Where the money goes, who sees it, and what to do next.

The same KPI set tells three different stories.

Mayfair is operating near the ceiling of what a 6-chair central London implant clinic can do. The 90-day move at Mayfair is not to push utilisation higher (it's already 91%) but to capture more value per chair-hour by pushing the full-arch share of case mix.

Brighton has the demand (386 leads, biggest in the group) but is choking on the operational capacity to convert it. The diagnosis is concrete: a single overloaded coordinator, a lab supplier with an above-average remake rate, and full-arch cases taking 38 minutes longer than at Mayfair. All three are fixable. See Tabs 06, 08.

Leeds needs urgent intervention. The site is two years old, the surgeon is good, but every single connected KPI is below target — call answer, case acceptance, surgical utilisation, maintenance recall, revenue per hour. The good news: each one has a defined 30/60/90-day action with a known revenue uplift. See Tab 12, P1 column.

Six pillars, ten steps, one patient.

The journey above is colour-coded by which pillar owns each step. The handoffs are where things go wrong:

Step 2 → 3 (Ops → Growth): a call gets answered but the coordinator doesn't book a consult. 384 leads vanish here.
Step 5 → 6 (Clinical → Growth): a CBCT is taken but a case plan never goes back to the patient. 125 leads vanish here.
Step 7 → 8 (Growth → Finance): patient says yes but the deposit doesn't land. 39 leads vanish here.
Step 10 → 11 (Clinical → Patients): restoration delivered but no maintenance recall booked. 85 patients exit unprotected.

Each of these handoffs is between two pillars. Each one is invisible if you only look at one pillar's dashboard. This is the case for DentOps.

The cost number that nobody computes — until it's too late.

Fully-loaded cost per surgical hour = base salary or day rate + employer's NI + pension + allocated overhead (nurse cost, room cost, sterilisation, supplies, software) + employer's portion of insurance · divided by actually-billed surgical hours.

This is the true denominator for surgeon profitability. A surgeon on a £250K package, with full overhead allocation of £180K (typical for implant practice), needs to deliver £430K of clinical revenue just to break even. At 1,500 billed surgical hours/yr that is £287/hr break-even. At 900 hours (53% util), break-even jumps to £478/hr.

Every line traces to a named patient list. Nothing is theoretical.

The £127K of unbilled restorations is 38 specific patients whose final crowns were cemented in March or April. Their clinical notes show the procedure done; the finance ledger has no matching invoice. Receptionists at all three sites can be handed that list tomorrow morning and run the second-stage billing flow. One week of work for £127K of cash.

The £412K of stalled case plans is 204 specific patients who sat in front of a surgeon, said they were interested, and went home to think about it. They were never called back. Each one of them comes with the case complexity, the value, the days since plan presentation, and the reason they hesitated (where captured). Call list ready to print.

Implant practices live or die on the maintenance book.

The high-LTV implant patient who attends their 6-month recall is the closest thing a private implant practice has to a subscription business. The patient is high-trust, high-engagement, very unlikely to switch providers, and refers an average of 1.4 new patients over their next five years. They also represent the practice's clinical liability tail: a patient not under recall is a patient whose complications surface in someone else's clinic.

Mayfair's 86% compliance is the result of one specific workflow: the next maintenance appointment is booked at the same checkout where the restoration is delivered. The patient does not leave the building without the next appointment in the diary. Brighton has the workflow on paper but enforcement is patchy. Leeds doesn't have the workflow at all.

This is a free 90-day fix. No new staff. No new system. Just a workflow rollout.

The mix shift is the highest-leverage move in the practice.

Hiring a coordinator costs £42K/yr. Switching a lab supplier saves £58K/yr. Reactivating 304 lapsed patients earns £73K/yr recurring. These are good moves — but they are all operational levers.

Mix shift is a strategic lever, not an operational one. Lifting Mayfair full-arch share from 13% to 18% delivers +£82K of incremental gross margin per quarter with no new payroll, no new chairs, no new marketing spend. Just better case selection by the treatment coordinators and case-acceptance training that pushes patients toward the right indication for their clinical situation (and for the practice's economics).