Intro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman: Well, it gives me great pleasure to have Richard Howarth on the bulletin today. Richard, I’ve known for a long, long time, but he recently sold your practise, Richard. How does that feel?

Richard Howarth: I suspect I would be a little bit less chill than I am now if I was still the owner.

Payman: And then after selling the practise… I know you’re a sailor, aren’t you? Instead of jumping on a boat and going to the Caribbean, jumping straight into designing a bit of PPE, a visor, which we’ll get onto. But Richard, really what I wanted to find out from you really to start with, there was just a story of [inaudible 00:01:01]. How did you start it? How did you get it to where it was?

Richard Howarth: Well, it started off being unhappy as an associate. I worked for a lovely principal and didn’t like the way she ran the practise, basically. I think about eight different nurses a week. I cared very deeply for the care that I was giving my patients, but was making no money out of it. And I was almost packed up dentistry.

Payman: Was it NHS?

Richard Howarth: It was NHS in those days. There wasn’t anything else. And almost packed up dentistry. My second choice of career would have been to be a pilot. So I was this close to changing and going somewhere else. And I met a guy called David Price. He’s unfortunately no longer with us now. He was in his seventies when I met him, and he introduced me to a group of dentists called the Dental Health Practitioners Group. And he did a seminar called Ten Steps to Startup.

Richard Howarth: And the seminar was talking about the ergonomics of the dental practise, how to design it so it was efficient. He was talking about how it related to a theatre. So you would go in and buy tickets and then cut them away. Or if you went in and you were going to the performance, you might go through to a bar or a lounge area, or even a restaurant pre seeing that show. You then go into the show, but you’d never see what was going on behind the scenes. And you could see within the room, loads of people were just switching off. What’s this got to do with me opening up in a practise? But his pattern was designed to put off as many as people as possible. He wanted just two or three people in that room who wanted to work alongside him.

Richard Howarth: I remember coming home when I was a very poorly paid associate. I worked very hard, but I didn’t gross very much. I was too careful in what I was doing. And I remember coming home and saying to my wife, “I want to give this guy what was a huge stack of money per month to help us set up in practise.” He gave me the confidence to [inaudible] notice. I didn’t have anywhere to go. I didn’t have anything organised. From that, I quickly learned that you make your own look.

Richard Howarth: So I was on the phone. I found a guy who had to retire through ill health. He’d had a lung taken out because of cancer and his practise was disappearing. There was no good will because he wasn’t working. So I offered to reopen it for him, give him a year of me working there, learning how to run a dental practise and gave him the opportunity to sell it at the end of the year, because I knew I wanted to set up a practise and staff it.

Richard Howarth: So he gave me permission to do that. I didn’t pay him very much for doing that. Even that was a rocky road. The nurse who was supposed to be helping me get things ready, turned a car over and ended up being badly injured. So I remember on day one, I’d hired a friend who had never been in dentistry at all. Jackie, she was just going to be trainee dental nurse. I just noticed on the desk, which said, “Receptionist and dental nurse required.” And we went from there. So I did that for a year while I got planning permission on three premises in Stafford, one of those being next door to a car park, and on that car park was going a medical practise and they phoned me up and said, “Would you like to rent some rooms above it?”

Richard Howarth: So I bit off their hand and set up what was Smile Style One. It was an NHS practise. We mixed, as we were allowed to do in those days, giving people choices and treatment.

Prav: Single handed?

Richard Howarth: Single handed. Just me. I get my leg pulled by a lot of my friends because my first dental chair cost me 500 pounds. It was purchased from the back of the Auburn [inaudible] Psychiatric Hospital, which was closed down. I remember turning up with a transit van and my wife and the caretaker lifting in a dental chair into the back of this transit van, along with a load of other [inaudible] that was stored in this [inaudible 00:05:24]. And if anybody knows how heavy a dental chair is, I’ve got no idea how the three of us actually lifted it and then lifted it out at the other end. But yeah, it costs me 500 quid for dental chair, a dental light, a wet developer, a little bit of cabinetry. And that was about it. Really.

Prav: Rich, what stage of your career were you in at this point? So you said obviously you’d worked as an associate for a period of time. How many years did you have under your belt before you took this leap?

Richard Howarth: Okay. I did a year and a half in hospital. I did two years in general practise. So I was 26. 25, 26.

Prav: Wow.

Payman: And then did you add dentist in the NHS system?

Richard Howarth: To the team? No. Initially, it was just me. So we just grew it. What happened was, we very quickly… Four years, I realised that my work was going to be down the private route. I was struggling very much with this concept of… The NHS didn’t seem to be adding up. You did the maths and you thought, “Well, we’re really struggling to make this profitable.” So really, we were providing private treatment for Mrs. Jones, which was subsidising Mr. Smith having his NHS filling.

Richard Howarth: I felt very uncomfortable ethically with that. And I decided that I had had to make the NHS just work on its own, or I had to step away from it. And at that stage I chose to step away and I decided that having premises above NHS doctors wasn’t going to work, apart from the fact my image of working with doctors to work with their patients with heart disease and diabetes and everything else, just wasn’t working. They weren’t interested in preventative medicine. They were interested in rent.

Richard Howarth: So I bought a very small building in the Centre Stafford which we then converted into what was the two surgery stroke, one booth practise. And so at that stage, I could run two chairs, but very quickly we moved to a dentist/hygienists model. And that was the model that I really worked with for years and years. So basically, the model that we came up with was, rather than me doing checkups, which I just felt was of no value whatsoever, what we would do is move the checkups to the hygienist’s room. So I was then an invited guest on hygiene point. And what that did was it raised the value of hygiene work. Working in a healthy mouth just makes dentistry so easy.

Richard Howarth: If you’ve got no blood, no bleeding, and then somebody who cares for their mouth, you can really do some fantastic work. Whereas in the other way around you, the patients come to you as a dentist, they see you as a dentist and they go, “Okay, you need to go and see the hygienist to get rid of this gum disease.” It lowers that priority in the patients.

Richard Howarth: The dentist is important and the hygiene is less important. Whereas if you make hygiene is the most important, and then the dentist plays a completely different role. And my analogy here is like a garage. So, when you take your car in, most of the time you’re taking it in for a service. And that’s what the hygiene therapy room’s about. It’s about servicing your dental health is making sure that you’re enjoying the best dental health you choose to have. Obviously you can’t make people do, because ultimately it is down to what they do, but that’s your role.

Richard Howarth: Whereas the dentist then becomes the repair shop, in terms of you’ve crashed your car, let’s make it better again, sort of thing.

Prav: Or give it a re-spray.

Richard Howarth: A re-spray, exactly. Exactly. It’s funny, I use that other analogy is the fact that if you want the spoiler on the back of it, we can do that too.

Prav: Nice. Nice. Give it a wrap.

Richard Howarth: Yeah, exactly. So basically that’s what I worked on. And then the plan was to be there for about 10 years. And it was the deciding factor. Do I continue as a single handed practitioner, or do I go bigger? And it became clear that as a single handed practitioner, the expenses of running a practise were increasing, we’ve got CQC come in, everything was just getting more and more so… And then your margins as a single handed practitioner were being squeezed and squeezed and squeezed and squeezed.

Richard Howarth: And it seemed sensible that we have to try and share that. And it took me five years to find premises. Right at the beginning of the recession, we found a super premises which literally needed gutting. We took them back to the bare brick and rebuilt the whole thing.

Richard Howarth: But the advantage of that was I can set it up exactly as I dreamed. So move three was my dream practise, the way we delivered the patient, it was this theatre analogy. We had a patient delivery corridor, we had our behind the scenes, which the patients never saw where we processed instruments and stored our stock. We even had Jack and Jill cupboards in the back of the surgery so that clean instruments are placed in one stack in patient sequence. And then when we finished them, they go into a dirty covenant and then they get taken out. So there’s no walking around the practise with dirty instruments that they literally are served in that manner.

Payman: How many staff did you end up with when you sold it? How many people were you in the end?

Richard Howarth: I would say in the end, we were four dentists, three therapists, and about 16 or 17 [inaudible] staffs, between reception. We always ran with more nurses than the average practise because we had… I know people call them TCOs. I hate the word TCO. As we’re always smile makers, and that came from the Olympics in 2012. Went down there and it was Games Makers. I think if you remember showing you around, I thought, “Oh, we need Smile Makers.” So, all the girls who helped the patients with regards to treatment plans and teaching them all the hygiene skills and all this sort of stuff, they’re my Smile Makers.

Prav: Richard, it seems that you were even back then very, very forward thinking even compared to today but what it seems to me, I don’t know what yet, what your patient journey looked like. And the hygiene stroke dentist, almost like co-diagnosis model that you were using almost sounds like the stuff that they were doing in the States way before we did it here in the UK. So what really interests me is what was your patient journey? If you could just walk us through as a new patient walking through into your practise, and then meeting one of your smile makers as it was, or then being communicated with throughout their treatment. And just talk me through. What would I expect in a consultation with you, Richard?

Richard Howarth: Well, initially very much so… I suppose at the front end, it looks a bit similar. We offer the opportunity for a client to speak with a nurse beforehand. No fee, they can just come in and quite where possible they may introduce them to a dentist at that moment in time, but not always. But a lot of that is about delivering our culture. We know our culture doesn’t suit every patient, it’s not right for everybody.

Richard Howarth: Some people don’t want the service that we, they act [inaudible 00:13:37]. So, we talk about our culture, a lot about what we’re expecting from them, what we’re going to give them. And we offer them the opportunity to do that, to have a full assessment. A full assessment is with a dentist. It’s not with the therapy team at that stage. It is with a dentist. So the dentist will do a full case assessment. And our aim really then is to deliver the patient to the point where they are accepting of what we call one of our wellness programmes. Roughly speaking the wellness programme is determined by their gum health. Obviously, if their pretty healthy, then they don’t need much, and if they’ve got huge pockets, then they need a lot.

Richard Howarth: And that wellness programme is really their get go. If they move their way through that, then we can progress and provide them increasing levels of service. Obviously, pain always takes precedence. So, if they’re in pain or they’ve got an immediate crisis problem, that will be sorted before we do that perio programme. But, getting through the perio programme is almost your qualification to being a member of Smile Style. And it also introduces them very much to this hygiene therapy model, where they are working very hard with the hygienists. In my case, they’re all therapists now, and with a qualified dental nurse delivering all health education. And, they like that.

Richard Howarth: The nurses don’t hurt them. They see them as that pals. I always say, I don’t like big spiders. If you put me in a room with big spiders and gave me a very important message, I don’t think I would take it on board. So, if you stick somebody in my room or even with a hygiene therapist, to some degree, we are somebody to be fearful of for whatever reason, culturally, and everything else.

Richard Howarth: But we want to get that message to that person as efficiently as possible. What we’re about. We’re changing beliefs and behaviour. If you’re taking beliefs, behaviour, working a very deep level with those patients, and therefore you want to put them in the best environment that you’re going to have the effect. So you’re going to have an effect. Once they’ve got through the perio programme, we’re doing routine dentistry. Once that perio has got to a level, and it doesn’t always have to be perfect, but it does have to be to a point where we can start to do restorative dentistry. We’ll restore them. We’ll-

Payman: Richard?

Richard Howarth: … get the function right.

Payman: Richard, you touched on culture there. I’ve been to well over a thousand dental practises in my time, and the culture from… Culture is a funny word because it means so many different things. But the way that your staff seemed like they were happy to help. Everyone seemed so happy in the practise. Do you think part of that is the fact that they’re more involved with the patient care, that they feel more fulfilled? Because life of a DCP sometimes it’s just carrying out instructions and you can bottle what you had in that practise.

Richard Howarth: Yeah. Each system creates its pluses and its minuses. One of the pluses that they do get is the fact that they do have their own patient list. They’re working one to one with patients that that does give them that extra involvement and reward. Just like as a dentist, when is it most rewarding? It’s when you’ve done that great restoration, or you’ve restored that mouth, or you whitened it and straightened it and everything else. And the patient is just over the moon. And, they want to give you a hug and a kiss in pre-COVID. And their writing letters to you and thanks very much and everything else, but it’s very much when you see the letters we get back. a lot of it is team. I’d really like to thank Richard and his team.

Richard Howarth: And I think that’s the point. And some of the girls get stuff specifically for them. They do get little gifts or something. They get that relationship, which is lovely. So I think there is that. It does create problems though. It’s not without its problems because, I get nurses who we’ve had over the years and they’re just not used to talking to a patient. Their told that that’s not their responsibility. You do not talk to a patient. It’s the dentist’s responsibility. I talk to the patient, you sit there and you do what I say.

Richard Howarth: And, I’ve had a lot of nurses just go, “Oh my, I just can’t cope with it. That’s… Deal with that.” Those are usually the ones that you don’t expect. Absolutely thrive in it. And to be honest, I have to say, we decided that the best ones are usually the ones grown in house. So we just hire and train and hire and train. And that seems to be a forever process within the practise. And a lot of the girls have come through. The disadvantage, is a big disadvantage is you raise their aspirations, massively raise their aspirations.

Payman: Why is that a disadvantage?

Richard Howarth: The disadvantage is they can tend to want to leave and go and do great things. So, I suppose over the years, I’ve accepted the fact that it’s much better to work with people who are going somewhere than to work with people who are just stuck. And, I’m proud of the fact that as well as building Smile Style, I’ve got probably in double figures now, people who are dental hygienists and therapists around the country, or have gone on into general nursing or practise managers elsewhere. So-

Payman: Yeah, now I get it.

Richard Howarth: It’s building people. It’s building people all the way through, and you just have to accept that.

Payman: That’s one of the nicest things about business there, Richard, I think. Watching people develop. I know we’re a bit pushed for time, I want you to fast forward to selling the practise. How did that feel? What was the process? Did you have lots of buyers in line? I mean, I’m sure they did. Lots of people wanted to buy that practise. It’s a beautiful place.

Richard Howarth: Yeah. I’ve got to thank the team behind me. [inaudible] were my agents and particularly Abby, she was fantastic. Yeah. I suppose in your head, you’ve got to get to the point where you’re ready to sell. And I arrived at that point. In the background, we’d been working on the practise to make sure that systems were right and everything was ready, and I think that was great. I had time. I was building up to it probably for three or four years, not with a specific date in mind, but just accepting the fact that when you sell that you don’t walk away, generally. And, I had in my head, “Well, I probably want to be done, or at least be able to make the decision to go if I want, in my late 50’s.

Prav: What was it that triggered that? It seems like it was a very structured approach that I want to be out of this game, in this period of time, I’m going to prep for three years, probably do your pre-due diligence, et cetera, et cetera. And did you have a magic number in mind that you were aiming for, or anything like that? What was the motivator behind you saying right?

Payman: He’s got a boat, Prav. He’s got a boat.

Richard Howarth: I suppose what you’ve got to understand was I’d already realised that the most important thing was to make a business that wasn’t just me. I was only working for two days a week and I had been only working for two days a week for a considerable amount of time. Years. And so we traded possibly making slightly more in terms of money for time. That’s the trade off, isn’t it? You can work five days a week and you can have a lot of money, but you don’t have any time. And I chose to do the other thing, so I had time.

Richard Howarth: But what I was finding was that time was just constantly being eaten up by managing the practise. I was very hands on. So whether it was recruitment, whether it was marketing, whether it was dealing with patient problems or whatever it was, the time just quickly evaporated as a principal and owner of the practise.

Richard Howarth: It got to the point where I thought, “You know, I’m not enjoying that as much as they used to do.” And equally the other thing, and I suppose this is relevant, I think that the business needs to continue to grow. I think any business needs constant nutrients coming into it. And there was getting to a point where there’s the limiting return on your investment. If I’d gone out and bought… And we have done, we bought Omnicam and various other things, but there comes to a point where you think, “If I spend a 100,000, 150,000 pounds on this, when do I get that back? Who’s benefiting from this?” And it was even more stark with me only doing two days a week. So really I was investing in all of this, for the associates.

Richard Howarth: And I suppose it got to the point where you’re, “Do you know what? It needs to keep growing. I need a partner. I need somebody to come in to help me keep this business growing, but I haven’t got the energy, and I don’t want to keep committing my finances to this indefinitely.” I suppose that came into the equation as well.

Payman: Richard, anyone else after putting that much effort in and then selling it and by having the sailing interest that you have, would then take a break?

Richard Howarth: Yeah.

Payman: But you didn’t, you started a PPE company. Tell us about Provizage. How did that come about?

Richard Howarth: That came about because it became very clear really early on that we were going to have to wear visors. I could see no way around it. And you see I wear glasses, since my forties I’ve had to wear glasses to see anything and I’m dead without loupes. And I just thought, “How the hell am I going to wear loupes?” And I’d obviously seen some things which clipped to the sides of loupes. And I thought, “My nose kills at the end of the day wearing such heavy things. The last thing I want is something stuck out even further and leaning on the nose, and I’ve got enough stuff on my head. And then the other thing, it reminded me very much of when I was younger. And I did a few years in hospital.

Richard Howarth: One of the clinics I was involved in was treating HIV and AIDS patients. And obviously in the time when we really didn’t quite fully understand all of that, and my consultant at the time insisted that we were as protected as we are going to be for COVID. So, full gowns and foot coverings, head coverings, masks.

Payman: Double gloves?

Richard Howarth: Not even single gloves, double gloves and a visor. And I just remember how hard those clinics were. I thought, “Geez, if this is what you know is that this is what I’m going to go back to, how am I going to function?” And I don’t know, it was just bumbling around in my head. And, came across my visor that I had in the garage for [inaudible 00:25:34], an old gaudy thing.

Richard Howarth: And so I got that out and spinning it around and thought, “Well, what happens if I hang it around my neck?” And fiddled around, and it seemed to work. I then built it out cardboard and made my son and my wife wander around in it and take pictures and things. Yeah, yeah, I get the, get the sizes right and the proportions right, and everything else. And then got somebody on CAD/CAM to design it for me, so I could then print one. And basically, it was for me really. and so I got that and I thought, “Geez, this actually works really, really well. This is absolutely fantastic.” I ended up walking around for days with it around my neck, thinking this just really works, showed it to a few people and they said, “We need [inaudible] .”

Payman: It just looks so much more comfortable around your neck. Doesn’t it? And you don’t get that weird sort of chimney effect. Yeah. Put it on, put it on.

Richard Howarth: This is it, here.

Payman: It’s a bit spaceman-ey and I like that about it. Look at that, Prav. It’s such an elegant solution.

Richard Howarth: [inaudible] with you. It’s just great. The other I liked was the fact that the patients it’s less intimidating. I’ve fought for years to try and make dentistry more-

Payman: Accessible.

Richard Howarth: Welcoming.

Prav: You’ve just taken a standard solution and flipped it on its head, haven’t you, Richard?

Richard Howarth: That’s right.

Prav: Amazing.

Richard Howarth: You’re a problem solver. And I just wanted to solve a problem that was there. And nobody seemed to be thinking about it. My wife said, “It won’t mess your hair up.” I see Prav, you’re like me.

Prav: I don’t have that. Mate, we’ve got the same problem there. No issues.

Richard Howarth: So, I can see it from the girl’s perspective. If they’ve got even more stuff on their head and that’s not what people want. And so it just lets the heat come out. Somebody was saying, “Won’t it fog up?” Well, I’ve walked around for days with it on and it doesn’t fog up at all and it just doesn’t get as hot because the heat can rise.

Payman: It’s reusable, Richard. Right?

Richard Howarth: Pardon?

Payman: Reusable, obviously.

Richard Howarth: Reusable, so it’s not disposable. The key bit for me is vision. You’ve got to be able to see what you’re doing. It’s paramount. That’s why I wear loupes with a light. If I can see it, I can do it. So we’ve actually gone a material, which is optically superior. It’s much thicker, it’s much more robust. It’s actually used in the nuclear industry for visors there. Because they’re always got higher protection and visibility. It doesn’t refract or, or split up your light. I would have staggered, you don’t know when you first start doing this, but literally it didn’t look like I was wearing anything when I was working. I didn’t notice there was any difference looking at it.

Payman: What do they cost Richard? And what’s the website? How do you get them?

Richard Howarth: Okay. So that they’re $49.99. Obviously, no [inaudible] until the end of July.

Payman: Oh yeah.

Richard Howarth: If you go to Provizage.com and that’s with a zed.

Payman: Provizage with a zed.

Richard Howarth: Provizage with a zed.

Payman: And can order online-

Richard Howarth: Order online and we do individual ones. We do small practise packs and big practise packs with various offers on at the moment if you get your orders in.

Payman: Well-

Richard Howarth: Just to let everybody know, we will be shipping at the beginning of July. We were expecting dentistry to be allowed back at the beginning of July, and obviously it’s been to go from prototyping to manufacture in such a short space of time, and testing has being pretty tight.

Payman: I want to welcome you to the world of dental supply, Richard.

Richard Howarth: Yeah. Yeah.

Payman: I’m sure you’re going to make a massive success of it. Just like you made a massive success as at Smile Style.

Richard Howarth: Oh, I hope so. Even it helps people out, it was never done to make… That wasn’t the primary objective. It’d be great if it does, but if I help anybody out, just like if I help a patient out, that’s why I’m a dentist. If I help my colleagues out and make what will be hard work over the next few months, a little bit less hard work, than I’ve succeeded or be another little tick in what Richard’s done in his lifetime.

Payman: Congratulations, buddy. Really, really lovely to see you.

Prav: Well done, Richard. And for me, having worked with lots of dentists, I can just say this interview has been an education. And I think it’s come from your terminology more than anything else. So talking about the garage, the re-spray analogy, the mechanic, nutrients in your business, all of these things. Sometimes you just don’t think about business like that. And it’s really refreshing to hear a completely different take on it. And then to top it all off, you turn a visor upside down and you create something amazing like that. So, hat’s off to you. It’s really, really good.

Richard Howarth: Thanks very much. That’s one thing that I’ve always found is, if you can talk in pictures so people understand what you’re talking about, you’re halfway there.

Prav: Yeah. Brilliant.

Payman: Thank you so much, Richard.

Prav: Thank you. Thanks for your time.

Richard Howarth: Guys, see you soon.

Prav: Cheers.

Payman: Bye-Bye.

Richard Howarth: Cheers, bye.

Outro Voice: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.