Hello everyone, and welcome to Nordhealth's Capital Markets Day 2026. My name is Alex Cram. I am the CFO at Nordhealth, and I want to start by just saying a big thank you to all of our in-person attendees for traveling to London to come and see us today. We have investors from all of the Nordic countries, the U.K., Germany, France, and I want to say a big, big thank you to everyone who has traveled, especially our guest speakers who have come from the U.K., but we really appreciate that they will do a fireside panel for us later. We have a fantastic agenda for you today. We are going to start off by going into our group vision and long-term objectives. We are going to have a deep dive on the Veterinary business and strategy.
We are going to follow that up by a look at our AI products and our vision for AI. We will take a short break at that point, and after that, we will have the fireside [panel] with two of the largest veterinary groups in the U.K. After that, we are going to go into our Therapy business, and then we will finish up with financials and guidance. Today's presenters are Charles MacBain, our Group CEO, James Stanier, the CTO of our Veterinary business, Karan Wallia, the CEO of our Therapy business, and then me. With that, I will turn over to Charles for our group vision.
Thanks. Hi, everyone. There are many new investors and there are current investors which will be watching this, so I wanted to start with going through a bit of the basics of what we do and then we will go into more detail in terms of strategy. Let us start with what problem we are trying to solve. The main enemy we are trying to solve is admin, right? Both in veterinary and in therapy, the admin burden has increased, mostly due to regulation in both these specialties. Most of this admin work is unpaid. Our mission is to be able to reduce and automate as much of the admin as possible. The mission is to give healthcare teams more time to care, right?
More time to care for their patients or pet parents, if in the case of veterinary, more time to care for the business that they are trying to grow, and more time to care for themselves as well. That is what we are trying to do by building our softwares. In terms of the two verticals, we operate in veterinary, where we do veterinary practice management software. We have just over 4,000 clinics across the world, and also in therapy, particularly psychology and physiotherapy, where we have 13,320 clinics. We automate admin for over 17,000 practices every day. We have over 75,000 active users every day across our products. I want to start with where we are positioned, especially now that there is a huge amount of disruption happening in the technology world.
The practice management software, which is the product that we sell, is the core of the practice, right? The majority of the data of the practice is stored in the practice management software. We own the data schema, right? We also are the place where the majority of workflows happen. The people interacting every day with this data to try to input data and extract data are doing it via our services. Right? We also have all the compliance feature built in for both veterinary and therapy, for example, and the permissioning. If a receptionist has access to this data, but not this data, and so on. We also have a lot of trust that we are very thankful for from our customers when we build very closely together with them. We will hear from two of them today on the veterinary side.
That is one of our key assets, and that we can work together with them to build great products. The next one is that when I started the business, we were around EUR 3 million and a bit , and so we did not really have the scale to be able to invest. Now we are north of EUR 50 million of recurring revenue, so we have the scale and P&L to be able to invest in building a world-class product. We also have lots of different practices where we can actually push things out to them so that they understand how they are working better. The last thing is the team. James will talk a little bit about it, but we have a fully AI- native team on the R&D side. Even beyond, we see our team members across other functions beyond R&D using AI quite a bit.
We have done a big restructuring of our product team, both in veterinary and therapy, to make sure that we have a great team for this era. It is always good to talk about, here is the strengths, here is what we can do, but we have actually done something about it. We have launched a great AI scribe for both veterinary and therapy. We were also the first to market globally on the veterinary to launch AI billing, which is basically when you speak, it actually adds the items as well. We were the first in veterinary to launch an MCP, which basically allows you to query your data via Claude or OpenAI. Also, we have an ability to do this within the product as well with Ask Provet. James will talk about this later.
We've also been able, both veterinary and also soon therapy, gather all the data from all the different sources. There's PMS that was imported from the previous clinic. All this data is hard to be able to access when you have a 15-minute consultation. We've been able, with AI, to extract all the relevant information to gather a concise patient history. Another great thing is that one of the big issues that we've heard from vets and pet parents is that they don't get the information they need. Our AI Discharge Notes enables to distill what's happened, the medical terminology into pet parents' language. On the therapy side, there's a lot of forms, especially as you go in many different Nordic countries where there's a lot of regulation.
A lot of the therapist's time was spent filling in those forms, that same information again and again, and they've launched this AI form fillers. Where we're going next, James will talk a little bit about this, but for now, we're improving and automating the recording of information. Instead of people in practice being typists, they can just do their work and speak. Most of that will be entered into the database. The second is summarization of information. The next step of it will be us proposing the next step based on the information that we have and then taking action, obviously with clinician control in many areas, and being able to coordinate better across the whole workflow, and also enable agent to coordinate within those workflows. The goal is the same.
This is just an enability technology, but our mission goal is just getting time back for the clinician, getting time back for the receptionist. A little bit about Nordhealth at a glance. We breached EUR 50 million of signed ARR. We've been growing north of 20% over the last five years. Our EBITDA minus CapEx margin is still a - 5.3%. We've been investing a lot in AI and also in expanding into new markets. It's actually quite profitable to recruit new customers. Our lifetime value- to- customer acquisition cost ratio is around 16. That's because we invest a lot in products because we believe product is the way to win. Our churn rate, this is the unique thing about our business. It's the best thing and also the worst thing. A churn rate of 3% means that people stay with us for 30 years.
Which is a crazy number. It's also hard to recruit people from, even though they're legacy software, it's quite hard to recruit those people to move over to you. The net retention rate. This is the amount that a current customer spends more every year with us. It's driven by two things. One is groups are buying other clinics, and they migrate them over. Secondly, we build new innovative products that we upsell to our customer base. Just a bit about the history. That's where I bought the company in November of 2018. Now we've been growing over 44% over this period of time. What I particularly like is the organic part. 75% of this growth has been organic. It's been conquering one country after the next. Next is adjusted EBITDA.
In 2021, we IPO'd, and we decided to get much more aggressive with our expansion. We invest a lot in the product and go to market to be able to expand in veterinary in the U.K., U.S., Spain, Germany, and you can see that this normalized. In 2025, we were aiming to be profitable, but then we decided to double down invest on AI in that there was a big disruption that could have happened, and we see this as a huge opportunity to be able to accelerate our mission of giving time back to care. There are four main things we are trying to do across two buckets. One is our customer mission, which is making sure that practitioners save time. That is our number one mission. The second is that how is by making the software do the work versus people manually doing the work.
The where is we are going into U.K., Germany, and U.S. on the veterinary side. On the financial mission, we want to grow with discipline. We want to make sure that we are profitable starting in 2027 and every year thereafter. Second is 15% recurring revenue growth, ± 2% as a group over the next three years. That is a bit about the overall. I will do a little bit of a deep dive on the Veterinary business next. Where is Provet today? I will go back to the same framework that I had for practice management software. On the data side, we have 4,320 clinics using our software every day. On the workflow side, there are over 21,000 vets using our software every day.
On the compliance side, we have very probably two specific permissions per role, per market so that the different corporates can decide, do I want to be fully centralized, or do I want to be fully local, have a full local economy? You have that ability to do that in Provet. The fourth is trust, and I think the best proxy for trust I like to use is churn, and actually, the Veterinary business has even lower churn than average at 2.2%. The scale. We actually treat 1.7 million pets every month on Provet. R&D, James will tell you more about it, but we have been investing aggressively in building up these AI tools because we see massive potential to be able to meet our mission. We have six agents live, and looking forward to iterate on those and build new ones.
In terms of the market in front of us, there are around 53,000 clinics in our target markets. We have 50,000 left. That is a huge amount of clinics. In terms of TAM, we have EUR 29.7 million, and our total TAM is around EUR 570 million. We are still a very small player just in our target markets. What we have seen is that in the Nordics, our EBITDA less CapEx margins can be around 40% at scale. We are aggressing very aggressively at our new markets, but that is normally the margin at scale. A bit more about the markets. We have around 58% of small animal clinics in the Nordics using our software. There are some competitors, all very local, mostly less than 20 people in those companies. In the growth markets, we only have a 4% market share.
You can see in the U.K. we've got around 14%, 12% in Germany, most of which are on Vetera, the software we acquired, 5% in Spain, and 1% in the U.S. These are the focus markets for us going forward for the next three years. I want to break down a little bit more about where the growth comes from. In terms of market opportunity, the total TAM is EUR 570 million, which is 19x where we are today. More than half of it is from the U.S. But we've got a significant TAM as well left in the U.K., and Germany, and Spain. In the U.K., our strategy is to go after the corporate. We'll hear from two of them today, and there's four others as well in the U.K., large ones.
Same strategy in Germany, where the corporatization is much lower, probably around 10% versus 60% in the U.K. Starting that journey with them. The U.S. as well is also a corporate-first strategy, where there's around 40 different clinic chains there that are not yet consolidated on one software. In terms of unit economics, last 12 months, ending June, we grew 13.6%. Our net retention rate is 109%, so this is mostly about clinic chains rolling out net new locations. Churn was 2.2%, as I mentioned. Our LTV to CAC is 26.7, which is quite healthy, so the amount we spend on sales and marketing relative to is quite low versus the revenue potential. As we mentioned, the EBITDA minus CapEx margin around 40% in the Nordics.
We're now the number one player by far in Europe, probably double the next, and number two in the world after ezyVet, which is owned by IDEXX. In terms of the revenue, in 2018 when I started, we were mostly a Finnish business. We used to have English classes, I remember, on Wednesdays in the office. It was a very Finnish business. Then we conquered the Nordics, one country after the next. Probably too many countries at the same time. I've learned that the hard way. In 2022, we mostly had the majority of the Nordics using Provet. We expanded internationally in the U.K., Spain, U.S. Now over 51% of our revenue comes from beyond the Nordics. I still remember showing this chart where we had just Finland, and then the Nordics was the expansion.
We're looking forward to not adding new countries and focusing on those to make sure that we provide a great product for those countries. The second part is our enterprise growth. The Nordics was one of the first parts of the world to be corporatized. A lot of the big corporates actually had their first roll-ups be in the Nordics, and so we benefit from that, in that those were our early customers. We really built Provet to be an enterprise-first product. You can see this translation where over 1/2 of our PMS revenue comes from enterprise customers. We do also have additional revenue of EUR 3.9 million from payments and other partners, which is a new business we've built. But the driving force, and we see going forward, will also be our enterprise partners.
In terms of growth, we have invested more in 2025, but we still remain both EBITDA less CapEx and EBITDA breakeven at least. The slowdown in our rate of profitability in 2025 was a deliberate choice. We do not want to be profitable but not have the best product in the market. We are committed to when there is an opportunity for us to accelerate our mission, we will go after that opportunity to make sure that our customers get the latest and greatest. How do we differ from our different competitors? Compared to incumbent PMSs, one is we are independent. When choosing us, we are committed to building the best software that can save you the most time. We do not care if we sell you more lab tests or we get more volume for you on your wholesaler. We are committed just on that one mission.
Second is we have made big pivots to become a native AI company. James will talk a bit more about that. The third is we do not talk about having agents. We actually built them. You can judge us based on the number of people that use those new features. There are some startup PMSs in the U.S. and U.K., for example. The big differential of us versus [them] is that practice management is hard. The best thing was the churn, the worst thing is the churn. If you are a VC-backed company and people do not churn, it is very hard to be able to gain that scale. The financial stability is not there. At some point, they might be successful, but there is a big chance that the amount that they spend, they lose every year.
If they do not get the next round of funding, they might go away. Right to the startup PMSs, we spend a lot of time on building secure products. The threat of security is increasing every day. The next is that we have built an enterprise first product with centralized reporting, centralized pricing, and item management. We are proving at scale. We have actually run hundreds of clinics on the same database. There are new competitors, which are AI scribes. They are point solutions just doing the clinical workflow. Yes, they are AI-native. They have got good agents. But you have to switch between one software to the next. They are only point solution. They are not only one solution. They also could go away because they do not have the financial stability, and they do not have all the different enterprise features required.
That is how Provet is positioned in the market. Now, the two growth levers. That is why it said win new locations. We have got 3,600 locations on Provet and of 53,600. The second is, as we add net new products, we can grow our revenue per location from around EUR 570 to EUR 1,190, or go into each of these separately. The first is on locations. Number one is the U.K. We have got around EUR 6 million of ARR today, and the total TAM is around EUR 60 million. We have got 14% location. TAM is hard because of the AI adoption rates will increase the TAM. As you can see, 16% of the market is owned by the top six players. That is what we are mostly targeting in order to win the U.K. Second is Germany. We bought Vetera in January 2022.
We left it there because we wanted to focus on the U.K. and implementing our corporate partners there. We've got around EUR 2.4 million of ARR today on Vetera. The total market's around EUR 80 million. Very little, a few clinics are actually owned by the big five. They're around 4%, but it's growing quite fast. This is a market that's very underserved. The majority of the clinics are on server-based software, so they actually have a server in the clinic, and it's the 21st century. Germany is normally quite a laggard on this side, but over time, they will shift over to a cloud provider. There's no current cloud provider in the market. Then the U.S. So focus on U.S. enterprise. It just repeated the playbook that we've had in Europe that's been successful with us.
The nice thing about the U.S. is, and what I want to—y es, it's a really tough market, but the expectations are high. If we do this, it also benefits all the rest of our customers in the rest of world because they're fussier. I always say Finland is the happiest place in the world, but it also has the lowest expectations. That's why there's a happiness gap, and that's why we can provide a great software. But the U.S., they're really fussy. When Microsoft first launched one of their products, they actually went to Japan because they were really fussy customers, and fussy customers build great products. We look forward to—t hat's also why we spent a lot of time with enterprises because they care, and they're very detail-orientated, and that's how you build great products. So that's on locations.
Then revenue per locations. We're at EUR 570. We make roughly EUR 500 from selling the practice management software, EUR 70 from payments and AI today. There's a huge opportunity for payments, which is around EUR 450. We also have the potential to upsell AI. We're actually making it quite affordable for everyone. It's around EUR 120. Then conversations, which is something that they use third parties for, which we're bringing in-house. That with the current pricing that we have, that is the change that we can have in our ARPU by upselling our customer base. So talked a lot. I want to summarize. So what to take away. Number one, we are the number one player in Europe. We've got around EUR 30 million ARR. We've got great unique economics. The reason I bought this business is this churn rate.
It's a great thing to have very low churn rate and faithful customers. Second, we've got good net retention. As our customers keep growing, we've got the opportunity to upsell them net new products, and it's very affordable to recruit new customers. Like a good LTV to CAC is 3. We're at 27, so. The third one is we don't need to go into new markets to be able to grow 19x bigger. I'll finish with the AI opportunity, and I'll hand it over to James, who will go through a bit more detail about the AI opportunity. Thanks for your time. James, I hand over to you.
Thank you.
Pleasure.
Okay. Just, firstly, can everybody hear me? All good? To put this into perspective, the last time we had a Capital Markets Day, which was in 2022, there was a new upstart product called ChatGPT that just launched. A lot has changed in the last four years, in terms of what we expect out of software, what we expect out of everything that we do. This section is just meant to show you kind of where we are at the moment, how we have gotten there, and where we are going in the future in terms of AI. I am also very aware that AI is one of these empty buzzwords. I would say I have got some examples of things we are doing in the product right now.
If you are watching this and you are physically in this location, just come next door at lunch, we will give you a demo of all the latest things and just show you how this is transforming. It is really exciting. We have got a really interesting sweet spot that we find ourselves in. In that, we have been around for a long time, and we have these things at the top, which are assets that take years to build. Being able to operate in many different locations, to have all of the workflows, the permissions, everything takes a lot of time, and actually working with customers in real life. We have also, over the time that we have been operating, we have structured data for all of our customers, thousands of clinics. We have a really rich amount of data behind the product.
Probably the most importantly, is that we, as a company, are highly trusted in our industry. We have got flagship customers, some of which are in the room, thank you for coming, who trust us to store their data, protect it, and make sure that the right things are done with it. We have that, and that is the foundations. What we also have, which is really interesting, is where we are today, is that we have a huge amount of engineering velocity. We have a very strong team, which I will get into in one of the coming slides. Importantly, is that in the last year or so that I have been here, we have really upskilled the team. We have completely changed how we deploy software.
We've ripped out and rewritten large portions of the stack, so that fundamentally now we're starting to manifest into the product all of the AI things, which I'll show you some examples of, from scribe to summarizations to Ask Provet. These things are now manifesting as a result of the last year of what we've been building. This slide as well, if you see this kind of grid thing going on, we kind of have the best of both worlds in that if you're an incumbent PMS, like ezyVet or one of the other competitors that we have, you are not this independent technology-first SaaS company, which is what we are and what we intend to be. Yes, you may have depth and breadth of data, but you don't have the infrastructure to do what is needed for the future.
Also, if you're a startup PMS, yes, you may be coming to market with a new tech stack, but we have the trust and we have the operational capability across many geographies to do everything at scale. We're really uniquely positioned in the middle. Also with these AI point solutions, which you see as well, there's lots of scribes, there's lots of these nice little tools that you can use. Sure, they're great, but fundamentally, if you think of like a hub and spoke model of a wheel, we are the hub. We are at the center of a clinic. We have the data, we have the knowledge, and we have the trust.
We find ourselves in the middle of a really nice situation where we have both the data and the trust, but also the skills in order to really move us into an even stronger position with our software. We only really had to just add agents now on top of what we're doing. We don't have to rebuild everything from scratch. We've done that journey. What we've been doing over the last year is effectively a rebuild of the team. When I joined, it's safe to say that we were quite underutilizing AI, both in terms of how we built software, but also how it manifested in the product. That's been my focus since I got here. I joined just over a year ago. I used to work at Shopify, somewhere that was very first to market with all of that kind of stuff.
It's like, "Can we do this for Provet?" Both myself and our new VP of Product have been on this transformation journey with the team. It's an expectation now that every engineer who works for me, you are generating code. We're using AI tools in order to ship software. We've gone from shipping weekly to hourly. We've already shipped about six times today in the time that we've been awake. It's a big R&D transformation. On top of this as well, we are at the moment very fixated around the talent density of our department. I don't have any big plans to triple the size of the team. I want to keep the team the same size and then make sure that everyone who sits in one of those seats is both a high-performing individual and they've earned their place.
I see over time us staying the same size or even getting slightly smaller, because at the moment with AI, as you know, everyone's theoretical upper bound of their productivity is unknown. We're on this journey of seeing how productive and how efficient we can be. We're fixing the size of the team and then just seeing us grow that way. Just in terms of some stats at the bottom there, 100% of engineers now are using AI tools to generate code. Almost 100% of our code is generated now. We do not write code anymore. We have spent a huge amount of time working on our code base and our tooling to allow agents to work within it.
Just measuring from when I joined to the end of last year, for example, we had 130% increase, over double the amount of lines of code shipped to production and doing it basically hourly, or less, compared to what used to be monthly releases. Under the hood, over the last year, there has been a huge amount of team rebuild going on. This also kind of transfers to how we think about building products as well. Amy, who I partner with, I have worked with in the past, at Brandwatch, which was one of, I think will probably remain to be in the future, the south coast of England's biggest exit. We grew Brandwatch there and sold it to Cision.
High trust with my product partner and all engineers, all product managers are super fixated on the two things that Charles said are really important, which is vets need to save time and also they need to run their businesses really well, and that is everything that we are focused on. In terms of the technical side of why that is important, we have completely rebuilt our data warehouse. All of the data that is stored in Provet is now in a completely different system to when I joined. We effectively have one clinical data model for all of our clinics, all of our countries, all of our locations. The storage is far faster than it used to be. Not only is that good for scaling to customer growth, all of the storage that we have rewritten everything into is built for AI.
When you use Ask Provet, it is the data model that we have rebuilt that has enabled that to happen. In terms of our stack, it is not exciting anymore to say that you are in the cloud, but we are a modern, cloud-native, API-first company. All the technologies that we choose now are to enable AI in the products for our customers. The really important thing as well is that because we have been in the game for a long time, we have great compliance, great audit trails, all the kinds of things that are kind of afterthoughts that the startups will have to think about. We have true scale. We are multi-region. We have a huge amount of data, and the more customers we have, the more data we have, the more insights, and the more that we can do with that data as well.
It is a virtuous cycle, which is really nice to be in the center of. You can talk about AI, but it is worth just to see in the product. I think I took these screenshots on Friday, so this is real. We have talked about AI scribe, and we have talked about summarization, which is where in the consultation, you can speak, and it will capture the conversation, create the transcript, create the notes, create the AI actions. Again, if you are here in physical location, you can get a demo. Also by rebuilding all of the back end, we have enabled something like Ask Provet, which we recently shipped.
The other part that we find vets struggle with, especially if they are not part of an enterprise group, if they are a solo vet or if they are part of a small chain, even though they got into veterinary medicine, they unwittingly also have just become an entrepreneur, even though maybe that was not their training or background. A lot of the challenge as well is how do you run a good business as a vet, which is hard because you have to think about a lot of different things. By using Ask Provet and putting agent on top of our new data stores, we can provide the whole ChatGPT, Claude, experience in the product to allow you to explore your financials, to alert you to are there any gaps in your revenue? Is there an action you need to take?
As time is going on, we are adding more and more data to this so that effectively it becomes your sidekick that helps you within the app in order to run your business as well. We are really excited about this, and you can ask open questions. It can generate data for you in tables, natural language. It can give you suggested follow-ups. It can break things down in charts. Really, the whole experience that you expect by using Claude or ChatGPT or similar, we have brought that into the product, liberated on all of your data, so that we can help vets run their businesses better. Again, about the foundations that we have been building. Over the last year, rebuilding all of our back end to enable products like Ask Provet, the nice thing is that within an extra four weeks, we shipped our MCP.
We will be doing the marketing launch of that very shortly, where for users who love Claude or ChatGPT, they can just authorize with our MCP server, and then outside of Provet, they can ask whatever questions they like about their practice. As an example here, using Provet appointment data, make a graph of my busiest hours and show which times I have the most customers. Using the MCP server, it can tell you that, and then you can go and build your own tooling. You can chart it how you want. You can export the data. By getting those foundations in the right place over the last year, we are really seeing all that underwater iceberg start to come above the surface, and the fruits are spilling out now, which is lovely.
This kind of gives you the direction that we're going in in terms of AI. It's been a rebuild of the team. It's been a rebuild of how we work, and it's now manifesting in the product. It's just the beginning, really. There's a lot that we want to do. With that, ends my section on AI. I'm really excited about all the stuff that we're doing. I'll hand you over to Alex for the next steps, I think. Thank you.
Hello. Thank you very, very much, Charles and James, for these incredible insights into the massive opportunity that we have in Provet and the product we're going to build in order to capture it. We're going to take a 10-minute pause now, just to allow the fireside panel to get set up. For those watching the webcast, we will resume the session at 1:45 U.K. time.
[Break]
Hi, everyone. We've got a fireside panel with two of our largest customers. One is Richard, who is CEO of Vets for Pets, and we've got Graham, who's Director of Innovation and Transformation at CVS, two of our largest partners. I want maybe to. We'll have a discussion all together to talk about the industry, to talk about the practice management software as a space, and then their experience with Provet as well. Maybe I'll kick off with, if you could briefly introduce yourselves and your business. Maybe we can start with Richard.
Sure. Hi. So, yeah, I look after the vets group for Pets at Home. We are the largest first-opinion practice, which essentially means entry-level vet group in the U.K. We make up about 10% of the vet market in terms of the sector. I've been with the business now for just two years. My background has been broadly in operational and performance management, including military, operational sport, retail, and hospitality. The vet industry is a relatively new one for me. I think one of the really interesting parts of it has been in recognizing how actually there's a huge change, and we'll talk a little bit about the change in the sector in terms of how pets are seen. But also in terms of the brands that look after the clients that own pets and how important that is and how that's changing as well.
We have 460 vets practices across the U.K. 330 of those are within the pet stores, and then the remainder are standalone vets across our ecosystem. We have a very unique model. Our vets model is essentially very similar to a franchising model. It is called a partnership model. We work in partnership with all of our vets practices. The difference between franchise, we provide all the service support that a franchisee would, and also the management support as well, to support all the management administration behind running a practice centrally. But what we do not do is we do not dictate any operational or clinical guidance. We provide support. Our practices have complete operational and clinical freedom, and that is the difference between franchising and partnership. We have a really unique model, 460 practices, and we have about 600 different practice owners.
When we talk about entrepreneurs, we have about 600 different variations of that, all under one brand banner, and all running local practices as part of a national chain, if you like.
Okay.
Yeah. Thank you. Graham Dodds. I am a veterinary surgeon by background, and as Charles mentioned, I am Director of Innovation and Transformation at CVS Vets. CVS Vets is a listed company. We have been around for, I do not know, 20 years now. I think growth predominantly through acquisition, mostly in the U.K. We have about 500 locations across the U.K. and Australia. The vast majority of that is first-opinion veterinary practices. There are some similarities. We do not have a tell approach with our practices. We very much support them to grow. We recently moved to the FTSE from AIM. That was in March last year. I think, although our results are not produced until September, our interims kind of stated that we drove about EUR 700 million revenue this year, which turned into EUR 140 million EBITDA. We employ 9,000 people, 3,500 of them are vets.
A similar number of nurses, maybe slightly more. I have been there about 10 years myself. As I mentioned, I am a vet by background. Before CVS, I had my own practices, grew them, sold them into CVS, which is how I ended up there. So very familiar with that journey. In the first five years of that ten-year tenureship with CVS, I was in operations, so I ran our referral division. We have a few multidisciplinary referral centers scattered across the U.K. I also ran our equine division as well. One of our areas of veterinary practice we decided to diverse into a while back was equine, and I ran that. But throughout my whole career, I have been really interested in challenging the norm. I used to do that a lot at the exec and, for my sins, ended up in this role.
For the last five years, I've been overseeing the transformation of many of our processes, but most of them center around technology, which is I assume why I find myself sat here today.
Thanks, Graham. Maybe I'll start with you on the, what do you see as the biggest source of friction or inefficiency that led you to make a change in practice management software?
Yeah. Well, I think that's the right to do it myself, right? Yeah. I think when looking back at the systems we did have before, I think it was mentioned by one of you guys earlier that we had a standard kind of traditional practice management system software, but written on Visual Basic 6. A very old piece of kit running on practice servers. I had to laugh when someone mentioned that earlier. We were that operator. We had made the decision to move to one PMS way back in the day for lots of reasons. But when we sat down five, six years ago and thought about the future, and we thought about the things that we wanted to achieve. Clearly, this wasn't the route for us. It wouldn't open them up, and we saw it at the time.
I think there were three key things, thinking back to that PMS, that were a challenge at the time, let alone our future aspirations. I suppose those three things, the first one was inefficiency in the consult room. There were lots of clicks to get anything done. You've talked today about making life easier for the vet. It certainly wasn't, and this was measurable. We saw it in things like billing audits. We would do billing audits to check that billing matches work done, and it didn't. There was a lot of opportunity to close that gap. Not all of that gap was the PMS, but a significant portion of it was. It was tricky to bill accurately, was just one example.
I suppose the second of the three was as we grow as a business, we wanted to be able to standardize and centralize a lot of processes. I've just mentioned we're there to support our practices, not tell them what to do, but it's much easier when you've got SOPs and protocols to help do that, and we couldn't do that. Again, because of the on-prem infrastructure, I think we had about 450 instances of that PMS across 280 servers, and to try and put anything out centrally was nigh on impossible. I suppose the third thing was data, a big one. We really wanted to get more out of our data, and we've been working very hard to take data from hindsight to foresight in CVS. Hindsight, we were okay, actually.
We could pull reports from our last PMS, but they were pretty static and pretty slow, and again, due to that infrastructure, hard to get access to. We needed to move. Those are three big things outside of cybersecurity and various other things that made us think we need to make a move.
Thanks. What about you, Richard? Do those challenges resonate with you, and what was the original decision for—
It was like a shot to the heart when I heard you talk about server-based businesses earlier on, because we are still server-based, but transitioning out of that. Yeah, definitely, clearly, one of the things about advances in technology, digitization, and everything around that is, at some point, you have to recognize the need to change. Legacy systems start to hamper you rather than help and enable you. That's definitely— I think you go through a period of denial initially, because it's a big change, and an investment as well. I think when you look at the last five years within the sector as well, the sector has grown disproportionately in terms of its volumes.
You need to be able to increase your capacity, enable and increase capability in order to really make sure that you can continue to grow at pace with the sector as well. You need the right support enablement to help you to deliver that successfully as well as that. I think really for us, the combination of all those things in recognizing how we need to change and really move from being a very analog-based business into a digital and AI-enabled business, actually, in terms of positioning ourselves.
Thanks. Maybe starting in history, CVS was the first one to choose. Why did you choose Provet versus any other practice management softwares out there at that time?
Yeah. Well, as Richard said, it's a big decision. There is a little—
Choosing a partner is a big decision.
Yeah, exactly. Your churn was informative. Yeah, it was a big decision. We knew that we wanted to do that, and the examples I just gave, they were today problems of the time. I didn't even touch on where we wanted to be in the future. It was clear that's what we needed to do. First of all, I think we started off with some golden rules that we wanted to go out and explore all PMSs with, and they included things like we wanted a cloud-native product. I mentioned cybersecurity already. We wanted something that could integrate with other third-party industry-leading technologies as they developed to give us that flexibility and scope. When we applied those golden rules to probably 30+ PMSs we looked at, those rules alone whittled the list down to very few, within which Provet sat.
We then came up with an internal assessment tool that we designed ourselves, really. Again, that looked at some of the problems that we have that were today problems, so things like diary management, billing, stock control, all that kind of bread and butter stuff. Beside that, some of the future things that we would like to be able to do. We then scored it. We literally spent time with yourselves and other players, and you might remember those days. We got access to the sandbox and played with them all. We scored them, literally scored them. Provet consistently came up as the leader as a product. The next thing, obviously, of course, all the due diligence and things needed done, but the next thing was for us to do a trial.
That was to really sense check our conclusions on the product itself, but also, we can tell you this now, it was to test whether or not you guys were going to be a good partner for us. Of course, it went well. I think we did one practice that we really focused on for a couple of months, and then we moved to half a dozen practices for a few more months. We were testing things like how well you guys could support us with the changes that we would expect to see, how adaptive and responsive you would be to things that we believed were gaps and stuff, and just general support, which is mentioned as well. That partnership for big scale businesses like ours is really important. That's how we did it, and that's how we ended up with Provet.
To summarize, we had a very open mind to begin with. We didn't have a clear view, and I think even back then, it wasn't so clear. It wasn't so clear how many of the players that were out there were really trending towards the top. Fast-forward to now, I think as you've conveyed today, that's a slightly different picture, but yeah.
But you were at [inaudible]
Yeah, I think we recognized really quickly that when you look at one of the things that Charles has brought out, which is relatively unique, is that you're in it for the long term in your partnership. Not only are you making, you're making essentially a quarter of a century decision on the back of a change when you look in the rearview mirror, has not been made more often than half of that time period. So anything from 50 to 20 years. So, it's a really significant moment in time. It's a significant change decision. There's a lot that you have to consider within that. We did primarily the same. So we took a representative group of our own practice owners because that was really important.
Slightly different needs, because you've got a need to have a certain level of local customization in order to have that clinical and operational freedom. But at the same time, within a framework of a really sound and solid future-proof system, with a partner that you know is going to be there in the next quarter of a century. Now, that's really important. Because it's a substantial investment as well, of course. Alongside that, we reviewed and tested 50 different operation systems, and then slowly worked those down. I think partly I would reflect, I think the sales team was one of the best definitely with what it promised. Actually some of the stuff you are delivering now. So that was pretty true. Not only that, yeah, I'd echo what Graham said about partnership. There are two things here.
An enterprise system with international influence is really valuable because you get to gain all that benefit as the system develops, and the inputs internationally are also helping to develop the capability, as well as us also contributing to that too. So a really meaningful international reach enterprise system has been really important to us. Alongside that, I think just a great partnership where there is always going to be give and take, and you don't sweat the small stuff together because you really tackle the big stuff. You have patience with each other, you understand each other as much as you can, and you challenge each other as well in the right ways. I think that I'd always measure the value of a partnership in how the team feels about actually interacting and working with.
If the team enjoy it, then that's a really good sign that you've got a good partner.
Maybe for both of you had your structured assessments, you did your pilots. What came out after this that you didn't think was important, which you think is important today?
There's one for me w hich I kind of noticed, and we'll probably come to the rollout that we did later in the conversation. I don't think we assigned enough importance to how intuitive the system is actually. I don't know if we kind of overlooked it or not. It seems obvious now, with hindsight. But I think we were just so used to platforms not being intuitive. We, in CVS, we've got, we call it Knowledge Hub. I'm sure you'll have similar. It's a training platform where we have a mixture of sort of bespoke training that we've done for whatever we need to help support our practices with. The practice management system section in that was huge at the time for our previous system.
We did, you may recall, we came up with some videos and training sessions for Provet. We did it ahead of our ultimate rollout we did. We always are monitoring everything, and we were looking at compliance of that training versus engagement in some of the workflows. Then again, there was huge mismatch. There wasn't much training done. The teams just managed to do it. Our conclusion was they either taught themselves or they learned from each other. Both of them are great wins, in the spirit of working together and getting everybody on the same page. As it transpires, as I say, I'm sure we'll come to it, we did quite a quick rollout of the system. I don't think that actually would've been achievable if the system wasn't so intuitive. I suppose that's one thing I would acknowledge.
Yeah. I think two things for us. The first is the realization that you're having to engage with a group of practices who aren't asking for this change. They know it's necessary, but they haven't invited it, so you are forcing it on them because it's necessary. You come to end of life with one system. You've got to move with the times. So the recognition that there have been over a decade of customization on something they felt really comfortable about, to say, "We're now going to change that." Helping them to understand the reason for the change, but not only that, actually really help them to understand the intuitive nature of what a new system might feel like.
I think alongside that, and I think this has been probably the most interesting development, is I think prior operating systems were highly administrative in terms of how they support the way the practices work. The reality is now that the development and capability of the platform that you run in a vet practice actually starts to inform you about how you change the design of how the practice works and how the practice delivers its experience to its clients as well. There are probably three key areas there, and I know some of these have been touched on. So the first is being able to consult with a client and their pet without needing to touch a keyboard.
That's a massive change and shift in terms of care, interaction, and also the capability of being able to then harness data to be able to prompt and suggest and really enrich that consultation, which can all be fed, can actually be fed through that whole experience. Then removing time in terms of actually then having to make notes afterwards and how you administrate that. The connection between the consultation room and then the administration within the practice and how that can be enabled and completely changed and differentiated in terms of providing different levels of information and also providing information in a really CMA- compliant way as well. So one of the key things from the Competition and Markets Authority has been about transparency, and about itemization, and about clarity.
Actually, having a platform that enables you to automate all of that and provide that in the right formats actually means that those elements are not things that practices have to think about because they can happen automatically. Then the final part, which is one that has surprised us, is that there are three things that come out really clearly from clients as customers. The first thing is that the number one thing that they value actually, in terms of digital integration, is online booking and how useful that is. Even if you have got a terrible online booking system, they value it. But actually, AI means that you remove any clicks to an online booking system, and it becomes a conversation about then customizing the booking to the best slot, your best preference.
When you then step back from that and you think about the client experience in a reception, because the one thing about vets is you are always going to get physical visits. That is guaranteed. That will always happen. But actually, the experience within a reception in terms of, am I acknowledged by the reception team? Is my consultation on time? How well-informed am I? Currently sits around a checkpoint, which is the reception. Actually being able to remove the reception desk and make it more about a client hosting experience because the digital functionality of the platform can support more self-help from the client and more guidance, suddenly revolutionizes the way that the client feels about, first of all, experiences care, and then how they feel when they walk away from the practice and think about your brand or about the experience.
Those things, I think they have been certainly more recent beneficial developments, and they will just become more and more relevant to what we do.
Maybe shifting on to rollout. In 2024, CVS rolled out almost 350 clinics in six weeks. Still remember the call for the eight weeks deadline—
Yeah.
—back in the day. What made it possible to implement at that speed, and what did you learn from that experience? If you had to redo it, how would you do it?
Caffeine made it possible. It was lots of sleepless nights. The product helped a bit, but the people clearly were really important in having the infrastructure around us to do that. It wasn't just rolling out the PMS for us, we also had to take care of hardware and various other things. There was lots of stuff going on in the background. Within our business, we had project management support, change management support. We also built a team of specifically trained PMS support people, which you helped us with. You provided your own, and you trained up some of our own people. Yeah, a lot of late nights. Having trust in Nordhealth as a partner was key. We really had to make sure that data migrations and things were done every night on time. I remember practices would close at 8:00 P.M.
The data migration would be done, tidied up, checked, and by midday the next day, they would be all on their new system with their new computers. That was it, really. Making sure we had the right people. There was a lot of work done around explaining the why. As Richard's covered already, it's a big change, and people in practice feel like it's being done to them. But if you explain the why, which I think we did effectively, it worked. Moving at pace was, I think, a good thing. Because quite quickly it created a critical mass, and everybody was in it together. I think once we'd made our minds up after that trial that that's what we wanted to do, it was the right approach. Whether I would do it in six weeks again, I'm not sure. But we wouldn't go that fast.
But certainly, I think once you made your mind up, going for it is the right thing.
What about you, Richard? The 50th clinic is now on Provet. As of July.
Yeah.
Right. How is the experience with implementations so far?
Well, we are about through 75 now. We will be at 100 in September. For us, I think it is always the fear of the unknown, I think is what prevents you from feeling comfortable taking certain levels of risk. I really admire actually what Graham and the team have done. I think there is always a great attraction to actually leaning in that direction and going, "You know what? Actually, it may be some short-term pain," but getting everyone through it and all together on it actually is not necessarily a bad thing. We have taken, I think, a more considered approach simply because we are very conscious of each individual practice being business-owned, essentially.
That doesn't necessarily mean that we won't consider and shouldn't change the approach we have, but we're certainly at a pace now where we're doing 12 a week on a regular basis, and continue to roll through. We're seeing a much better level of consistency and confidence, which I think is really important. That starts to then build advocacy and then builds understanding and builds excitement actually, to a certain extent. I think we're in a good place. I think you have definitely challenged our thinking more than sometimes we'd have liked to, but I think that's really what a healthy partnership all means.
That's really helped us to also, I think, hold our nerve when you make decisions to step into the unknown, and rely on that experience that sits around you, and to give you confidence that you're not stepping into the unknown alone. You've got experience and support around you with that.
We did have rollback and contingency in place, but I think of those 340, I think there was only one or two that didn't quite go to plan, and we got there in the end. But yeah, it was interesting times.
Now shifting to AI, where do you see the AI creating the most immediate measurable value for your practices?
Yeah. I think I probably touched on the three key touch points that we've identified, but actually the reality is that it's only as good as the data that you provide it with. For us, actually, and it's one of the big benefits of cloud storage again, is that actually data sharing is much easier and smarter. But actually, also we've got to remember that we're part of a much larger pet group. And within that, we've got an incredibly rich seam of data in terms of on clients, customers, and on everything to do with pet care, actually.
Really being able to harness that, not just because it's beneficial commercially for the group, in terms of actually being the U.K.'s only complete pet care provider, but actually within that as a vets group, being able to use what is essentially independently built data at a server level by practice to be collectively harnessed as a total means that every practice benefits from that, and benefits from the information that that provides to help it to make decisions, to be more intuitive, to be more efficient, more effective, and to help guide it based on really good quality information. Without the data, you can't harness it.
And I think for us, that's been really important in recognizing how significant that is, because that sets the foundation, and then you've got to enable it with the way that you can provide data and share it, in order to then be able to really harness it.
Thank you. What about at CVS? Where do you see the AI opportunity to transform your workflows?
Yeah. Well, I have got to agree with everything Richard has just said. I think going into the consult room and looking at some of the stuff that you can showcase today next door for the people in the room, really clever stuff. I do think that the opportunity for efficiency lives mostly in there. Any interaction around the customer or client, pet parent, to use your terminology, to give that vet focus and time to interact with them properly, I see a huge benefit there. Because it does, as I say, as a vet myself, it does distract you somewhat, having to constantly turn away and make sure that your notes are typed up when you are already running five minutes late for your next consultation, et cetera. You get the picture.
The client experience that we would love to deliver, that for the same reasons we struggle to do. I do not know if it is a real stat, but it is said that a veterinary customer will leave the consult retaining only 5% of the conversation that was had. We would love to be able to send them home with access to comprehensive notes that are relevant to them. That is easy to do when you have got plenty of time, but you do not, whereas AI can do that. As you know, we have been trialing that element of your product for a while now, and that is really transforming that customer experience as well. I think the sticky touch points are in the consult room and giving the client that experience that sort of extends beyond that. I really see a huge value there in the day-to-day workflows.
Within the data as well, again, Richard has touched on data already. I mentioned earlier, we want to get to the point of having real foresight and understanding what our clients are doing across the business. CVS as well, we do have our veterinary practices, but we also have our online pharmacy. It would be great to have a single customer view across our entire estate and start to understand what behaviors, if anything, do exist out there. Even if it is down to disease, what is the incidence of arthritis at certain age groups and certain breeds? What might that do for our business?
Should we be reaching out and utilizing this platform and CRM to contact customers sooner with breeds and species that fall into that bracket, and get those patients into care faster and sooner, which is great for the pet, great for the owner, and is hopefully commercially successful as well. So two key areas. There is the sticky touch points that make the workflows clunky. I think there is a huge bit on data where we could start to strategically inform how best to grow the business and provide better care to those patients that are going to become ill as they get older.
How do you make the decision on whether to build your own? Both of you have access to development resources, or buy a third party for that or have it in the PMS?
Yeah. I do not know. It is early thinking, this one. We have trialed third-party apps at the minute across our estate.
Yeah.
They have gone well. They are good, some of them. I think what you are doing now is I can see the acceleration, and we are utilizing your product really well. My gut feel at this point is that the more that you can have within the PMS, probably the better. I am happy to be challenged on that view. I think although at the minute the use cases are early, I think as things expand, applying that AI beyond just scribe technology and extending it into looking at the history of that patient in conjunction with other anonymized data from other patients of same backgrounds and things like that, I think it would be much faster. Whereas third-party applications do not have that level of integration, cannot work that fast. Then there is just the simple administration of that technology in the consulting room.
Having more windows open is more clicks, which is clunkier, et cetera. My gut feel from the way I see it evolving, it is nascent, but I think if that can be achieved, which it looks like you are on the track to do, that would be my preference at this point, but we will keep an open mind.
I would agree. Simpler is better. The constant development in technology and how you can use it, if it does not make things simpler and easier, then it becomes a real challenge. These are highly complex systems in terms of what they are able to do, but you do not want to have to worry about that. The complexity of the system should take care of itself. Actually, the simplicity of how that means, so reducing actually the number of providers you work with, reducing the number of systems you have to try and access in order to enable you, I think is always going to win. I think simplicity is such a critical part of being able to deliver success in an ever complex world. That is it.
Yeah. We both want our vets and nurses to vet and nurse. The more we ask them to start playing with multiple systems to achieve an outcome, the harder that will be, and the compliance will drop. I think that fits with that conclusion, yeah.
Maybe we are very deep on the veterinary industry, but just for the investors here, if we zoom out, we have had the pandemic boom in pet ownership. What do you see the outlook for the veterinary industry in the U.K. more broadly in terms of the next couple of years?
I think—
Yeah.
—what's been fascinating, not only have you had a massive growth in volume of pets, 38 million pets within the U.K. You've also had significant capacity and growth within the sector as a result of that. Pet ownership has changed significantly, too. The U.S. commonly refers to pet parenting. Pet parents are a very clear definition of how pet ownership's changed. The dog in the home now has a place on the sofa in front of the TV. They used to be in a kennel. The indoor plant in the sitting room being replaced with a cat tree. I was in one of our pet care centers the other day, it was very funny, and there was a couple there in a dog aisle, and one of them brought out this dog safari outfit and said, "What do you think?"
Their partner said, "That's perfect. We need to get that." That just again helps to reinforce how the pet sector has changed significantly. If you zoom that into what that means for vets, I think that the sector is going to continue to remain strong. You've got a very high volume of COVID pets who are reaching maturity and going through maturity in the next five years. We refer to that as a smile curve in terms of the maturity and the need for vet support. I think that you can also see that technology continues to move on. The industry is really shifting from one of treatment and responsive care to preventative care, and all based around wellbeing provision through life stage.
That's a big shift, and that will continue to move forward, particularly pet health, preventative health, and how insurance and subscriptions wrap around that to provide and make pet care much easier.
Yeah, just literally the same. I was thinking, oh, better mention preventative pet care, then you did it already. Yeah, I walked around Kensington Gardens earlier, and there was a few dogs in prams. It is interesting to see. I completely agree. I think the future is really bright. I think the post-COVID boom, as you say, veterinary spend is somewhat reluctant from a client's perspective when it comes to reactive care. There is no doubt that the puppy and kitten boom that we saw during COVID, that will come. I think, as I have mentioned earlier, utilizing technology to make sure that we get that opportunity to speak to those clients as soon as possible is going to be key. As I say, using data and using CRM, I think we will be able to do that better than we have ever done before.
I do think that the way the generations are changing and our pet owner ages and the Gen Z-ers that are coming through that own these pets, they want to be able to do things on their own terms, in their own times. They belong to a subscription model world with Netflix, Prime, and all these other things. Our health plans that we have had in the sector, which in the past have been product-led to cover the cost of worming, fleeing, and vaccinations and things like that, will and should change, I think, into service-led propositions, which will enable, I think, clients to bond with their vet throughout their pet's life, so that when the pet does start to become ill, they can be seen sooner, and that reluctant purchase that I mentioned will be somewhat less reluctant at that time.
I think with tech enablement and those changes in dynamics, I think the future is very bright for the sector, and I am very proud to be working in it.
Thank you. Thank you both for your time, and thanks for your partnership.
Thank you very much.
Thank you.
Thank you. Great.
Graham, Richard, thank you so much for coming down today and doing the panel with Charles. I think you've given our investors and audience more insight into the industry that we serve, the client base, than we ever could have. So a massive thank you there. We're going to take another comfort pause now, say 20 minutes. We will reconvene at 20 to 3:00 U.K. time, where we will kick off with Karan on the Therapy business. See you in 20 minutes.
[Break]
Welcome back, everyone. Next up, we have Karan Wallia, our CEO of the Therapy business, who will be taking you through the strategy for that business.
Okay. Good afternoon, everyone. I am Karan Wallia, CEO for the Therapy business here at Nordhealth. I spend a fair amount of my time with customers, so that is therapists and clinicians, because I think that is still the fastest way to learn about our business, the market, regulation trends, our customers' business. Often you pretty much hear the same thing, which is these therapists, they have been trained for years to serve patients and treat patients, and still they have to spend their evenings, nights, weekends, doing hours of documentation, filling forms, and writing notes. For every hour of administration that we can help them save is an hour they spend towards treating more patients or providing better care outcomes. That is really the job. That is what the Therapy business is about. That is what our mission is and what our product solves for.
Over the last almost two years that I have been here, I focused on maybe a couple of things. The first is enabling the migration of our users in Norway. The second is consolidating our lead in Finland. Lastly, building an AI-native operating system for therapists in the Nordics. Our core segments are psychologists and physiotherapists, so musculoskeletal and mental health. The first thing in the morning, they open our software, they spend their entire day in it, so it takes care of everything from patient intake, their calendar availability, medical records, journals, invoicing, insurance reimbursements, and so on. Really the administrative side of practice management, along with medical records, electronic health records in one system. Our system is sort of the center of gravity for the clinic's data and their operations.
We have 13,000 clinics, 27,000 therapists that trust us with the most important part of their clinic, the most difficult things to move for our practical purposes, which is the clinic's memory, so their data again, and their daily operations. Unlike a point solution like, say, telehealth or patient engagement tools or even an AI scribe, we are not optional. We are not an add-on tool. We are really what the clinic is built on. They build their entire practice around it. They have 15 years of patient history and therapist history in that system. Patients and therapists will come and go, but really, their practice is built on this system. I think that is what makes us quite defensible. Also, the third point here, compliance, that is generally speaking quite an underestimated factor in our business.
Every time regulation increases, rules tighten, or data privacy rules tighten in different markets, audits, which are becoming more routine, certifications which are becoming more expected to win larger accounts, this continues to increase. Every time this increases, it makes it a little bit harder for a new entrant to enter this market because the barriers continue to go up. For us, this is business as usual. Organically, that gap against potential new entrants tends to widen for us.
When you take that along with the trust that our customers give us, the churn rates that you can see, the scale where we have the opportunity to serve more than half the therapists in our market, along with the R&D muscle we have, especially around our AI capabilities, that positions us very well to win the race to be the system of action, as Charles calls it, or the agentic PMS. When we think about the agentic PMS, agents are only as useful as the data they have access to, right? Or the context they can work in. So really patient history or for example, the regulatory protocols that you've got to follow in different markets, or the access to workflows you can act on. That's really what differentiates us when we think about this.
Also, I think being early on this path is definitely helping us widen our gap from existing competitors in this market. Also, when we think about the opportunity ahead of us, we serve a large part of the market in terms of the number of therapists. But in terms of the total TAM, there's still some distance ahead of us. We're only 28% of the total TAM, which we look at as the number of therapists and the available spend per therapist. We do a good job with taking our PMS to market, but there's clearly an opportunity for us to capture more of their wallet share. Doing that at margins that we've proven at maturity or scale, 45% cash EBITDA margins, makes it very attractive. That really makes the opportunity very valuable for us.
I thought it'd be nice to share a little bit about our product and where it's headed. So maybe the easiest way to consume this is if you think about an afternoon at a physiotherapist. Before a patient comes in, there's already a patient summary with the important markers of follow-ups from the last session and so on to ask. When you're sitting in a session, our scribe is open, listening, transcribing. So by the time before the patient leaves, the note's already written. Then our co-pilot is putting together documentation, whether that's a discharge note, a treatment summary, writing a referral to another doctor, or an epicrisis. So for example, in Finland, there's a Kela reimbursement form, which takes 20 minutes to fill in because you've got to look at the entire patient's history before you fill it in to get the reimbursement.
That's now two clicks away, one to generate the summary and the other to submit it. So we're really having impact there with our co-pilot. You can imagine in the future, we'd also have a reception agent that based on the consultation is already scheduling your next appointment. Right? One thing to notice is all of this is sitting within our product, right? It's not a separate tool. Like today, you have a lot of AI scribes that do a good job of taking notes and transcribing and summarizing those notes. But this is all within our product, right? So it has access to that context that I was talking about. This is why we think that we're well positioned to actually move forward on this, towards the system of action. Also, a little bit about our market.
Today, we're around EUR 17.7 million in ARR, and we see there's a lot of opportunity, especially to capture more wallet spend from our existing therapists in our existing markets. We've always shown you the Therapy business as a complete portfolio, but today we can actually take a click down and look at Norway, Finland, and Denmark independently, where we have strong market share in Norway, for example, but the opportunity there is really executing this migration well because that allows us the opportunity to then have much stronger margins, very attractive margins. That then gives us a base to be able to upsell AI products or whatever other products on which today on a legacy base is not possible for us.
Finland, I see this more as a proof point for what a mature market looks like in our portfolio, so I'll come back to this in a couple of minutes. Denmark, this is where we have a lot more white space to grow. We've done a good job on the mental health side. There's work for us to do on the physical health side in Denmark. I think the key takeaway here is we still have clear headroom to grow in our existing markets. Also, I think the economics for our business are fairly durable. Where we have high market shares, we're still able to generate organic growth. If we look at our net retention and 4.5% gross churn, that's a signal that our base, they stick around, they grow a little bit more each year. They spend a little bit more with us each year.
Every euro we spend to acquire a customer, we roughly get EUR 15 back. At maturity, in Finland, for example, we have a 45% cash profitability margin. Markets that we choose to compete in, we, over a period of time, are the market leader. On the revenue side, we've been able to grow steadily, even though we're in markets with high market share. But underneath this, all our focus, effort, and investment has gone towards executing a large-scale migration in Norway. The goal for doing that is to be able to actually optimize for long-term growth, to set the foundations to then be able to actually expand our business with those users. Because it's a large install ed base with which today it's difficult for us to expand because they're sitting on a legacy platform.
Instead of squeezing short-term growth from a legacy platform, we've chosen to take the long-term investment option here. Also, you can see our customer concentration. It's pretty healthy, which means we have a pretty diversified base, thousands of small, durable relationships, which in general is hard to replicate. The same story shows up in our margin profile where our margins have taken a temporary dip because of investment in two key areas. One is the migration, and the second is building out our AI capabilities. What we do know is that this is a temporary dip. We do think the underlying business is healthy, and as this deliberate investment starts to normalize, we can start to see the margins that we planned for actually show up as they do in Finland already, for example, which is much further along on the maturity curve.
Talking about that, Finland, we have a 45% EBITDA CapEx margin. An easy way to think of this is, let's say if any of you own this business outright, EUR 0.45 of every EUR 1 would turn into cash, show up in your pocket every year. That is basically this business. When I think about this business, it is a business that returns roughly half its revenue back in cash, after funding its own growth, and does not ask for more capital to keep doing so. These cash flows are pretty defensible, repeatable. We have 95% of our customers come back every year, so this money tends to show up. Finland is not special. It is just further along on the maturity curve. It has gone through the investment cycle, and our goal is to replicate similar economics in Norway. As a business, we have two main missions.
The first is migrating our Norwegian customer base from a legacy platform to our modern platform, and second is AI. On the first mission, our margins in Norway have clearly been held down by a fairly complex migration that has taken longer than we would like. We do see that post-migration, when investment does normalize, we can be at some fairly attractive margins and aim for something close to where Finland is today. The levers to getting there are really our R&D investment tapering off, us being able to retire some of the legacy license costs, and operational synergies coming from being on a single platform. Earlier today, I got the question on, "Hey, is the migration project on track?" The answer is increasingly yes. We have 1,000 migrated users. We have 700 users that are already booked for future migrations.
That number is steadily increasing. We start to see a more predictable pace over here. Maybe it makes sense to also share with you how we internally think about this project. Going back to first principles, these are not customers we are trying to win. These are customers that we already have. We know what the future looks like because Finland shows us what a sticky, high margin, cash generative business can look like. It is quite important for us to be able to handle this migration in a very customer-friendly manner. I guess from the outside, cautious can obviously look like slow. We do optimize more for lifetime value than for migration speed. I think by the end of 2027, we should be in a place where the vast majority of the migrations are behind us.
Then we start to slowly see some of the savings actually coming in. The second mission is around AI. I think I remember reading somewhere the best type of sale you can make is to a customer you already have, and that is really what this is. We have a customer who buys our PMS, we upsell them our AI product, and they are worth roughly double to us. We have 1,400- 1,500 paying customers today. They refer other customers to us. The nice thing about this is the opportunity is really ahead of us. We are early, it is nascent, and we have an opportunity ahead of us over here. Just from an industry perspective, the supply of therapists is not increasing, so it is physically constrained. The number of graduates is pretty static.
But the demand is far outstripping the supply for mental health services or even for physical health services with an aging population and so on, especially in our markets. The only way to do this is to expand their capacity, and that's really where our AI tool comes in and our AI products come in. As our customers grow, we have an opportunity to actually grow with them. So it's interesting that the more pressure that there is on a clinic, the more valuable our product becomes, and that gives us an opportunity to grow as well. Finally, everything we've spoken about so far has been very focused on Norway, Denmark, Finland, basically our Nordic markets, where we still have some headroom to grow and opportunity to expand our ARPU.
When you take this in perspective of a global opportunity, we're essentially a rounding error. The important thing that gives us some level of conviction, some level of belief that we could mean something in a broader market in the future once we've finished executing on our current priorities, is we've been able to build a winning team and a winning product in the hardest markets in the world. The Nordic markets we operate in are the most demanding in terms of regulatory infrastructure and compliance, most demanding in terms of localization. They have the most change-averse customers. So being able to actually win in a very, very hard market gives us a fair bit of confidence that we could replicate and leverage our existing muscle in the next set of markets that we might look at after we're done with our existing priorities.
Then finally, just to wrap up, we're a clear leader in our category, in our markets. That gap between us and other players as well as potential entrants is widening as we continue to invest rapidly on AI. Our market leadership position gives us the opportunity to have healthy recurring revenues, an opportunity to expand on our already large installed base that we have. We have a healthy churn. At maturity, some highly exceptional cash generative opportunities and margins as well over here. Finally, a lot of the opportunity we have, at least in front of us right now with our current priorities, sits in our markets. Beyond that, we'll then do a strategic review once we are well underway on our existing priorities and then consider what's next for us in terms of our growth. So that's it from the Therapy business.
I'm happy to take some questions when we do a Q&A. Thank you all very much.
Thank you very much, Karan. We are going to turn over now to financials and guidance. I am going to start by giving you all a quick update on Q2's performance for both business units. Starting with the Veterinary Business Unit. In H1, we have signed three more 100+ clinic enterprise groups. These three are currently all either in pilot co-development or early implementation. On top of that, we have signed EUR 564,000 of new ARR in Q2 alone. In July, we also announced that we had completed early implementation of Vets for Pets, which means that we are now on to the core rollout, and rolling out in earnest. We are also very excited that our second clinic in Germany is now on Provet. We hope to have many more in Germany onto Provet soon. On our mission to build the leading AI PMS, Ask Provet went live in Q2.
Our clinical AI agent went live in Q2, and the Provet MCP went live in Q2. You can see, as James explained to all of us, the pace of rollout is, and pace of deployment is just increasing massively at Nordhealth. Finally, on our quest to reduce time to value, we built some migration tooling that we launched in Q1, and we have seen this cut onboarding time by more than a quarter across the business, which is fantastic progress. One of the legacy platforms that we acquired in Norway, Sanimalis, we sunset in Q2 seven years after we started the migration. We are extremely happy to have the final clients migrated over from Sanimalis onto Provet. Vetvision, which is a Danish company that we acquired, we are aiming to sunset by the end of the year.
Looking at the Veterinary ARR growth, we have been re-accelerating our year-on-year growth, and ARR has grown by 13.6% between Q2 last year and Q2 this year. This is driven by a net retention rate of 109.9%, which is itself largely driven by enterprise clients rolling out new clinics. As Charles mentioned, we have an incredibly low churn of 2.2%, and the increase that you will have seen since last quarter in our signed not implemented is now that we have completed the early implementation of Vets for Pets, we have included the full rollout number in our signed but not implemented number. On the adjusted EBITDA minus CapEx, you will see that in H1 2026, we are lower than we were in H1 2025. This is, as you are all aware, due to all of the increasing investments that we have been making, that we made during 2025, particularly on DACH localization and AI transformation.
While we are on a path of increasing profitability in the Vet business unit for H1 versus H1 last year, we are still a little bit below. Moving on to Therapy. Updates for Q2. Similar to the Vet business units, we have shipped a lot on our path to becoming the leading AI PMS. We shipped the AI patient overview, we shipped AI-generated epicrisis. We shipped custom AI document templates, and we shipped custom feedback templates. As Karan mentioned on the Aspit migration, we have 1,000 users migrated as at the end of Q2, with many more booked. We have 700 on top of that booked to be migrated. We launched MediPay integration for collections, and we have done appointment overviews and the ability to create and manage group sessions. We have launched that as well.
Finally, on Therapy growth, there has been EUR 1.2 million of ARR signed in H1 2026, across new business and upsell, which is up 24% on H1 2025. We are seeing an acceleration of growth in the Therapy Business U nit. You can see that in the ARR numbers, which are at 10.8% growth year- on- year, driven again by healthy net retention of 104.7%. This has been helped a lot by the AI scribe, which has been growing very rapidly in the Therapy business, and again, healthy gross churn below 5% at 4.5% in the Therapy business. Therapy adjusted EBITDA minus CapEx has already been showing its curve back. in 2025, we expanded the team and invested in the migrations. Now that we have a well-formed team, we have been allowing that growth to re-accelerate profitability.
Year on year, EBITDA minus CapEx has increased in H1 from EUR 0.7 million to EUR 1.2 million in the Therapy business. I am going to take you now through the group-wide financial updates. On a group basis, in Q2 year- on- year, we have grown 12.5% in implemented ARR, as you know, driven on the higher end by the Veterinary Business Unit, but with therapy growing at an increased pace as well. 108% net retention rate, again, was the largest amount driven by Provet expansion amongst existing large clients. The blended churn rate incredibly low, 3.1% across the group. As I mentioned in the vet section, the increase in signed not implemented coming from that inclusion of the full Vets for Pets rollout. Now turning to our accounting quarterly reported recurring revenues.
Q2 year on year reported recurring revenues have grown by 10.2% up to EUR 14.2 million in Q2. Our underlying recurring revenue growth, which is the one we really care about, has grown by 14.6% year- on- year from EUR 11.3 million up to EUR 13 million. That share of recurring revenue as a share of the total revenue, very healthy at 91.2%, increasing year- on- year. For H1 as a whole, we have had a 9.1% increase in total revenue up to EUR 27.6 million. Again, that underlying recurring revenue has grown by 13%, up to EUR 25.2 million, up from EUR 22.3 million in H1 last year. Again, a very healthy share of recurring revenue at 91.3% of total revenues. Looking at quarterly adjusted EBITDA minus CapEx.
For a while now, we have been saying that we would be holding our costs relatively flatter and allowing that growth to filter to improving EBITDA minus CapEx, and you can see that in our Q2 results. Versus last year, where we were at EUR -1 million for the quarter, adjusted EBITDA minus CapEx, we are now at EUR -0.7 million. We are starting to see those improvements in profitability filtering through. It was EUR -1.5 million last quarter for another reference point. In H1 EBITDA minus CapEx, you can see that for the H1 as a whole, when you add the two quarters together, we are still at EUR -2.2, which is a reduction versus H1 of last year. As I mentioned, that trajectory is positive, and so we are expecting improved profitability as the year continues. How that translates to cash.
We have our adjusted free cash flow, we have reduced by EUR 0.9 million. Our adjusted net result is EUR +0.2 million. We have had some timing differences in the cash flow. Actually, July was a pretty good month for collections, so we are expecting some of these numbers to filter through, but this is mostly timing difference versus the EBITDA minus CapEx result that I presented for Q2. On the H1 adjusted cash flow, the adjusted net result for the full half year, EUR -0.4 million adverse, which is driving some of that EUR 2.3 million adverse. But another point to note is that in Q1 2025, we had collected a very large one-off backlog, which is somewhat skewing this year-on-year difference by about EUR 1.1 million. The remaining working capital variances are coming from Q2 that I explained on the previous slide. Finally, on our balance sheet.
We retain a very healthy balance sheet. We have EUR 12.5 million of cash as at the end of Q2. We still have no interest-bearing debt. We have a very healthy equity balance of EUR 55 million. There have been no material equity transactions in the quarter, and any changes in goodwill have been to amortization or FX. Turning on to guidance. For 2026, I am very pleased to tell you that we are still on track for the guidance that we gave, so we are not restating or reiterating guidance. We have said we are going to do a full year recurring revenue of between EUR 50 million and EUR 53 million. You can see from H1's actuals of EUR 25.2 million, that if you annualize just that, we are already on track, but we are continuing to grow through the year, so we are very comfortable on our recurring revenue range and guidance.
On adjusted EBITDA minus CapEx, as we saw, we are at EUR -2.2 million on our H1 2026 actual. But with that improving profitability through the year, we again feel comfortable that we will remain within this guidance range. Finally, on the three-year guidance to 2029, you can see here that in the last few years, on a group basis, we have had year-on-year recurring revenue growth between 13.6% in 2025, up to 21.5% in 2024. So that is our historic range. It has been a bit lower on the Therapy side, between 4.4% and 7.5%, a bit higher on the Veterinary side, between 21.5% and 35.4%. For 2026, we have been guiding between 9.5% growth and a 16.1% growth.
I am very pleased to say that for 2027 to 2029, we believe we can maintain a CAGR across those three years, actually at a slightly top-end, even slightly elevated versus 2025 and 2026 range of between 13% and 17%. So that is a 15% CAGR from 2027 to 2029, ± 2%. The reason we have confidence in this level of growth is across both business units, we have a very positive outlook. On the Veterinary side, as I hope Charles has proven today, we have a strong right to win in the growth markets that we already serve. We have the most enterprise-ready solution anywhere globally, and we have a large upsell headroom on our revenue per location. From the Veterinary side, we are guiding 20% CAGR, ± 3%, over that 2027 to 2029 period.
On the Therapy side, we have been demonstrating strong AI upsell across our existing base and across the future migrated base. We are going to continue to gain market share in the Nordics, then post-migration, we believe we can accelerate growth even further by investing in new markets and new product development. We have already seen the growth rates in Therapy increase from these single-digit percentages that you see in the last few years to over 10% ARR growth that you have seen year-on-year today. For Therapy, we are guiding 10% CAGR from 2027 to 2029, with ±2%. Next, it is very important for us to be masters of our own destiny. We will, from 2027, be both adjusted EBITDA minus CapEx profitable and cash flow positive.
Given the current macro uncertainty in financial markets, we feel that we have a lot of strength by really generating our own cash and using our own cash to fund growth and not having to go out for external financing at any point. If we do go out for external financing, it would really be for an M&A or some inorganic growth. For our own operations and the numbers you see here, we are going to self-fund that through generated cash and profits. The reason we have a lot of confidence that we can become profitable in 2027, firstly, we are going to maintain our healthy growth rates. Year-on-year recurring revenue increases. In 2026, it is between 10% and 16%. 2027 to 2029, it will be around that 15% mark.
We are going to let that flow through to the bottom line using our healthy gross margins, which in the last 12 months have been 78%. We still maintain very healthy SaaS gross margins that allow that revenue to turn into profit. On the sales and marketing side and CAC improvements, we are very disciplined in how we manage our sales and marketing spend in order to ensure that the money we do spend pays back within a reasonable time frame and is very profitable. You have seen from our unit economics that we have a lot of headroom on our CAC and that it is a very efficient use of our money, so we will leverage that in order to retain profitability. As I mentioned earlier, our onboarding efficiency has increased as well, so we have reduced time by 25%.
We are going to continue to improve our onboarding efficiency, which will lower our CAC and allow us to grow more profitably. Finally, on the fixed costs, you have seen over the last six months after a year in 2025 of growth, we have been holding headcount a lot more flat. In fact, in 2026, we have had a 4% reduction in the size of team, but without any reduction in productivity or output, because really each team member has been delivering more than they ever have. So we are going to maintain a relatively controlled fixed cost base and allow those gross profits to give us more overall EBITDA minus CapEx. Finally, sunsetting the legacy platforms. These are a huge win. We sunset Sanimalis in Q2, Vetvision will be by the end of the year. Obviously in our future, we have Aspit and Vetera.
By clearing the way in these old platforms, we give ourselves the ability to focus on our core flagship platform without complexity, without distraction, which saves cost and allows us to move more quickly. We care deeply about getting all clients onto our flagship platforms. I also wanted to talk a little bit about the investments that we want to make during this 2027 to 2029 period. It's our intention to be a high growth business for a very, very long time. To do that, we are going to continue to reinvest some of the surplus profits that we're going to be making in 2027 to 2029. The first of those is we're going to increase our U.S. presence on the veterinary side, local leadership, local go-to-market.
We really want to increase our footprint in the U.S. in order to be able to take advantage of that ginormous opportunity that Charles presented earlier. On the therapy side, we have this huge addressable market that we can go after. We're going to need to invest in expanding to new markets and new product development, all within the boundary of making sure that on a group basis, we are cash flow positive and EBITDA minus CapEx positive. That's it. To reiterate, the three-year guidance, 15% CAGR between 2027 to 2029, ±2%, driven by Veterinary at 20%, ±3%, and Therapy at 10%, ±2%. All the while, we're going to be adjusted EBITDA minus CapEx positive and cash flow positive, excluding any potential M&A. We will not be sourcing external financing to fund organic growth.
With that, I will turn over to Charles to conclude the session.
Thank you very much, Alex. Thank you. You've heard a lot from us today, so I just want to summarize the key takeaways. One is across both business units, practice management software is the core infrastructure of a clinic, and it gives us a unique right to win to be able to build great agents on top, because we control the data, the workflow, and so on. We have the unique right to have a way better agent than others that are standalone. The second is that we own the number two vet PMS globally, and the number one in Europe, and the number one therapy PMS in the Nordics. We've got really strong market positions in the markets that we're in. The third is the low churn. Customers stay with us for a long time and trust us with their business.
At scale, we can see very strong, unique economics, not only on the net upsell, which is churn plus net retention, which you will see from increasing the average revenue per location, but also in the sales efficiency that we have gotten of recruiting new customer. What that yields is the profit margins that we see in the Nordics for Veterinary, which are around 40% EBITDA minus CapEx, or 45% in Finland for Therapy. We also have great headroom for growth. We have got a great opportunity to continue to expand. We are only a very small percentage of the veterinary market in our current markets, and we have got a great opportunity to conquer the rest of the Nordics and go beyond therapy.
On the guidance, Alex went through it, but we are looking forward to, as Alex mentioned, it is really important for me to make sure that we are never reliant on anyone else. Also for our partners, customers, that we always have enough cash and some buffer to be able to be masters of our own destiny. So being cash flow positive and having a growth rate of 15% ± 2%. Thank you very much for your time, everyone. I think next will be Q&A.
Yes.
Go ahead.
Thanks a lot, everyone. Thanks, Charles, and to all the speakers today. We are going to take some Q&A now. So we are going to bring some stools up on stage, and we are going to invite the four speakers from Nordhealth up on stage. Q&A is open to the room. There are people with microphones who will hand you a microphone. What you need to do if you want to ask a question is please raise your hand and one of the people with mics. I will direct the people with mics to the people with hands up, and you can fire away with your question. You can either direct a question to one of us if you have a specific person in mind. Otherwise, I will direct your question to one of us. Great. Torbjorn.
Hi. Just wondered if we could start with a comment on AmeriVet, the rollout that was canceled earlier this summer. Maybe touch upon what the reasons for the canceling of the rollout was.
Charles, maybe you want to take this one?
I'll take this one. We originally had a CEO of AmeriVet, which wanted to build a product together with us in the U.S. That CEO used to work for VetFamily, which is now part of IVC, and that's what we did with IVC. We're doing with many of our partners here, is that we work together to localize the software for that market together. There was a CEO change, the management change, and that strategy changed in that they wanted the software that was localized from day one. Even though the technology is quite old, they decided to go for the current solution that's localized fully for the market.
A follow-up to that one, because given that AmeriVet was an important proof point for the U.S. market, has it made it more challenging to get into other processes with other potential customers in the U.S.?
We've got other corporates like PetVet365, for example, which rolled out in the U.S., and we're also talking to lots of other corporates. In the end, there's the market in the U.S. for corporates, there's two players. It's either ourselves or ezyVet for now. ezyVet have a broader array of integrations than we do currently. That's only a matter of time. Once we do have that only remaining gap solved, I think we'll be in a very good position to be able to win all of them. We've got PetVet365 as a good example of a good corporate that's with us in the U.S.
I can just continue. On the three clients that you mentioned, the 100+ clinic clients, what geographies did you sign those in? The 300+ clinic clients that you mentioned, what geographies are those clients connected to?
Geographies. We're not disclosing specifics on the clients. I mean, the number of enterprise clients you can see per geography is relatively low, at least of that kind of scale. While we're in pilot and early implementation, we're not yet disclosing the geographies or the specific client names.
The reason why is that I hear of a pilot, I will go after that customer because I know they're willing to switch PMS. I just don't want to provide that opportunity to potential competitors.
U nderstood. On the upselling opportunity, particularly within veterinary, both payments seems to be a very large part of that. What is the key selling points for clinics to use your payment solution instead of a third party's one?
Payments is a very weird market in that, actually, this is not an opportunity for corporates that much, or it is an opportunity that they can get a good payment solution, but pricing, we basically provide that cost to our partners here, for example, because they get very low rates. Smaller independent clinics have very high rates relative to the enterprises. The value prop is you pay the same as you pay today, but you've got a fully integrated solution. An integrated solution means you don't have to key in manually the amounts, so less errors, less work. Secondly, which is fun for the accountants here, is that invoice to payment reconciliation is fully automated. You have to spend way less time to be able to do that and way less time if you have a third-party accountant to be able to do your books.
The opportunity is on the non-corporate side, at least on the revenue opportunity. We still provide that to corporates because we think it's a great service, but we don't make a significant amount of money from that.
On the unit economic side, you touched a little bit on it, but both for payments but also for the AI solutions that you are searching to upsell to those customers. How does the unit economics look?
When we look at the unit economics from the slide, actually, that's actually gross profit. It's the way that accounting works for payments is that we take out all the cost, which are normally made up of two things. One is interchange, which is the amount Visa, Mastercard charges, and then the second cost is scheme fees and also the added payment fees. This is just on top of that what we make. We have cost in terms of providing support for that service on our side. Then on the AI side, the cost is mostly on the development. Right.
Yes, the cost of AI models is increasing if you've got the latest tool. But if you want to use the latest frontier models for everything, it's also very slow. It's not always the best use case. Who knows where model costs will end, but currently, I think that the gross margin of those is not the real issue. The real issue is that developing it and iterating on it, that's the main cost. It's a fixed cost versus a unique gross margin issue. Gross margin is probably similar to the software.
I guess I could just quickly—
Yeah, please
—add to that as well. I mean, in terms of AI models, we are not reliant on any particular provider for any kind of special functionality. All of the AI that we have done in the product is built in such a way that we can very easily switch to different providers if we need to. I think more recently, it has been quite interesting insofar that there has been a huge amount of Chinese open- weight models that are very cheap. If we wanted to switch to them tomorrow, it is a few lines of code, and we have switched. The kinds of things that we are doing in the product, we are not reliant on any particular provider. I am not worried about cost of using AI at all because I think the market itself is keeping prices down. We are completely agnostic in terms of our solution.
Cheap also means faster. Actually, it does not mean that if it is cheaper, it does not mean it is less good, actually. Sometimes there is cheaper and better because the processing is much faster.
Yeah. I think the other thing that is interesting as well is that, we do not have to use the latest frontier model as soon as it comes out. Up until recently, we were using models from nine months ago. They were amazing nine months ago. They are still amazing today. Whatever the sort of narrative out there of the cost of AI, we have complete control of what we use.
How we decide it today is basically we want to use the best model, regardless of the cost, because cost is not really not an equation. It happens that as we test out different models, the speed to quality ratio is better with the non-frontier models.
I think it's also worth highlighting that for normal day-to-day workflows, there's a bit of a natural cap on their usage, because for one consultation, the scribe will do its job, take all the notes. The summarizer will summarize that one consultation into the actions and the discharge notes. It's not like they are aggressively consuming over and over and over again. It's related very much to the number of consultations, which has a cap per day.
Yeah. The kinds of workload that we require our AI models to do are not the kinds of things that you need the biggest frontier models in order. We don't need Fable or Mythos or even [GPT-5.6 Sol] to do the kinds of efficiency savings that we're doing in the product, so yeah. Speed and cost is not a problem.
Yeah. But if you're just thinking about on the AI side again, like you mentioned on some of the AI-native companies, especially on the AI scribe solutions, for example, where my impression is at least that you have the possibility as a customer to use an AI scribe solution from another company. If those kinds of solutions essentially become a commodity, what justifies your ability to take a margin on that that's in line with what you have elsewhere in the company?
You are right. Over time, there will be a commodity in the ability to convert speech to text and then text to summarize. Yes, you can have additional templates that are on top of that you can generate. But it is about if it is a commodity, why would you open a net new tab, a different workflow for the clinic. That is actually great for us in that we believe that we can build just the best one because we got a unique advantage that they are already in our software. They press one button, they do not have to go to a separate software, and the notes get sent from the third-party software. As you heard from Richard and Graham, having to open a net new tab is annoying. That being said, we are still an open software.
That is really important for me, is that I do not want us to be a closed bastion where you are stuck with us. Because then it will not put enough pressure on James and his team to be able to push. I want them to always have the third-party competitors there to be able to compete against us. If we think about their margin. Their price is much higher because they have two things to pay back. They have to start a relation from scratch with a company, and the cost to serve includes all the things that we have support and AI cost. But the first part we do not have. Because you are an established relationship. We actually come into the market at a significantly lower price point as well because we are able to compete on that.
Maybe just to add to what Charles said, especially from the therapy side, where there are quite a few AI scribes out there. I think our ability to command a reasonable price going forward as well will be a function more of the value we create for these customers. Today, the scribe is one thing, which is mostly around summarizing a consultation. But it is the actions that follow after the scribe that is very hard for a product that does not have the patient history or the Denmark or Norway or Finland's regulatory protocols that they have to follow in a certain way or reimbursement rails and so on. Or even just simply the workflows to act on to actually do anything beyond that.
For the example I gave in Finland, where we fill in the reimbursement form for you, which actually takes a lot longer than writing the notes for a consultation. Though that flows from the consultation itself, it is difficult for a scribe to do. Today, the feedback we get from our customers is, they start to value that aspect a lot more. I will pause there, but that is why it is important for us to migrate. But that hopefully explains where we generate value, gives us an opportunity to continue to command a price.
There is other things beyond just AI scribe, as Karan suggested, like for example, Ask Provet. If you had to use a third party for that, which you can, you would have to think about and configure role-based access for every single person in a separate system, where now anyone can just connect to it, even via MCP, and the software already knows what data you are allowed to see, not allowed to see. You do not have to do it in two systems, which is quite annoying if you are in the central team of one of these corporates, just doing it once in one system is annoying enough, you do not want to have to replicate the same thing in another system.
Thanks. On therapy, you mentioned the migrations being speeded up. Is that kind of the pace we can anticipate moving forward also throughout 2027?
On the migration, it has been a complex project. I think the thing that has taken us a lot of time is setting up the regulatory infrastructure for Norway, and to be able to then migrate our customers. We are a lot better at that, where I think we are significantly more predictable. The size of the iceberg is quite well understood today as compared to maybe 12 months ago. Internally, there is a lot more confidence, but I think the right metric for us should be how confident are our customers, right? Is that booking pace continuing to increase? Because the way it works is they test our product, it is a word-of-mouth-driven market, and then they select a date themselves. That is how these bookings are happening right now. It is not like we are putting a date for them.
They are selecting a date based on when they have availability, sometimes it is weekends and so on. That number is moving in the right direction. At least what we are all working towards quite hard is to make sure that continues to happen. There is also an aspect on unlocking cohorts. That is when a set of features and functionality is developed, it is piloted, tested, and we know we can migrate at scale. That unlocks the next set of cohort that we can then invite for bookings. That machinery is clicking significantly better every quarter.
Can you give us a sense of where you would have to be to consider entering new markets? I understand it's difficult to give an exact number on how many you have left to migrate.
Yeah. The way I think of it is, right now the migration is taking up a lot of our energy and resources. Once that investment starts to normalize, which means we have enough confidence that from a product perspective we're there, and then it's really just an operational play, that's when we would then think of reallocating that product investment towards our next mission. As a business, we take a fairly long-term view in the way we approach these market segments and so on. It's important for us to be quite focused because that's really our strength. We have great talent. We'll focus them on one or two missions, and then that gives us the opportunity to succeed and then dominate. But we're not in a rush.
It's most important that we do this well, unlock those margins, and then leverage that talent to go after the next big bet.
Karan's being kind. When I bought this business, I made the classic mistake of a first-time CEO in trying to do too many things at once. We're positive and we think we can get things done very quickly, and the size of the iceberg is always larger than you expect, right? What I've realized the key to success is focus your resources on fewer problems so that you will come up with a lot of unknown unknowns, but at least the speed from an unknown is found out and resolving it is quicker. Yes, if we have an enterprise customer, for example, that's missing a feature. Now that, we can quickly solve that problem for them to unlock them, versus spreading yourself too thin. We're trying not to make the same mistake again. We'll make new ones, but at least not this one.
Okay, and then last one from me. Seems like having customers that act like consolidators in the veterinary market has been a very important growth driver. Just thinking about the guidance until 2029, how important do you believe or expect that component to be moving forward?
Very important. I think, at least on the veterinary side, it is for two reasons. One is enterprise customers are using a lot of the capabilities of the system. They are pushing the system, and they are pushing us to develop a better system. They are very data-centric. In terms of making sure that we are cutting edge, it is a partnership as we talked with Graham and Richard earlier today, in that they have got ideas, we have got ideas, and together we try to create a better software. In terms of crafting a better software experience, it is core, right? In terms of the future opportunity, yes, I am pretty sure that Richard wants to grow his business and Graham wants to grow his business as well, so they will continue growing themselves. We are beneficiaries of that, which is wonderful, and we will have net new enterprise customers as well.
Where we have to work, and one of the big unlocks for growth for us is how do we make sure that these enterprises are onboarded as efficiently as possible for zero disruption. Every time it is a big decision to change, how do we make it a smaller decision? So that the cost to change is less in terms of disruption for the clinics. That is one of the big things that Danny and I are working together.
If I can add to what Charles has said, this is one of those areas where the individual markets each have their own very relevant dynamics. The reason we are in the position that we are, being so enterprise-ready relative to the entire rest of the veterinary PMS space, is because we were originally a Nordic company and the Nordic veterinary clinics were the first to start consolidating into larger veterinary groups. That is why we built a veterinary PMS to serve enterprise clients is because we took that journey with them. That is why for the other major European markets, we have been able to come in and into countries where the consolidation has been happening, but they do not have a local player that is able to satisfy their more complex needs.
The U.K. was relatively early among some of the European countries, and it has gotten fairly consolidated now. Although a lot of the enterprise groups have yet to bring all of their practice management softwares onto one system. Then you look at a country like Germany, which is much, much earlier, less than 10% consolidated, where we feel we have a big opportunity to go in early as the only truly enterprise-ready solution on the market, and work with these enterprise groups in their earlier stages and help them grow.
Okay. Thank you.
Do we have any more questions? Please raise hands if so. Ole.
Hi there. Could you, on the development side, talk about are there any synergies between the two business areas in terms of AI development and how does that work at this point?
James, you want to start?
Yeah, sure. At the moment, we are very separate. In terms of we do not share any major infrastructure. Behind the scenes, the products are very separate. We have had some small things that we have done. For our speech-to-text pipelines, we use the same one on both sides of the business. But really, they are very separate and I think honestly, it is easier to keep things apart right now. Often a mistake you can make is thinking that all the software and all the development and all the processes come together in any company, but that honestly just slows things down. There is very little shared at the moment, and that allows us to operate with freedom.
That is how it is usually. More and more the, cost of share, that building infrastructure, building code is going down. The cost of collaboration is what makes us move slow. We are going to keep things very separate. That does not mean that Karan does something cool, and I am like, "Okay, cool. I will show it to James," and they do interact together in terms of when one has solved the problem, the other one can get faster to the solution. That does not mean that they are shared infrastructure, shared code. I think it should be completely separate, but marketing can talk to marketing and so on.
Yeah, I think we share a lot of learnings.
Yeah.
Especially when we were doing the AI scribe, I remember the way we went about our testing methodology in therapy and veterinary. We spent a lot of time talking about what is the fastest way to find fit with different types of customers and specialties. But infrastructure, James is right. That is very separate. On the learnings, I would say as well as design systems, those types of things that you can build once and use together, that makes sense. That is not our biggest focus. So where it makes sense, we are very pragmatic, but when it comes to if it is going to make us slower, we usually would prefer that not to happen, especially when it comes to AI, where things are moving fast and we are building our right to win.
Yeah, just maybe to add a tiny little bit on that. The average number of engineers on a project is two or three, which means that we do a lot of projects concurrently. Also you find that if you think about sharing and if you think about more people on more things, you end up building more software. There is a benefit to being a fairly fixed small size, is that we can build the things that a small team can build. If you pointed Microsoft at this, they would put 2,000 people on it and it would be a very different bunch of software that they would build.
Sorry to add one extra piece to that. There are two functions that sit truly centrally. The first is security. We have a Chief Security Officer who has a small team. They do not change the code in either of the platforms. But their job is to make sure that both business units are held to the same high security bar. Because obviously we are handling very important data and we want to have the absolute highest level of security on the products that we build. The second is finance, because of course, we need a certain level of financial control that is consistent across both business units. So those are the only two truly shared functions at Nordhealth.
You provided the margins in Therapy Finland of 45% cash EBITDA margin. To what extent have you included the AI, let us say, investments in that number?
Yeah, so for Finland, so in Diarium , which is our Finland business, it basically includes the R&D in that number. The EBITDA minus CapEx number does include our engineering team. AI within Therapy is a shared service, so we have not built separate AI everywhere. We just build it once and then everyone consumes it. So it has been built by a small separate team.
So there is some costs included in that number.
Yeah.
Then on the Therapy side, you seem to have more than half of the therapists in the Nordics, right? Then your revenue share was a lot less. 28%. Can you remind us and elaborate a bit on why there is this gap?
Yeah, I think—s o a few things. One is, right now, we sell mainly just the PMS to our therapists. But if you think about the different softwares that are very adjacent or attached to a PMS that our users spend money on, for example, AI is a large part of it. Another large part of it is around patient engagement tools like telehealth, payments, and so on, which we simply yet haven't gotten to. But they sit very adjacent. They're very connected. We integrate with Nets Group and other such players or ExorLive or exercise apps. We see that as opportunity that the only way they use those apps is through our software. We see a clear opportunity there. The biggest part of that is actually around AI, because that's where the amount they're willing to spend is fairly large.
That's where we see the largest opportunity within that TAM to go after, because we do have a large installed base.
Hello. Can you expand on the margins for the group? It seems you have given guidance for the revenues, the organic growth, and it seems like from Alex that you have good visibility or a plan for the cost. As a reference, you guided for 20% cash EBITDA margins on your last Capital Markets Day. How should we think about next year and the coming three-year span in terms of margins?
I think the reality on this, and thanks for the question, Jonas. The reality on this is we do want to retain a certain level of flexibility on how much we want to invest on the next three years. It is extremely important for us that we are masters of our own destiny. We will be EBITDA minus CapEx profitable. We will be cash flow positive. We will certainly be above that threshold. But the exact amount that we need to invest over the next three years is something that we will get better visibility on as we get closer to the investments. Our objective is to be a high-growth business for a very long time. We absolutely could optimize over the next three years for cash flow and EBITDA minus CapEx, bring these numbers way up, and still hit the revenue numbers.
Then that might not yield the same long-term growth beyond 2029 as we expand even deeper into the U.S. and find new markets and new products in therapy. We will be EBITDA minus CapEx and cash flow profitable between 2027 and 2029, each of those years. But we did not want to guide exactly how profitable because we want that ability to continue investing for our perpetual growth. Hans Christian.
Yeah. Thank you for good presentations today. Just wanted to ask, you mentioned M&A, and you have a track record of doing M&A, obviously. Just wanted to know if you are able to provide some more color on your M&A strategy going forward. How should we think of this, if it is relevant within the Veterinary segment to kind of capture legacy systems and new customers and migrate them and also within the Therapy segment, if it is at some point relevant there as well? Any color on that would be interesting.
We are always pragmatic on this one. In order to buy a company, one needs cash. First thing that we go to sellers, make sure we are cash flow positive to have the cash to be able to buy a company. That is one. Because I think at these levels of valuation, I do not want to raise equity. Just even if I could put in more cash, it is just not the right thing to do for a shareholder base. That is the first thing, having the cash. The second is if we have got a good opportunity to buy a software at a fair price. Currently, even though you hear SaaSpocalypse, the transactions are not available to, t hey have not reset their multiple that they were looking to sell at. Would I love to find an attractive business at a fair price? Yes.
And we'll figure out a way to get the cash if that's the case. Especially as we get cash flow profitable, we can also use debt at that point to do it. Even though I poke, I haven't found someone who's willing to sell to me at the right price. I'll keep poking. Remember, when I bought this business, I think it took me eight. They weren't for sale. It took me eight months, but I poked a lot. I went to sauna with the fellow Finns who were selling the business a couple of times, and then at the end, they decided to. If there is a good target that we think is good, I'll poke a lot and we'll get it at some point. Like a dog with a bone, I'm learning from my end customers.
Excellent. Do we have any more questions? Wonderful. Well, thank you very much.
Yeah.
Oh, sorry, James.
Yeah, sure. Thanks very much for a great presentation. Maybe just on the 20% investment reguide, if you could sort of break that out for us in terms of the backlog rollout expansion within customer base and then new logos as well.
This is a level of breakdown that I won't go into too many specifics, but I think what gives us confidence on this number is really the pipeline that we have. As you know, we're well underway on our Vets for Pets rollout, which is, as Richard said, 75 clinics down on a 450-clinic business. We have 300+ clinics in our pipeline that we're piloting or co-developing or early implementing. We have a strong right to win in the U.K., Germany, and increasingly the U.S. So, our confidence in that level of growth comes from the existing pipeline that we have that's going to see us in the near term. But also our confidence that on that three-year horizon, we'll be able to keep topping up that pipeline and hitting that number.
As we, particularly in a market like Germany, which is very early in its consolidation, when we sign up some of these large enterprise groups, they're still consolidating at a reasonable pace. That gives us a certain amount of automatic growth as they grow and expand.
The reason we don't guide separately is that it's really hard to understand the pace of rollout of a corporate, in that we've had some that have taken weeks, some that have taken months, right, some that have taken years. Because there's different things in terms of incentives, there's different things in terms of the level of localization that they would like to have, or it's a different business model. Vets for Pets is a different business model than our previous one with the franchise model. So we had to build this whole franchise feature. That's where it's hard to guide on that, because if it was my decision, we'd go as fast as possible and it'd be localized, but there are some gaps, and we want to make sure we do right by our customers.
When we push, I want to make sure it's pushed and successful. For example, in Germany, we're partnering with these customers in all different markets, and they ask me, "When shall we migrate?" So we only push when we think it's the right thing to do to the customer, because it's going to be a long-term partnership. We're going to be decades together, and if I tell Richard to do something now, and then in three years, we'll still be together, but he'll be arguing with me for a long time, so we won't be able to upsell things to him. When they go into new markets, they won't take us with us. That's where it's hard to understand exactly how fast to go.
On veterinary AI, are you able to provide an attach rate at this stage and any initial feedback from customers that gives you an understanding of willingness to pay for the product?
Yeah. I think on the attach rates, do we have that there?
It's not a number that we've provided.
We have not yet. Therapy was early enough to launch it, right? I took over product engineering in June last year, and I think we launched the initial trial late last year and iterated on it. We've got quite a few customers that have signed up, but we're still rolling it out with them. We'll provide more information over time on the AI attach rate. What do you think? Do we think we'll have more —You piloted a few. What are your thoughts? Exactly.
[inaudible] within CVS.
Yeah.
I expect that the positivity that you're receiving from the floor today is justified.
Yeah, I'd add to that. I think the point that Charles makes about making sure that it's really value- additive and cost-effective, makes it really easy in terms of the decision point. For us, we know that actually rolling out and embedding the system in is the first step. We have a lot of our practices currently using secondary AI scribes in the current system who definitely want to be able to integrate and fold it in to not only just make it simpler, but also then start to harness all the additional AI functionality that you only get with the platform and the data within that platform as well.
Yeah. On pricing, we're significantly cheaper than the competition because we don't have the whole CAC that's associated with the licensing model. Yep. Mathieu?
Mathieu.
A follow-up on this AI topic. Do you think at some point we will be able to report the pure AI revenues so the market can figure out the growth you achieve through AI and maybe be a bit more reassured about disruption?
Maybe I'll take this one. AI will be an enabling technology throughout our platforms. There are some parts of it that we'll sell and some which will be included in the core, right? I'll give you an example. Ask Provet is a core capability that is available for Pro and Enterprise customers, so that is included in that. But then the cost of the core maybe is a certain amount because of the fact that it has it in. But then we've got some AI features which are add-ons and because in the markets currently, that's the market standard, that AI scribe's your add-on. That'll change over time. We set out with online booking. Online booking used to be an add-on, now it's a core part of the PMS.
Over time, net new features that are add-ons will change in what's included in the package, so it's hard to differentiate this percentage, the package of the AI. We'll give guidance as we have in therapy on, here's the current number of people which are using AI scribe, for example. But in terms of revenue, it's hard to say, "This is AI revenue," because in the platform, let's say it's EUR 100 that you pay Provet, right? And they've got access to the whole platform and Ask Provet what percentage should I put the "for AI." That's a bit hard to assess, if that makes sense.
A question on Germany. Looking at the revenue per clinics at Vetera, it is much lower than what you achieve at Provet. Could you explain the gap and—
Yeah.
—what is the strategy in term of migration?
Germany is a different software market in that historically, there is cloud and SaaS. People obviously blend it together. SaaS is a pricing model. In Germany, it is not a SaaS-based pricing model. It is a you pay for a license fee up front, and then you pay a support fee just for support, but you have the software and you own it yourself. That is what we have in Germany. Currently, Vetera customers do not pay for the software, they just pay for the support. As they transition, they will pay for the support and the software itself. What is good about that is that imagine they want to shift from, if they are a n Aspit customer, they want to shift to a competitor, they can pay a SaaS license fee for that. Right?
In Vetera, in Germany, because they do not have the SaaS license model, they have to pay up front a huge amount. The cost to migrate is not only the onboarding costs that we charge, plus you have got the pain of switching costs, plus you have got an additional third cost, which is the software license fee you have to pay in front. Actually, the cost to switch not to us is actually higher in Germany than it is to others markets. As they shift from the support fee to a SaaS fee, that is what we will see the change. For most of our enterprise customers, we have already negotiated the pricing because it is the same pricing in all of Europe, and we do not change the pricing for DACH specifically.
In the U.S., I think most of the market is still with IDEXX and Covetrus on-prem software. Do you think at some point they will sunset their on-prem product and you will have the opportunity to maybe gain more customer?
I don't think that they'll have a formal sunset until they're almost at the end, right? They're smart enough not to give that opportunity to us, I think. Right? It would be great if they did, right? Because then we can force migrate. Some have. That's how we got PetVet365 is one of the competitors bought a competing software and they forced migrate, and then they lost half their revenue base. I don't think that they'll give us that opportunity. I would love that, too, but I don't think so. These two players, it reminds me a bit of the U.K. when we first arrived. When we first arrived, IDEXX Animana was by far the number one cloud player. IDEXX bought them, and then we haven't heard about IDEXX Animana today, right? We don't compete against them, get any deals, right?
IDEXX is a big company, and they make money and they do great job with the lab equipment. On the software side, it's moving really quickly, and they haven't been able at least to compete in the U.K. relative to other players. Let's see what they do in the U.S. They bought ezyVet, which was entrepreneur-owned by someone from New Zealand, Hadleigh. IDEXX bought them, and I think that they're starting soon to pilot their AI scribe, right? They're quite delayed in innovation. Yeah.
Okay, then last question regarding liquidity of the share. Any comment, any new idea to improve the liquidity of the stock?
Yeah, of course. We are very aware that as investors, liquidity is an important part of the equation. It is absolutely our aim to get Nordhealth to a place where it is easy to be able to put several million in or take several million out without anyone noticing or it moving the share price. It is not an overnight play. There are a few things that we have started doing and that we will continue to do to be able to get there. The first is growing. This is the number one most important, flat out. We are just going to become a bigger business, and that by itself will help us get more visibility, more attention, and the bigger the business is, the easier it is to invest in and out of the business. That is the number one thing that we are going to do. We have taken some small steps recently.
For example, we signed a liquidity provider agreement in, I want to say May, or yeah, around May. That for smaller investors, they could get in and out of the company more easily, and we always have a live price going. The other thing that we are going to do in the coming years is we will do an uplisting onto a main market. Obviously, that gives us access to more investors, but also more investors access to us because some of them have main market only mandates. That is another important thing that we are going to do. Bit by bit, we are going to do a little bit more on the IR side to increase our visibility and keep telling our story.
One such example being today's event, where we want to be able to communicate and spend more time with investors and let them have more access to us.
I have also bought back a lot of the liquidity, but the coming years, to be frank, and at some point, I will run out of cash to buy it back so there will be more liquidity available.
Great. I think that's us at time. I am going to say a huge thank you to everybody who is on the webcast. We will close the session now. Thank you very much to everyone who has dialed in. I will stay two seconds for some final instructions for the people in person.