the bigger the first course of treatment, the less likely patients are to return

Our Breathe member practices measure (amongst others) these three (essential) key performance indicators:


  1. New patient numbers and source
  2. Value (in £) of new patient treatment plans and acceptance
  3. Active patient list size

First off, let me give you some benchmark figures from Breathe members:


  • New patients. From 7 to 35/month.
  • New patient source. On average (and dependent on marketing activities): 50% Word of Mouth, 30% The Internet, 15% Signage and Walk By, 5% Other marketing activity.
  • Average value of new patient treatment plans, £180-£1800.
  • Active patient list size, (patients who have returned to the practice in the last 2 years), NHS, 1800-2500 patients/full time dentist, Private, 900-1400 patients/full time dentist.

Recently, I was collecting this data from a group of Breathe Business Clubbers and I noticed an interesting correlation:

Practices with the highest new patient values often struggle to build a list of returning patients and, conversely, practices with below average new patient values easily create a list of patients willing to return for more treatment year by year.

Is there a relationship between the size of the first treatment plan and the patient’s willingness to come back for regular six monthly checkups and treatment? It seems so. Let’s try categorising three different examples of dental practice:

1. General mixed dental practice. Either, NHS treatment with upgraded private treatments, or private capitation and/or or private pay as you go. Suburban or rural position, probably long-established with most new patients coming because of word of mouth recommendation.


  • The dentists are low grossing with an average new patient value of £200-£350.
  • Clearly, the first treatment plans are modest and the patients return every six months for a little more treatment.
  • Average returning treatment values are around £150-£350 and around 95% of patients return year on year for their Check up and treatment appointments.

2. General private dental practice in a suburban area with some marketing activity and some word of mouth recommendations.


  • The dentists are low to medium grossing with an average new patient value of £500-£850.
  • The first treatment plans go someway towards fixing the new patients’ dental problems and the patients return every six months for a little more treatment.
  • The original treatment plan is completed over a couple of years and then they become maintenance patients, often content to join a maintenance plan.
  • Average returning treatment values are around £200-£400. Around 90% of patients return year on year for their Check up appointments.

3. General private dental practice with an interest in cosmetic dentistry or advanced restorative dentistry. Positioned in a town or city with considerable marketing activity and some word of mouth recommendations.


  • The dentists are high grossing with an average new patient value of £850-£1800 (or higher).
  • The first treatment plan is intended to fix all of the patients dental problems and the patients are asked to return every six months for Check ups and Hygienist appointments.
  • Average returning treatment values are around £180-£270. In reality, only around 60% come back for their maintenance treatment and many of these stop coming after a short time and seek a practice more like the examples above in no’s 1 and 2.

As a dentist, my preference (and yours?) would be to achieve dental health for the patient early in our relationship, preferably in the first few courses of treatment and then simply maintain their dental health with regular check up and hygienist appointments. However, many patients seem to prefer a different approach. Maybe it’s because of years of NHS-style dental treatment where treatment is delivered piecemeal? Whatever the reason, it’s clear that many patients prefer to have modest, inexpensive treatment plans with the inevitable outcome that their oral health gently and predictably deteriorates.

So, is there some sort of middle path? I suspect that many practices have found a treatment model (as in the second example above) that suits their patients and their catchment and although rarely discussed, they know in their gut what their patients will say yes to and what they will resist. These practices will generally be successful because they are meeting their patients financial needs and necessarily dumbing-down their treatment plans to suit.

The first example practices are often under-treating their patients and in these practices, the main problem is the low self-confidence levels of the dentists and their poor communication skills. It is not particularly effective, either for the patient or for the practice, to continually be doing small amounts of dental treatment. The patient never really gets well and the dentists are faced with doing endless, boring single unit dentistry.

The third example practices often have dentists who are very confident, skilful and great communicators. The problem for them is that their marketing costs and cost of patient acquisition will be high because they constantly need a high number of new patients and their returning patient numbers remain stubbornly low.

I’m not sure that we can easily change patients’ perceptions and behaviours! However if you are the sort of dentist that likes to get your patients’ treatment completed early on in your patient relationship, then I have some suggestions as to how you can ensure that they keep returning to your practice for maintenance dental care:-


  • Revisit the proposition that your practice makes on it’s signage, web site and marketing collateral. What promise is your proposition making? Is it transparent? Do new patients know what to expect when they first visit your practice? What standards of dentistry and clinical care do you wish to offer?
  • If your proposition and your style of delivering dentistry is “fix and then maintain” when and who tells your patients this? Do they get it?
  • Survey your non-returning patients. Our research demonstrates that many stay away because they feel they are being oversold to. If this applies to you and your non-returners, revisit and review your new patient consultation, treatment planning and treatment plan presentation process.
  • Do your patients understand the necessity to return for maintenance dental appointments? Who tells them this, are they effective at communicating this? Are these patients offered a great value practice membership scheme such as offered by DPAS or Practice Plan?
  • Do your patients feel that their maintenance appointments are good value? Have you asked them? Could you add value to these appointments or reduce the fees?
  • Is your practice better in the courtship than the marriage?! In other words, is your practice all about new patients and your maintenance patients feel like second class patients?
  • Is your practice well resourced to deliver maintenance appointments and dental wellness?
  • Do you guarantee your dental treatment providing your patients return for maintenance appointments?
  • Have you considered giving a years “free servicing” with a big treatment plan?
  • Have you considered giving a free Membership Subscription with a big treatment plan?
  • Do you have an effective reactivation process to reactivate patients that need maintenance appointments?
  • Make it clear in your marketing material and your sales support material that it’s normal and expected to return to the practice for maintenance.
  • Do you make your maintenance appointments, easy, at hours to suit your returning patients, inexpensive and good value?
  • Is your practice proposition about wellness rather than intervention?

Having a substantial reservoir of patients returning regularly for maintenance gives a practice momentum and adds to the confidence of all who work there. I would be very interested to hear your experiences and how you persuade patients to return for maintenance treatments after a big ticket treatment plan.

Contact me on:


m. 07770 430576


With All Good Wishes,



Simon Hocken BDS.

Director of Coaching

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