12 Aug 2020  •   •  8min read

Why and how we run a membership-only practice

Josie Hutchings speaks to Jessica Crawford-Clarke about their experience of running a practice on a membership-only basis…

Financial security and reliability have always been important, but after recent events it may well have become more of a priority, especially for practice owners.

Having a membership plan in place proved to be a lifeline during lockdown for many practices. The vast majority of patients kept up with their plan payments, meaning those practices still had a regular monthly income.

While we don’t know whether we will face another lockdown in the future, many practices are considering introducing a membership plan and potentially making their practice membership-only as a way of future-proofing their practice in general.

To find out more about how being a membership-only practice works, I spoke to Jessica Crawford-Clarke, partner at Shrubbery Dental Practice, which has operated this way for 15 years…

Josie: How did being membership-only affect the practice during lockdown?

Jessica: It really has been our lifeline. Being a membership-only practice has always ensured we have a steady stream of income to cover the majority of the monthly outgoings in the normal setting. But it truly has been invaluable with the current situation due to COVID-19.

Our patient base is very loyal, we see them very regularly, we feel in part due to being signed up on membership and thankfully they have stood by us through this torrid time. They have been wonderful and although we have had a handful of cancellations of membership, it has only been marginally more than the usual attrition, the majority of our patient base has stood by us.

As many of our colleagues will likely agree, the Government help to private dentistry has been at best disappointing. We are very grateful to have had financial help with the Job Retention Scheme, but many of the outgoings have still needed to be paid, for which the membership collections have kept us afloat.

Josie: Fantastic. I’m sure when you went membership-only it wasn’t because you were predicting a pandemic! Can you tell us why you thought that would be the best approach for the practice?

Jessica: We moved to an entirely private, membership-only set up many years ago when the ‘new’ NHS contract came into force in 2005.

We felt it would enable us to provide the best service for the patients to transition from paying NHS fees to a relatively small monthly amount, compared to pay-as-you-go (PAYG) fees or a hefty plan to cover predicted treatment needs. This way patients would benefit from the essential routine care and only pay for what they need when they need it. With the added benefits of our in house and worldwide emergency assistance.

Our membership options helped to ensure all of our patients could still see their dentist and afford private dentistry, as they could spread the cost throughout the year for their routine care, based on their individual need.

When we told patients about the change, we advised them that it was what the practice needed to do to enable us to continue providing the best service. We reassured them that in fact spreading the cost of their routine care with monthly payments would mean they wouldn’t have to find large sums of money each time they attended.

We feel having all patients on plan enables us to care for our patients in the best way possible. The majority of our patients attend very regularly, thus it makes preventive care much easier and enables us to catch problems early and avoid lots of emergency/pain-based visits.

Josie: How do you explain being membership-only to new patients?

Jessica: From the outset we are proud to say ‘We’re a membership only practice here’.

We discuss this at the initial conversation and that the appropriate membership for the individual will be recommended at their new patient consultation. We would say 99% of the time patients are very happy to sign up. We break the costs down to be transparent so patients know what they are paying for and so that they can see the budgeting benefit of being able to spread the costs by paying monthly if they wish.

We do sometimes get calls asking for ad hoc appointments for pain and it can be tempting to squeeze someone in but we avoid doing this unless they agree to a new patient consultation and to joining the plan. It means we can get to know the patient and provide the most appropriate care not a simple fix with no follow up.

It’s a good idea to be strict about it, if you make the decision to move to this business model, do not budge. It is surprising how many patients really appreciate the sense of belonging and there are very few that decide not to book and join.

It’s very important to have a team that backs the decision and supports the membership only ethos. Everyone needs to be on the same page and reinforce the message.

If someone doesn’t want to join the plan or is annoyed that we can’t treat them unless they join, we see it as a short-term loss for a long-term gain. If they’re not happy about being on membership then we’re not the right practice for them, and we are confident in saying this. But this is avoided by informing the prospective patient at the initial point of contact.

Josie: What advice do you have for a practice considering moving to a membership-only basis?

Jessica: COVID-19 has been a scary time but it is a time that is perfect to implement changes. People have been unable to do things that they may ordinarily take for granted like booking dental appointments or finding a new dentist. They may well now feel it is time to take better care of their health and now is a great time to start as you mean to go on.

If the step is too far a jump from PAYG to full membership, you could consider an interim measure as we have. We have an annual membership which allows patients to be members of the practice and take advantage of the emergency service but not sign up to full routine care.

These patients pay full price for treatment. The carrot for our full members is a discount for such treatment (we offer a 20% reduction for full members) to reward their loyalty further. People love to feel they are getting a saving and it does definitely help with the decision to sign up to the right plan.

For the full plan, being transparent with costs and showing there will be a financial saving, will help patients feel they are getting a good deal. For instance, the costs of what is included in our basic membership is two hygiene visits and two dental health checks. Plan members will not pay the full amount if signed up on the monthly membership and we can show them figures to back it up. Patients can see they are saving even without the discount on further treatment and so in effect the plan sells itself.

If the team all truly believe it is the right thing for the patient and everyone is ‘on the bus’ it makes it much easier to advise patients as to the benefits they will receive. Keep the positive messages at the core of patient communication.

Create a culture that patients want to belong to and make sure you deliver. Reinforce the benefits they will receive and that the plan makes it easier to take control of their own health as regular payments will make it less likely they will lapse in their routine and preventive care. The added benefit of spreading the costs means their dental care is covered even if unexpected costs crop up and may otherwise make dental health take a back seat.

Make sure you do the sums. Membership plan prices are difficult to change once they have been signed up to with regard to patient expectation rather than logistics. Carefully set out the ideal plans with regard to time and what is included and get input from your team.

Make sure all your team are on board and make sure they have the knowledge to communicate with patients effectively. They must be pro-plan to reinforce the message and be able to confidently relay the plan structure and benefits.

In essence it is a great way to structure the business to ensure outgoings are covered in the normal working setting and for sure has helped us survive through the pandemic.

Let’s hope we never have to go through anything like this again, but for those who feel it is time to take the brave step and change how your business runs, we have never looked back and are so grateful for all the help and support practice plan provide.

Josie: Great advice, thanks Jessica, and thank you for sharing your experience.

About Jessica

Jessica is a partner at Shrubbery Dental Practice, which was originally founded by her grandfather in the 1950s. She qualified as a dental surgeon in 2011 and has worked in both NHS and private dentistry.