The Dental Business Guide
Presented by the team at Samera Business Advisors. The Dental Business Guide is all about helping aspiring dental practice owners build and grow their dental business empire. Tune in for tips and tricks by leading industry experts on how you can start and grow your dental business.
The Dental Business Guide
From Single Chair To Small, Strong Group
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What if the smartest way to build a dental group right now is to keep your clinics close, your service boutique, and your metrics painfully simple? We sit down with Dr Smeeter Mera to unpack a practical blueprint for modern DSOs and independent groups that want strong EBITDA without losing their soul. The market looks different after COVID and Brexit, and old assumptions about city‑centre sites, rapid rollups, and one‑size‑fits‑all staffing no longer hold.
We start with geography as strategy: clusters within 30 minutes unlock shared teams, rotating specialists, and agile diaries. From there, we make the case for quality over headcount—grow capacity inside great locations before chasing more leases. Patient experience becomes the moat: a calm front of house, warm phone etiquette, and reception spaces that feel like an oasis rather than an ICU. Those small touches drive recall, reviews, and the signal clinicians trust most: consistently full books. When patients choose to rebook with the same dentist, revenue predictability follows.
Location strategy has shifted too. With hybrid work thinning city footfall, we favour high‑density residential areas, strong suburban high streets, and dependable anchors like supermarkets that never stopped trading. On staffing, flexibility wins: split shifts, school‑friendly mornings, and weekend crews widen the talent pool and cut churn. To scale without draining culture, plant owner‑operator energy in each site through meaningful incentives or equity. And skip the rookie mistake of single‑vendor convenience—triangulate every major spend and build a reliable supplier book.
If you’re weighing your first squat or tuning a growing group, this conversation lays out a clear, field‑tested path: cluster your sites, obsess over experience, measure recall and chair occupancy, and let full books be your north star. Enjoyed the episode? Follow, share with a colleague, and leave a quick review—what’s the one change you’d make to your patient journey this month?
If you require any help, don't hesitate to reach out to the Samera team at www.samera.co.uk. We are all here to help you!
Thank you,
The Samera Team
Okay, welcome everybody here back to the Dental Business Guide podcast here with myself Arun Mehra and Dr. Smita Mehra. So hi Smita, how are you doing today?
Speaker 1:Hello, yeah, very well, thank you, Arun. Thanks for having me back.
Speaker:So in this vein of us talking about DSOs and groups, I thought we'd do a podcast today about um if you were gonna start a DSO or group today, what would you do? So, Smita, just give a quick background about who you are, what you do, and where you come from quickly, just for everyone's benefit, and then we can ask start asking some answering some interesting questions.
Speaker 1:Uh great, yes. Uh thank you. I'm um a dentist and I run a group, but I started back nearly 30 years ago, uh qualifying from the University of Birmingham. And um now I'm in a position where I'm looking at uh helping DSOs grow uh buy or sell. And yeah, the the the the whole environment uh and canvas has changed so dramatically over certainly the last 22 years, which is when I started um the first Neme Tree. Uh and so yeah, things have changed a lot. I think the biggest change uh I would say now is um it's staffing. So trying to get uh really, really good members of staff and labor generally, whether they be clinicians or auxiliary staff and team, is has has sort of changed dramatically since COVID and certainly since Brexit. So with that in mind, if I were to start up a new group today, I would make sure that the surgeries or the practices are very much close in proximity to one another, as opposed to 22 years ago, I wouldn't have minded if one was in Scotland and one was in Newcastle and one was in Norfolk. It wouldn't have really mattered to me. But now definitely the geography matters.
Speaker:So on that note, so thank you for sharing that. So your non-negotiable when you're starting a if you're starting a group today would be what? Geography?
Speaker 1:Yeah, geography of the the practices, either if you like me, you you like opening squats, or if you're taking over a group, um, just try and make sure that A, the locations of the practices are close to each other because you can share so many things, not just obviously staff, etc., but you can share team members, like the practices I'm in at the moment. We've got somebody off at the moment, and we're we're borrowing somebody from the other clinic. Uh, and that's not a problem because they're just half an hour away from each other. But if they were five hours away from each other, you wouldn't be able to do that. So, and that becomes um so much more cost effective and efficient because then instead of taking on two full-time members of staff or three full-time members of staff, you might you might get two and then one part-time. And so the the cost starts to uh make sense as well. Not only that, you you've got things like uh specialists that you can easily share when the geography is common. Uh again, that would be a lot harder if they had to travel two or three, four, five hours. You'd have to pick new people. And the other thing is geography matters. You don't want to be buying or setting up in a place where it's so remote that trying to staff it is very difficult. If you're taking over an existing practice in a remote uh area, you might think great, because you've got full monopoly because there are no other practices there. That's brilliant. But when you're trying to then recruit for a changeover or handover of staff, you might not have many people wanting to relocate there or living there in order to work for you. So just these geography, in other words, is very important.
Speaker:So right now we're seeing a real flight to quality kind of in the DSO market now. So if it was a new group, how do you balance, I suppose, the the need for rapid growth with the kind of boutique clinical excellence you've always championed at the Neem Tree? How would how would you advise people to do that? What should be their focus?
Speaker 1:Well, for me, it is, and and this is obviously just personal, the boutique side of things uh and the private side of things um have always trumped the rapid growth. I always, you know, even back in the day, never wanted to have a group that was, you know, um 50, 60, uh hundred in size. It was always five to ten clinics. Really good, high-end, good quality, um, and you know, selling, I suppose, the vision of dentistry that that, in my opinion, was what the patients deserved. So it depends on what your business model is. Um, but certainly in my case, I I definitely believe that quality trumps quantity. Um, you can still grow a group, but it can be a small group, but high quality and earning just as well for you. You could grow the number of chairs in each clinic, which obviously you've got to look at the square footage of the place you're in and the ability to grow when you take over a practice or when you're setting up a squat. Um, so as long as it's in a really great location, then uh you know you you can grow that, no problem. It doesn't have to be the number of clinics, it can be the number of chairs, but quality definitely over quantity.
Speaker:Okay, so on that note, if you look at the current environment today, as as a as a an individual, you go to a hospital today and you have a uh you go to an NHS hospital and your normal care is you're waiting for quite a while, could be a number of hours. But and I suppose patients are used to that kind of mindset in the NHS world. But now, if you were going down the route of, as you've done, in private clinics, private care, um how does a new group design a patient journey that actually feels like an oasis rather than a clinical assembly line like you might feel when you go to an NHS clinic or an NHS hospital?
Speaker 1:Well, like everything, I think it's all about the quality and the small touches. It's about the front of house. Um, and the first port of call has to be um top-notch. It's got it's it's customer service or patient care. Um, you know, you've got to have a bright, smiley face at the front desk, a very cheery voice on the phone. Um, that's where it all starts. Their first point of contact has to be um uh you know quite quite a sort of wow uh service. And then little touches within the in the the clinic or or little touches within reception, a nice environment, a bright environment, fresh environment, regularly changed, redecorated, um, is what it you know it takes. So that a patient comes in and feels like they want to take a deep breath as opposed to hunch up their shoulders with with worry because the phone's constantly ringing and it sounds like intensive care. So these sorts of things matter, but again, it depends on your what what sort of um your ethos is within the practice. Um these little things where the patient is treated like a V V IP is is what matters. Uh, and that can be in a in a wide variety of different clinical settings and non-clinical settings. Uh the bottom line is the patient has to be on top of your list and on top of your wish list of of who to treat really, really well. And then the rest follows.
Speaker:Okay, all right. So you've always said staffing, um staffing, location is an important aspect in dentistry, okay, and as you mentioned that earlier. Um now we're in a world of remote work and changing city centres. In your mind, someone who's been doing this for so long, what does the ideal 2026 location look like for someone who wanted to build a multi-site group? Because remember, patients work from home a lot more now, okay. Um, we you had you had a clinic many years ago in Canary Wharf, right in the heart of the financial district. Um, would you open up one there again? Just wondering what your thoughts were.
Speaker 1:Uh, really good question. I think um my the the main kind of kind of drastic shift in my mindset with regards to thinking about this, it has to have been COVID. I think prior to COVID, there was the life before COVID, uh, BC, and life after COVID, AC. So I think before COVID, obviously the the high footfall central city, London, for example, um, locations were key where everybody went to work and they saw you at work and that was you know uh very visible um centres um and and high footfall. I think after COVID, um the the big change has been for me, the answer to this question would be still a high density population, but somewhere that's got a high residential population, uh, and still maybe a nice village street or a nice town street, um, probably not in central London or central centre of the city, wherever you are in the country, but uh somewhere suburban where, as I say, there's a high density but more residential, and definitely somewhere close to a supermarket. We all know the power of the supermarket back in COVID. That never stopped uh even for a single day. So um, yeah, that has changed. In other words, high density, but a residential, but still a kind of affluent population, but that's just my business model.
Speaker:So people have to eat at the end of the day, as you say, they need to go to a supermarket, correct, and that will never stop.
Speaker 1:So yes.
Speaker:Okay. So now, as you mentioned earlier, staffing uh clinics is a massive hurdle still in this industry. So if you were building a team from scratch today, how would you structure the practice culture to ensure that you're the employer of choice? So people would choose you.
Speaker 1:Well, I guess again, since COVID, things have changed a lot and Brexit, because um there's been so much movement of labor uh, you know, uh, well, to Europe and beyond. Um, and so I think that the sort of uh people that are uh are now looking for jobs, uh certainly auxiliary uh team members, um, they have got used to this kind of hybrid working pattern. And even though within the dental industry it that's not really been a possibility, far less than other industries anyway, uh people sort of have that expectation. So if you can, if you want to be an ideal employer, if you can either instead of let's say having two or three or four full-time members of staff, what you might do is do split shift. So you might have some people who want to work mornings and they want to get home for their children, etc. And that's fine. If your business can allow that, then why not? Why not listen to to the sort of uh labor demands, I suppose, that are that are out there right now. Uh and others, uh, for example, they might have other issues going on in the morning and they but they can do the afternoon evening. They can't get to you in in rush hour, so they can you can then offer them a split shift and they can do afternoon evenings, or they can do, or you get separate people members of staff at the weekend. It's a little bit more of a hassle, but it certainly can be done where you're listening to the demands and needs of your team members, but still running uh a viable business whereby um everyone's a winner, I guess.
unknown:Sure. Okay, thank you.
Speaker:I suppose now let's move on to something more kind of financially orientative, I suppose, with my hat on. Um now in a in the DSO playbook we talk about eBit DAR and the predictability of eBit DAR above all else, okay, for folk for groups to focus on in terms of profitability for valuation purposes. But from your perspective as a clinician, okay, and this is sometimes where it gets lost in the translation by many investors, is that ultimately eBit DAR is important, but what do you measure instead? Okay, what are the metrics that makes you know or makes you happy that okay, my clinics, if we get that right, the eBit DAR will follow anyway. Okay, so from a clinic, I suppose from a clinician's point of view, what's the most important thing?
Speaker 1:Yeah, I I get the question, and I think it's obviously EBITDA is very, very valuable, certainly when you're looking at your business as an asset, and certainly when you're looking to buy and sell. But from a pure clinical point of view, I suppose, you know, now when I look at the uh at the practice, I suppose my measure of success are full books, because um the practices are mature enough to be uh looking at um recall appointments, i.e., you know, the the the quality of your dentist that you have, in my case, associate dentists, are measured at the six-month stage or the three-month stage, or whenever they recall their patients. If the patients want to come back and see them and agree to booking that at the time that they treatment complete or they finish their last course of treatment, then that to me is a real measure of success and that I've got my team right and um and the customer services right, and uh, you know, everything we're doing is aligning. Um, if, however, they see these dentists or clinicians or hygienists um and and they sort of don't book back, and you've got empty books in three months or in six months or whenever, or even next week, um, and you know, everything else is equal. In other words, the financial situation of the country is okay, and um, there are no tsunamis or there's no COVID or there's not nothing else. If everything else is equal, then to me, full books and and good comments and good reviews um are a real measure of success.
Speaker:Okay, no, it's very interesting because uh me from an accountant's perspective is valuation and e-bit are you from a clinical perspective is the chair occupancy ultimately and and positive comments. Correct, yeah. Yeah, okay.
Speaker 1:Happy patients at the end of the day. If you've got happy customers, happy patients, um, you've got a really good, viable, and successful business.
Speaker:Correct, and that translates ultimately into profitability. Okay, all right. So you've over the years set up multiple practices um in across the kind of Southeastern London area. What is the one mistake you made early in in the early days that you would be most would be most careful to avoid if you started another practice tomorrow?
Speaker 1:If I were to open up a squat um again tomorrow, I think that the biggest mistake I made right at the beginning was just going with one provider for everything, not having the knowledge, being very green, uh, not sort of getting the best of three quotes in in anything really. Um, and as a as a result, like many others, you know, you tend to get ripped off. Um, I don't think I'd make that mistake again now because I've got my little black book of everything from uh electricians to chair providers to uh sundries um and also specialists. So uh I'd like to think I wouldn't be making that mistake again, but made plenty of mistakes of the years.
Speaker:Sure. I suppose I suppose a closing question here on this short podcast today is um we have lots of listeners who are young dental associates, not just here in the UK but all over the world, male, female. Um if you had to give a 60-second elevator pitch who wants to start their own practice or even their own group today, what would your golden rule be?
Speaker 1:Um great, that's being put on the spot. I think um my elevator speech today would be let's say, I mean, I, you know, I wouldn't say I was a specialist, but I my my sort of pet passion is um squat practices. So I suppose my pitch would be more related to the squat practices. Um, and things have changed so dramatically over the last 22 years. For example, the whole e-class planning permission has changed the whole landscape of opening up squats. Back in the day, it was D D1 planning, and you know, we fought long than hard to get D1 planning status for the certainly the five clinics that we looked to open, um, which were anything from uh architectural offices to laundretes to basement car parks and so on and so forth. And there was such a joy in actually converting them, but it was a bit of a battle to try and get that planning permission. Nowadays you don't have to worry about any of that, as a result of which many, many more uh young uh dentists uh have sort of joined the force, as it were, to open up squat practices on on busy high streets. What that has done though is it it has flooded the market um with providers, and that has its own problems with competition and so on and so forth, which you know is not competition's never a bad thing, but um, you know, a little bit of experience with sort of handling practices and business does go a long way. So uh good and bad has happened over the last you know 22 years, but uh like I suppose my advice was uh then, it's exactly the same now. It's all about location, location, location.
Speaker:And then one final question to kind of just get your thoughts on is when we when you started, when we started these groups many, many years ago, back in 2002, 2003, okay, we were fresh-faced, kind of naive, not really sure, thinking, oh, okay, we can start to group up. And you you saw the groups of other industries like coffee shops like Starbucks or Costa, and and we thought, oh well, maybe we could mirror that. But the reality is that running dental clinics is very, very different to running a franchise coffee chain or whatever it like as as I just mentioned, okay. So, and we've seen many, many groups emerge over the years, but struggle really with keeping the soul of the practices alive whilst they try to scale. So, from your perspective, how do you how how how do you or how do you suggest people keep the soul of the practices alive whilst they try to scale? Um, I don't think I've seen many people do that particularly well, but I've seen that worked well in the Nene Tree when you got to a size of about five clinics. Um but going beyond that, it gets even harder. What would your advice and thoughts be on this point?
Speaker 1:I think you're absolutely right. Um the difference between a coffee shop and a dental practice is is very, very difficult because uh I suppose a coffee shop or a chain of shops, like I don't know, H ⁇ M or Marks and Spencer, etc., they all are product-based. And I suppose if you've got the general culture uh or staff um ethos or customer service, then you're kind of onto a bit of a winner because what you're trying to sell is the same product. You've just got to look after your customers and how you sell it to them or how you market it or how you label it. But in a dental practice, it's all about the service and it's a need and want-based industry. But patients really, really rank their dentists based on the care levels and their personalities, in other words, the dentist's personality or the clinician's personalities, as well as front of house and nurses, of course. So um I think yes, getting to, let's say, five clinics is is doable, I suppose, because you can try and translate that culture across the board. But getting beyond that is very, very hard unless you've got a sort of owner-operated person within each clinic or a heavily incentivized, let's say, clinician, or somebody who's got shares or some other financial uh incentive to for the clinic to do really, really well. If that's the case, then the clinic has a chance of translating that vision across the board. Um, but if not, then it becomes very, very difficult as you scale and grow because then it then it starts to become about the numbers uh and less about the ethos.
Speaker:Very interesting, Smita. Well, thank you very much today for sharing your insights uh and your experiences. Um this is Arun Mehra, and we've had Dr. Smita Mehra talking about the first time. Thank you very much. Yeah, no problem at all, on on the topics surrounding DSOs. Uh and uh watch out for our next uh podcast soon. Thank you.