This Physio Owner Had £70 Left After Payroll. Now He Runs 20 Clinics | with Rhys Carter, BOAC #71

0:00Jamie George: So my first day of running a business, I hired a receptionist, but we didn't have a clinic yet because we were a bit behind. So she started anyway, we sat in a coffee shop, she told me she was pregnant on her very first day. I had no idea what I was meant to do in terms of HR or how that looked. And then literally whilst I was trying to figure that out, my landlord called me to say the lease had fallen through and we had to find another clinic premises. Paid payroll at the end of the month, I think I had£70 left in our overdraft account and suddenly realised I need to figure this thing out pretty quick.

0:25Jamie George: Otherwise it'd be a pretty short-lived experiment. I bought a cryo chamber thinking it was cool because that's what sports people did. And then I realised that normal people don't want to sit in a freaking cold chamber three minutes and pay for the privilege in rural half a year.

0:37Rhys Carter: 300 % clinic growth in the first 12 months, not from zero.

0:41Jamie George: There was a random established clinic. We've got plenty of sites across the UK. We've got two more sites opening early next year. Ryanair are not known for being the world's most luxuriant airline, but they're very popular because people know exactly what to expect. It's always consistent and that's what people need. I think in general, no, people don't speak to their patients enough. We think that just by being a good physio is enough. Somewhat controversially, not everyone agrees with me on this decision in our industry, but we went away from having receptionists, which means that we have to have a central team.

1:09Jamie George: Why? I think bluntly the consistency and standards there is not good enough. As we got bigger, I wanted to be able to control that customer experience better. And that was such a loose way of controlling it that we made a decision a few years ago to go away from it. Whether you have 20 sites, 50 sites, 100 sites, 200 sites, whatever, The scalability of it, the numbers almost like a slightly irrelevance because it's really hard to run three sites if you haven't got a scalable system to do that. I felt like we were on this rocket ship where you're grabbing on and it's getting faster and higher. When you're grabbing onto it, you can control culture and you can control performance a bit better and you're touching every point and everything.

1:47Jamie George: And then when it gets too fast, you can't hang on anymore. And you have to have the support mechanism to make sure that you can deal with that. I've genuinely probably nine out of 10 things that we do or try, we get wrong. If I could go back and change anything, it would be...

2:07Rhys Carter: Before 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. Verillo is one of them. Learn more at verillo.co.uk. Now on to the episode. I should do this? Yeah. You sure? Yes. And then just put it on the floor? Yes. We've never done this before. That's a dose, man. Very smart, that thing. Good. Hey, everyone. This is Jared. I'm one of the co-founders at Coherent Healthcare, and we are back today for another episode of the Business of a Clinic.

2:44Rhys Carter: Today we are here with Rhys Carter, who is the Group Managing Director of Carter & George, which is a multi-site MSK group here in the UK. We're going to hear more about it. Thank you so much for joining. I'd love, if you don't mind, just starting with a sort of two-minute version of bring everyone up to speed. Who are you? How did you get into this? Where are we starting this conversation? Sure.

3:07Jamie George: Thanks for having me. Yeah, I'm Rhys. I'm a Group MD of Carter & George. cartoon george is a multi-site msk group um co-founded by myself and jamie george jamie's far more interesting and well-known than i am jamie's uh the well there's former england rugby captain now current england player and uh yeah jamie and i have been good friends for 25 years we uh we started cartoon george eight years ago after a conversation that involved a few too many drinks in a bar in Dubai and we decided that um yeah we decided he was injured at the time and uh I was working as a physio out there and you know we were just discussing one day about how health care is different for athletes and um yeah some of the stuff I was doing with some of the athletes I was working with and one thing led to another and all of a sudden I was on a plane back to the UK setting up a physio practice to try and emulate that in there in whatever way we could so that's how we started it's very different now to what it was but yeah

4:07Rhys Carter: that was that was the story to get going got it and without giving us too much information tell us a bit more about the conversation in that bar in dubai what was the what was the sort of

4:18Jamie George: flavor of the yeah no jamie jamie was training for rugby fans watching jamie was uh in pre-season before well he was actually training for the british lions tour of new zealand at the time and he ruptured his bicep and so he was uh in a break against time to be on this dream tour and he was making this like freak recovery because of all the stuff that these guys get access to and he happened to be kind of out in dubai resting and uh yeah we were friends before obviously so he just came caught up with me i was working in sport and in private practice we were talking about how in dubai this model we have all this cool kit you have all the stuff everything you need as an athlete that's why he was there um i mean i was talking how quickly he was recovering and you know it'd be pretty interesting you put like a normal person in that environment would they have the same type of experience and one thing led to another and then that was kind of an idea then a concept then I actually could you actually try and do that and is there is there a business there and um yeah I was kind of coming to the point that a lot of people in Dubai get to where you're kind of bored of yeah bored of it so you're kind of for me it was a pretty risk-free thing to come back and have crack at it and I've always kind of believed you gotta give these things that give these things a crack and back yourself and that's what we did so yeah that was that was pretty much where it started very much a organic idea got it so eight years ago one night in a bar first clinic yep tell us about clinic one what is that thing well i'll take you go back to that well yeah funnily enough i was doing a presentation on this the other day so clinic one we we opened in april 2018 i had never had any experience whatsoever running a business literally whatsoever i was a physio um and i was extremely naive um from a business side i remember having some money our bank account the day we launched thinking that we actually came in ahead of schedule forgetting that if I didn't make more this month than it cost me to run it then we're going to run our money pretty quick um and it's a true story I remember so this is a very true story to give you a baptism of fire into business on my first day uh running a business I hired a receptionist but we didn't have a clinic yet because we were a bit behind uh so she started anyway we sat in a coffee shop she told me she was pregnant on her very first day I had no idea what I was meant to do in terms of HR or how that looked and then literally whilst I was trying to figure that out my landlord called me to say the lease had fallen through me had to find another clinic premises um kind of scrapped around figured out what to do we opened it went really really well I remember three months in thinking things are trending well uh paid payroll the end of the month I think I had 70 pounds left in our overdraft account and uh suddenly realized I need to dig this thing up pretty quick otherwise it'd be a pretty short-lived uh experiment so that was how started pretty rough and ready stupidly uh took on a three and a half thousand square foot lease with 10 treatment rooms and so uh it kicked out everything you needed to have a proper healthcare setup um which is because that's what we wanted to do we wanted to create that environment whether that was a smart move as a as a first venture i don't know but it ended up working out okay but yeah we we kind of went you know kind of uh all guns blazing to get going and yeah it worked out okay there's some bumps along the way god did you have that sort of looking back

7:16Rhys Carter: it's that sort of energy that people get when they look back at a series of decisions and they they say huh i mean that's that i probably that could have been done differently yeah i mean yes

7:26Jamie George: it learned i've learned a lot i learned a lot very quickly around kind of like economics of how to think actually works because you know i bought a cryo chamber thinking it was cool because it had you know that's what sports people did and then i realized that normal people don't want to sit in a freaking cold chamber three minutes and pay for the privilege in rural architecture so you know i was like hang on we probably should get rid of that and you start learning things i spent a lot of time developing my knowledge of how to run the business as well as kind of my clinical stuff i'm still doing um and then yeah we kind of just organically organically grew this yeah we start hiring people because of demand and then you've got to deal with people and yeah that brings its own problems and yeah i didn't have to manage people i didn't know how that worked so yeah there's lots of stuff i learned i learned a lot in the first two years i mean i can come on to that in a second but covid like happening in march 2020 which was we were not quite two years old at the time and we're just getting going and then to be shot that kind of tests a completely different set of skills um so yeah that was that was a nice bump in the road but um yeah these things are good you know you kind of learn from them and i think now we're we're in a much better spot having done all that stuff the way we did it too rapidly the the covid one's an interesting thing i opened

8:37Rhys Carter: clinic in the middle of COVID as well and that was not a good idea yeah and was your experience

8:43Jamie George: similar that was not a good idea yeah I mean so we so we had I remember very well so March 2020 until the point we shut was our best ever month to date like everything was trending well I think we had four or five employees at the time things are starting to go well and then um the COVID happened yeah fully shut I know a lot of people kind of pivoted online very quickly I was really like torn but but keen to stick to our guns and do what we're good at and decided not to compete in that space we don't do and still don't do virtual stuff we just doubled down what we're good at and just batten down the hatches hope the cash would carry us through and you know kept trying all the stuff everyone's doing at times trying to keep the team engaged and everything else um yeah and then maybe off the back of that like just to show you kind of sometimes if you back yourself to get through and you have a you know a vision of where you want to get to we we lost no staff so everyone we retained every single person no one left and we didn't need to get rid of anyone and then when we relaunched uh naively but ultimately for the success and future of carthor and george we were given a opportunity to acquire a practice in october 2020 which i've never had any experience of acquisitions of businesses but uh as organic as these things come out a patient who was a physio who knew someone that was shutting down a practice because they didn't want to reopen after covid i said that's a shame she's been there for 20 years or something let's then have a chat i said to her how much do you want free i've got no idea how these things work she said a number sounded reasonable and we figured out how to do that and ended up opening our second practice october 2020 which yeah timing wise people would probably say he's not smart but um yeah to put some numbers to that that clinic grew by 300 percent in his first 12 months and that was the kind of that that was the kind of that was the go forward yeah Exactly.

10:27Rhys Carter: 300 % clinic growth in the first 12 months, not from zero. And that was a good lesson

10:34Jamie George: about them didn't have to do everything from scratch. And so they kind of informed a bit of the other growth that we've done. Yeah, we've done both. But that was the first experience I'd had of kind of taking what someone had, improving on it and going from there.

10:47Rhys Carter: Just out of curiosity, before we jump to where you are right now and what is, you know, what is size of the group? i'm so curious what were the what levers did you pull to unlock 300 growth in the first 12 months

10:59Jamie George: good people yeah like we hired some very good people um we improved the the way the experience was as a patient like i think it was underrated i think people in our sector love to hone in on how important the skills and experience of the clinicians are and those that might have seen the sort of stuff i put on linkedin i'm very passionate about giving good people the right opportunity and actually developing people so like we opened a clinic we made it look nice we put good equipment in there we got some great people forget like don't confuse that with experienced people we put some good people who had enough experience to do that we figured out an operating system about how we measured performance and uh yeah through a bit of marketing behind it which yeah in small single site operator practices is not particularly well done in my opinion um and uh yeah we kind of just did that and good people nice place good equipment

11:53Rhys Carter: bit of marketing everything kind of just went went what it does yeah got it and so now you're in 20 sites yeah combination of organic and inorganic yeah how just like give people a sense of the size how many clinic team members or patients seen per month or whatever just just sort of a benchmark for where the clinic group is now that we see we've got uh we're 20 sites

12:15Jamie George: across the uk a lot two more sites opening early next year um we have around a team of just over 80 people that's clinical and non-clinical so from a non-clinical side we have operations marketing finance teams and in our clinical provision we have a team of physios uh we have 10 of our sites are cq3 registered so we have a team of sports medicine consultants and we have a pilates we've just launched our first pilates studio about three months ago which uh which is part of our rollout plans now so um so yeah we kind of got a multi-disciplinary team across those three those kind of three points in terms of how many you know size how you quantify that i think a lot of people talk about numbers of clinics the all of ours are self-contained high street practices with multiple clinicians we see about 65 000 people a year so it's it's a decent size and um yeah i'm probably more proud than that most of our staff and senior positions have been people that we've trained and promoted and uh and have developed and uh yeah i'm very proud of that i'm very proud of the fact that our quality hasn't changed our net promoter score remains above about 94 out of 100 across all our patients surveyed last year so like yeah i'm very proud of the growth and size great but the reason we got there actually is because we had great people and as you get good people they need somewhere to go if you want to keep them you need to create opportunities for those good people to stay and that's kind of why and how we grew very quickly

13:39Rhys Carter: So just to pull on some themes, it seems like a big part of the group strategy, growth strategy, is the people, enabling the people, training the people, supporting the people. So obviously talent is a huge part of the journey you've been on. It feels like, at least from the original thinking from the bar in Dubai, that there was also a unique view of high performing, you know, sort of tech forward and or therapy forward thinking to this like a modern provision sort of piece going along with it. are there any other sort of big building blocks that you see as as part of the pyramid that are really down at that base layer aside from the the vision for the clinical provision which is maybe slightly slightly outside of the normal plus the team focus which may be normal not normal depending on the group but what else is sort of really at the foundational level for you

14:32Jamie George: um i think the team bit to leverage it slightly and go down a slight different avenue a lot of it's around the career opportunities i don't think our profession does a particularly good job of actually offering a career for people because the stats would show that you know the data would show that i think it's 50 attrition from the profession within 10 years of graduating which is not good um and maybe i'm slightly controversial in my opinions i think i think progression in a profession is largely uh pseudo you can the movement and pay and stuff but in terms of seniority and responsibility particularly in the private sector none really you're a physio until hopefully you're going to pay rise and you're still a physio into the physio if you look at what motivates people and actually what retains talent particularly in healthcare where people are skilled people that you know smart and they've got a bit about them they're motivated by having autonomy they're motivated by having progression opportunities they're motivated by becoming masters of their skill you know that's the kind of three things that you know well documented that motivate people and so if you incentivize people in those ways so we have pathways that people can run their own practice that they run their own practice autonomously and they get support from our senior team but really they've got complete control over looking at the problems in the practice sorting them out people recruitment managing the difficult situations hard conversations all these things we put back into these guys for them to manage their insights we offer But yeah, I'm biased.

16:00Jamie George: I personally think a best-in-class internal CPD program for our physios to become better physios. We've got extensive opportunity internally to train, externally to train. We've got someone whose role is one of the top physios, out of the next GB canoe kayaking physio, Tom physio, that his role is to develop our physio. There's no other role for him. His job is our product. And then, yeah, you get great opportunities for progression. you get autonomy around how you actually want to run your site and then you have yeah the best in class professional development and that tends to look after people and if you look after people they tend to look after you so that that like yeah there's bells and whistles and there's some cool stuff you can do and there's some fancy campaigns you can run or whatever but ultimately it comes down to getting good people looking after them retaining them and empowering them to you know to be good.

16:54Rhys Carter: You talk a lot about people. The people focus so far has been, as you've described it, the team, the ladder, the mobility. And I think it's actually, I don't think it's only true in NSK. I think that I previously ran a medical aesthetics, dermatology site, and I think very similar reality there, which is that if you come in as a clinician, there is a ceiling on where you go and similarly on the administrative side you come in and there isn't necessarily mobility how do you think about the mobility components the talent the development of the non-clinical staff yeah yeah if that's trickier um i think we went through a phase

17:39Jamie George: actually in the in the interest of transparency because all these things always sound great right But one thing we have absolutely got wrong, and it was to do with that exact concept. So I'll talk through both clinical and non-clinical, actually. We scaled the business very quickly. We grew. Our management infrastructure and approach didn't scale at the same speed. What started happening was it went away from what I just discussed, where our end autonomy and these guys having full control of what happened in their clinics, which is what we did when we were small. It started going towards a more directed, like, yeah, this is what's wrong.

18:12Jamie George: This is what to do about it. You go and fix it. I'll check in next week type approach. And we started getting attrition of some of our more experienced team members. And the reasons were nothing, nothing kind of catastrophic. But the reasons were like, they were painful for me because there were things like, it's just about time to try something different or, you know, what's the worst that could happen? And I was like, it should be a risk to leave us. Like it should be somewhere where it's like, fair play. If you want to have a go, leave, try something else. Absolutely no problem. but it shouldn't be an easy decision or it shouldn't be a risk-free decision because you should want to be like but this place is pretty cool right so we we got that wrong like we did get that wrong we lost some good people and i thought that was my fault um and in the non-clinical side of the same thing we started filling roles with kind of as we as we put kind of like square pegs to square holes you know get someone in who's if you want to put someone in marketing get someone who doesn't know how to be a marketer you know we we did that for a while um and then yeah you get you lose you lose some good people um because you kind of block that progression and unintentionally you lose the let's go back to what you said there you just remove all your progression in the mastery part of it so we uh we we broke back on that um re-empowered these guys to to get back what was good create opportunities both clinically and non-clinically and importantly for clinical people that find interest in a non-clinical setting avenues where they can actually go into roles like HR or yeah they might find marketing really interesting then we might push them that way and develop them in different ways so yeah we've we've rechanged that pathway as a result of getting it wrong and we did get it wrong and it was completely on us we we grew quickly and didn't adapt how our managing approach changed.

19:55Jamie George: How do you think that shows up in in a

19:59Rhys Carter: I guess you're in a group setting where it's single brand and single executive in the sense that I'm sure there is that autonomy at the site level. But a lot of the strategy as such is being set at the top co or the top head office. We've worked with groups who are structured similarly where there's effectively a group MD or CEO, whatever you want to call it. And they have ultimate responsibility, decision-making, and influence over the entirety of the organizations and all the sites. And then we've also worked with groups who are, I would describe as more decentralized, where it's a top co. Maybe it's not even the same brand.

20:44And they sort of hold solo brands.

20:48Rhys Carter: And in our experience, different strokes for different folks, but in our experience, that model feels harder to work inside of it. at least for us, because there's almost this tension between what the executive feels is actually the right business decision, and then what the site operators are sort of happy with, even though the executive can ultimately force his or her will, you obviously don't want to be forcing over and over again a certain thing. So there's that sort of tension. How do you, as a more centralized provider, supposed to decentralized, how does that show up? that's a it's an intentional decision you've acquired 12 12 you know other clinics so why did you why did you feel that was the right decision for you at a strategic level that that comes down

21:35Jamie George: to for me which i know a lot of people think is the kind of the the wishy-washy part of a business but and i think for transparency i used to think the same but have very much done a 180 on this and that is like having extremely clear mission vision values like if if you know if everyone in the organization knows what we're trying to achieve and how we do it and what and how we do and how we go about it here it sets a culture it sets the culture this is what we do around here this is not what we do around here these are the standards that we have here that is a that is the standard and we will celebrate that that is not the standard and that needs to be called out and you know the vision is and if that is constantly communicated in every meeting in every interaction in every appraisal in every piece of marketing and in every everything it gets constantly reinforced that people feel aligned in their individual sides what that micro culture is about what they do for lunch or you know what they do on the weekends or you know the little quirks of each individual plate that is that's autonomous they can they can do what they like within reason they you know that's that's that's part of the individual individuality of it but but ultimately it comes back to like if that aligns to where we're going how we get there and the way we do things around here then they can get they can they can do that

22:51Rhys Carter: yeah yeah it's it's really interesting because the we were speaking earlier today with the i guess your equivalent in in this decentralized shape and and it was very interesting because he he said uh you know i can force this thing but there's only so many things i can force before that first starts with the site level leadership where it starts to become yeah and i wonder if it boils down to what you're saying which is the extent to which the vision the mission the values like what why are these things that we are doing important because they align to that and and if that's not clear and if that's not known and shared and adopted this at the site level then inevitably you do end up with i think that's hard if you're

23:31Jamie George: running a multi-site or multi-brand uh group which i know there are many out there that do good job but where that gets hard is like how do you get site a and site b to be brought into the same thing when they're not actually the same like knitted group and yeah you have your centralized team i assume in terms of how you run things in the back office but like how do you get those guys really believing in the same thing i think that is harder to do um but yeah i think for me it comes down to if everyone knows like this is what this is the whole point of like in carter George this was the whole point of Cardinal George why do we exist this is how we go about it and this is what we're trying to get there and that's our culture and that's our standards and that needs to be reinforced think you create you create a positive movement if you like toward those things and off the back of that you you create a great culture and and and conversely I know that as a fact because when we did the opposite like I mentioned a minute ago that's when culture struggled and that's when you get attrition and that's when you do get people fighting it hard.

24:34Jamie George: I totally buy that. Yeah, I totally buy that. Okay.

24:37Rhys Carter: 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. It'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 healthcare.

25:12Rhys Carter: To learn more, visit us at coherenthq.com. Now back to the episode. So, okay, got it. So let's maybe hang on the theme of people. Yeah. There's a whole other group of people that you and your teams see a lot of that have nothing to do with employment and these are your patients. So you have this other people category. Yeah. I think the decision to be premium in the sense that you're delivering a very modern clinical provision, you're thinking very carefully about the patient as a customer as opposed to just a receiver of a thing that then leaves. As far as I understand about your brand, those are all sort of baked into what patients can expect when they engage with you.

25:51Rhys Carter: Can we talk a little bit about, as in keeping with the name of the show, the business of a clinic? So the patient as a customer, obviously patient as patient, there's clinical provision, there's clinical care, there's clinical governance, all kinds of clinical stuff that has happened. What about the patient as a customer? How do you think about the person, the consumer, as opposed to the person, the patient?

26:16Jamie George: yeah um for me is a big thing is around the patient experience not necessarily what happens in that room on a technical level um and that starts with the very first interaction they have with your um the website through to how your guys answer the phones to make sure that that journey matches what the website says and then when they answer the phones what is the comm structure between when they actually have booked an appointment before their first appointment does that match the previous journey when they come into the reception does it match does the way the physio treats them and communicates them match what happens after that session does that match that whole journey needs to be one continuous consistent brand if you look at the strongest brands in any other sector the reason they're good is not not always because they're the best there are brands that are extremely you know in in aviation you know Ryanair are not known for being the world's most luxurious airline but they're very popular because people know exactly what to expect you know exactly what the booking process is going to look like you know exactly what you can get charged extra for you know exactly what standard you can expect that it's always consistent and that's what people need so from a consumer perspective for us and we spend a lot of time and don't get me wrong it's not like we've nailed this that we still work on this a lot we have we have a monthly customer meeting which is literally just about this journey like how is that journey needs to be improved and we run through it from the very first interaction to the last and that is all around how can you consistently nail that customer experience so it's reflective from 0.1 to 0.20 in that journey and I think that is how you ultimately what we're trying to do you like to very back a bit like what we're trying to do is create the first brand within the sector like can you create a brand and when people think of brands they know high street brands if you think of a pharmacy you think of boots you think of a health food shop you think of Holland and Barrett if you think of you know why do people go to M &S for lunch because you know it's going to be pretty decent you know it's a consistency and so for us everything we do about the patient is around how can we create consistency in our journey because that's ultimately how we yeah you get repeat business how your patients are happy to know what to expect and yeah ultimately hopefully create create a brand around that.

28:30Rhys Carter: I know some groups that are doing that in other healthcare verticals dental etc that are really focused on that high street experience, sort of Optics Express or whatever, the same sort of idea that there's going to be a recognizable brand in the space. And it's interesting to hear you reference Ryanair and not reference a hospital. And we often find ourselves doing the same thing, which is to understand what needs to be built in healthcare. Sometimes you have to look outside of healthcare.

29:03Jamie George: 100%. Where else do you look? uh in consumer brands i went for we went through a patch where we recruited non-clinical people from everything other than health care for this exact reason um i wanted people to get perspectives from hospitality and retail and leisure and adjacent things like it doesn't have to be completely separate but things like how do like gyms look at this stuff like like because there are reputable gym brands upscale right and i think health care like there is no one really that yeah you get micro like micro centers like in london there are brands in london within our sector that have created fantastic reputations but like if you go to birmingham do people know who that who they are probably not and that is uh that is hard so i think you have to look outside healthcare because there isn't actually a path and you know you look at you look at yeah in supermarkets we always talk about kind of like being the mns how do you be the mns of physio or health or msk healthcare and you know but by that what we mean like we're not we're not the former mason of healthcare if you want that and there are plenty of people five minutes from where we are now where you can go and get the best of the best of the best and spend a fortune yeah we're also not cheap and cheerful budget sit market we're trying to be kind of you know dependable solid quality you know you're going to get but it's consistent experience wherever you go and uh no one's done that in my opinion in our sector so you have to look outside and the ideas from outside in which in markets that are let's face it are more mature than mfk you know even if even within healthcare then this one and veterinary are the two that have got more mature markets and you look at what those people in those sectors have done and they have done this very well at scale you know we've our operations director for example come from medivet you know they've got a thousand site you know group or whatever it is you know that they've managed to scale in with a brand and reputation because things are consistent and they know where to, they know what customers want, they know the customer very well.

31:05Jamie George: So you have to look outside because in healthcare, particularly MSK healthcare, in my opinion, it's not been done.

31:11Rhys Carter: So you've got this overriding view that there's an opportunity to build a brand in this space that's recognisable, top to tail of the country. You can really, that's where you're building forward. You're bringing together a team, you have a management team of people who have seen healthcare operations at scale, a la Medivet, et cetera. And you talked about the customer experience. Now, we do work in MSK. And one of the things that we find, which is, I think, unique to MSK, is we always say there's outpatient care and there's outpatient care. MSK is whatever the other ones are not. There's something about MSK, if you think about dental, if you think about aesthetics, is my background, we do some work medical aesthetics, dermatology, when you look at that form of outpatient elective care, so much of it is about what happens when you're in the room.

32:04Rhys Carter: And then there's some following up that happens when you leave the room. Whereas in MSK, so much of that customer experience is actually not in the room. How does that show up in the decisions that you've made in terms of the patient journey, customer journey? How are you maintaining those relationships in between?

32:23Jamie George: yeah we use um bringing the subject of ai there are parts of there are parts of what we do which automate tasks based on certain behaviors and patterns that we see patients have um there are other things that we um we very much are human i think if you're gonna touch on that debate uh i think you have i don't believe ai is here for human jobs i think in our sector let's say i think but it is here for us though to to improve efficiency and things that humans don't need to touch and some parts of marketing is certainly that you know in terms of what happens after a patient leaves you for the first time but before their second session do you need someone who's like manually sending out emails to check in probably not like you can you can automate that journey so it's still a nice journey the person receiving you probably knows it's not a person typing them an email but it's still a nice journey and so yeah we look at it i mean to give you maybe a bit of an insight about how we map that journey we we go from literally everything like i'll give you a snippet of what we would do we would say okay the patient has knee pain they leave it they rest it they try some they google some exercises that doesn't work now they're in the market they don't even know what person they need to see they need to see someone so how do we show up at that point in time like who where are we to make sure that we're in the right spot when that person's in the consideration phase then when they've decided physio is the profession they're going to pick or medicine or you know the life is whatever for us let's say physio they've decided they're going to pick physio and now they're going to search physio near me let's say how do you make sure that you are one of those people that matches the type of things that person wants what does that person want to hear that person doesn't really care that you do shockwave you know we do but do they really care probably not at that point do they really care that you've i don't know got uh the world's best physio working, probably not at that point in time.

34:14Jamie George: All they want to know is, can you help them? Can you see them quickly? Is price point roughly within their range? And I think we should, as a refresher, be more transparent about pricing on things like websites

34:24Rhys Carter: because they're going to find out,

34:27Jamie George: so you might as well let them be empowered to make that decision. And then they come onto our website, and then they come onto your website, and they're in the consideration. So, okay, what's the next thing? They're probably going to look at staff profiles. How can you make sure your staff profiles match the person that's searching how can you make sure the testimonials actually speak to the person that's looking it doesn't who can't yeah we've got a background with sport but like does the 65 year old lady with an arthritic knee really care that we saw a professional boxer or something for their knee no they do care if someone similar to them has been seen had a great experience so how can you match that so when we're looking at customer journey and how we communicate with patients outside of the room is every single touch point to make sure it reflects the person and who our audience are and to start with to in order to do that you have to have a deep understanding about who that person is and that and physio is a classic and i used to be this right that is not everyone like we are not we do not help everyone there are much better people out there for certain things certain types of person certain you know whatever there are better people out there we are extremely clear on who our patients are and therefore our marketing and branding patient journey matches who that person is because we're talking to them and And, you know, everyone's bought something before where they're buying something because they see themselves.

35:45Jamie George: That's reflective of who they want to be. You know, Hirox athletes going and buying whoop bands because they watch a guy who's doing Hirox who's got a whoop band. That's me. Why wouldn't I do that? We have to be the same in our sector. And going back to what you're saying, I don't think we're very good at it. We love to talk on websites about, you know, we've got a shockwave machine. and our physios have got 25 years of clinical experience and we did rotations in the NHS and we're like, is that really interesting to the person that's like, well, they want to know, is that what's wrong? How is it going to get better?

36:16Jamie George: How long is it going to take? And like, have you treated people like me before and I can trust you? And if you can show up in those answers to your patient and customer segment, then you're on to a winner.

36:25Rhys Carter: So it's interesting. I remember when running clinic, we often talked about the dilemma of the stock image. Yeah. Where, you know, everyone on their aesthetics clinics or whatever, we have this case, well, it's the person who's struggling. Speaking by Mark. Right, exactly. It's like, oh, I've seen that person. Where did I say, oh, that clinic. So I think this idea of speaking to your customers is an interesting one. And it's interesting because of what we do here.

37:04Rhys Carter: intentionally being provocative, do you think that you speak to your patients enough when they're not in front of you? Like, or healthcare providers in general? Is there enough?

37:14Jamie George: Yeah, there's a spectrum there. I think in general, no, people don't speak to their patients enough. We think that just by being a good physio is enough. And, you know, I'm sure, you probably guys know more than me, is it Byron Sharpe's, that kind of like Bible on branding and stuff shows that people actually inherently despite what we think are not very loyal like they will they will shop around and try different brands even if you've given them an amazing experience so just by being good once doesn't mean that you've got them you know you have to you do have to kind of nurture that relationship they're people like you have to treat them and speak to them like people and at the end of the day that's what it is so yeah I mean I don't um I think think most you know the the profession why was it the profession is getting better and it is getting more mature is evolving to be a better sector but historically and still now a lot of operators do not communicate enough with their patients on the contrary you have to make sure that you're not bombarding these people because these people also have lives outside of your your physiognic or your health care clinic they don't really care about receiving an email every three days updating them on you know the latest this and the latest that like there's a there's a cadence to it and i think particularly you do start using automation which we do you have to map that journey and make sure that like actually they're not receiving two emails on that day because you've hit one from this side one from that side that triggered that automation and that automation because yeah like we've got all this stuff wrong before so i can talk from my own experience like we've done it before where people like stop emailing me like why do you send me so much stuff um and yeah yes you have to balance that balance that right but um yeah in general like we should be communicating with people building relationships with people the whole industry is built and building relationships with with our customers and yet we don't intuitively communicate with them like we would when trying to build a relationship with anyone else makes sense

39:07Rhys Carter: the the thing that it's interesting to hear you said you've made those mistakes before the sort of over communications obviously the other part of the communication challenge is what comes back in yeah so you've got all this stuff going out and this is we would say this when a lot of the customers that we work with now will come to us from an AI receptionist or some other form of, you know, keep sending it out. And they'll say, you know, we send all this stuff out. And then someone's got to be there when it comes back in. And like, how do you handle that in an efficient way? One of the things I always think is interesting is that healthcare might be one of the only industries in the world that doesn't have like a dedicated customer support software.

39:45You've got Zendesk and you've got all kinds of fresh or whatever else.

39:50Rhys Carter: How do you guys think about patient support or customer support? Obviously, there's clinical support. Put that aside for a second, but just on the customer support side.

39:57Jamie George: Yeah, we benefit a little bit here from scale. So we have a central team. So we have, I suppose, our own office of people answering phones. We've got four or five people full time doing that for us. We also have a proper customer support software that we use. So we use a software where our phone calls are recorded. It uses AI to track sentiment on those calls. It picks out keywords and sends them to our marketing team to make sure that we know what our patients are talking about on the phones. It tracks complaints. It logs how long the calls are. It has task-based things. It's a central inbox for phone calls, WhatsApps, emails, on live chat.

40:42Jamie George: It's like a proper patient relationship or customer relationship software that we, you know, our team don't have traditional phones. They have headsets that links with the software. They can log in in the morning. It might be email first. Next one's a phone call. Next one's a live chat.

40:57Rhys Carter: Yeah.

40:58Jamie George: So we're quite lucky that we have that set up. That, I would say lucky. Like it's taken probably eight, probably two about eight months to integrate that properly. And that was a costly, costly project that we did. but for us we need to because that's the only way we can be consistent um you're right because you send out lots of comms you're gonna get it back and as you get bigger like even if you don't send out lots you will naturally get stuff coming in and you need you know you need infrastructure to deal with that um somewhat controversially not everyone agrees with me on this decision in our industry but we went away from having receptionists um which means that we have to have this central team why i think bluntly i think the consistency and standards there is not good enough and i as we got bigger i wanted to be able to control that customer experience better and that was such a loose way of controlling it that we made a decision a few years ago to go away from that and so if you walk into any of our practices now um they are they are a digital journey at the start where you check in on an ipad you sit down the physios come to get you it's kind of autonomous in that front um because we have a central team that are much more consistent because there's less of them they're answering more calls they understand the customer journey better so um yeah we went away from that smaller practices who have the ai kind of phone receptionist has kind of hit the hit the market hard we we trialed that about two years ago before it kind of really kicked off in fact we even so primitive at the time we were trying to build our own one at the time um i actually think for small practices that i've got fairly simple flows like that actually is a good place for that when it gets more complex we have 75 clinicians across 20 sites with 150 different services with different pricings and stuff that's where it it does struggle a little bit um but the technology is getting better but yeah i think the consistency of that has to be good so however you however people dress it up in terms of you know dealing with customer inbound customer queries or questions or complaints in some regards the the experience has to be consistent so however you create consistency at the size of a clinic has to

43:08Rhys Carter: be has to be what you're trying to focus on interesting thinking forward you said you've got two new sites joining 2020 we're in right now 2026 2027 yep two seconds now you're in 22 sites yeah if we were to sit down in three years assuming that no one managed to get their claws into into your business um 42 sites 82 sites it doesn't matter as long as it's growing and the standards are there what we yeah what's the sort of what's that goal like we want to we

43:38Jamie George: want to get to 50 sites by 2030 okay so that's our kind of like you know our our vision we're gonna try and get that i say that it's a kind of part of our vision but that's what we want to try and get to um but more importantly for me like whether you have yeah 20 sites 50 sites 100 sites 200 sites whatever the scalability of it the number is almost like a it's like irrelevance because it's really hard to run three sites if you haven't got a scalable system to do that it's really hard to run 20 sites you haven't got a really scalable system to do that is it much harder to run 50 sites as it is from 20 sites if you've got a playbook that's scalable and you've got autonomous people that know what your standards and culture is and you have scalable communication channels and scalable hr systems and scalable clinic launch plans and everything else like i think that's actually what you're trying to create because if you create that the number that you get to is kind of the outcome of that to be honest it's not um yeah it'd be really hard to run two sites if you didn't know how to communicate cross-site you know if you'd have to have a if you get to yeah i'm sure someone's well someone actually said to us ages ago that the complexity changes at seven sites 17 sites and 77 sites so yeah we're between 17 and 77 so at the moment we're going to keep going until that that point changes again but um but yeah i think for me it's just about creating a scalable model where i want to get to yeah 50 sites in the next what three and a bit years is the plan we're going to give that a good crack and um but but i feel very comfortable with that no i didn't because the infrastructure is there and then you feel a good layer on top of that yeah it's definitely that course the stuff needs to improve on we're not we're nowhere near good enough yet but like we are we have a system that scales much better than we would have when we had 10 sites it would have been harder to open 10 to 12 the way we were than it is going to be from 20 to 30.

45:25Jamie George: Got it because you've done that hardening at the head office level and that that invested a lot of time in in figuring out proper infrastructure like what is that proper onboarding like like you need a proper hr system you need a proper phone system you need to have um management trainings and proper days where you actually align people to make sure they know what to do how do you hold meetings how do you know the person in Glasgow is holding a meeting in the same way as the person in Hurst-Pitpoint down in Brighton. You have to have a scalable way to do everything. And so once you've got that, it's about training people really well, empowering them, and then rolling out the same scalable template.

46:03Rhys Carter: Last question for you. I want to respect your time. You've been very generous. The idea of going from 22 to 50, 20 to 50, is a for for a software business is usually a question of some more features and more customers but the the end the engine largely turns itself the the software is inherently scalable for a services-based business as is yourself there are a lot of things that need to scale to touch on some of them the infrastructure the team the one of the things i'm curious about is what what do you think won't scale well from where you are right now what is what are the things that are

46:42Jamie George: keeping you up at night that are we're gonna feel this one and then plenty i mean yeah one of the big ones was our um and we've touched on earlier one of the big when we have changed it one of the big ones for me was always i felt like we were on this rocket ship right where you're going grabbing on and it's getting faster and higher and you've got two or three people grabbing on because when you carrying onto it you can control culture and you can control performance a bit better and you're touching every point and everything you know you kind of it's breaking a bit but you can kind of just just about hang on and then you get too fast right and then when it gets too fast you can't hang on anymore and you have to have had you have to have the support mechanism to make sure that you can deal with that so for a long time what kept me up at night was like if i don't tell those guys what to do how are they actually gonna you know how they actually can deliver this um and we saw that like i mentioned earlier on we all that happened we had a bit of attrition of people that were good people that i didn't want to lose and that's that that was our ass that was our problem um but we fixed that so like that i feel more comfortable with um i think that uh with some of the stuff that keeps me up at night recruiting is always a challenge in our sector finding good people like i don't as i said earlier like somewhat controversially yes there's a place for good clinicians and experienced clinicians but i'm much more interested in hiring good people and uh you know if good people come along like they're rarer than uh as the saying goes they're kind of like finding good people is quite hard and uh i think that that sometimes worries me a little bit um yeah there's plenty of stuff there's plenty of stuff that worries me you know i think the wider the wider climate of the world you kind of you're kind of being held to held to ransom a bit by what happens and when private health care luckily thankfully private health care tends to perform fairly well through economic turbulent times but yeah 60 percent of our patients are self-funding so you know you are you are playing with the idea that you have to make sure your experience is good because if you're not and you drop the ball there then yeah that's your that's your business so yeah that keeps me up at night sometimes making sure that yeah our quality is still good and we're still you know really nailing it um for me like the main main thing is like we have to feel like we're still like the underdog scale-up startup attitude for as long as we can as soon as it gets too corporate i'm a bit guilty of like sometimes getting a bit like that and that's when things that is when things start to break and so like if like yeah if you ask me on a different day like marketing keeps me up at night operations keep me up at night recruiting keeps me up at night cash flow keeps me up at night everything keeps me up at night but But like fundamentally, what it comes back down to is like, can you maintain the same attitude and culture that we had when it was just me and two or three other people as you can when you've got 200 people or 300 people or 500 people?

49:36Jamie George: That's a bit that, who knows, I've never done that before. Let's see. but my belief at the moment is yes you can but you need to be very very intentional and very very structured about how you live and breathe your culture and your kind of vision and making sure people are aligned and understand what's expected of them because that is the only way that i can see that you scale the people side and that's the biggest variable in our sector really appreciate

50:02Rhys Carter: the insight thank you for sharing the story i think people who are in the uk may have already seen the sites that you run. Others may go have a look around and see what's going on there. I think the reception-less clinic is more and more a topic of conversation. It's like, is that good real estate? And how do you make that part of the clinic really work? So interesting to hear that you've already sort of jumped across the chasm in terms of pulling that away from the site. I guess before we wrap up, I always think it's interesting to look back on the journey you've been on and say um the one decision i would have made differently for the maybe more one decision but one decision there's plenty that you the the thorn in the paw that says you know what actually

50:42Jamie George: i really needed to um it's a hard one you know genuinely like i still love it and i have fun and yeah like there's loads of stuff i've got i've genuinely probably like nine out of ten things that we do or try we get wrong um like there's some stuff that like hurts a bit when you think back like you know we've designed a piece of software which i thought was so good and like didn't quite scale how i thought it was gonna and like that killed me a bit like we've done some like pretty like awesome mugs campaigns i thought were awesome that didn't quite work like there's so many things i've done and there's so many there's so much stuff i mean what would what would i change i probably that that bit we've discussed a bit say without kind of copying out the answer i think if i could go back and change anything it would be going back and spotting the point in time where we needed to like not slow down the growth but like the build the autonomous management infrastructure underneath it because that bit was the hardest bit we lost a few people who were good that i liked personally and they were good team members they were good at their jobs and i was actually because we took our off the ball and i was that wasn't because yeah they'd run their race it was because we thought you could run it at 50 sites that you can when you got 10 and you can't and so that would be the only thing i'd change but um yeah not to be too cliche or you know cringe about it but like like everything we've done that's gone wrong has ultimately yielded an upside because we've learned not to do that again if you keep repeating the mistakes that's a different question but we're very intentional like that didn't go well let's not repeat the same mistake again you know i've done that you know done stupid stuff we just predicted growth and hired like 10 people thinking it's going to happen and didn't happen probably wouldn't do that again but it did teach you a really good lesson not to do that again and so i don't think you can really say like that was terrible we'll never do it it's more like there's lots of stuff that's kind of helped us refine the model and you know there'll be peeps of stuff that will get wrong again they'll keep refining the model and every time we do that That would get a bit sharper.

52:45Jamie George: So that's, yeah, a fly cop album. Yeah, that's what I do.

52:48Rhys Carter: No, no, not a cop album. I think refreshing and honest. And if that's been your experience, then I think that's what, I mean, that's why we invited you in to share exactly that. So I really appreciate it. Rhys, thank you so much. For those listening, thank you. This is Rhys of Carter and the journey from one side bar in Dubai to now 20 sites, seems to be 22 sites. Thank you so much for sharing your story. I really appreciate it. Thank you having me. Yeah, absolutely.

53:07Jamie George: Thank you so much for joining us

53:09Rhys Carter: 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.