How a £2M Dental Practice Can Still Run Into Cash Trouble — And How to Fix It

Your cash position should feel rock-solid once you’re producing over £2M a year.

But in practice? That’s where things start to quietly break.

Not because you’re underperforming. But because you’re scaling volume without a model built to protect your liquidity.

Since 2019, as a Dental CFO and accountant, I’ve helped over 67 UK dental practice owners — including flagship, private, and multi-site clinics — navigate the exact cash compression that appears after you cross seven figures. And here’s what I see over and over again:

At this stage, most owners have already:

• Added 2–3 associates or therapists across chairs
• Taken on equipment loans to expand or upgrade
• Retained specialist consultants or new marketing support
• Shifted to higher ticket treatments (aligners, implants, smile design)

These are smart business moves. But without a cash system that matches scale? They quietly trigger chaos.

You start making decisions based on gut feel. Cash drops below threshold by the 12th of the month. VAT pots get used to cover payroll. And somehow, despite seven figures, you get paid last.

“I’m making less money — and it’s less cash — than when I was doing £800K production.”
— Samit Chitnis, Principal Dentist, Denmeand and Coarsa Ltd

That quote isn’t rare. It’s the silent reality for many clinics doing over £1.8M+ — especially when income timing and owner pay aren’t structurally protected.

According to internal Dentpulse reviews, nearly 1 in 4 high-revenue practices report some form of cash flow anxiety within 60 days of hitting a record revenue quarter.

And it’s rarely about revenue. It’s about rhythm.

Fast Takeaway

Even at £2M+ revenue, your cash system can still fail.

• You’re not protected by revenue — you’re protected by structure.
• Timing mismatches, high fixed costs, and “pay-last” models trigger liquidity strain.
• Fixing it means anchoring owner pay, syncing income with outflows, and forecasting forward.

Why Do High-Earning Practices Still Struggle With Cash Flow?

High-earning dental practices still run into cash flow stress because income scale outpaces financial structure.

As a dental accountant and CFO since 2019, I’ve seen this pattern in nearly every seven-figure clinic I’ve reviewed. On paper, £200K+ monthly income should create stability. But without cash logic to match, you get stress — not surplus.

This is the exact table I share with our Dental Practice Financial Management Mastermind group:

Misconception: “If we’re making £2M, we should always have cash.”
— Heard in 11 out of 20 reviews of seven-figure practices with overdrafts

The result? You’re rich on paper — and stressed in real time.

That breakdown usually happens for three specific reasons — and each of them is structural, not emotional.

1. Income Timing Lags Behind Outflows

Yes, if your inflows and outflows aren’t aligned.

Tip: Income isn’t late — it’s just out of sync with your liabilities.

Common Income Timing:

• Private treatment: Settles daily, clears in 3–5 days
• Plan income: Drops ∼10th monthly
• NHS income: Monthly, often delayed or adjusted

Fixed Outflows:

• Salaries: 28th
• PAYE/NIC: 22nd
• Loans: 7th + 15th
• Lab bills: Delayed, but predictable

Internal Data: In 8/10 practices over £1.8M, at least one major cost lands before the primary income source each month.

When cash doesn’t arrive in time, you borrow from reserves, defer suppliers, or delay your own pay. That’s not strategy — that’s survival.

2. Owner Pay Is Still Treated as Leftover

Most seven-figure practices pay themselves last.

Mistake: Thinking owner’s pay will “sort itself” once everyone else is covered.

Typical payment order:

• Pay team
• Pay labs
• Pay taxes
• Pay associates
• Then see what’s left for the owner

That logic might work at £500K. But at £2M? It’s a disaster.

You’re the principal. Your income must be hardcoded:

• PPBT™ (Personal Profit Before Tax) target
• Cleared-cash based pay runs
• Forward-forecasted owner distributions

Quote: “We didn’t miss a single supplier payment — but I hadn’t paid myself for 6 weeks.” — Dentpulse client, private ortho practice, £2.1M turnover

3. There’s No Weekly or Forward Cash Visibility

If you can’t see cash three Fridays out, you’re flying blind.

Question to Ask: “What will our available cash be in 21 days?”

If you can’t answer, you’re making decisions off your balance, not your plan.

At Dentpulse, we install:

• A 13-week rolling forecast (cash-in, cash-out, by week)
• A 12-week buffer aligned to fixed costs
• PPBT™-led pay triggers

Data Insight: In 100% of our seven-figure clients who implemented forecasting, stress events dropped by 73% within 60 days.

This is why revenue doesn’t equal rhythm. And rhythm is what protects your pay.

What Causes Cash Flow Failure in a £2M Dental Business?

There are three main causes of cash flow failure in a £2M annual production dental practice: Chair Cost Unknown, Associate Pay Drift, and No Cleared Cash Buffer.

From what I’ve seen inside 7+ multi-chair clinics, these failures rarely come from overspending — they come from overgrowth without cash flow clarity.

Here’s where cash failure typically hides:

Internal Data: From our records at Dentpulse, in £2M+ practices without pay logic, 82% report director pay delays by Q3.

💬 Lived Example:

“We were flying in terms of patients — but we had to delay PAYE by 3 weeks and I hadn’t paid myself for 2 months.”
— Principal at a 2-location mixed practice (2024)

What We Worked On:

• Mapped chair-level costs to work out occupancy/utilisation vs benchmark (90%)
• Re-aligned associate pay to production and a 15% profit target
• Implemented a CFFP™-based 13-week forecast

Result: Within 6 weeks, they retained £48.2K in surplus and paid Corporation Tax 10 days early.

Next Strategic Step: Strengthening Your Management Structure Without Breaking Cash Flow

Once you fix your cash rhythm at the established stage — aligning income timing, securing a 12-week buffer, and protecting director pay — the next pressure point becomes operational capacity.

Most £2M+ clinics reach a ceiling not because of clinical limits, but because the owner is still acting as the de-facto operations manager.

And here’s the pattern I see again and again in seven-figure practices:

You fix cash flow → stability returns → growth accelerates → operational load explodes.

That’s when the big question surfaces:

“When should I step back from ops — and when is it financially safe to hire an Operational Manager?”

To understand how to time this hire without straining liquidity, read:
When to Hire Your Operational Manager — Without Straining Your Cash Flow in an Established Dental Practice

This guide shows you:

• The revenue and payroll ratios that signal you’re ready
• How to model the full cost of an OM (salary + NI + onboarding impact)
• How to time the hire so your profit and PPBT™ stay protected
• The cash-flow traps established practices fall into when hiring too early or too late

If you’ve stabilised your cash but feel stretched, this is your next essential move.