We all complain that Christmas starts too early when we see selections of ‘across the miles’ cards appearing in the shops around August Bank Holiday and when the high street lights begin to go up in mid-October. Yet it doesn't stop the majority of us suddenly realising on about 10 December that we haven't sent any cards, done any shopping or put up any decorations.

Practices, with their ability to book ahead, should be different of course. But are they? Nope, just like the rest of us practices constantly get caught out by the lateness of their timing and Christmas cards are no exception. Ideally, as with forward planning needed for festive department shop windows, thought needs to be put into the practice Christmas card, if indeed there is to be one, probably about now for December 2011, never mind 2010.

If, for example, you decide that it would be ideal to have a picture of the practice on the front of the card then you will need a good image to make sure that, when printed, it doesn't arrive looking blurry and out of focus like some rather seedy looking estate agent's literature. The trouble is that if you haven't already got a photo then the one you take in say, October, isn't going to look especially Christmassy; more sort of Octobery. Had you wanted a snow scene, then you should have taken it in back in January when the usual scenery was endowed with the charm of falling flakes and beautifully sculpted drifts. Unfortunately, at the time, the country came to a white-encrusted standstill, with burst pipes, lethally slippery pavements, cancelled appointments, staff unable to get to work and patients marooned in otherwise nearby homes. What would we have said to the bright spark of a team member who had asked if we thought it would be a good idea to stand around outside the practice for next Yuletide's card? It would have been a short sentence muttered between scarves and hot chocolate!

So, without spending a huge amount of time and energy on fake snow blasted onto the front of the building or getting the hygienist up a ladder sprinkling soap-powder over the entrance, the decision moves to selecting what sort of ‘off the peg’ image you can use instead. The range is vast and time is tight so the likelihood of setting up a team sub-committee or staff-room working party is not really practical. What sort of image would suit the feel of the practice best?

Traditional can be good. The classic stagecoach pulled up at the village inn with young urchins happily playing snowballs wearing wretched clothes in circumstances that would otherwise condemn them to contracting pneumonia at the very least. Maybe not then. Attention moves to the ‘contemporary’ look instead. Cubist-style Christmas baubles daubed onto a black spruce tree inverted into a compost heap. Not sure that's quite going to work for the majority of the patients, so how about a cartoon with a jolly dental jape of a caption?

Enter Santa Claus fitting dentures to the reindeer - ‘This year I've got Dasher, Flasher and Gnasher in the team’, or having landed down the chimney in someone's sitting room is placing some tooth bleaching kits with the other presents – ‘It's a white Christmas all round this year’. The best said about them is that they're usually sold for charity, so somebody smiles for that reason if no other.

Had you started a bit earlier in the year then a competition to design the best card would have been a possibility. The only difficulty here is deciding how to balance the categories of entrant. Are you going to have a free-for-all and compare every entry like-for-like or have age groups, ability levels and themes? Tough when it comes to a delightful green triangular looking blob created in runny watercolour with the wording Hippy Crhistmis from 4-year-old Damien pitted against a sublime oil on canvas view of the local countryside bathed in the subtle light of a winter sunset by Royal Academy local artist Angela Midhurst with contributions going to the church steeple restoration fund.

A modern alternative may be an e-card or even an email alert to patients to visit the practice website and download a card of their choice – perhaps even personalised with snaps of the dental team beaming merrily and decked with Father Christmas hats, reindeer antlers and snowball ear muffs. Somehow though it seems a bit ‘Facebooky’ for what you want to achieve.

Maybe carol singing instead? Little preparation, all-inclusive and capable of visiting tens of patients' homes if not hundreds. Perhaps with special dental carols – The holly and IV sedation, Hark the herald DCPs sing, Away in a molar. OKAY, okay, the stagecoach and urchins win – Merry Christmas one and all!