Practice profile - An integrated approach

TRUDIE Imrie was working as a manager within NHS Scotland when she had a phone call from former colleague Paul Stone. They had worked together in the department of oral surgery and orthodontics at Perth Royal Infirmary – he as a specialist oral surgeon and she as a departmental administrator.

Paul had often discussed with Trudie his plans to someday open a private specialist dental clinic – one that would bring together a varied team of specialists offering integrated care all under one roof but outside of the hospital. Now that vision was set to become a reality and he was asking Trudie if she would come and run the business.

Trudie had by then taken on a role in NHS Scotland setting up managed clinical networks – the first being for cleft lip and palate and then another for phototherapy services. What Paul was proposing was a totally new challenge – managing an office with staff and specialists, having to deal with finance, marketing, procurement, IT, health and safety regulations, HR issues and recruitment, premises management and much more. But after some deliberation she decided to accept Paul’s offer and in 2007 became clinical manager of the Blackhills Specialist Dental Clinic.

“It was a risk but a risk worth taking,” says Trudie as we chat in her office overlooking the Ochil Hills in rural Perthshire.

Blackhills operates in a purpose-built clinic located in a business park in the village of Aberuthven just off the A9 between Perth and Stirling. It started out with only two specialists – Paul and the other founding partner Ken Watkins.

“There was quite a learning curve coming here,” says Trudie. “It was only me and one dental nurse. I was doing everything – reception, typing, IT support, everything.”

But in the intervening years the practice has grown to eight specialists with five dental nurses, three administrative assistants and one general assistant. Trudie has helped oversee that growth with a zero staff turnover and a thick “testimonial book” of appreciative patient letters displayed in the practice waiting room.

Paul Stone happily acknowledges that Trudie’s skills have in no small way contributed to the success of the clinic as testified by Blackhills being named Best Specialist Referral Clinic at the Scottish Dental Show Awards 2013. At the same ceremony Trudie brought home the award for Dental Business Manager of the Year. Not bad for someone with only six years experience as a practice manager.

Complex cases

Blackhills Clinic provides treatment for all aspects of adult dentistry (apart from orthodontics). “Almost all our business is through referrals from other dentists,” says Trudie. She estimates that the clinic has about 600 referring dentists and treats 750 to 800 patients per year. They come from as far as the Shetland Islands and the Scottish borders but most are from the central belt of Scotland.

Each of the clinicians at Blackhills is a GDC-registered specialist, providing the clinic with a wide range of expertise in oral surgery, prosthodontics, restorative dentistry, endodontics, periodontology and dental and maxillofacial radiology. All of the specialists work at the clinic part-time having other academic and NHS commitments.

“Many of our patients come to receive dental implant and restorative treatment as well as periodontal treatment for gum disease,” says Trudie. “Some of our patients need full mouth rehabilitation; they may have a difficult occlusion and failing extensive crown and bridge work that needs to be dismantled and reconstructed, often utilising dental implants. So we do see and treat some really complex cases.”

Blackhills has three surgeries with a central sterilisation room and its own cone beam CT scanner – one of the first to be installed in an independent dental referral clinic in the UK. This allows the specialists to image patients in three dimensions and is used on a daily basis for the precise planning of implants and other complex dental treatments.

Perhaps the most unique aspect of the Blackhills Clinic is its emphasis on integrated treatment. Paul Stone explains: “We work together as teams. So a patient might see three or four specialists during their consultation appointment. We find that this is an amazingly effective way of arriving at the most appropriate diagnosis and treatment plan. It also saves the patient having to make multiple visits by enabling them to see several specialists at one go.”

Blackhills also has a policy of only treating patients for the problem for which they have been referred unless other significant issues become apparent during treatment. Patients completing their treatment are always sent back to their regular dentist for continuing dental care.

“Maintaining good relationships with referring dentists is essential because in reality they are also our clients,” says Trudie. “We don’t ever want them to feel we’re taking their business.”

Marketing to dentists

Indeed, keeping referring dentists onside has become a big part of Trudie’s role at Blackhills. The clinic runs regular educational meetings to support referring practices and last year inaugurated a half-day symposium. It was held at the Perth Racecourse conference facilities and had 170 delegates and 20 trade stands. The theme was “team working” and Blackhills specialists lead a range of sessions. All the organising was down to Trudie. This year they expect an even bigger turn out and have invited business and marketing gurus Ashley Latter and Les Jones to give the keynote presentations.

Says Paul Stone: “It’s a major event for us and a significant cost. But it’s good service to provide really excellent education to our referrers because without them we don’t have a practice. They rely on patients coming through their doors and we rely on them sending us patients for the more complex or specialist treatments.”

Herding chickens

Working in a business with overheads and profit margins was also a departure for Trudie, coming from the NHS. Private patients offer a different challenge. “Their expectations are a lot higher,” she says. “They expect really good service and assume they will be seen quickly.”

Given the number and overwhelmingly positive comments from patients treated at Blackhills it’s clear that they are doing something right.

“It’s been that way from the beginning,” says Trudie. “We like to give our customers the feeling that they’re always welcome and that they are going to be really well looked after. We want them to see that we are completely professional and ethical and won’t provide dentistry that’s not appropriate to the patient’s needs. It’s purely patient focused.”

So to what does Trudie attribute her success at Blackhills?

“I am a very calm person,” she says. “When there’s a problem my attitude is ‘we’ll just sort it’. You have to think logically. Stop, think.”

Paul Stone is a little more expansive. He says: “Running our practice is a bit like trying to herd chickens because there are so many different people –specialists in different hospitals and universities, part-time and full-time staff, and then all the different referring dentists and their patients coming from all parts of the country. Trudie really is the glue that holds everything together – and it’s on all levels.

“Some practice managers can be strong-willed and quite dogmatic but Trudie is different. She also has a good perspective of what’s important and what isn’t – and she’s taught me as much as anybody to take a step back sometimes.”

Jim Killgore is an associate editor of MDDUS Practice Manager

SCALP

Trudie Imrie is also the administrator for the charity SCALP (Scottish Association for Cleft Lip and Palate) and spends many hours co-ordinating fund raising activities and working with the various groups involved to distribute funding and organise educational events, as well as helps maintain the profile of this important organisation which is so relevant to dentistry. Blackhills Clinic supports this role, giving time to Trudie as well as financial support to the charity. To learn more go to www.scalp4kids.org