10:18
Michael: Um, but at the same time, whether they're partners or sponsors or whatever you want to call them, relationships, you've got some very cool ones.
10:25
Michael: I'm not gonna name any names, but also I've seen in the past and present, well, I haven't looked recently, some not very good ones that maybe aren't the most credible people, uh, or credible businesses.
10:36
Michael: What kind of plans have you got to do proper due diligence on your partners?
10:40
Michael: Because I think, and I'll make an assumption here, or a bit of a guess, I think if you did proper due diligence on all of them, there would be a percentage that would definitely be gone.
10:48
Michael: So what kind of due diligence are you going to do, if any?
10:51
Katie: So I think historically there have been partners that you may be talking about, and actually, obviously, I don't like looking back, but they were free coming in that historically been established there, and at the time I think there was due diligence done, but things change.
11:05
Katie: So we are doing an annual review and checking through things.
11:09
Katie: So there is, and then they're interviewed and talked to, and we try and check how they're aligning.
11:15
Katie: So we have got some, you know, some benchmarks that we're expecting.
11:19
Katie: So we will be reviewing, but also when you say things like that, we're sort of reliant on feedback to know, because actually, some people say things are credible and other people will say they aren't.
11:30
Michael: You know, I appreciate that.
11:31
Michael: There's definitely a judgment.
11:32
Katie: Yeah, I may say There's a judgment call to a certain extent.
11:36
Michael: There certainly is, but you should be in the game of making those judgment calls as you've got a responsibility to the clinics to make those judgment calls given your knowledge, and you know, you you you can't just go, well, okay, 80 people think this business is crap, but 20 think it's good, you know what it's a judgment call.
11:54
Michael: I think you've got to sort of use your expertise, knowledge, and market to go, you know, you know what, we're gonna get rid of this one.
12:00
Katie: Well, absolutely.
12:01
Katie: You know, if there are queries raised, we do tend to raise them then directly with the partner involved.
12:09
Michael: Well, you did with us, actually, to be fair.
12:10
Michael: You you did with us.
12:12
Katie: I think you had a few comments from people and uh came to us and said But we need the comments and we need to know what you're questioning because you know, with all the best of them in the world, I am also trying to work and run it and do some other bits.
12:24
Katie: So unless people inform us.
12:26
Katie: So it's a little bit like you saying, you know, people leave so they might leave because you first saw it didn't do a thing for me.
12:32
Katie: And you go, well, if you could tell us what you wanted, and you know, that would help.
12:36
Katie: So it is that not knowing, you know, we're all very good at complaining about things, but do we ever tell the relevant people?
12:42
Katie: It's a bit like going away from a restaurant going, oh, that was rubbish and I didn't really like that, and not feeding back because it's not useful.
12:49
Katie: You don't, you know, the restaurant doesn't know, and then you just go and bad mouth, and then then it it it becomes a bit of a trickle effect.
12:55
Katie: And as you know, in the in industries like ours, that's not helpful.
12:59
Katie: So it's far better to confront things.
13:01
Katie: So you need so we need to know we are reliant on our members or our potential members to tell us what if they've got an issue with us, if there's something they wanted us to do.
13:10
Katie: Because if we don't hear it, we don't know it.
13:12
Michael: Yeah, I know that's a fair argument.
13:14
Michael: On the other hand, let's take, I won't mention any names, but a piece of software that we both, well, I certainly know, did things that weren't, or software companies are not pieces of uh software developers that did things that weren't particularly nice, um, yet they're still fully aligned with you guys.
13:29
Michael: And I feel like Physio First has a responsibility to not only publicly slate them, like I did, um, because I can't be the only fucking person out here like saying, look, this is not okay and this is not okay on behalf of clinic owners.
13:42
Michael: That's not really my place.
13:43
Michael: Um, but not only did was there no sort of public slating of it, and maybe I'm wrong on this because obviously I don't have internal stuff, but was there anything internal that said, guys, you can't do this, you need to bugger off now.
13:54
Michael: Like we can't deal with you.
13:55
Katie: Yeah, well, I know exactly what you're talking about, and uh, there was an internal raised, and then we reviewed the members that were using it, and they didn't actually have the same issues because they were more historical users.
14:05
Michael: So they didn't have that in itself, that in itself is but we but we Right.
14:11
Katie: Well, you know, uh it's it's you're right, and that but actually that relationship is also under review because that whole business is under a whole review.
14:20
Katie: So yeah, there's only so much you can do and energy-wise.
14:24
Katie: They're not high on the list.
14:26
Katie: We've taken on uh newer software companies since, so you know, things things are changing.
14:32
Michael: Which again, to be fair, who am I to some extent, but I I I do have a fair amount of knowledge, probably more commercial knowledge than many other people, and some of which I'm also like I'm not so sure about.
14:43
Michael: But I guess that leads into another question, which is what does what does representing the private practice group actually look like today?
14:54
Michael: Because I suppose your argument is, well not your argument, but I suppose your response to something is my number one for me is protecting them from nonsense.
15:02
Michael: That that for me would be the way that I I I would run the business.
15:06
Michael: I would protect them from nonsense and then I would move on from there.
15:09
Michael: Not to say that's right, I think you know it's it's not necessarily right.
15:12
Michael: Yours is, well, the nonsense stuff is kind of we're very busy doing other things, that has to take a bit of a back seat, which is essentially what you just said.
15:20
Katie: So what is what no no no no I'm gonna stop you there, okay.
15:24
Katie: Our primary concern is to look after physiotherapists in business.
15:28
Katie: We may have some software, we may have some partners that you you don't feel we should be strategically aligned, but actually those are the small friends.
15:35
Katie: The big business is helping people try and understand that they need a business plan, that they need to have the right procedures in place, they need to know what their business responsibility is and and and promote a community of support.
15:49
Katie: And to be someone who actually talks to the CSP and complains to the CSP, to be honest, some of that commercial stuff is not our primarily most important thing.
15:58
Katie: But that's a bad point.
15:59
Katie: And Anjon, so I think you know, your insight is you know truly is truly valuable, but our insight might be slightly different, and we might be people with a different take.
16:09
Katie: But I don't feel that the commercial, because they're not really commercial relationships, you you know, no one pays us any money for it.
16:16
Katie: So we're not being bribed off.
16:19
Katie: Well, our main passion is to support physiotherapists on a day-to-day basis, recognizing that they're in business.
16:26
Katie: Now, as you know, that is quite a lot of work in the first instance for some.
16:30
Michael: Absolutely.
16:30
Michael: Yeah, I'm just interested to see where you know what if you had a sort of a Maslow hierarchy, what is at the top, what is at the bottom, and then what do what do you see as really important?
16:41
Michael: Because I think um, onely you you mentioned it, very, very important, I think, for clinics to become commercial, have business plans and look at their metrics and so on.
16:51
Michael: I'm not sure Physio First is necessarily best equipped to do that.
16:54
Michael: Um, although I think you probably do that via Celia.
16:57
Katie: Is that yeah, yeah.
16:58
Katie: So we have business webinars, we do it all through um we do that through Celia.
17:03
Katie: We encourage with all the company, we've got compassion frameworks, we've got yeah, so we've got lots of things in place.
17:09
Michael: And Celia, and Celia's brilliant.
17:10
Katie: Um and that's our USB, to be honest, Michael, is that you know we offer business support and practice day-to-day sort of uh you know, a community to help.
17:21
Michael: So if we looked at it as a as a hierarchy, so and just put it into four, what would you say?
17:26
Michael: And again, for clinic owners thinking about joining, because I think they should, by the way, but what is it?
17:31
Michael: What what are those four major things?
17:33
Michael: What are you doing?
17:34
Katie: So in terms of so we do monthly webinars, so we've just had a accountant.
17:38
Michael: I mean in terms of what it means to represent private clinic owners.
17:42
Michael: So it's one maybe talking to insurance companies and negotiating their local.
17:48
Katie: Yeah.
17:48
Katie: I do that all the time.
17:50
Katie: They hate me.
17:51
Katie: So they can't really cope with how candid I am.
17:54
Katie: You know, ever every um meeting I do with various uh insurance companies, I go, no.
17:59
Katie: So are we talking quality, proper reimbursements and long-term gains, and actually probably reduce your cost overall and and higher customer satisfaction?
18:08
Katie: Are we talking about that yet?
18:09
Katie: And they go, no, not not that's not on the priority list yet.
18:12
Katie: And I went, you know, I don't know why we bother, but we keep trying.
18:14
Katie: And you know, and I keep pushing the data that we are collecting through because surely at some point someone will recognize that has value.
18:21
Katie: So, yes, so I do talk to private medical insurance companies regularly.
18:25
Katie: I attend lots of independent and private events, so and I talk to the Independent Doctors Federation.
18:30
Katie: I have a contact with Infin, so we have uh regular discussions on what's happening in the independent sector more widely.
18:37
Katie: I also have the joy of being involved, obviously, as a professional network of the CSP and and trying to modernize some of their attitudes towards the um the healthcare sector as it is.
18:47
Katie: Hence, I write quite a lot of um pieces on LinkedIn and you know, and and basically also trying to keep aware of of the changes within the industry and the innovation that's coming in that potentially we can't ignore.
18:59
Katie: So things like you know, not going, oh, when Flock Health brought out physiotherapy, an AI physiotherapy clinic, rather than panic about it, let's turn that around.
19:08
Katie: Let's look how we can utilize it.
19:10
Michael: Let's let's focus on that, because that was gonna be one of my questions.
19:13
Michael: Because something I've seen, and it's not across the board, but I think it's a vast majority of clinic owners, they they tend to be quite resistant to change and to innovation.
19:22
Michael: Um and I don't think that's necessarily just a clinic owner thing, you're gonna get that from old lawyers or whatever.
19:26
Michael: It's just one of those things.
19:27
Michael: You certainly get it from private banking.
19:28
Michael: Um, but they are quite resistant to change and innovation, and they seem to actively fight against that change rather than seeing things as opportunities and embracing those things.
19:39
Michael: Why do you think that is?
19:41
Michael: What do you think can be done about it?
19:42
Michael: And and just to pick up on Flock as an example, I would say the amount of articles I have seen or comments on LinkedIn written by clinic owners saying this is ridiculous, nothing will ever replace the human touch.
19:55
Michael: When in actual fact, I think it the data shows that it does to some extent.
19:59
Michael: And and you know, why the fight against it?
20:02
Michael: Why not?
20:03
Michael: Christ, this is amazing.
20:04
Michael: How do we use it?
20:05
Katie: Well, I mean, everyone's resistant to change, okay, in general.
20:09
Katie: I mean, I love change.
20:10
Katie: So I yeah, I I find it exciting.
20:14
Katie: But I think it's it's trying to explain it in a way that people understand that actually, you know, embracing things and then re So we uh I'm talking on Friday about, you know, actually our human flaws will be our strengths.
20:27
Katie: So we are never going to lose that humanity in healthcare.
20:30
Katie: You're never gonna lose that conversation where you have a patient with a knee pain who's actually got a husband with dementia, that's what she's trying to manage, and that's her major problem.
20:38
Katie: You're not gonna get that from an AI.
20:40
Katie: But an AI will perhaps solve some early stage problems.
20:44
Katie: It won't, you know, and hurrah, if it takes people off the waiting list and they're not gonna have long-term persistent pain, we should be celebrating that.
20:51
Katie: It's getting, which was sort of the wake-up call, wasn't it?
20:54
Katie: When when when one of the comments was, it's better than private physio.
20:57
Katie: Well, actually, if someone's saying that, hang on, we need to check what we are doing.
21:01
Katie: So we are quite clearly not doing something well.
21:04
Katie: And is that our communication?
21:05
Katie: Is that that patient didn't go away with the right thing?
21:08
Katie: So I think we use it as an opportunity to check, well, you know, perhaps we need to think that bigger, holistic picture, perhaps we need to think about lifestyle changes a bit more.
21:16
Katie: Perhaps, you know, we need to add things to our practice, Pilates, whatever, whatever, that will make that a better journey for that patient than an AI card.
21:25
Katie: So yeah, I mean, I am quite annoyed because I do, I actually like new, I like embracing new things because I think it's an opportunity.
21:33
Katie: So all you can hope is that showing that enthusiasm, especially when you're as old as me, um, and taking that forwards will really help enthuse others who are more reluctant.
21:43
Katie: So we got the, I'm an early one, and we've got we've got to bring the lagards with us, um, and and hopefully we get them to see sense.
21:50
Katie: So we're not massively, I mean you know, I'm not against manual therapy and treatments and stuff like that, but it's got to be for the right reasons and you've got to recognise its limitations.
21:58
Michael: Yeah, I and I I completely agree.
22:00
Michael: I I think if we just take AI as an example, I don't think that everyone is resistant to change in other industries.
22:05
Michael: I think they are embracing it just in just en masse.
22:09
Michael: It's it's crazy when you see how many businesses have implemented it and are implementing it.
22:14
Michael: I saw some interesting things from Chat GPT about business use now and number of business licenses.
22:19
Michael: So I I think that the MSK, and I don't know about the rest of the medical industry because I'm not in it, but MSK is certainly a little bit different to the corporate world when it comes to embracing AI.
22:29
Michael: And I think you made two interesting points.
22:30
Michael: One is that uh it can certainly help to to do some due diligence because when patients say, Christ, this is better than physio, it's a it's a good thing.
22:43
Michael: It shouldn't be seen as a negative.
22:44
Michael: If someone says to us as a company, this AI is better than what you do, we need to go bloody hell, okay.
22:50
Michael: Well, we need to bloody improve things, or we implement it, and and so I think there's that.
22:54
Michael: But I I do think that there's a lot of clinic owners.
22:57
Michael: I I saw uh heard one the other day saying, we're not gonna implement um AI phone answering.
23:02
Michael: Not gonna happen.
23:03
Michael: People want to hear a human on the other end of the line.
23:05
Michael: And I just thought to myself, Jesus Christ, this is this is not the way to go.
23:10
Michael: And it's absolutely not true.
23:11
Michael: It's like the amount of times I hear from clinic owners, we don't want to put a WhatsApp chat on the on a website because people don't want to WhatsApp and talk to yes, they do.
23:18
Michael: And Mavis, the 80-year-old, is is WhatsApping a phone, mobile phone company or using the chat there.
23:23
Michael: So don't think that she's not gonna use it with you.
23:25
Michael: And I and it is interesting that in this industry there is a bit of a resistance.
23:29
Michael: I do wonder whether is it partly to do with the worry that you're gonna lose your job, that that you become redundant to some extent?
23:37
Katie: That might be the worry, but we know that's not the case.
23:39
Katie: Because I mean, the whole my thing is the whole joy of physiotherapy is that yes, there's the MSK factor, but actually, with our training, we can we can attack all, you know, there because there's comorbidities.
23:52
Katie: We we complex patients should be our dream.
23:54
Katie: Becoming that generous specialist, so we're gonna have scope for those advanced practitioners that want to do the ultrasound diagnosis and the injection stuff, that's great.
24:02
Katie: But actually, the if you look at population health statistics, where the money's at is the frailty, the elderly, the, you know, there is there is no shortage of demand.
24:12
Katie: So I don't think we have to be scared about it.
24:15
Katie: I think, you know, I will use it for my clinical notes, I will use, you know, lots of automations for any of my sort of software and make life a bit easier, because why wouldn't you?
24:25
Katie: But that the idea is that then it gives me longer to actually engage with my patients and do what I like best.
24:31
Katie: And and that should be nothing but celebration.
24:33
Katie: So I think we're both converted on it.
24:34
Katie: It's just trying to bring everyone else along with it.
24:37
Michael: I'll I'll give you two examples though, where I can see it's already having an impact and a negative impact.
24:42
Michael: The first, let me start with a question: what percentage of people that go and see a private physio, private physio clinic, on their first appointment actually need to go and visit that physio, or could be absolutely fine if they just sat at home, put their leg up and waited a week.
24:57
Michael: What percentage of people need to go into that as well?
25:00
Katie: Well, I mean, when I speak to students, I mean I will go in and say, if you're in the MSK world, you're not fixing anything, okay, because we are designed to heal.
25:09
Katie: Okay.
25:10
Katie: But what you're doing is hopefully supporting, reassuring, and guiding them on that journey to speed it up or make it less traumatic.
25:17
Katie: So, yeah, we could say that 90% would get better anyway, but that's if they're well informed, that's if they know what to do, that's if they're not that's my first point, because uh I agree with you.
25:29
Michael: A percentage, I think Nice said something like 50%, but uh it's probably a bit higher.
25:33
Michael: Well, there's there's different percentage on back pain, but then there's been papers since to say it still has but here's here's the question then, because this is where there is a potential danger to private clinics.
25:44
Michael: Chat GPT is r and or whatever AI is relatively high quality in that early stage diagnosis for for the majority of things, not the most complex things.
25:53
Michael: But if it's relatively accurate, and I put in, I've just twisted my ankle, should I go and see a physio?
25:59
Michael: And it says, Can you walk on it for more than a couple of steps?
26:02
Michael: Yes, I can.
26:02
Michael: Is it very swollen?
26:03
Michael: Yes.
26:03
Michael: Put some ice on it, wait a few hours, see if it feels any better, then come back to me.
26:08
Michael: That same person would have gone to see a physio straight away, now is not seeing a physio.
26:12
Michael: And we're seeing more and more of that where people are questioning AI as to whether they should go and see a physio.
26:18
Michael: The AI says, no, don't worry, you don't need to yet, give it a few days, give it whatever.
26:23
Michael: And so I think that that is having, and this is to this point, although I I I think we'll have the data in the next two or three months, to this point is that it's anecdotal, but we can see some level of relationship between the increased use of AI for MSK questions or healthcare questions and the reduction in first appointments across MSK.
26:41
Michael: Interestingly, we see this most pronounced in chiropractic appointments because the questions are things like my chiropractor says only 25 appointments or session, should I take that?
26:53
Michael: Or my chiropractor says final, I need an x-ray for my spine check or my back pain.
26:58
Michael: So we are seeing an impact there.
27:00
Michael: Um, and as I say, it's more pronounced with chiropractic.
27:03
Michael: Right now it's anecdotal, I have to admit that.
27:05
Michael: But some data soon that is gonna say less patients are gonna be using i physios in the first instance because they're gonna get enough information from GPT.
27:14
Katie: Yes, that's sort of dependent on your client set, doesn't it?
27:18
Katie: Is how clients are coming to see you without a day of an injury.
27:21
Katie: I mean, most of mine I would screen with a phone call, and I quite often would give them the that basic advice, peace and love, and you know, the up-to-date soft tissue stuff, which actually ChatGPT might not be doing.
27:31
Katie: Um, and would also, you know, want to check that, you know, they haven't got the tender points that are specific that might show that they need to go and have an x-ray.
27:38
Katie: So I would be precautionary on that.
27:40
Katie: But I'd also say that I don't get that many that want to come in that day or that I actually want to see that day.
27:45
Michael: I think privately, no, I I would say, and we see this, I think something around 70 to 80 percent of people, if they can't get the same day or next day on online booking, won't book in.
27:55
Michael: It's so, so important that that you have that availability.
27:58
Michael: Our advice to clinics is always keep a session or two open each day because otherwise you are going to drop patients.
28:05
Michael: Uh just we see it all the time.
28:06
Michael: In fact, we can see cost of acquisition directly related between appointment availability same and next day.
28:12
Michael: Because everyone, yeah, I've got I've got a click in my elbow.
28:15
Michael: Oh my god, I must see you today, otherwise I'm gonna the world's gonna end.
28:18
Michael: So I think that's well, yeah, there may be.
28:20
Katie: And then I think I think again, some of this may be geographical or because you know, I I work in a semi-rural area, so we've got manual labourers, they're losing that they're not gonna rush.
28:32
Michael: No.
28:32
Michael: So I probably see particularly men.
28:36
Katie: Yeah.
28:36
Katie: So they will hold back.
28:37
Katie: Um and actually, I suppose that's where some of my video stuff comes in that we might get people booking in sooner if they're concerned about stuff.
28:44
Katie: Yeah, so they are.
28:45
Michael: Here's the other thing though.
28:46
Michael: So uh I've touched one the is it gonna impact first appointments?
28:50
Michael: The other thing is, and I've heard this from a few clinic owners now, the number of patients that come in and see you that are incredibly well informed, diagnosed, have got the treatment plan, and the clinic owners like, Jesus Christ, this is actually really bloody good.
29:03
Michael: And one of the the threats is that a patient comes in more well informed than the clinician.
29:10
Michael: Or the clinician says, You should do X, and the the the primary example is you need an X-ray, otherwise I can't see you about your back pain.
29:18
Michael: And the AI says, Ah, no, you're wrong.
29:21
Michael: Let's take what percentage of clinics, let's say, offer cupping, right?
29:25
Katie: Or or not too many physio ones.
29:30
Michael: Tons, absolutely.
29:31
Katie: Well, I don't want to talk about this.
29:34
Michael: So, what percentage of clinics do cupping, um uh I don't know, taping, for example, or any of the other things that may I mean I know one that does CBD laser.
29:44
Michael: Yeah.
29:45
Michael: Um, so if you are doing things that are just, I mean, how many people use the rock tape things that you press on your neck to whatever it is?
29:53
Michael: You know, there's a lot of clinics doing that stuff.
29:55
Michael: And we've seen that that their numbers of reports have dropped.
29:59
Michael: And I do wonder whether the threat is you better hope that your clinicians have really great knowledge and and are up to date on their CPD, because if they're pushing things like deep uh I don't know, needling for knee.
30:12
Katie: Yeah, I mean, I suppose I don't really want to get into the clinical uh indications, but yeah, I would hope that people are doing evidence-based and best practice where where applicable.
30:22
Katie: And that's what we would recommend because that's what normally the quality is, and that's where you'll get patients recommending you because you haven't had anything that's potentially a little bit on the edge.
30:32
Katie: Not really good at yeah, I'm not very good at voodoo or anything, so I it's not my bag, and I probably want to avoid talking about it.
30:39
Katie: But I'd I want people to go away with the right information.
30:43
Katie: Now, there is some good information that might come up with Chat GPT, but again, it's not really personalized because you know need to know a little bit more about that person.
30:51
Katie: So there's usually more to gain from having a decent assessment with a physiotherapist because you're then hopefully going to get your optimum because you know where that person, what drives that person, what that sort of behavior aspect, what how you're gonna click into what will make that person go to get back to that, what rather than a rather standardized, generic, what there's just been surfed off the internet.
31:14
Katie: So I think there will, you might be right, the patterns may change a bit, but there is, you know, in general, things haven't changed dramatically in terms of how people are presenting with muscoseletal problems.
31:28
Katie: What we are finding is that there's a vast increase in the in the independent sector of community, private clinics setting up, franchises, etc., and neuro, um, loads of neuro rehab and a lot more pediatrics.
31:42
Katie: So what we're seeing is a change in the market, and you may be right with MSK, well, and also there's more competition with the curries and the ostrichs and things, although I would say it would be nicer to work in a bit of collaboration for some of that.
31:54
Katie: But where I see things changing in the independent sector and where we're seeing our membership change quite dramatically is away from MSK.
32:01
Katie: We're getting more and more.
32:02
Katie: So, as in Manchester at a business course, and we had 16 physios, you know, and 14 of them were neuro or pediatric.
32:08
Katie: So it's quite exciting that the sex is changing.
32:11
Katie: Or we could say, well, it's slightly, it means there's challenges quite much challenges in the NHS.
32:16
Katie: But so the sector is growing, but perhaps in a different way.
32:19
Katie: And maybe as you say, the MSK may plateau off, and we may need to all become, you know, experts in frailty or what, you know, how to help the older generation.
32:26
Katie: So I think again, people will need to evolve and change, or and it might just happen naturally.
32:32
Katie: My patients are growing older with me.
32:34
Katie: Yeah, that happens.
32:36
Michael: It's it's an interesting one because I think it from from what I see, AI is becoming a little bit of of a threat to poor quality um physio.
32:47
Michael: I think we would probably disagree on uh the percentage of poor quality patient care out there.
32:55
Michael: Um I I think it's probably much, much higher than than you would think.
32:59
Katie: Perhaps it's just our members that are not such an issue.
33:02
Michael: No, because we say we don't take on member people that are we in fact I just said to someone we we said no to someone that um wanted to come on because they wanted 200 x-rays a month um for as an outcome or as a as a marketing outcome.
33:16
Michael: And I'm like, yeah, we don't do that.
33:18
Michael: Um there was someone that wanted to mark us to market a wand, you know, the magic electro monolith wand, and I'm like, yeah, I'm not getting involved in that.
33:24
Michael: So we do try and stay away from from some of that stuff if we can.
33:28
Michael: Although I've had an argument with someone on on the wand and it's efficacy.
33:31
Michael: But um, no, I I do think that there's certainly a bit of a threat there, and I I've heard it from clinic owners as well.
33:37
Michael: But talking of um because you just touched on it, and let's make it this last one because we run over slightly, but it's really been really fascinating.
33:44
Michael: Let's talk about change in the industry and uh the uh the number of clinics being bought out, the P that's in the industry, the the the the the investment, what you think, whether you think that's a positive thing, a negative thing, and what you see the result being over the next few years.
34:01
Katie: Goodness.
34:01
Katie: Just just a light one to finish on.
34:03
Katie: I suppose I find it slightly concerning.
34:06
Katie: I mean, A, I want practice owners to be aware of what what they're letting themselves into, and if it's been their baby, that no, it's gonna change.
34:15
Katie: There is just no way.
34:16
Katie: So, you know, it it you know, obviously it's an individual decision.
34:20
Katie: What slightly concerns me is how it's homogenizing that care.
34:24
Katie: Because the whole thing about physiotherapy is that therapeutic relationship.
34:28
Katie: Whatever you're doing to that patient, it's that relationship that's really important.
34:31
Katie: Because if you don't have that relationship, people are not gonna get better or they're not gonna believe in you, they're not gonna recommend you.
34:37
Katie: So when a clinic is literally, it has the same sort of website, it doesn't have much information about the different physios, and it's just you know, book your appointment here and it doesn't really matter who, it's a heart sync for me.
34:48
Katie: So and you know, there is only sort of a ceiling that you're gonna get with the the healthcare or physio clinics at the end of the day.
34:56
Katie: So it's they make it generic for a reason to try and keep it as cheap as possible and get as much returns.
35:02
Michael: That's the thing.
35:03
Michael: And then the worry is if you're investing however many millions or hundreds of thousands or whatever it is, how how interested are you in patient outcomes above and beyond your pure profits, right?
35:14
Michael: Well, yeah.
35:15
Michael: Can you be?
35:15
Michael: Can you be?
35:16
Michael: Yeah, if you're if I if I buy, and we'll use it as an example, if I buy pure physio for, I don't know, whatever they were sold for, 20 mil, whatever the the number was.
35:25
Michael: I'm and by the way, Finn's obviously one of the best people in the industry that's ever existed.
35:30
Michael: I think he's incredible and what he's achieved and and he's done that all the while whilst being completely ethical and really caring, like he's brilliant.
35:37
Michael: But I I know that P, you know, are they sat there when when when they're looking at the numbers thinking, yeah, do you know what?
35:43
Michael: Let's put more money into this and make less profit to make sure these patients do better?
35:47
Michael: Or are they sat there going, we want more money, we need to make that money back?
35:50
Michael: Um and it's an interesting question, right?
35:53
Michael: Across the board.
35:55
Michael: How important is money gonna be in the commercialisation of clinics?
35:58
Michael: And I've got one of them on actually next week or the week after where I'm gonna be putting those questions to them.
36:03
Michael: But are they ever going to care about patients as much as you would being a private clinic owner and being in a community and looking after people?
36:11
Katie: Yeah, uh well I think pro probably not.
36:13
Katie: And that is the consequence of it.
36:15
Katie: And but you know, I don't know, if you've been around long enough, things go full cycle and at some point you feel there'll be a that's enough of that and it will just go round again?
36:24
Michael: I think two things might happen.
36:25
Michael: One, it it's such a trend at the moment, let's just buy clinics.
36:28
Michael: The multiples are really, really high.
36:29
Michael: I don't know if that continues.
36:31
Michael: I because I think that you're right, there is a ceiling.
36:33
Katie: There's a ceiling, surely, at some point, and it's not going to be economically viable to carry on doing that sort of correct.
36:40
Michael: And then the other thing is, um I I'm interested because you you we talked about PMI and so on.
36:44
Michael: Is it true, and I may be wrong, but uh is it true that some of the bigger clinics, let's say, can negotiate far better rates with insurers than your average clinic?
36:55
Katie: Do they have preferential not particularly well it it actually all more equates down to geographical where you are.
37:05
Katie: Where you are, where the supply of the clinics is in relation to that.
37:09
Katie: So if you're in a clinic and you're only the only clinic in that 20-mile radius, you're more likely to be able to get what you want.
37:17
Michael: So it's not necessarily to do with uh we turn it.
37:19
Katie: Most most of the PMIs will will try and push it down one of the big providers because that's what they have contracts with.
37:27
Katie: So that's their ideal because you can get it.
37:29
Katie: It's much easier to deal with one big company.
37:31
Katie: So that's the way it goes.
37:33
Katie: And in terms of negotiations, as far as I've been informed, it's you have more leeway if there isn't another clinic down the road who's going to do it for half the price.
37:41
Michael: So this is interesting, right?
37:42
Michael: Because if one business owns 50 clinics, suddenly now actually white it's a positive, right?
37:47
Michael: Because our complaint is physios aren't paid enough.
37:50
Michael: Well, if you've got, like in the veterinary industry now, whether I think there's four companies or whatever that own every VEX in the country, now you've got a much greater power to negotiate.
37:59
Michael: So that could be one benefit if we want to It could be in theory.
38:03
Katie: I'll be interested to see if it plays out in practice.
38:06
Michael: It's an interesting one because it there's there's so many clinics being bought out.
38:09
Michael: And I do know that some of those insurance companies are looking at acquiring.
38:13
Michael: Well, we know that um one already has acquired a few clinics.
38:16
Michael: So I do wonder whether they're going to start acquiring clinics themselves and then push all the work through them.
38:22
Katie: Yeah, I mean bupa are permanent buying various clinics out.
38:25
Katie: So, you know, and and they've got a partnership with the SENTI.
38:27
Katie: So there's, you know, it's it's all out there, but a a lot of it is supply and demand, which is where Fiji struggle to understand the economics of um the sector.
38:37
Katie: If there's a lot of physics in the area, you're less likely to get a high commander high price.
38:42
Michael: Yeah, no, and it's it's a shame.
38:43
Michael: But then at the same time, I I think one of our jobs is to get clinics off of um.
38:48
Katie: I mean, that's our our business model that we advise is to be, you know, as much not reliant on PMIs as is possible.
38:55
Katie: So you use them as it suits you.
38:58
Katie: But the strongest power physics would have is actually to walk away when they're not reaching the prices.
39:02
Katie: But this is the problem that doesn't happen.
39:04
Katie: People just sort of try and make do, which I totally get.
39:08
Katie: But if we were much braver and we could sort of state our own claim and walk away, then we'd have much, much more strength.
39:16
Michael: Right.
39:16
Michael: I listen, I could I've got another 20 questions I could talk to you for hours.
39:19
Michael: We need to go.
39:20
Michael: I need to let you go.
39:20
Michael: You've got enough on.
39:21
Michael: I don't ever promote stuff on here, ever, but I will say go join physio first.
39:26
Michael: And and I think it's it's really important that the private clinics have a place um and someone that can represent them.
39:33
Michael: And and I know you're, you know, historically maybe not the greatest organization, but you you are making change, and I think you can affect change more effectively the more members you have.
39:42
Michael: So if you're a physioclinic owner, go join.
39:45
Michael: Yeah, go and join.
39:46
Michael: Uh as I say, I don't normally promote stuff, but I'm happy to promote this one.
39:49
Michael: I as I say, could ask you a million questions.
39:51
Michael: Thank you so much.
39:52
Michael: Maybe we'll do another one at some point.
39:53
Michael: Uh and you've been a really good sport and uh not talk too much at some of my more controversial questions.
39:59
Michael: So no, many.
39:59
Michael: Many, many, many thanks.
40:01
Katie: Thanks, Michael.
40:02
Michael: Cheers.