He Built 4 Clubs for 500 Health Practitioners - Vishal Amin, founder of Until.co.uk, BOAC #62

0:00I was frustrated by the fact that firstly I had to go find these practitioners, didn't know if they were the best ones for me. I then was coordinating a lot of the advice and care. My physio would say, oh, you should not do it, stay off your ankle. And my PT would be like, no, we just keep you moving. I pay my PT£80 an hour, he's getting paid£20. Reality, as a personal trainer in this context, you can't live in London on that earning. Practitioners didn't become practitioners because they wanted to sit behind a computer screen. And consumers quite quickly get bored of the experience. In place of going, hey, I want my refill of my antibiotics, you actually want to engage with a person.

0:33There's a lot of ways to make healthcare provision more efficient. One of the things that is absolutely backbone is the authentic, vibrant human relationship between practitioner and patient. When it comes to health and wellness service provision, very hard for a brand to claim they own the customer. Because who owns a customer? Not the brand. The clinician owns the customer because of that relationship. And so we built the business on the premise that these individuals are the brand. When I want to do a post-op assessment and I want to hand over to a physio, I don't want to write a letter anymore and get it sent into a black box.

1:03And the mother the whole time was sat there going, where am I? I'm here to see my dentist and now you've got a pediatrician here. In fact, we've had some surgeons say to us, we cannot refer to some of the brands we used to refer to because their best clinicians are now out on tilt. I've got a knee pain, do I see a physio in osteo-chiro? Someone's told me it's a physio, where do I find the physio? It's just a mess, right? And so even AI in the service delivery and the support of a consumer to navigate that is going to become more and more important.

1:34Before we get started, this episode of The Business of a Clinic is sponsored by Virilo. Virilo is the trusted marketplace for clinic owners looking to sell and groups and clinic buyers looking to acquire high-performing clinics. There are very few specialized marketplaces in the UK that focus on this transition for clinic operators. Virillo is one of them. Learn more at virillo.co.uk. Now on to the episode. Hi, everyone. This is Jared, one of the co-founders at Coherent Healthcare, back for another episode of The Business of a Clinic. This is going to be an interesting one because our guest does not come from a clinical background and is doing something very different to a lot of the other guests that we've had in the sense that he is rethinking the genuine infrastructure, the things you touch, feel, see, to actually get great care delivered in a way that feels modern, fresh, customer-friendly.

2:25We've obviously had a chance to chat, but I think maybe just to start for folks who don't know who you are, two-minute story arc of where it all started and where are we today, and then we can go from there. Yeah, look, I, born and raised in London, had aspirations to go into banking, was at LSE, and then graduated and someone I knew in the US said, look, why don't you come and interview for a startup? And this was 20 years ago, startup wasn't a thing. And I candidly went, he paid for my flights, went there for an interview, got the job at this healthcare business and knowing nothing about startup healthcare and definitely not insurance and kind of joined this six-man team and went on a crazy three, four-year journey building a health insurance services business.

3:07And so that was my first real exposure to that world. I ended up being the CFO there. That business ended up being then sold on and rolled up. And I came back to London to join McKinsey, which I thought was my dream job, and was always frustrated by having experienced the US healthcare system. I know it's got its faults, but because of the nature of the privatization, there was a lot of inefficiency in NHS, which I was always looking at going, why is this broken? Then I spent 10 years in consulting. So I did some work with the NHS when I was at McKinsey, did some work in pharma, but really got my entrepreneurial kickback by joining an innovation consulting firm where I basically got to build products and services.

3:46That gave me exposure to hotels. It gave me exposure to pharma. It gave me exposure to alcohol. Lots of very different worlds. And it led me to want to start various small businesses. And so I went on to join and found a consulting firm. and whilst I was building that consulting firm it was all about purpose and culture I was doing side gigs I started a hair salon I started an Airbnb rent-to-rent business we did a restaurant and so that gave me a lot of stimulus on the different types of business models that existed at the same time as I went on my own consumer journey I got a PT it's the first time I could afford it I got a physio I got a therapist I got a massage therapist and I had this incredible team around me and for the first time had the experience of the impact beyond hey I want to look good on holiday but like the performance impact the mental health impact but I was frustrated by the fact that firstly I had to go find these practitioners didn't know if they were the best ones for me I then was coordinating a lot of the advice and care my physio would say oh you should not do it stay off your ankle and my PT would be like no we need to keep you moving and then my third frustration was cost had been a barrier to me going through this experience earlier in my life but most of the money I was paying wasn't going to the practitioner that was having the impact on my life it was going to a middleman I pay my kitty 80 pounds an hour he's getting paid 20 and for me after I built that relationship he's the one I'm going for it's his energy his knowledge his passion his commitment he could have moved up the road to another gym and I would have followed him and so that's what those the combination of those frustrations made And you go, there's a different way of doing this.

5:27And that consultancy firm went on to be sold. And I pre-COVID went, all right, let's go. Let's go on the next kind of entrepreneurial journey. And that was 2019. But really, we didn't get going until after. So where are we now? It's four or five. So until today's four clubs across central London, we have 500 practitioners from five verticals, people that work out of gyms, a train, treat. So in your treat category is physios, osteos, chiros, podiatrists, coaches. So psychotherapy, counselling, talk therapy, and then medical and dental. So medical is everything from aesthetics to men's health, women's health, orthopedics, radiology, oncology, and in your dentistry, everything from general dentistry to specialist dentistry.

6:06So we have 500 practitioners across those verticals that run their businesses from our four locations today. And then over the next 12 months, we're going to scale that proposition both much more broadly across London, but also overseas. overseas. So I think we were talking before, one of the challenges of doing things differently, and I think it's interesting to say you guys are doing quite a few things differently. The first one is that you call them a club, which I don't think anyone who provides healthcare thinks of where they work as a club, although maybe they should. When you go on that journey to doing something differently, trying to impose your will on a market that maybe historically has been resistant to things being done differently.

6:52Particularly in the UK, right? You have an 800 pound gorilla NHS that does certain things in a certain way. It's very good for some things, less good for other things. You have a sort of growing melting pot of private practice activity, which seems like a very natural fit for some of the stuff that you do. What are some of the headwinds, blockers, points of resistance that you've really had to go through in order to get to four clubs, 500 practitioners, multiple verticals? What are those roadblocks that you've seen as an innovator in the space that you've run through? Yeah, a lot of the roadblocks come from the industry perception, right?

7:26And I think the benefit of being an innovation consultant was I could sit in front of a CEO of a FTSE 50 business and explain to him why a new idea was going to work. And he would give me 50 reasons why it didn't. And then I'd prove to him that he was wrong. And it wasn't because I was smarter than him, but he had got to his role by accumulating experience. And you almost forget what is an assumption you've made versus a reality. And the world changes around you. And I think we have had the fortune of building until in a moment of real change, right? your post-COVID moment where a lot of the wellness practitioners who were freelancers before weren't furloughed but their clients had gone to them and all of a sudden they'd gone from feeling like the brand they worked for was the poster child to realize that they are the poster child they are the celebrity they are what the consumer is looking for and so they don't want to move back into a model where that brand is taking 70 percent of their income and all of a sudden we pop up and we go hey no come here we are we you are as a practitioner are our customer so some of it was industry norms and people going can't put you can't put 30 40 50 physios in one location let alone 30 physios 30 pts 10 doctors so there's that mindset was a challenge i think the second challenge for us was what is it right you went to you're calling it a club is it but it's a clinic it's a gym it was and continues to be a challenge comprehension for us because our customer until they experience all they come and physically come into our facilities they don't quite comprehend it and so look I guess those were the big two challenges that we have our way through and continue to work our way through probably will for the next for sure at some point there will be across the chasm moment where everyone will say it was obvious and we're just not there yet because it's early days.

9:21I think we were speaking earlier, I used to run private practice operations in medical aesthetics, dermatology, in London and in New York. Space is not an easy thing. As it turns out, I do not come from a property management background. I cannot DIY my way to almost anything that's not food. At least you can do food. Yeah, at least I can do food, exactly. But I remember the first time our HVAC broke and having to figure out how you fix that problem. Not intuitive. You get rot in the shop front. Every problem that you've probably seen a thousand times over at this stage, we learned firsthand. CQC, you mentioned earlier, was a big part of that headache as well, which having someone do that for us would be an absolute dream.

10:04So the fact that you do that for your club members, your practitioners, is a dream. I imagine that many of, much like myself at that time, many of the people who would take space may also not fully understand just how much headache until you've eaten the shit until you really know how bad it is yeah you're telling listen we're going to do all this stuff for you does that really a is that a big thing do i how do you overcome that person listen guys trust me it's bad it's it how do you get there with your we overcome it when a practitioner leaves to start something they come back going oh that was a bad idea.

10:44I think at the moment, the alternative is so bad that it is less of an issue, right? Like, when the alternative is, I can go work in a gym where I have to wear their uniform, and they pay me 20 pounds when they're charging my client 100 is a big enough problem. Because the reality as a personal trainer in this context, you can't live in London on that earning, right? You have to be working so many hours and as your audience will know it's not doing 40 hours in consultation versus a 40-hour work week's nine days so intense when you're sat in front of your client or your patient and you are engaging them there is a and so when you're not paid and that's my whole argument it's not about them being paid overpaid it's about just enabling them because they are the value driver in that conversation to be paid fairly and so that's why it's less of a challenge And that being said, we're humans, right?

11:41And so naturally, when we started, one of the reasons we built until the way we did was because I'm not a practitioner. It helped me that I'm not steeped in 20 years of experience because I didn't have all the rivers of thinking that existed around how things are done or what things look like. Otherwise, we wouldn't have built until, candidly. And it's the reason when I went and spoke to industry folks, they were going, it'll never work. It was because they all had a river. Usually a good sign that you've got something that might work. Yeah. And so what I had to do was interview and speak to loans or practitioners, right?

12:14I definitely wasn't building for myself. I was building for them. And so the opportunity to go and speak to, I think we spoke to almost 500 practitioners before we even put pen to paper on what does the room look like? What is the equipment? What's the flow? What's the experience? What's the front of house responsible for? And that gave us the, that's when we realized that space is the foundation for a lot of these guys. Because sure, you can do these things online. it's not the same experience right practitioners didn't become practitioners because they want to sit behind a computer screen and consumers quite quickly get bored of the experience of going unless you're going hey i want my refill on my my antibiotics you actually want to engage with a person and so space became the obvious place to go everyone was going left we wanted to go right and so yeah that's how we started it's interesting you use a word in that engage so we say a lot of things.

13:07We say a lot of sentences with the word engage in them, given the work that we do. What we hear more and more from providers, be they clinicians, clinical leaders, C-suite of groups that are providing clinical services, take your pick. Against the backdrop of the AI monsoon, which will make all humans irrelevant, there is a very clear line of sight from most of the people that we've spoken to that there's a lot of way to make healthcare provision more efficient. One of the things that is absolutely backbone is the authentic, vibrant human relationship between practitioner and patient. How does that show up in the space that you're creating?

13:56I guess first question. And second question is, in order to allow that to exist, you have to get rid of a lot of that noise, which I think is part of what you were saying is like, we at Until are going to keep a lot of this stuff out of your way so that you can really get deep on the person in front of you, which I know is a huge pain point for solo site practitioners all the way through the groups who are spending all of this time, energy, and resource dealing with stuff that's actually not core business. So how does the integrity, the authenticity, the engagement between practitioner and patient show up inside of your facilities?

14:32It shows up in the whole business model is based on that. Because I fundamentally believe that when it comes to health and wellness service provision, very hard for a brand to claim they own the customer. Because who owns a customer? Not the brand. The clinician owns a customer because of that relationship. and so we built the business on the premise that these individuals are the brand they are the product and so when they come walk through our door and say hey we want to build here the thing we're trying to understand is are they good enough to be part of this community and their customer following tells us whether they're good enough right and so for me I'm like that comes to life in our environment because they're bringing the consumers to our space they're inviting consumers the consumer is not coming because they go oh I should go to until yet they're going oh my PT goes there or my physio or someone's recommended me a brilliant female health doctor so I'm gonna go there and they come into a space and all of a sudden they realize that we're a melting pot of some of the leading practitioners in London and so they go okay from a you've now taken away my selection headache you're in a location that's accessible and convenient and in an environment where I want to be right a lot of the medical surgeons they're not going to do surgery in our rooms thankfully and we definitely don't want to go that far but for pre and post a knee odd the orthopedic surgeon is going great I've got a relationship with St Mary's and but when I want to do a post-op assessment and I want to hand over to a physio I don't want to write a letter anymore and get it sent into a black box here I can introduce him to Charlie I know Charlie and so when I see Charlie in the clubhouse, which is our community space just for practitioners, I can be like, how's Vish doing?

16:24How's his recovery going? Is there anything you need to know? So all of a sudden, because practitioners became practitioners because they care about that delivery and the impact they're having day to day. And so that's how it comes to life in our clubs. It's interesting, you give the example, I imagine Ortho walking out of room A, turning left again, knocking on room B and saying, hey, here's my patient, which I'm not having a good, but this idea that it's almost community governed or community-led care. It's very interesting. It's a very interesting moment. Look, very early on when we opened Marlaban, where we first introduced medical and dental, we had this lady come in to see a dentist general checkup and she brought her kids with her, probably school holiday, and her youngest was quite poorly.

17:06Just done well, I suspect. And while she was waiting in the waiting room, all of a sudden the youngest starts fitting and stops breathing. now happenstance has it that we had a pediatrician in the in the room who was able to the team was able to look at our roster see who was available pulled the pediatrician out was a and potentially saved the life of that child and the mother the whole time was like they go where am i that i'm here to see my dentist and now you've got a pediatrician here and so that for me was a moment where i was like this is why we're building what we're building and we don't want that to happen on multiple occasions, but I guess it just brought to life that why should consumers feel like all these things are massively fragmented when feeling well, feeling better is served by all of these providers.

17:52It's quite singular, our goal. Exactly. It's interesting, a lot of the practices that we work with, which are not in the until umbrella, as much as there are standalone facilities, probably more than practitioners, but some of our larger practices have very entrenched, longstanding relationships with the clinic across the street. You're right. We are a dentist and just over there is the audiology, whatever it is. And the amount, we do a lot of patient handling, patient operations, patient service. The number of times we will see a question about a service line, that clinic does not provide. And the clinic will say in their SOPs, if you get a question about this, send them to not location, to your point.

18:32Clinician-wide, they work across town. I've lost track of it. And it sounds like that's almost the invisible patient experience layer is you don't need to go across town. Actually, now it's all here. They're going to refer you. They're going to refer you across the hall, not across the city. And there's nothing stronger than the practitioner that you have trusted to do X referring you to the practitioner Y and then do Z. Because that trusted relationship is there. And the reason it's not new, it's not and it's not unique to health care. law, accountancy, it's the same model. The whole idea of a law firm is you find your lawyer, you build a relationship with them, but often they'll refer you to their mates who go outside of the firm because it's all based on trust and human relationship, right?

19:20We do employment law, you need a property lawyer. That's that firm, this person, not the firm, the person. That's this person. Because what that lawyer is doing is he's going, this is my trusted relationship. This consumer, this business person is trusting me with their with their real estate now when they want to do litigation i want to make sure that they get the right person because reputationally the impact is on me and that is exactly what's happening in that instance and that's what's happening in our clubs where you've got these practitioners and suck and the beautiful thing is now a practitioner will come there let's take the orthopedic surgeon example and he'll go actually there's this physio that i refer everyone to he should be here too because this is a better model for him.

20:05In fact, we've had some surgeons say to us, we cannot refer to some of the brands we used to refer to because their best clinicians are now at Untilt. And so that's the way I see this market continuing to evolve. And it applies in aesthetics, it applies in wellness, it applies in core healthcare. Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic. Coherent helps fast-growing healthcare providers engage, support, retain, and nurture their patients from intake to discharge. As you get bigger, your patient body grows enormously, and it becomes much more than just another hire, just another front office team member.

20:44It's no longer a people problem. You need technology that can scale with you. Coherent helps you do that by keeping every patient on track. In short, we're the agentic CRM and patient support platform for outpatient hands-on health care. To learn more, visit us at coherenthq.com. Now back to the episode.

21:27Online. And some of the practices that we support, and actually we had someone join us for a conversation a couple of weeks ago who he's in a marketing space. And it was Ali with Medico Digital as a healthcare marketing services business. And he was saying that one of the biggest shifts that he's seen in the 10, 15 years that he's been running his business is the fact that the asset is the clinician, the brand is the distribution vehicle. It's just like where you find them. Or more, even when you think about marketing performance, we don't touch the marketing side of the house but when you look at marketing performance the ad set that drives is practitioner exposure visibility trust and it goes all the way through it's like that's the retention mechanism it's the acquisition mechanism it's how you get patients in it's how you keep them there it's that really strong leveraging center of gravity around the clinician which i think is interesting and it's why we built we built we saw the emergence of instagram and you've seen proliferation it started with the personal trainers building their brands but now you've got the doctors and the dentists and you've got content being created which is serving that community but it is every personal brand is critical everywhere this is an example of me working on my personal brand but it's not something i really ever wanted to do and i was somewhat cynical about it and then you just realize the power of it is incredible and i believe whether you're a doctor or a dentist or a graduate, thinking proactively about your personal brand now is really important.

22:53But that is, to your point, I find it really, brands are going to have a much tougher job of trying to position themselves as owning the customer. The power dynamics are very different. One reason, I'm thinking about our customer base, and I can imagine how there's a real point of attraction to until in two cases. The first one is I'm confident in my ability to build my business or my practice, but I'm not yet at a size, shape, or scale to go need 10 ,000 square feet of my own. Sure. So I'm out of the gate, but not yet running at full speed. And so I get it. And similarly, you were saying earlier, some of your tenants, I won't name their names unless I'm okay to name their names, but I will not name their names.

23:34People who need satellites, they've got a big thing going on over here and actually they just need a room and a better environment that they don't have to worry about because their core business is actually in the deep surgery and not in the thing so i get that as well 100 yeah look as i said we serve individuals who want to build their own practices now they have to worry about a personal guarantee a lease a fit-out cost all of the the the hvac breaking down the the front of house not turning up these are things that are distraction from the core value proposition that each of these practitioners is delivering, but all the way up to now teams are going, hang on a second, why are we paying all this overhead and distraction to have a clinic when we could all of a sudden have a full clinic model by moving to until, and we only pay when we generate income?

24:20That becomes really attractive, right? Because they can book by the hour. Which they're using. When they're using it. So all of a sudden their cost base is directly tried for revenue. And that is a unique model across the market. now all the way up to the big companies going oh i do blood diagnostics i if i am in that space with the clinicians who's going to get a referral so we started we've got whole ecosystems building across our clubs we've got diagnostic providers saying could i put a dexter scanner in your space can i put an mri and we have people come to us why don't you guys do it it's not our business right?

25:00I'd much rather support someone whose focus it is on building the infrastructure and the supply chain and the demand for a product and put them in our ecosystem. We have blood cleaning, we have brain analysis, we have all sorts of, as the technology and the health hacking progresses, we try and keep things largely mainstream and science-based, but all of that stuff needs a home. And they prefer a home where they're surrounded by by referral agents effectively than anywhere else. Completely. To your point around infrastructure, new patient flow, ability to serve more holistically, all of that exists.

25:35Can I, as a practitioner, a clinic leader, whatever it is, can I scale in your facilities? Absolutely. And so look, have we had people leave until to build their own facilities for sure? Is that a success in our eyes? Yes, because they've grown, right? do I think that we can build an infrastructure that means you never have to leave absolutely and so whether that's you take your own space you take it more permanently but for me I'm I want to be able to go to brilliant practitioners and go I'm going to take care of all the staff that frankly you should not be thinking about and I was just having the conversation with my team because some of them will go I don't need to take care of me I want you to teach me teach me about social media teach me about running my admin better the problem with that is that they don't do it because they don't have the skills they don't have the passion they don't have the time and so I could teach you but two weeks later you're going to leave going I'm going to make all these changes two weeks later you're going to have done nothing so my view is that you spend your time and energy doing what you do brilliantly get better at what you let's church if you can do some training train yourself more on what you do and let us take care of the low level, the low value adding services, much like what you guys provide.

26:57And you focus all your time and energy on having the impact that you want to have. It's interesting when that's, so we, it probably shows up differently when we speak to prospects, I guess, potential tenants or club members, depending on the language. When we speak to prospects, we often find that they fall into one of three categories. The first one is hugely problem aware and actively trying to solve it. That's obviously a very easy conversation. I know I have this issue. I want to move forward. More so than in any other business I've been part of, the second category feels disproportionately large in terms of healthcare buyers.

27:32And that category is, I'm good. I've got it. We were just talking about it with someone else earlier today. There's this mindset of, we already do that. I don't know how to have that conversation, but you, okay. How, from a mindset perspective, you're seeing a huge part of the market. You're seeing, I would imagine, given the brand and the proposition, you're also probably seeing a growth mindset audience. Practitioners who are trying to be best in class, you're probably doing some curation, quality control at the front end because you're trying to curate selection. So I guess it's a little bit different because we don't have that problem.

28:09But I'm curious. I think it shows up when you were saying some people say, teach me so I can do it. And you're actually saying, that's our core business is X, our core business is Y. How have you navigated the old guard? We're good. This has been done. It's all fine. Nothing to see here. So most of our business is inbound, right? Or it's a practitioner going, as you said, you heard about us because you heard that loads of people coming and people going what is that it was intrigue right and most people don't really understand our proposition until they come in and experience it but absolutely i have but as we're building out the proposition and i sat in a room with 20 of our leading practitioners a couple of weeks ago and i talked to them about this ecosystem that we want to build around them so they because i now can do group buying i can now give them access to ensure their patient has a really great experience and some of them will go oh but i'm already doing it fine that's okay right but the reality is they will learn the lesson when they see other when they see they can't sleep because they've had a bad experience because then they may be doing it but we know execute it's like the idea is not the value it's all in the execution and so i think people like that learn when it goes wrong and I think particularly coming from non-clinicians really hard to have that conversation because it's it's when I was a consultant and every client I'd speak to would go oh but our business is different you've got that solution you've done it for all my competitors but our business is different you can't answer a question all you can explain to them is why what you've done it what impact it's had and that's the story of BUs right we will tell people that practitioner x worked as an employee used to be a low limb specialist started until on half a day because finally he could see a potential of starting his own clinic but he never had the capital or risk appetite before and now he has a team of nine people running across his organization and that's given him the headspace the opportunity to have a podcast to write a book to create go and follow his other dreams and ambitions that sit outside of the clinical delivery that some of the best practitioners never get away for can we talk about patient experience for a minute sure which you touched on earlier i keep coming back to showing up to a doctor's office with your kid i'm living that now with my own kids how that looks and feels like you've talked a lot about practitioner side experience the value proposition why it makes sense who it makes sense for I found myself reliving my own days picking a site to open visiting we ended up in a old the site that we took over used to be a fish store okay it was a fish store for about 20 years on great Portland Street and fish stores as it turns out produce an incredible amount of humidity from all the tanks so everything every imaginable surface that could be rot mold gunk whatever or we had it all, the whole thing, rip out everything, producing it.

31:21I found myself wondering if this were there, would we have done it? And I think the answer is yes. The caveat is we had very specialist medical tech that was unique to our service delivery. We had built that tech from zero and it was the size of two pool tables. So the question I think would have been, does this even fit and how does it fit? If the answer is yes, then I can totally see the appeal because of the headache. I also now then find myself thinking about our patients. So I get how as a provider, it would have been attractive. Subject to, as a patient, would I have been able to deliver?

31:57We were trying to do the Soho House of Tattoo Removal. It was like very niche, but Soho House of Tattoo Removal, that has a very specific look and feel. It has a very specific vibe. We wanted tattoo art on the wall. We wanted a great coffee machine. We wanted people to have a warmth of experience. This is just similar to you guys, but how do you think about I guess clinicians will give patients their own experience but a lot of that experience is being there how do you think about the it's part of the product how so what is that product as a patient so that I've had I often will get practitioners will come to me and go we're spending a lot of money with you and for what I'm spending with you I could rent this space and my simple answer is if you think if your alternative to us is just renting a space you should go and rent a space and because it tells me that what you're not valuing is the customer experience that we create we manage the front of our staff how that how your patient is greeted how the environment they're in the waiting room all of the amenities and the services that exist the community aspect all becomes important but for me our primary is always the practitioner but we if we don't think about the consumer we haven't got business and as we're expanding our portfolio we're spending more and more time and energy going okay how do we create a really unique consumer experience because that is part of the practitioner's product ultimately and we will how do you think about refreshments the space the environment we're not we want people to come in and not feel like it's a gym they're coming to see a doctor in a gym but they also don't want to feel odd coming to a space like ours and going to a puzzle trainer and i'm definitely not the brains that can do that but what the team have done is created a blend that allows you to go somewhere and feel like it's got the cleanness and the lines and the clarity and the lighting that's needed to deliver a clinical service but the softness and warmth that feels like oh it's the club and it's somewhere where I'd want to hang out the thing that I can't help but ask the question how does that show up when patients are not physically in front of you so there's a huge part of the patient experience which is the hour that they spend on site yeah And that hour is disproportionately impactful.

34:12One of the things we always say, and I will die on this hill, if the patient is under your care, they see you for three hours a year. Sure. And then they don't see you for 364 days plus 21 hours. How does Intel think about the patient experience for the 364 days and 21 hours? We obviously have lots of different practitioners where that counts differently. You see a personal trainer, you've seen way more. and I absolutely agree with you that is the reason why I think personal trainers have more impact on their consumers is because of that the extent of which they're in front of them but I don't think clinicians and practitioners think enough about the outside the hour session because they're trained because you can in the UK where it's the NHS which it's just let's say how many people can we try now they think all the value is delivered in that time and I 100 % agree with you it's absolutely not and I think technology is the route to do that and so it's why our proposition is evolving to not just be the space and the hour but helping the clinician go how else what are all the other engagement points and how do I serve that patient so I'm front of mind and they feel cared for right they feel valued through the experience not just the moment that they were paying me.

35:30And the reason that's important is because it also teaches the patient that what they're not paying for is the hour or the 15 minutes or the 10 minutes, because then that's just a transactional experience. And what they're paying for is someone to care for them. And the only way you can do that now outside of that is a digital engagement. We had a guest on the show not long ago who talked about the difference between senior dentist and calling out a plumber and how the dentist charges you for the hour that you're with them. But that hour needs to actually cover a huge amount of service provision, whereas the plumber is not in any way hiding the fact that they charge you for the call out, they charge you for the parks, they charge you for the work, they charge you for the cleanup, they charge you for the checkbook.

36:08So when you pay your plumber, the bill is so big, but they have figured out how to communicate very clearly the different components of that value, whereas in dentistry or whatever it might be, you come and you say, I'm consuming this thing. So I think that makes a lot of sense. What it makes me wonder is so much of the innovation story right now in healthcare is digital, the AI-ification of healthcare and the very sloppery slope that comes with that, as I will continue banging on about. Because as with most things, you introduce new tech into the world without thinking through what happens next.

36:44And social media is a phenomenal example of that. We did this great thing and also introduced a global mental health crisis for young people and no one really saw that coming. and now we're trying to undo that. I think we will see versions of that in healthcare. A lot of our customers are customers who have jumped hard on the AI bandwagon. Give me the AI receptionist. And then, oh, hold on a minute. It saved me five minutes. I paid 25 minutes over here. It got me one more customer, lost me those four. So that trade-off is still being a bit... What I think is so interesting here is that your innovation story is tech, but it's very much in the physical world.

37:195%. I don't know. This is an interesting version of innovation, given what's happening in the world. So I have to ask the question, as a physical business, as a real world business, you walk in, you touch it, you see it, you feel it, your practitioners see it, your patients see it. Where does AI show up? I think the mistake people make is when they think of themselves as a physical business or a digital business. I think the nature of engagement with consumers, today means you have to be hybrid in whatever format that looks like and I'm not sat here replaying the WeWork story where I'm trying to sell the physical business as a tech business, we're not but I think if we're not if tech isn't deeply interwoven into our experience we won't create the optimization and the opportunities that exist and so for me the brilliant thing about having physical environment is that you can go and test things in the physical world and then go, okay, how do we use tech to optimize this?

38:18Not let's implement the tech and then figure it out. And that's why I think we haven't gone down the option of just saying, oh, let's just build a box and then build loads of boxes inside it and let people just occupy the box and not have any of our own people. Because when a consumer comes in, they need to feel greeted. And that connection is part of the experience as you've discussed. But the AI should be stripping. I know there's the kind of cynical view of AI, but AI is no different to technology or the industrial revolution. I really bought into the fact that it's just going to make us more efficient.

38:51Then the question is implementing it well. And there's a lot of lazy implementation. But you can't expect someone, it goes back to, like, why would you expect one of our physios to know how to implement AI? right that is the responsibility of businesses like yours and ours to support them on that journey and go look we'll take care of this we'll take care of that often people will compare one software to another and go this one's good and this one's crack often it's not the software that's the problem it's the human user and the way that they're using it right and so look how ai ai will be a really core part of what we're doing whether it's internally until and how we're using it or how we're supporting our members our practitioners to implement it into their workflows all in service of helping them do what they do best or spending all their time and energy it's all about where do you spend your time and if you're spending on things that you shouldn't be doing to waste your time and that's the way we think about application we've spun up the ability for should you be thinking or spending huge amounts of money building a website because your collection no let us do that for you do you need to now go learn seo or pay an agency to go overcharge you to just write some blogs well no because we'll take your knowledge and get it done for you and so it's going to proliferate the industry in the ways that we haven't even imagined and i think we're just scratching the surface but i don't think you can look at it as physical and digital i think you have to look at now things as hybrid solutions really focused on driving value for the consumer.

40:32And in our case, the consumer is the practitioner. And I want to be clear, we are equally solving a problem for consumers who go, I have a problem. I've got a knee pain. Do I see a physio in osteo-chiro? Someone's told me it's a physio. Where do I find the physio? It's just a mess, right? And so even AI in the service delivery and the support of a consumer to navigate that is going to become more and more important. You hit on it there, and maybe this is respecting the time you've already given us very generously. You talk about we've only scratched the surface of it. The proliferation wheel is starting to spin.

41:07Who knows what comes next? If we sat down together in 24 months, 60 months, whatever the time horizon is, long enough for things to have changed, not so long they've changed more than once. Sure. Where are we? You said you're opening in the U.S. in the near term. So is this more sites, more delivery? Is it more ecosystem? What is the next chapter for the business? Yeah, I mean, look, we built physical sites to prove it works commercially. So we can go to one of our customers is the landlord, right? Going to landlord and helping them solve the problem, which is I have 5 ,000 tenants in this building and they all have different health and wellness needs.

41:47How do I build the right amenity to service them? and so over time we don't need to own the real estate but we what a lot of the landlords are finding is building them building a gym or building medical rooms that then sit empty or they then need to figure out how they feel it's painful so our value is then building a community of practitioners that have an element of vetting have an element of infrastructure that underfits them so that consumers can find the right one really quickly and then deploying that community and the technology across an infrastructure of physical spaces. I think very quickly we are going to lose the aesthetics clinic branded that has 60 of them because consumers and passion for personalization is going to overtake that and it's going to mean that people want to feel like they're able to curate their own products and services.

42:43And I think until it becomes the infrastructure layer that does that, leveraging technology and physical infrastructure. Very cool. Okay, this is a slightly different genre to the usual practice leader from a clinical perspective, but a lot of interesting things that came out of it. I always say at the end, what are some of the things I'm taking away? One of them is I'm imagining a future where, as a patient, I don't go look for a practitioner. That's the ambition. I can totally, assuming that you're within geographic distance, striking distance, et cetera, but I can imagine when I was living in London, And it would be a huge relief to not have to figure out if the clinician selection process was good.

43:28If there were brand quality trust, I totally would. So that's one of the things I'm taking away is that actually we can enable better choices, easier choices. Take the friction out of choosing if you have that sort of risk. The second thing for me is oftentimes people that sell to healthcare providers, and we are one of those people, I think everybody's website somewhere says, we do this thing so you can do that thing. We do the website so you can do the healthcare. We do the patient op so you can do the healthcare. I have not yet come across the we do this long list of things, but those things are really hard and very tangent.

44:13We do your HVAC, we do your CQC, we do so you can do the healthcare. That's a claim that I think stands much stronger and taller amongst the we do a tiny thing in your stack so that you can do. because ultimately if you've got a lot of people doing a tiny thing in the stack, then you just have to go manage them. And that's... It's a fragmented experience. Yeah, it's still a fragmented experience. So that's the other thing I'm taking away is actually we do the four walls that you have to operate in and all the things around those four walls so that you can show up and do actually the thing that you are most contracted.

44:48It's very interesting and food for thought. Thank you everyone for joining. Thank you for joining as well. Really appreciate it. The opportunity, really enjoyed the conversation. Yeah. Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way. We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time. Thanks so much.