Fictional client
Bramfield presented 1,940 treatment plans worth £3.1m and patients accepted £1.9m of it. The other 792 plans — £1.2m — were diagnosed by a clinician, explained to the patient, and then left, because “I’ll have a think about it” is not a status that anything tracks. 578 of those patients were never contacted about it again. Private dentistry is a business where the diagnosis is the easy part, and the software either owns what happens next or nothing does.
Bramfield Dental & Aesthetics does not exist. We cannot show live client systems, so this study is built around a fictional practice — invented business, invented clinicians, invented patients, invented figures. What is not invented is the work: the treatment plan lifecycle, the governance regime, the two recall cycles and the failure modes are all real, and the screens are genuine working pages rather than pictures of pages. Every mockup on this page opens and responds to clicks.
On scope: Bramfield is a local private practice serving its own community — two sites, patients who live nearby, and treatment delivered over months. It is deliberately not a medical tourism operation, which is a different business with a different problem. Bramfield is set in England, which matters: clinician registration is UK-wide but the inspectorate is not, and a practice in Wales, Scotland or Northern Ireland answers to a different one. The specifics of registration, prescribing and consent also change — in a real build all of that is configuration, not code, and nothing here is advice.
Bramfield runs two practices in Cheshire — mostly private dentistry, with a facial aesthetics clinic that has grown into a fifth of the revenue. Nine dentists, three hygienists, two aesthetic practitioners, 6,800 patients. The dentistry is excellent. What happens between a patient being told what they need and that treatment being booked is held together by the memory of whoever was in the room.
Every one of these has a clinical face and a commercial one, and the clinical face is the more uncomfortable of the two. A plan nobody followed up is not only revenue — it is a diagnosed problem getting worse in somebody’s mouth.
One idea holds this together. A treatment plan over £1,000 cannot be saved without a named owner and a first follow-up date — not a reminder, an owner, the same as any other piece of work in the building. It cannot be closed without a decision: yes, no, or not yet, each with a reason. That single rule is what turns £1.2m of forgotten plans into a worklist.
Everything else reads from it. The diary knows which waiting patients could fill today’s cancellation. The recall engine knows which patients are on a clinical reminder and which need marketing consent. The governance register applies the same expiry logic to certificates that the plan applies to follow-ups.
One thing this is not: a system for pressuring patients. A patient who understands a plan and declines it is a good outcome and closes it cleanly. What it counts is decisions recorded, not treatment sold — which is both the ethical position and, as it happens, the one that produces better numbers.
Seven screens follow. Each one opens as a real page — click through them.
The morning view for a principal or practice manager: outstanding treatment by age, chair utilisation against target, follow-up rates by clinician, and a list of what a person should actually do before six o’clock — ordered by clinical consequence first and money second.
The screen this study is built around. A £4,850 plan presented thirty-four days ago to a patient who did not say no — he said he needed to think about the cost, and nobody ever mentioned that it could be paid monthly.
Five follow-up steps, none of which existed as a task anywhere. The plan separates what is clinically driven from what is elective, prices the consequence of the delay using the practice’s own conversion rates, and shows the same failure repeating: this patient stopped attending for three years in 2020 and nobody rang then either.
£1.2m of diagnosed treatment sitting unbooked, and the honest number underneath it: £312,000 is what the pot is actually worth once you apply the practice’s own conversion by age. Quoting the £1.2m is how software gets sold; quoting the £312,000 is how it gets kept.
More than half the plans have no recorded reason at all. The smallest group — forty-four patients stalled by anxiety, twenty-one of them clinically active and left for five months — is the one to fix first.
Four and a half hours of empty chair today, forty-one patients on the standby list who would come at short notice, and 214 patients with treatment already diagnosed and waiting for a slot. Three lists that live in three places.
Underneath, why the chair sits empty across a year: 518 patients simply did not turn up, against a practice that sends one reminder and never asks for a reply.
Two entirely different cycles running side by side. A dental recall is a clinical reminder on a six-to-twelve month interval. An aesthetics top-up is a commercial approach about an elective treatment on a three-to-four month cycle, and it needs marketing consent.
Running the second under the rules of the first is how a practice ends up with a complaint it cannot defend — so the system holds the distinction rather than leaving it to whoever runs the list.
An aesthetics clinic bolted onto a dental practice inherits two regulatory worlds at once. The dentistry is inspected and the clinicians are registered; the aesthetics side turns on who prescribed, whether that prescriber saw the patient in person — a prescription for an injectable cannot be written remotely — and whether the practitioner was inside their competence.
One clinician’s mandatory medical emergencies training lapsed in August and he has treated patients on eleven days since. Nobody knew, because the certificate is a PDF in a shared folder — the same failure as the treatment plans, wearing a different hat. Eleven days of treating patients without it is the kind of finding an inspection does not let go of.
The screen also carries the complication protocol: the routes a patient can use to report pain or a colour change after an injectable, and where each one has to land. It is the only queue in the practice that is not allowed to be a queue.
A second audience, and a nervous one. The same plan in plain English — what is wrong, what would be done, what it costs, and which parts are genuinely optional. It separates the £3,270 that is clinically driven from the £4,850 total, and shows the monthly figure that nobody mentioned in July.
It also says the thing a practice rarely puts in writing: you are under no obligation to have any of this, and if you would rather do nothing we will book a review instead.
Four phases of two weeks each — eight weeks end to end. The treatment plan and its follow-up clock go live first, because 184 of those stalled plans belong to patients with an active clinical problem. Each phase ends with something the team actually uses, not a demo.
Weeks 1–2.
Weeks 3–4.
Weeks 5–6.
Weeks 7–8.
Eight weeks is possible because most of it already exists. The patient and case records, document handling, expiry tracking, escalation rules, the SMS and email engagement engine and the portal are running in production across six sectors already. What actually gets built for a practice is the sector core: the treatment plan structure, the clinical-versus-elective split, the two recall bases, and the governance register. That is the part this study is about, and it is the part we would spend the eight weeks getting right.
This took a fictional practice and made its process visible. The same exercise works better with a real one. Tell us how your practice actually runs and we will build a working mockup of it — your treatments, your language, your brand — before anybody commits to a build.
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