Practice Life Issue 3 March/April 2014 by The Magazine Production Company

March/April 2014 www.practicelife.biz

Harnessing Technology in Your Practice New tools for the job

Telephones and Conversion Why it pays to take that call professionally

Modern Maternity What you need to know and do

Open book accounting Should you share your financials with your staff?

THE MAGAZINE OF SPVS AND VPMA

In the Spotlight: RCVS Chief Exec Nick Stace on his first year Special Feature on Well-being

EDITORS’ LETTERS

Editors’ Letters

ello again and welcome once more to another edition of Practice Life Magazine. This is issue number 3 and I hope that you’re getting used to the format with the regular sections being repeated and enjoying what we feel is, perhaps, the best thing about the magazine: lots of contributions from real people who work in practice providing the benefit of their experiences and giving our readers hints and tips that are tried and tested rather than simply theoretical. In the last edition the issue of mental health problems in the profession was raised. This is something that I know is of concern to many who work in veterinary practice and yet can be a subject that is hard to broach, so continuing this theme those of you who went to the

e all make mistakes. In our last edition we inadvertently missed a buying group from the feature which has since been rectified. I too was mildly embarrassed at the photo of me “dancing” with Helen at the SEVC Congress (I now unequivocally apologise to our VPMA President!) Way back in the 80’s I interviewed Trevor, the musician brother of Paul Daniels. In my introduction I referred to Paul as a conjurer and immediately got the sharp end of his sibling’s tongue, putting me straight in no uncertain terms that Paul was not a conjurer but an “unusualist”. Big mistake. Some of these faux pas haunt you forever. Even at VPMA/SPVS Congress in January, despite planning and even rehearsing for my chairing of one of of the streams, I still managed to curtail nine years from the service record of Nick Steele

SPVS & VPMA Congress in Newport at the end of January will have seen there was a full stream on the Friday dedicated to Mental Health & Wellbeing. Following on from that and as promised in the December issue, you’ll find that our regular Wellbeing section has been extended in this edition. Congress was excellent and as Ian mentions below, it was good to finally meet my co-editor! Finally, thank you to those of you who have contacted me about the magazine’s content; it’s good to know that the articles are being read! I hope that I answered the queries to your satisfaction and will be more than happy to hear any comments about this edition so please don’t hesitate to get in touch.

Stephanie Writer-Davies, SPVS editor

at Pfizer and then Zoetis... another apology! This edition of Practice Life will hopefully give you some pointers on mistake-avoidance in areas such as maternity matters and harnessing technology and lots more. Speaking of congress, it was great to see some familiar faces, alongside a chance to make new acquaintances (plus I finally got to meet my coeditor Steph from SPVS at long last!). Everything from the superb Celtic Manor venue through CPD for every taste to the social productions, meant that initial feedback from attendees was extremely positive. I hope you enjoy this issue and... oh yes... if anyone knows how to avoid the mistake of having your Twitter account hacked – twice – solutions written on the back of a twenty pound note gratefully received.

Ian Wolstenholme, VPMA editor

Practice Life is the magazine of SPVS and VPMA. If you are interested in joining either or both associations, visit www.spvs.org.uk and www.vpma.co.uk

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Contents Editors SPVS Stephanie Writer-Davies BVSc MRCVS steph@practicelife.biz VPMA Ian Wolstenholme, Practice Manager ian@practicelife.biz Publisher Mojo Consultancy Ltd 181 Sandpit Lane St Albans AL4 0BT Tel +44 (0) 1727 859259 info@mojoconsultancy.com www.mojoconsultancy.com Advertising and Sales Enquiries Libby Sheridan MVB MRCVS libby@practicelife.biz Tel:01727 859259 Sales Administrator Eva Lambe eva@practicelife.biz Practice Life is the magazine of the Society of Practising Veterinary Surgeons and the Veterinary Practice Management Association. It is distributed quarterly to the members of both associations as well as a wider mailing list of veterinary practices annually. www.spvs.org.uk www.vpma.co.uk The magazine contains articles on veterinary business and management as well as other topical updates and relevant features. The information contained within these articles is intended for general information only and does not replace the need for advice from qualified professionals in the relevant field. Articles and photographs are welcomed for submission, though publication is not guaranteed and is at the discretion of the editors.

© 2014 Practice Life All rights reserved. Practice Life is edited, designed, and published by Mojo Consultancy Ltd. No part of Practice Life Magazine may be reproduced, transmitted, stored electronically, distributed, or copied, in whole or part without the prior written consent of the publisher. A reprint service is available.

UPDATE: NEWS & VIEWS 5

SPVS NEWS New President’s introduction and Disease Surveillance

VPMA NEWS New faces on council

SPVS/VPMA CONGRESS 2014 Were you there?

NURSE TALK National VN Awareness Month and CPD roadshows

IN THE SPOTLIGHT RCVS Chief Exec Nick Stace on his first year in office

COLLEGE CORNER Fake vets and nurses: How to ensure you don’t hire one

VDS NEWS Nowt so strange as folk

g WELL-BEING Special Feature on Mental Health and Building Resilience

g MANAGING PEOPLE: Modern Maternity: Parental Leave Update

CLIENT CARE AND MARKETING Telephones and Conversion: Why it pays to take that call professionally

BUSINESS HEALTH AND FINANCE Open Book Accounting: Should you share your financials with staff?

PRACTICE DEVELOPMENT Special feature: Harnessing technology in your practice

CPD DIARY Focus on Digital Technology day and 2014 CPD dates

WHAT’S COMING UP Events listing and a peek at what’s in the next issue

54 28

Opinions expressed in this journal do not necessarily reflect those of the associations, the editors, Practice Life Magazine or its publisher, Mojo Consultancy Ltd. ISSN 2053-1877

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News & Views CALL FOR PARTICIPATION IN VETCOMPASS MITRAL VALVE DISEASE STUDY Veterinary surgeons working in primary-care practices across the UK are invited to participate in an exciting new study on degenerative mitral valve disease (DMVD) in dogs. The research is funded by Petplan Charitable Trust and is part of the Veterinary Companion Animal Surveillance System (VetCompass, www.rvc.ac.uk/ VetCompass), a collaborative not-for-profit research project led by the Royal Veterinary College (RVC). The study aims to identify factors associated with survival in the primary-care setting by evaluating basic clinical measurements and cardiac biomarker levels (NT-pro-BNP) in dogs with DMVD. To recruit dogs with DMVD into this study, veterinary surgeons at participating practices simply obtain owner consent, take a blood sample for the new Idexx cardiac assay (provided free of charge to

practices) and record baseline measurements such as heart rate and murmur intensity at the time of study entry. In addition to making a valuable contribution to research, further benefits of participation include free analysis of the new Idexx cardiac biomarker assay, free RVC CPD and regular up-dates on the study. Participation within VetCompass also facilitates clinical audit and practicebased research.

For further information or to express an interest in participating, please contact Maddy Mattin: mmattin@rvc.ac.uk, mobile 0775 775 0492, office 01707 667 168. www.rvc.ac.uk/VetCompass/research-projects/degenerative-mitral-valve-disease-dogs.cfm

RCVS Question Time and PSS Surgery The RCVS is hosting one of its Regional Question Time meetings at the Village Urban Resort Chester St David’s, near Ewloe, on Thursday 22 May. The event will start at 6.30pm, with a buffet supper, followed by the meeting at 7.15pm, where vets, VNs and practice managers will have the opportunity to pose their questions to a panel comprising members of the RCVS Operational Board and the Veterinary Nurses Council. The topics raised on the night depend on what matters to the delegates, but at the last meeting, in York, robust discussion took place on issues as varied as 24/7, student numbers, graduate prospects and salaries, mental health within the profession, the review of the Practice Standards Scheme and microchipping. Meanwhile, during the daytime of 22 May, and in the same venue, we will be holding free 45-minutes Practice Standards Surgeries with a Scheme Inspector. This is a great opportunity for those thinking of joining the Scheme or facing an inspection or re-inspection to get some detailed advice tailored to their specific practice needs. An invitation to the evening meeting will be sent to all those living within reasonable travelling distance, but if you would like to attend, or you are interested in a PSS Surgery, please contact Fiona Harcourt on f.harcourt@rcvs.org.uk or 0207 202 0773.

APOLOGY It has been brought to our attention that in our Buying Group feature in the December issue, we inadvertently missed out the Vetcel Group. We would like to apologise for this oversight.

Vetcel work to improve member’s profitability by reducing the cost of their purchases on pharmaceuticals and other goods/services, by negotiating the very best discount terms possible from our partners. We strive to provide a high quality, transparent and reliable service. We pay 100% of discounts earned in the month following purchase. We charge no membership, administration, joining or termination fee and do not tie members into a contract. ADVERTORIAL

SPVS/VPMA Congress Delegates Support Animal Welfare Foundation The Animal Welfare Foundation (AWF) announced that it would put the £1,822 raised during the SPVS/VPMA Congress’ Masquerade Ball towards production of its popular evidence-based pet care advice leaflets. Founded and managed by vets, AWF uses science, education and debate to improve animal welfare. AWF Chairman Tiffany Hemming said: “Our pet care advice leaflets are distributed through veterinary practices so it is fitting to receive this support from the SPVS/VPMA Congress which brings the whole practice team together. AWF is a small charity, which is totally dependent on donations and £1,822 is a significant and valuable contribution to our work.” SPVS President Adi Nell explained why AWF was his choice for official charity and that the decision received enthusiastic support from VPMA President Helen Sanderson. Adi Nell noted: “AWF was my choice because I wanted to support a charity within the veterinary profession. Helen agreed since AWF has done some great work educating the profession and the public as well as funding impactful research.” AWF is currently celebrating its 30th anniversary and has recently marked this milestone by awarding a number of grants for veterinary research into diseases and welfare of horses, cattle and sheep. AWF leaflets currently available can be downloaded from http://www.bva-awf.org.uk/petcare-advice, leaflet batches for the practice can be ordered via bva-awf@bva.co.uk.

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NEWS IN BRIEF

JOIN THE TOUR DE VET The Tour de France is visiting Yorkshire this year, and inspired by the buzz around this iconic event Mike Brampton, inventor of the CAT (the UK’s most popular BP system), is planning his very own ‘Tour de Vet’ this summer. Throughout May and June, Mike will be travelling the country by bike, dispensing the tutoring and coaching that he usually delivers at Nottingham University Vet School, but this time in practices. Mike will donate all his fees throughout the Tour to the wonderful charity Canine Partners. So if you want to help out a very worthwhile

cause, as well as benefitting from an hour of one-on-one high quality CPD, book now. Your CPD session with Mike will cover a range of topics, including: • Taking accurate blood pressures • Extending your clinical management • Improving cash flow Call Mike on 01903 522911 or email mike@thamesmedical.com to book your place

Vet Charity Challenge 2014 announced... Following the success of the 2013 Vet Charity Challenge, which raised £50,000, we are pleased to announce that 2014’s event will take place on Saturday 27th September at St Francis School, Pewsey, near Marlborough, Wiltshire. The event consists of teams of four walking/ running, cycling and kayaking as well as some orienteering and mental and physical tasks.

Registration opening soon Registration will open at the start of April. Spaces are limited and in 2013 filled up very fast, so to avoid disappointment it is highly recommended to book early. The charities being supported in 2014 will be Hearing Dogs for Deaf People, SPANA and Cats Protection. Gavin Mitchell from BCF commented, “We were delighted at the success of the Vet

Contestants from the 2013 challenge

Charity Challenge in 2013, we had 50 teams taking part and raised £50,000 for 3 deserving charities. We hope to top this in 2014, making the event even bigger and better than last year.” Andrew Groom from Kruuse added, “A massive thanks to all who took part in 2013 and to all who donated. We hope to see you all back plus more in 2014 to continue to make this a great event.” The Vet Charity Challenge is sponsored by BCF Technology, Kruuse and Vetoquinol and supported by the VMPA, Mojo Consultancy and Veterinary Practice magazine. For more information visit: www.vetcharitychallenge.co.uk or call Jason Rogers on 01506 469102

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SPVS News

SPVS NEWS

Colin Thomson, the new SPVS

President, looks forward to his year in office...

Our Council meeting this coming April will be my first as SPVS President. How will this meeting differ from my very first five years ago? There will be more female faces, and the average age will lower – although in both these respects we will still not have reached parity with the demographics of the profession. When I joined Council we were being cautious with our finances, having had several poor years. Now after a few years of surplus, we are in good financial health. Largely this has been due to improved financial performance from our CPD events and our congress. In turn, this has been driven by using professional events organisers and by joining with VPMA for both CPD and Congress. I would contend that both of these are more focused and higher quality than they sometimes were in the past. We now produce this magazine jointly with VPMA. Again we have professional publishing help, and I believe this has resulted in a vastly more educating and entertaining production than our former journal. We started a review of our activities about 2 years ago. It’s taken longer than we thought, but the outcome will be a more modern, efficient and hopefully more effective society. Some changes are still work in progress. We’re currently forming a company along with VPMA to streamline the financial and management aspects of our joint activities. We’re converting from a society to a Company Limited by Guarantee, both to reduce personal exposure of our Officers and Councillors, and to streamline our dealings with other organisations and ease our tax planning. Our surveys of fees and salaries will be spruced up. We continue to talk to many organisations, responding to reviews and requests for opinion as well as proactively seeking to put the case for the vet in practice. Reviewing our activities and making them better for our members is not enough. There is also a need to fill the gaps others have left in improving the lot of the vet in practice. Here we’re looking at practice business benchmarking and with VetXML, making safe prescribing easy. The well-being of vets concerns us – how can we help prevent vets’ mental anguish and stress? We wish to encourage younger vets to take partnership, directorship and other ownership roles in practice and are developing a series of resources to help the would-be practice owner, as well as seeking the opinions of recent practice owners, to identify the pitfalls in different modes of practice ownership. But, when I look round the Council table meeting this April one thing won’t have changed. Most of those there will already be running a veterinary business. We’ve tried hard to shed the epithet of ‘the bosses club’, but have to accept that most of those getting involved with SPVS will be at a certain stage in their career. Despite this, SPVS’ focus is still on the practice as a whole – better practices are happy workplaces with fulfilled workers: vets, nurses and others. As SPVS President my effort will be not solely for the practice (or its boss), but for all who work in practice. I aim to do what I can to improve everybody’s Practice Life.

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SPVS GOLF DAY 2014 – 24th June, The Oxfordshire We are pleased to announce that the 2014 SPVS Golf Day will be at the Oxfordshire on Tuesday 24th June. The Sponsors will again be Dickinsons Financial Management Ltd (Keith Dickinson) and Hazlewoods Accountants of Cheltenham (Phil Swan and Mark Beaney). Last year the weather was very unkind to us (as those of you who were there may recall!) but hopefully this year with a June date we may be luckier, although whatever the weather, the Oxfordshire is a superb course. We had a very good turn out last year and are hoping for a repeat in 2014, so for more information and to secure your place please contact Keith Dickinson on Keith.Dickinson@shireinsurance.co.uk

SPVS Dates For Your Diary 2014 April 14th and 15th – SPVS Officers and Council meetings if there are any items you’d like discussed or points you’d like raised please contact the Hon Sec, Tom Flynn via the SPVS Office May 30th to June 6th – Scubascene diving and CPD in the Southern Red Sea For more details contact the SPVS Office July 21st and 22nd – SPVS Officers and Council Meetings If there are any items you’d like discussed or points you’d like raised please contact the Hon Sec, Tom Flynn via the SPVS Office

SPVS NEWS

VETERINARY DISEASE SURVEILLANCE: call for help from primary-care vets SPVS has been approached for help from two organisations researching disease prevalence and treatment. You can read more about the two projects here and what practices can do to further veterinary knowledge and understanding.

Building an evidence-based knowledge base

The Veterinary Companion Animal Surveillance System (VetCompass) collates and analyses data from primarycare veterinary practices to reveal vital information on the health and welfare of companion animals in the UK. The project, which is led by the Royal Veterinary College in collaboration with the University of Sydney, aims to improve the welfare of companion animals by investigating the frequency of and risk factors for disorders recorded by veterinary surgeons. The outputs of these studies support an evidence-based approach that is highly relevant to primary-care practitioners. The project also aims to facilitate practices with internal analysis of their own data and to generate valuable benchmarking information. To date, 190 veterinary clinics have shared data on over 3.5 million episodes of care relating to 601,334 animals. These data have been used to estimate the prevalence of and identify risk factors for epilepsy of unknown origin, chronic kidney disease and diabetes mellitus in dogs and hyperthyroidism in cats. Other studies have explored the geographical distribution of disease, usage of antimicrobials and glucocorticoids in practice and longevity of dogs. VetCompass studies supported by the RSPCA and the Kennel Club Charitable Trust have revealed unique insights into the extent to which dog breeds are affected by inherited disorders. A Dogs Trust Welfare Grant has recently been awarded to fund a VetCompass project entitled â&#x20AC;&#x2DC;Evidencebased prioritisation of canine inherited diseasesâ&#x20AC;&#x2122;, which will progress and re-focus the priorities for improving canine health.

Pet Plan Charitable Trust is supporting a novel study exploring the survival of dogs with degenerative mitral valve disease that will evaluate the prognostic value of cardiac biomarkers and simple clinical measurements in the primary-care setting. The VetCompass project will run indefinitely and aims to recruit as many veterinary practices as possible. Currently, practices with recent versions of RxWorks, Teleos, Vet-One and ezVetPro practice management systems are able to share data with the VetCompass database. These systems offer a standardised list of diagnostic terms (VeNom codes, www.venomcoding.org), from which appropriate diagnostic terms can be recorded at episodes of care. VeNom terms are rapidly selected from a dropdown list of matching or related terms by typing in the first few letters of the diagnosis, or the first letters of more than one word. Practice staff and VetCompass researchers can subsequently use VeNom codes to identify animals that were assigned a specific diagnosis. Data shared with VetCompass include demographic data (e.g. species, breed, sex), VeNom diagnostic codes, treatments prescribed and clinical notes. De-identified data are automatically uploaded to a secure database at the RVC, making participation in the project time-neutral. No personal client information or financial details are shared and all data collection is fully compliant with data protection legislation. The aims of the VetCompass project are endorsed by organisations including SPVS, RCVS and BVA (VetCompass 2013).

In addition to facilitating VetCompass research, recording VeNom codes allows practices to better analyse their own data. Such internal analyses have many applications including clinical audit to evaluate responses to protocol changes as well as assisting decision-making to identify equipment or training needs and encouraging practice led research. VeNom terms enable faster reviewing of patient histories and completion of insurance claim forms without lengthy interrogation of free text clinical notes that may be plagued by colloquial terms, abbreviations and misspellings. Practices participating in VetCompass are acknowledged on the project website and provided with posters and leaflets to promote their involvement with welfare-focused research to clients. Further benefits, such as free CPD and subsidised diagnostic tests are also available for specific projects within VetCompass. The VetCompass project provides a valuable resource that will both improve the health and welfare of companion animals and also offer significant clinical and management benefits to collaborating veterinary practitioners.

For further information or to express an interest in participating, please contact Maddy Mattin mmattin@rvc.ac.uk, tel: 01707 667 168 (office) 0775 775 0492 (mobile) VetCompass website: www.rvc.ac.uk/VetCompass/

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Surveillance system that gives back

SAVSNET (the Small Animal Veterinary Surveillance Network) is a charity set up between University of Liverpool and the BSAVA to generate surveillance of companion animal disease in the UK. SAVSNET collates data from commercial diagnostic labs and vets in practice, publishing results on its website (SAVSNET.co.uk) as well as providing free benchmarking to participating practices. Here we show how SAVSNET works in a typical practice: Step One – Getting data: You enter the consulting room for a morning of consultations. From the list it looks like it will be another busy morning. The consultations proceed as normal, but at the end of each one, a new window has appeared (the SAVSNET window) allowing you to submit syndromic surveillance data to SAVSNET. You are asked to indicate the primary reason for this consultation; was it GI signs, respiratory signs, skin conditions or tumours, or was the animal well and needing a vaccination or a check? Your first and second patients came in for vaccinations and the window disappears after a single click on the vaccination button. Towards the end of the morning, a young dog, let’s call him Homer, comes in with diarrhoea. At the end of the consultation, you click on the

GI signs button. In 5-10% of consults SAVSNET collects additional data through a short follow-up questionnaire. This is one of those and another window follows the first, asking you a few additional questions about Homer’s disease; is he also vomiting? Is the diarrhoea of a large or small bowel pattern? The questions only take 15-20 seconds to complete (and only appear in 5-10% of consults). Step Two – Using data to help animals: At the end of morning consultations, while you have a quick coffee before operating, you go to the savsnet.co.uk website which shows national results for diseases like Homer’s. You can see dogs are more than twice as likely to present for diarrhoea as cats, and that the main treatments used by your anonymous peers are diet modification and antibacterials. You wonder how disease in your practice compares to these national averages. SAVSNET will provide these answers. You login with your practice details and see hotspots of GI disease mapped in your practice. You are able to see that Homer is not the only dog from that area to present with diarrhoea. While you ponder this, one of the receptionists calls; “I’ve got a client on the phone who wants to know if she should vaccinate her cats against feline calicivirus. Could you have a word

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with her?” You go back to the SAVSNET webpage to the page on Infectious disease of the UK and click on the disease map for feline calicivirus; a map of the UK shows confirmed cases over the last 12 months and links on the page take you to recently published guidelines and resources on the disease. While you discuss the pros and cons of vaccination with the client, you can also direct her to the webpage to see the evidence underpinning your recommendations for herself. SAVSNET aims to do this and more. We are currently rolling out the SAVSNET questionnaire to users of Robovet software, but are planning to incorporate SAVSNET into other software soon. Our aim is to convert data from practices (and laboratories) into information that is useful, beautifully presented and easily available to practitioners via a system that fits seamlessly into practice life. This will benefit us, the pets we treat and their owners. All this is only possible with the support of practices like yours. Why not ask your PMS provider if their software allows you to take part? For more information on the SAVSNET project, and how your practice could take part, see www.SAVSNET.co.uk or e-mail SAVSNET@liv.ac.uk.

VPMA NEWS

Regional Co-ordinator,

Renay Rickard

MEET YOUR REGIONAL ORGANISERS If you are not in touch with your local regional group and would like to get more involved, please contact the VPMA Secretariat.

It has been a busy few months within the VPMA regions. Regional meetings are being organised across the country so look out for information on our web site and on our facebook page. We also had VPMA/SPVS Congress at the beginning of February. Many of the regional organisers (ROs) there had their blue rosettes on, and we met up with many current and potential new attendees for our regional meetings which was fantastic. We also used the networking event on Thursday evening for an RO get together. I am very proud to announce that our table won the quiz which, after a light hearted start, got very competitive towards the end! We also held a strategy meeting there on Friday afternoon. Our main aim for 2014 is to ensure that each region holds at least three meetings a year, with members encouraged to attend any meeting they want to, within or outside their region. We will continue to inform members about every meeting – not just those that are their most local. We will also be holding joint meetings across some regions which are an ideal opportunity for you to get together with a different bunch of people. Another aim is to ensure that the speakers and content of the meetings is what you, our members, want – so let your ROs know the topics you would like to hear about and we will find the speakers. Don’t forget to give feedback to your RO after the meeting. This is invaluable in helping us to maintain a good standard. On the subject of speakers, there is now a form available on the VPMA website (again check with linda on this one that its ready!) for individuals or companies who are interested in speaking at one of our meetings to get in touch with us. You can use it to suggest topics and give detail on what you’d like to talk about. We hope to see many of you in the upcoming months. As always don’t hesitate to get in touch with me via the Secretariat.

Renay

YVONNE SHAW Central Scotland Tel: 0787 925 4399 ro1@vpma.co.uk

RITA DINGWALL East Sussex Tel: 01435 866058 ro9@vpma.co.uk

GILLIAN KIDD Scotland Tel: 01408 622217 ro2@vpma.co.uk

HELEN SANDERSON Oxfordshire/Wiltshire/Berkshire Tel: 07765 338607 ro13@vpma.co.uk

PAULINE GRAHAM Cumbria Tel: 07803 228720 ro3@vpma.co.uk

CLAIRE BAKE Co. Durham Tel: 01388 602707 ro16@vpma.co.uk SUSAN LUNN Stoke on Trent/South Staffordshire Tel: 01543 424100 ro17@vpma.co.uk

DENISE WHITHAM Herts/Beds/Northants Tel: 07837 058155 ro4@vpma.co.uk MELVYN WILKINS Gloucestershire/South Wales Tel: 07887 895274 ro5@vpma.co.uk

JULIE BEACHAM Buckinghamshire Tel: 07710 317310 ro18@vpma.co.uk

CATH GRIMSEY East Anglia ro6@vpma.co.uk

SUZANNE HEADINGTON South West Tel: 01242 680000 ro20@vpma.co.uk

MARK HARWOOD London Tel: 01242 680000 ro7@vpma.co.uk

RENAY RICKARD Cornwall/Devon Tel: 01208 872254 ro21@vpma.co.uk

d! e d e e n p l e H source library

ing a re . We are build PMA website V e th n o rs for membe sharing your y b s e u g a e ll d Help your co and tips: sen ls o c to ro p templates, vpma.co.uk @ t ia r a t e r c to se

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VPMA News VPMA President,

Helen Sanderson

VPMA NEWS

NEW FACES

welcomes another year in office... Spring is at last in the air, and I hope you’re surviving the floods and gales. I hope that those of you who attended our joint VPMA/SPVS congress enjoyed it and got a lot out of it. I have to say the venue, speakers and the masked ball exceeded all my expectations. I’m delighted to say we will be returning to the Celtic Manor Resort next year so book early as we expect it to sell out! As I embark on my second presidential year I am looking forward to further developing our member benefits. Renay has done a great job growing our regional meetings, and together with SPVS, our joint CPD programme is going from strength to strength. This year we are delighted to offer reception training and also the first step in management training for those who are starting to head up teams. On that note, working with the College of Animal Welfare’s Business School, we’re pleased to announce a new ILM Level 3 Certificate in Leadership and Management. We consider it a great stepping stone between our VPAC and our CVPM qualifications, and ideal for nurses entering management. Have you noticed the new VPMA logo? We felt that it was time for an update to reflect the dynamism and modern nature of the organisation. We have carried the fresh new colour through to the website which has been made easier to navigate. We’re also currently building a member library of resources for you to share best practice. Please support us in this initiative by sending us your templates, protocols and anything else you think would be useful for others. Together, we’re looking forward to another year of growth in ‘Managing Veterinary Excellence’.

Julie Beacham takes over as Honorary Secretary and Cath Grimsey as Treasurer Following the successful and well-attended Annual General Meeting of the VPMA held at the Celtic Manor Resort on 30th January, some familiar faces have completed their terms of office and were recognised for their service and dedication. Taking over from Stephen Broomfield as Honorary Secretary is Julie Beacham, Practice Manager at Wendover Heights Veterinary Centre in Buckinghamshire. Steve remains a council member. Treasurer Bob Moore has ensured that the financial footing of VPMA has been sure and steady for several years, now handing over the reins to Cath Grimsey, equine veterinary practice manager from the Welsh Borderland. VPMA council member Dennis Owen has also completed a long term of office and filling the vacancy (appointments subject to ratification in March) will be Angela Andrew who, since 1999 has been Practice Manager at Connaught House Veterinary Hospital in Wolverhampton and Ruth Mackay, Managing Director and Veterinary Surgeon at the Rowan Veterinary Centre in Lancashire. The VPMA has been fully represented at the BVA by Sarah Hibbert and RCVS Practice Standards Scheme Committee by Carole Clarke for several years. Their roles will now be taken over and shared by Renay Rickard and Rita Dingwall. In her AGM report, VPMA President Helen Sanderson, embarking on her second year of office, warmly thanked all who had contributed to the progress of the association and presented gifts of crystalware to Bob, Sarah, Dennis and Carole.

Best wishes,

Helen Sanderson

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Angela Andrew and Ruth Mackay join council

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SPVS/VPMA Congress 2014

Were YOU there?

CONGRESS SPECIAL

CONGRESS SPECIAL Editor Steph Writer-Davies reviews the social aspects of this year’s SPVSVPMA Congress and why, despite its growth, it still retains its intimacy.

here’s no doubt that this year’s joint SPVS & VPMA congress delivered on all fronts. There were more delegates and a larger commercial exhibition than last year as well as excellent lectures and interactive sessions covering a range of topics very relevant to veterinary businesses which offered helpful, practical advice that I can imagine making immediate use of in my own practice. However, despite the joint event being far bigger than SPVS congresses used to be, somehow the friendly, social feel has remained and I’m sure that was helped by the vast majority of those attending coming for the whole conference and staying in the hotel where it was hosted.

Some of the new SPVS Officers Team (L to R): Honorary Secretary Tom Flynn, Honorary Editor Stephanie WriterDavies, (Now) Senior Vice President Adi Nell, (New) President Colin Thomson, President Elect & Congress Officer Nick Stuart

AND WHAT A HOTEL! I had driven past the Celtic Manor Resort on several occasions and knew of its reputation but hadn’t appreciated quite how spectacular it was; the almost cathedral like huge lobby was an impressive first sight of the hotel when I arrived and my room was very comfortable with a view over the Brecon Beacons (which looked lovely on Saturday morning after there had been a dusting of snow overnight). The food we had over the 2 days was good; breakfast was what would usually be expected in a hotel of this class although there were some interesting extra options (our retiring SVP, Gudrun, was very excited to discover a pancake making machine and went back for seconds!) and the buffet lunches provided to delegates were far better than the traditional ‘packed lunches’ we’re used to at BSAVA congress. Then there was the amazing spa and of course the golf for which the hotel is famous – just not enough time for conference delegates to make use of all the facilities though many partners did. On Thursday night there was a ‘networking dinner’; a chance to meet other delegates and to test our general knowledge

skills with a quiz put on by ex-Mastermind contestant, Steve Broomfield. Needless to say, there was friendly competition between the tables though there seemed to be a bit of cheating towards the end! Friday night’s masked ball was really splendid with a wonderful meal, amusing speeches and an excellent band which saw the dance floor packed to capacity. It all officially finished at 1am but there was no shortage of people making use of the hotel bar to continue socialising; the numbers dwindled as time went on with the last stragglers finally turning in about 4.30am which meant a fair few bleary eyes at breakfast on Saturday! For SPVS members congress closed after lectures finished on Saturday with the Society’s AGM where the motion for SPVS to become a company limited by guarantee was voted on and approved. Jacqui Molyneux was made a Lifetime SPVS member in recognition of her work for the society and dedication to the cause of the practising vet, and Colin Thomson was inaugurated as president.

Practice Manager at Connaught House Veterinary Hospital, Angela Andrew gets taken back...

The inimitable Bogus Brothers

ongress 2014, what can I say? I enjoyed every minute. The only problem I had was deciding which lectures to attend from the brilliant array on offer. In the end I decided to indulge myself, followed my heart and focused on personal development – including coaching and mindfulness, two topics which have had a profound effect on

me in recent years, both personally and professionally, and which I am now definitely going to introduce in practice. I have been talking about doing this for some time but now I am determined to “walk the talk”. What an inspiring start to the year! Anyone who attended the mindfulness sessions should now be able to understand that the lady who took to the stage with the Bogus Brothers at the wonderful masked ball, shaking her tambourine and singing along to Bryan Adams’ “Summer of 69”, was not under the influence of alcohol but displaying the feelings of happiness and sheer exhilaration that thoughts connected to that music were invoking in her in that moment and which were displayed in her behaviour. How do I know? Inside information. That lady was me and I make no apologies for the lack of choreography but I urge everyone to find your “Summer of 69” and when you need a lift, play it inside your head and let the feelings do the rest. Practice Life z March/April 2014 z www.practicelife.biz

CONGRESS SPECIAL

Practice Manager Julie Beacham, tells us why her New Year resolutions got made a little late this year...

f you missed the 2014 SPVS/VPMA Congress, you missed a treat. After the formalities of the Thursday evening VPMA AGM, we had a networking dinner and fiercely competitive quiz night, hosted by our own Mastermind contestant, Steve Broomfield. Congress proper started the following morning with a plenary session from Tracy Killen, HR Director at John Lewis who spoke about the rapidly changing world of business and what vet practice can learn from them. It was fascinating and demonstrated how applying the basic rules of business really well creates a culture of employee engagement that leads to success. Before we left the room, we also had a taster of mindfulness which involved closely studying a raisin. I shall

never take dried fruit for granted again! For the rest of Friday, we had the difficult choice of four lecture streams including one on equine management and another devoted to mental health and wellbeing. My Friday was spent chairing and listening to international speaker Katherine Eitel who covered various aspects of leadership. There were some really useful tips and I’m sure that I wasn’t the only one in the room making some very late New Year’s resolutions. Saturday lectures included a stream for vets five to fifteen years qualified and several lectures on coaching. At 4pm, it was all over for another year and we set off for home, inspired and informed – and looking forward to the next time.

Editor Ian Wolstenholme caught up with Congress speaker and Leadership Lioness Katherine Eitel KE: All great leaders are great communicators and when you remember that people have instinctive knowledge and wisdom already, your job is to awaken their natural abilities and desires to succeed. When you can attach your nugget of information to this desire, it’s a much easier conversation. You need to find a “place” of agreement before you step in... e.g., “I need this (thing) to be different. I have an idea about what would make it different, but I’m open to what you think. We need this result but it doesn’t have to have any one particular way of getting there”. You can still be very direct, but you just come at it with a different strategy.

Ian Wolstenholme: Your colleagues across the pond seem very adept at holding meetings and finding time to run them to great effect. I know that you’ve spent some time before speaking at congress in several UK vet practices. Has it been a bit of an eye opener? Katherine Eitel: Well Ian, you know what... there is not much difference! There are similar struggles in the profession of healthcare and veterinary medicine; such busy operations with so many moving parts. We often think there is so little time but it is important not to view meetings as a cost but rather an investment. True, it may take a little time to see the return but it doesnt have to be that complicated; one hour a month is better than nothing. IW: You would think that with the armoury of techniques at our disposal these days that there would rarely if ever be any issues when it comes to having difficult conversations with staff. What “roaring” or “purring” advice have you been offering to delegates here? www.practicelife.biz z March/April 2014 z Practice Life

IW: Two words – brave decisions. What advice would you give to readers who are a little scared of taking such, particularly in the light of the huge legal repercussions if they get it wrong? KE: I still believe we should document all our conversations. Do what you need to do in a very simple format and have any difficult conversations quickly – don’t wait years to do something you can do in days! Do the minimum you need to do to keep yourself safe but don’t stay so safe that you make no progress. IW: External facilitation: How would you convince (an owner or manager) to give up the reins for a period whilst someone like you comes into the business to assist? KE: Getting a professional facilitator into your practice without giving up control should be possible. They should ask “What are the business and team outcomes we need to achieve?” and be really clear about that. They should help to keep things on track and where you intended them to be. This is the part that business owners find difficult.

Some parts of this interview have been abbreviated. To hear Ian Wolstenholme’s full conversation with Katherine Eitel, go to http://1drv.ms/1cWYx4O

Nurse Talk 16

NURSE TALK

In association with

BVNA – how can VN’s get involved with us?

National Veterinary Nursing Awareness Month 1-31 May 2014 | Nationwide

Have you ever wondered what it means when you see BVNA Regional Coordinator (RCO)? We are a team of Veterinary Nurses that are regional co-ordinators for the BVNA. It is our aim to provide Veterinary Nurses with good quality and affordable CPD. We are based all across the UK; every BVNA member should have their own regional coordinator.

‘National Veterinary Nursing Awareness Month’ helps create awareness of the importance of the veterinary nursing profession and the provision of responsible pet care.’ To enable more veterinary nursing staff around the country to come together and get involved with promoting the profession we will be campaigning throughout the month of May. This will hopefully give even more practices a chance to organise fantastic events in their area and have fun with their clients and local residents. It’s an ideal time for you and your practice team to organise events to promote your profession. You can also hold open days so clients and potential clients have a chance to see the services you offer and the level of care provided by your practice team. BVNA will be attending a number of country shows and external events to support the campaign and ask that all nursing staff up and down the country help by getting involved. We will be running our annual competition during ‘National VN Awareness Month’ open to anyone working within the veterinary nursing profession with some fantastic prizes to be won. Further information will be available shortly via the BVNA website www.bvna. org.uk and a practice poster will be available in the March issue of VNJ. This campaign has kindly been sponsored by Anistel, Avid, Hill’s, Merial, Petplan, and VN Times.

Join us in celebrating our amazing profession!

DON’T MISS THE BVNA CPD ROADSHOWS BVNA CPD days are full day events running from 9.30am to 5.30pm gaining you a whopping 6 hours worth of CPD! Subjects will cover Clinical Governance, Emergency & Critical Care, Behaviour, Laboratory Skills, Nursing Clinics and Nutrition.

Being an RCO is an enjoyable role – we get to meet lots of our colleagues whilst attending local CPD that we have provided for our members. In return we all meet in October at BVNA Congress. Since our CPD became compulsory the RCO role provides the much needed CPD for all RVN’s. At the moment we have several vacancies and would love to hear from you. We are looking for support in the regions of: • Sussex • Surrey • London • Norfolk/Cambridgeshire • The Southern North East • The Channel Islands. If you are a VN/RVN and a member of the BVNA and would like to know a little more about what being one of our team entails, please email donnaleighlewis@hotmail.com (RCO Team Leader) or contact the BVNA office.

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NURSE TALK

Outstanding Contribution to Pet Health Counselling’ Award for Norfolk VN Clare O’Dwyer, a veterinary nurse from Terrington Vets in King’s Lynn, has been presented with Royal Canin’s first-ever ‘Outstanding Contribution to Pet Health Counselling’ Award. Clare was recognised for her dedication and contribution to the role of Pet Health Counsellor in her practice, working hard to promote preventative health care whilst running a wide variety of pet health clinics for local pets and their owners. For example, in the past year alone, Clare has organised obesity clinics, dental clinics, puppy parties, senior pet clubs and an open day for the practice, as well as presenting bravery awards to some of her recovering patients. Royal Canin presented Clare with £500 of high-street vouchers, along with the award’s inaugural gold badge and certificate, plus a hamper stuffed full of goodies including food, a mug, t-shirt and stationery. The award presentation was made by Royal Canin’s Clare Hemmings VN, ably assisted by practice colleagues who helped prepare a surprise buffet and party along with her husband and special guest of honour, Sherman her pet French Bulldog, who she’d hand-reared from a pup after he was born with a cleft palate. The Royal Canin Pet Health Counsellor scheme was set up to encourage Veterinary Nurses to advance their professional development and, whilst this is the first award of its kind, Royal Canin has been hosting an annual Pet Health Counsellor of the Year Award ceremony for a number of years, to recognise exceptional contributions to pet health care.

Introduction to management The Veterinary Practice Management Association and The College of Animal Welfare (CAW) have put their heads together to promote two accredited qualifications in Leadership and Management, aimed at the veterinary sector. Delivered by the new CAW Business School, the ILM Level 3 Certificate in Leadership and Management is aimed at those working in or aspiring to a leadership position within practice. The qualification is awarded by the Institute of Leadership & Management, and is set at the equivalent of ‘A’ level standard. The ILM Level 5 Diploma is delivered to Foundation Degree level. The VPMA is boosting the benefits of each course by offering students a year’s free membership of the association. Both courses have already seen a mixture of vets and nurses enrol, with the aim of learning best practice as they take on more management responsibility. VPMA’s President Helen Sanderson was keen to stress the benefits to practice employers of encouraging further study, “We see these courses being a useful introduction for those new to management, as well as a stepping stone to our own Certificate in Veterinary Practice Management (CVPM). They will give your staff members the knowledge and confidence to tackle management-related issues, and bring out the best in other team members. This, of course, has the potential to boost your bottom line through increased staff retention as well as decreasing recruitment costs.

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I feel that this training is every bit as important as clinical CPD and should be actively encouraged if there is an interest there.” Subjects are taught as a combination of online tutorials augmented by case studies, self directed research and a number of face-to-face sessions (two weekends for the Level 3, and four for Level 5 at the CAW headquarters in Huntingdon). Both courses allow for personalised, flexible study with the support of tutors and other students. The Level 3 Certificate is estimated to take about 12 months to complete, and the Level 5 Diploma, 18 months. Both are assessed through assignments and learning logs. A special discount price of £950 (+ £105 ILM registration fee) for the L3 Certificate and £1950 (+ £166 ILM registration fee) for the L5 Diploma can be spread as interest-free Pay As You Learn payments until qualification. Several courses run each year, with the next L5 commencing in March. To read more visit www.business.caw.ac.uk/ilm-courses and www.vpma.co.uk/education

IN THE SPOTLIGHT

This month, In the Spotlight talks to Chief Executive and Secretary of the RCVS, Nick Stace, about his first year in office, the Strategic Plan and some other recent initiatives...

in the You took on the new role of Chief Executive and Secretary of the RCVS in September 2012 – tell us why this role was thought to be necessary? From a personal point of view I am delighted that the role was developed but for the College it makes sense for a couple of reasons. Firstly, it brings more professionalism to how we manage projects and resources within the organisation. Secondly, having a Chief Executive provides a greater sense of direction in how we meet challenges and how we do things in relation to both the profession and the public. Thirdly, it allows us to have a distinction between our regulatory responsibilities, our other Royal College functions and the running of the organisation. Tell us about your first year in office. It was very enjoyable – I think it’s important that the leader of an organisation does enjoy what they are doing because they are more likely to do a good job and enthuse others to do so as well. I’ve been working with a very strong team and supportive Council. It has felt like a fresh start for the College – finding out and understanding how the profession and the public view what we do, where we are successful and where we need to make improvements. On the downside, I have realised that there is a vocal, negative minority within the profession who carry a disproportionate amount of influence.

But, if anything has been learnt from the First Rate Regulator initiative and my many practice visits, it is that the opinions of this minority are not reflective of the profession as a whole. What will the new Strategic Plan mean to members of the veterinary profession at a grassroots level? The central driver of the Strategic Plan is about improving the College’s service agenda which means being more responsive to the demands of both the public and the profession. For example, we recognise the anxiety for vets who have been complained about and we’re aiming to reduce the amount of time the complaint process takes while not compromising on its fairness or robustness. We’re also looking at ways to improve and streamline the way the registration fees can be paid. Furthermore, we want to beef up our advice service. How would you define a first rate regulator? What was the thinking behind the First Rate Regulator initiative and what changes at the College will be most apparent to both veterinary professionals and members of the public? I think a first rate regulator is there to represent the public interest and be in the driving seat of reform because, if it is not, then government may step in to take over. In order to be a first rate regulator we need to be ambitious in following through on our plans so that

we are not just playing catch-up with other regulators but actually setting the trends. The project initiated a process of constantly challenging ourselves as an organisation, which is key to being first rate. For example, one of the pieces of feedback we received was that the public and profession didn’t feel they understood where they were in the complaint process when they were part way through it. This affirmed the need to improve the way that we communicate during the process. Many members of the public were also unhappy with the decisions we made regarding their complaints. We only deal with serious professional misconduct and many complaints, therefore, fall outside our remit. We are now looking at a consumer disputes resolution service to deal with these other complaints. It is the right thing to do for the organisation and it is also in line with the European Union’s Directive on alternative dispute resolution for consumer disputes which comes into effect in 2015. What do you think the biggest barriers will be on the journey to regulatory excellence and how will the organisation overcome them? The biggest barrier is that we have great ambitions and we need to manage expectations around delivering them. There is clearly a lot of work that needs to be done and we need to

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IN THE SPOTLIGHT

prioritise properly so we don’t bite off more than we can chew. In addition, we need to make sure that we have got the right skills for our staff and Council members. As CEO I do welcome a healthy dose of scepticism within the veterinary profession and the public because it keeps us on our toes, but there is a barrier if such scepticism leads to people being distrustful of the College and our intentions. So, we have to redouble our efforts to effectively communicate all our big decisions such as the proposals to change our Royal Charter and to demonstrate that they are well thought through, command support and are well intentioned. What are your thoughts on the perception that the RCVS is ‘an old boys club’ and ‘not in touch with clinical practice’? It is not an old boys club but it is not perfect either and further reform of Council will be required over time. My experience of working with the individuals on Council has been overwhelmingly positive and we are blessed with some very thoughtful, intelligent and caring individuals who only wish to do well by the profession and the public. On the down side, while Council understands many of the challenges that the profession faces, consumer opinion is not adequately represented. The size of Council is also an obstacle to truly effective governance and of course more vet schools will see the numbers on Council pushing 50, with most regulators reducing their number to 12 or even nine members. Many recent graduates are said to live in fear of a disciplinary procedure. Do you think that’s a reasonable fear? I’m not sure that I agree that graduates do live in fear and certainly they have no need to do so – according to our latest figures an average of just five per cent of vets who have been on the Register for four years or fewer have had complaints made about them. As an organisation we spend a lot of time talking to student vets about the disciplinary process and dispelling many

of the negative myths. For example, in the seminars that we hold for students at the vet schools, we talk about what they need to do to avoid complaints and we also point out the unlikelihood of receiving a complaint and of this complaint ending up in front of a Disciplinary Committee. At time of writing you are calling for evidence on the provision of 24-hour emergency care. Owner expectations often differ from what can be achieved by the profession. How will you marry the two opinions? We are currently seeking evidence from animal owners and practitioners and we will be doing further research with animal owners as well. This is very much a fact finding exercise and I wouldn’t like to come to any particular conclusions before it is finished. Our Standards Committee will want to look at the facts before them before putting any recommendations to Council. It is important to point out that this isn’t a referendum on out-of-hours services – we are gathering evidence and understanding the challenges of the profession and public in regards to this area. Do you see any merit in a more narrowly focussed veterinary degree with, for example, a veterinary surgeon qualifying to treat small animals only? My view is that the veterinary degree as it stands at the moment is about right. We have looked at the Day One Competences for all newly qualified vets and the current way that we are managing that seems to be appropriate. It is good for the profession that students have a broader veterinary degree and then to be able to make

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choices to go, for example, into small animal or mixed practice or research or industry or politics during the course of their career. If we narrow the degree we will not only restrict the choices that vets will have and their value as a commodity in the market place but, from a clinical perspective, also reduce the breadth of knowledge they gain from comparative study across a range of species which is so important for a proper understanding of the veterinary sciences. If the Royal College is unable to take a position on the future of veterinary education and graduate job prospects, who can? We do take a position on veterinary education in terms of setting and monitoring the standard of veterinary degrees and that is what we will continue to do. However, we have no remit to control the number of veterinary schools or students nor do I feel it would be right for us to have such controls. This is a private sector profession and if we did try and restrict the market in this way then the Competition Commission would want to have serious words with us! If there is strong opposition in the profession to new vet schools then that is a matter for the representative bodies. The other point to make is that freedom of movement within the European Union means that any attempt to restrict the number of graduates in the UK would be counter productive as it is likely that the number of graduates from abroad would rise to meet the demand. www.rcvs.org.uk

College Corner

FAKING IT? In the 2002 film Catch Me if You Can, Leonardo DiCaprio plays a serial imposter who poses in turn as a pilot, doctor and lawyer. He didn’t try his hand at veterinary surgery, but we know of those in the real world who have… So, how do you make sure you don’t hire one? Over the last few years there have been several cases where practices have employed individuals, in good faith, who have turned out not to be all that they seem. Sadly, none turned out to be secret film stars… but they have often hit the headlines. How do you make sure that your practice doesn’t make the news for all the wrong reasons? Fake veterinary surgeons and veterinary nurses come in many different guises – although all of them pose a threat to animal health and welfare and, to an extent, the public. Once discovered, some can be handled by the College (if they were registered, albeit illegitimately, often using fraudulent documentation or stealing a bona fide practitioner’s name), others are dealt with by the police or other regulators – in which case the College will assist. Often those involved have some degree of training or experience, although typically they never qualified – quite often they failed their exams or dropped out for some other reason. In other cases, individuals have been found practising with qualifications that could legitimately have led to registration but they either faked some vital documentation, did not bother to register with the College, or did so in the wrong category – so were practising illegally. If you are a veterinary surgeon, practising veterinary surgery in the UK, you have to be registered with the College as ‘UK-practising’. It’s pretty black and white, with a very few exceptions. Meanwhile, veterinary nurses are learning that, alongside the benefits of becoming a profession, come the downsides: unqualified people holding themselves out to be veterinary nurses. In this case, the situation is not always clear-cut, because the law currently does not provide statutory protection for the title of ‘veterinary nurse’ other than for the purposes of ensuring that veterinary surgeons only delegate minor surgery and medical treatment to those whose names appears on the RCVS List/Register of Veterinary Nurses. What can you do in practice to avoid hiring a fake? No doubt you follow up references for potential employees, but here are some more things to consider: • Check online (findavet.rcvs.org.uk/check-the-registers) to see if the person is registered with the College; if you have grounds to think the person might not be genuine, please call us, and say that you have specific concerns, rather than just asking for a Register check. It may be that they are registered but that your grounds for concern are genuine and some further investigation is in order. • Always ask to see formal photographic identification from new employees – preferably a passport or driver’s licence; take a photocopy of this, and tell the person you are doing so. • If the person is being supplied to you via a locum or recruitment agency that claims to have made relevant checks, it’s worth asking

what checks were made and double-checking these (unless the details of the checks can be made available to you). • The College always asks to see original documentation – certificates, letters of good standing etc – from overseas veterinary surgeons when they register. There is no reason why an employer should not ask to see similar documentation, if they are in any doubt, or even the Certificate of Registration issued to all registrants. • If the person seeking work is an overseas national, ensure they are entitled to work in the UK – the College may register someone, but it is not our responsibility to ensure they are otherwise legally entitled to work. • If you are employing a recent graduate, ask to see their certificate of completion of the Professional Development Phase. • Be wary of employing someone who may be qualified as a veterinary surgeon but is prepared to work as a veterinary nurse. They are different professions and require different types of registration. If someone is incorrectly registered, or registered as neither, they have no legal right to carry out delegated tasks under Schedule 3, regardless of their training. • If someone has qualified as a veterinary nurse but not yet registered, be aware that they are no longer legally designated as a student, therefore legally should not be carrying out Schedule 3 tasks. • Be aware that a student veterinary nurse may only carry out Schedule 3 tasks, under direction and supervision, within their own training practice and within the course of their training: a student who locums in another practice cannot do so. • 0While it is the responsibility of the individual to ensure that their registration is current and in the appropriate category, it is the employer’s responsibility to ensure their staff are working legally – ie that they are in the ‘UK-practising’ category if they are to be employed in a UK role. Of course, having said all of this, it’s worth putting things into perspective. The cases of fake professionals, whatever walk of life, have a habit of hitting the headlines. But we have over 26,000 veterinary surgeons on our Register, and over 11,000 nurses on the List/Register – against which the number of dodgy characters really is just a handful. That’s not to play down the significant threat to animal health and welfare – and public safety – which they represent, but it would be a shame if a culture of mistrust – both from within the veterinary team and from the public – became the norm. It’s only because veterinary surgeons – and to an extent, veterinary nurses – are regulated professionals, that such aberrations become news. Have you experienced this issue in your practice? Let us know on editorial@practicelife.biz or Twitter @PracticeLifeMag

feedback

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VDS News

VDS NEWS

Nowt so Strange as Folk T

ed was a larger than life Texan, who had mysteriously found himself marooned working in Yorkshire and it is fair to say the natives of God’s Own County found his cultural peculiarities difficult to comprehend. Ted never tired of telling anybody prepared to listen of the great benefits of Texan life and in response they would be only too happy to live up to the old Lancastrian proverb ‘you can always tell a Yorkshireman, but you can’t tell him much’. Ted was prepared to concede Yorkshire puddings were a pretty neat idea, but as for cricket… Fred was puzzled given Ted’s obvious patriotic fervour as to why he had chosen a Portuguese water dog, Jesse, as his chosen four legged companion, rather than a rugged-jawed home-based variety. All became clear when his client proudly explained that the breed was the favoured pet of Barack Obama. Realising Ted was about to launch into an extended discourse on why everything in Texas was better than the Yorkshire equivalent, especially the climate, Fred enquired swiftly as to the purpose of the day’s visit. The Texan became unusually reticent, noticeably blushed and his booming voice dropped to a whisper as he explained Jesse had recently escaped whilst on heat and he was concerned she had enjoyed a little dalliance with some local miscreant. Fred chuckled and after a cursory examination of the bitch, he suggested as a precaution to avoid any danger of a Texan-Yorkshire hybrid being delivered in nine weeks, he could simply administer a misalliance injection. It was not as simple as that of course; Ted wanted to know all the ins and outs regarding the risks of such an injection and wondered whether a wait and see approach would be safer. However, after much debate, he agreed with Fred’s proposed course of action although Jesse’s painful reaction to the jab stimulated another lecture on how their vets back in Texas were ‘just better at this sort of thing’. Three months later Ted presented Jesse again. All had been well, but recently she had become rather tired and had lost her zest to swim. Worse still, members of the ‘flat cap and whippet brigade’ down the local were starting to tease him about his once lively dog now sleeping permanently at his side. Fred could find no abnormality and subsequent blood tests were also unrevealing, so he recommended referral. This pushed Ted to seek a second opinion with an American vet he had discovered locuming nearby, so at least Fred no longer had to listen to barbed comments about UK vets’ diagnostic abilities, compared with their counterparts ‘way out west’. Two months later, he was surprised to learn Ted had made an appointment to see him and just assumed his comrade in arms had escaped Yorkshire, back to the Big Apple. He could not have been more wrong. Ted explained his countryman had of course immediately suspected and diagnosed Jesse to be suffering from Addison’s disease, but it was not his concerns about Fred’s failings as a diagnostician, that he wanted to discuss. Ted was a big fan of the Internet which he claimed to be another big ‘American Idea’

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but as Fred was summoning up the energy to correct him, the bombshell was dropped. Ted had been ‘Skyping’ Jesse’s vet back home, who had pointed out the data sheet for the misalliance injection specifically said the medication should not be used in breeds with a genetic predisposition to Addison’s disease. He believed Fred should have been aware Portuguese Water dogs fall into this category. Nonplussed, Fred tried his best not to give away that he was totally ignorant of not only the data sheet entry, but also the predilection of this rare breed to Addison’s disease. Ted considered that across the Atlantic, a vet in Fred’s situation would do the honourable thing and pay for Jesse’s life time treatment for the condition. Fred was no mathematician, but even a rough calculation of the potential costs made his head spin and he simply asked Ted to put his claim in writing, thereby buying some thinking time. The letter arrived the very next day and given the Texan was looking for over £4k, Fred speedily handed the matter over to the Society. The consultant’s investigations revealed the truth of the matter. Although the superseding vet had indeed considered Addison’s disease as a differential, further bloods tests had discounted the condition and eventually she had put Jesse’s lethargy down to Ted’s recent habit of feeding her barbecued Tex-Mex ribs, rather than dog food! A simple change of diet had cured the problem and the vet admitted she was also oblivious of the datasheet entry. It appeared Ted’s claim that Fred had induced Addison’s disease had rather fallen at the first fence, a point the consultant was swift to point out. Despite the happy outcome of this claim, the Society is now regularly assisting members, practising in all branches of the profession, who have being caught out by the ever changing contents of datasheets. This situation probably reflects that updates are no longer sent direct to practices, but simply altered covertly online, or published in the depths of veterinary journals in the sections most of the profession would rather not admit to reading, even to their closest friends. For this reason, it is perhaps worthwhile delegating a member of the practice team to regularly review the online datasheet updates of any medications commonly used, in case a significant new contraindication has slipped in, without warning, to trap the unwary.

WELL-BEING

Well-being

SPECIAL FEATURE

Understanding and supporting mental health in the profession SPVS-VPMA Congress this year ran a full day stream on Mental Health & Wellbeing. We’ve expanded this month’s Practice Life Well-being section to continue the focus of the associations on mental health in the profession. In this issue, SPVS Council Representative for the VBF, Karmen Webbe, interviews mental health worker and national co-ordinator of the Veterinary Surgeon’s Health Support Programme (VSHSP), Rory O’Connor. Rory is a trained psychiatric nurse with 39 years’ experience of working with mental health and addictions. Here, he gives some background on the issues particularly affecting veterinary professionals, as well as advice on how to deal with the perceived stigma of mental illness. Psychotherapist and mediator Teresa Mulvena, focuses on stress and depression, with advice for managers on how to improve the practice working environment and coping strategies for staff. She also outlines how individuals can build resilience into their own lifestyles.

Karmen Webbe interviews Rory O’Connor from the VSHSP

t is common knowledge that mental health problems have been all too commonplace amongst those working in the veterinary profession as shown by the activities of the VSHSP. Between 2008 and 2012, VSHSP received 390 enquiries. This has resulted in 183 patients (37% male and 63% female) being treated for: affective disorders (mood disorders grouped together due to their response to particular classes of drug which include: depression, obsessive compulsive disorder, bipolar disease, and schizophrenia) (131 people), substance abuse (45 people for alcohol and 125 for drug abuse), and eating disorders (15 people). 60% of patients are being treated for multiple disorders. It can be difficult, particularly in a small business, to manage these issues and to offer the level of support required both to those with mental health problems and also to the working team as a whole. Team members may have to cope with potential long staff absences or altered behaviour from a colleague and will also require support. Karmen Webbe: What motivated you to become a mental health worker and what led you to become so involved with the veterinary profession in particular? Rory O’Connor: I did an undergraduate degree in psychology and went on to be a mental health nurse. Whilst nursing I obtained a masters degree in addiction and also a counselling diploma. From the late 70’s to the early 80’s I began to work more exclusively with health professionals. I began monitoring the situation in the USA which had a specialist support service for health professionals experiencing mental illness and took the decision in the 80’s-90’s to work exclusively with doctors, dentists, nurses, and vets. I was commissioned to develop the NHS programme in London for health professionals as a clinical advisor. Since then I have found myself working increasingly with the veterinary profession and have been the VSHSP co-ordinator for 4-5 years. I have continued to take inspiration from across the Atlantic and have been invited to undertake a residency this November with the Oregon Physicians’ Health Programme. I now work almost exclusively with veterinary surgeons and nurses. KW: What do you think are the main factors that pre-dispose veterinarians to mental health and addiction problems? RO’C: I think we have to accept the figure that that one in ten people are likely to experience dependency issues in their lifetime. What probably pre-disposes veterinary professionals in particular to these issues is a combination of character traits. Vets tend to have high expectations, are perfectionists, and often are unfamiliar with failure. If you add to this a combination of: low self esteem, poor coping strategies, and a high stress working environment, these can easily lead to depression and anxiety. Accessibility of drugs also plays a factor, in particular, access to analgesics, which are commonly used by veterinarians inappropriately to relieve their own pain (psychological or physical) even though they will know that Practice Life z March/April 2014 z www.practicelife.biz

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IN ASSOCIATION WITH THE VETERINARY BENEVOLENT FUND

“It is essential to recognise these problems as an illness with a treatment. In most cases people will recover and purely sympathetic responses such as ‘poor you, isn’t it a shame’ are of no value. Give respect and esteem to those affected and provide treatment and services in equal measure to those for physical illnesses such as cancer or heart disease”. pharmacologically these substances are depressants. Ultimately substance abuse will lead to an increase in depression and anxiety. Pre-disposition to suicide probably stems from the significant pressures of being a vet. Again, accessibility to lethal means probably contributes. In addition, euthanasia is an accepted practice in veterinary medicine. It may follow that euthanasia is a viable solution to the problem of living. There is a lot of work being done on this topic currently, including Mellanby (2013) ‘Improving wellbeing in the veterinary profession’, Veterinary Record; Bartram et al (2012) ‘Recognising and responding to mental health problems in the workplace’, In Practice. KW: What is the most common problem you are approached with? Is there any bias with regards to age/gender amongst those contacting VSHSP? RO’C: Affective disorders are the most common problems that callers are experiencing and there is an even split between the main types. The main reasons why people are calling include: how to deal with dilemmas, how to manage unresolved grief or abnormal expression of grief, or how to www.practicelife.biz z March/April 2014 z Practice Life

manage lifelong issues that have started to emerge due to a sudden failure to cope. Finally there are those with a familial pre-disposition to mental health disorders, characterised by abnormal brain function. There is a combination of genetics and lifestyle factors that lead to mental health issues. The biggest group of callers would cluster in the 35-40 year old category or the 40-49 year old group. This is probably due to the increasing complexity of life at this age where people are perhaps coping with relationship difficulties (either at home or within the practice), family losses, such as loss of a parent, and also with disappointment due to a perceived lack of career progression and a feeling of inertia. Often it’s a matter of ‘fruition in time’ where years of coping finally come to a head. There is no significant gender bias although more women tend to contact the VSHSP than men. KW: What is a typical working day for you like? RO’C: A typical day is untypical! The phones go live from 7.30am to 10.30pm. However, they can be live 24/7, especially if I intuitively feel that someone will call due to some information I have been given during the day. The vast majority of my time is employed in responding to and planning visits to callers. The days vary: today I’m travelling to visit people that I am monitoring at home or in practice across the country and will be on the move from 7.30am until 7.30pm. Last week I spent two days with a family and in the practice of an individual who had committed suicide. Usually I’m making enquiries about cases, assessing them, chasing up treatment pathways, and monitoring people after they have been referred for treatment. I also visit vet schools and elsewhere to speak about mental health issues. Currently I also monitor the Health Protocol (referenced in section 15 of the RCVS Code of Professional Conduct) that I helped the RCVS to set up which looks after those whose mental health problems interfere with their professional capacity. The General Medical Council had a protocol as part of their fitness to practice measures and the RCVS were keen to create something similar. The protocol helps determine how much mental health issues affect fitness to practice and offers a program of rehabilitation for those who would like it. I maintain regular contact with the individuals on the program and issue the RCVS with progress reports every three months.In total I am probably looking after 162 people at the moment. KW: What sort of treatment methods do you use and how do you gauge success? RO’C: Each treatment program is specific to the individual but a general example for someone with an affective disorder would be to firstly link with local services via the G.P. The G.P. may decide to manage medically with prescription drugs or may offer a psychological referral resulting in C.B.T (Cognitive Behavioural Therapy: a ‘talking therapy’ where patients are encouraged to identify cycles in their behaviour and thoughts, which are contributing to their disorder or having a negative impact on their wellbeing. Patients may then

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learn particular techniques in order to control, break, or cope with the cycles) or a psychiatric assessment depending on the severity of the case. I will assess the patient’s management and also encourage lifestyle improvements such as regular exercises, relaxation techniques, or referral to a specialist who can teach these techniques. Most importantly I maintain contact and low level maintenance is a great way of preventing relapse. I often get feedback saying, ‘it’s nice to know someone’s remembered me’. The frequency of reviews will decrease as the patient recovers and after six to eight positive returns, we have a lengthy discussion where they might decide to leave the service with the promise that they can always come back if needed. I am building on evidence from Spain, the US and Australia that veterinary surgeons in specialist services do very well. Ongoing support for three to five years gives a positive long term outcome. KW: Do you think there is still a stigma attached to mental health issues and how do you suggest we overcome it? RO’C: I agree that there is a stigma attached. Mental illnesses are invisible in nature: you haven’t got a physical scar as evidence of something being wrong. There is also a lot of fear of these problems. It is vital for members of the profession not to be fearful and to keep talking about these issues. It is important to give respect and esteem to those affected and to provide treatment and services in equal measure to those for physical illnesses such as cancer or heart disease. It is also important to be empathetic and not just sympathetic. By this I mean giving respect to somebody by recognising that they have a problem and by agreeing to walk alongside them in their journey from illness to recovery without commenting whether they are more or less addicted/depressed/suicidal on any given day. It is essential to recognise these problems as an illness with a treatment. In most cases people will recover and purely sympathetic responses such as ‘poor you, isn’t it a shame’ are of no value. It is essential to recognise these problems as an illness with a treatment. In most cases people will recover and purely sympathetic responses such as ‘poor you, isn’t it a shame’ are of no value. Give respect and esteem to those affected and provide treatment and services in equal measure to those for physical illnesses such as cancer or heart disease. KW: Given the stigma attached, is it useful to inform the rest of the working team if one of your employees is experiencing mental health issues? RO’C: A practice manager or owner should encourage the affected employee to give their consent to inform the rest of the team. It might be useful for the employer to take advice from Vetlife/VSHSP on how to go about this or to arrange for somebody to come to the practice and talk to the team. In most cases people in the practice will already be aware that there is a problem as most of these problems are slow burners. It is important to get these issues out into the open if possible and a phased return to work is very important. Vets have a duty to protect animals and the public, but this duty of care should extend to those working alongside them.

“Vets have a duty to protect animals and the public, but this duty of care should extend to those working alongside them”. KW: What tips can you give on recognising mental health/ addiction in colleagues and how would you suggest the topic is broached with them? RO’C: Usually you will notice a change in performance; often a deterioration in well-being. It is important to ask why there has been a change: has there been a change professionally or in the practice? Secondly there will often be a change in persona: you may notice that somebody is quieter or louder than usual, that they are more stressed, more easily angered. Often these changes can be explained by a change in the person’s personal life. Don’t be afraid of broaching the subject. If in doubt, ask a question. For example, if you smell alcohol, it is worth being willing to say ‘have you had a big night?’ rather than just ignoring it. KW: What are your tips to providing support to a colleague with these issues? RO’C: Talk to one another and maintain relationships. These of course can be harder if there is conflict within the practice. Staff must remember that these are illnesses from which people recover. There should be policies on illness and staff absence etc. and these should be applied but it would be better to treat each situation on its own merit. At the end of the day there is a need to be honest and to balance practice wellbeing with an individual’s wellbeing. If the situation becomes untenable, then the discussion needs to be candid and in some cases it might lead to a dismissal. KW: What tips would you give to employers/employees in handling the ‘fall out’ related to long periods of absence etc. that may occur as a result of treatment? RO’C: Support of the individual with mental health issues is the first concern and employers should remind people of this. However, it is important to look after the people who are left behind. It may be necessary for example to get a locum if absences are leading to people being overworked. The benefits of looking after the workforce can often justify the costs. KW: What do you think we can do to support each other more in the workplace? Is there some basic advice you would give all bosses/employees? RO’C: We should share. Sharing information is vital and so is a willingness to share time together. We all have busy lives and practices so sharing time together is not always easy. But it Practice Life z March/April 2014 z www.practicelife.biz

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is very important to show willing. Team bonding through social events and looking out for each other are key. Common courtesies should not be overlooked such as saying ‘hello, how are you?’ meaningfully and actually wanting an honest answer. Employers should promote a sense of job satisfaction and whilst there is satisfaction in being paid well, there is also satisfaction in a job well done and done well together. KW: Do you think young vets are adequately prepared for the profession in terms of coping with potential stress/mental health/addiction problems? RO’C: There has been an increased emphasis on mental health in veterinary education. There is no perfect solution

but vet schools are making a difference by heading in the right direction. There is increased awareness of mental health issues and the services that are provided for those affected. I believe that new graduates should be given some understanding of what a good practice looks like though this will be hard. Getting a good start is essential. It is important that they don’t just take the first job offered but actually think ‘Will I fit in here?’ Finally it is important to remember that once students qualify they may need ongoing help whilst in practice. We cannot prevent the difficulties that the job will throw at them but it is important to give them the opportunity to know that if something goes wrong, there is somewhere they can go for help.

Well-being in the Workplace:

Manager and individual responsibilities Teresa Mulvena is a psychotherapist, workshop facilitator, and accredited workplace mediator, primarily working with staff in the NHS. She also has a private practice. She is particularly interested in relationships, communication, and conflict management. Stress induced illnesses are responsible for the loss of 13.5 million working days each year in the UK. Organisations have been prosecuted for not doing enough to reduce stress. This article will look at what can be done to reduce stress and improve mental health at work, both at an organisational level and through actions an individual can take to address their own emotional wellbeing.

AT AN ORGANISATIONAL LEVEL

he Health and Safety Executive state that all employers have a legal responsibility to minimise the risk of stress-related illness. They have produced some excellent guidelines on how management can reduce stress at work, www.hse.gov.uk. It is impossible to eliminate pressure, but stress occurs when the demands upon us outstrip our capacity to cope with them. Clearly strategies include looking at reducing stressors, along with building personal resilience.

Common stressors identified by the HSE at work that management should address include: • the demands of the job, (including long hours and the complexity of the work itself), • conflict and difficulties in relationships (clients and colleagues), • lack of support, • how much control and autonomy people have, • how change is managed • and clarity of roles. www.practicelife.biz z March/April 2014 z Practice Life

There are some interesting inter-relationships between these factors. For instance the demands of the job cause much less stress if people have some control and support.Increased absenteeism results from a combination of high demands and lack of control. One HSE study showed a 10-20% increase in sick leave with this combination. http://www.hse.gov.uk/research/rrpdf/rr431.pdf Each of these stressors can be combated. This is not just to increase morale at work, but these factors have an impact on business because they affect performance, absenteeism, and staff turnover. • Demands This includes workload, time pressure, and difficulty of tasks. It is not clear that a busy high pressure environment on its own causes stress. Often people complain about the pressure and the hours, but sometimes being busy can be stimulating, and whether this leads to stress depends on other stressors also being present. Cont’d on Page 27

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CBI Fit for Purpose Report 2013

● Schedule time on a regular basis to discuss work performance and to enquire about wellbeing. ● Encourage appropriate use of sick leave entitlements. ● Reallocating workload: could you spread tasks throughout the team to allow the person to work flexible hours or take time off for any appointments? Could you relieve them from particularly stressful tasks such as out-of-hours work or busy evening surgeries? ● Providing a quiet, private and secure place for a person to take any medication or to be alone if they need to can be very helpful. ● With the employee’s express permission, you may request medical reports or advice from their medical team.

£50,170 COST PER SICK VET BREAKDOWN OF COST

■ 64% ■ 10% ■ 8% ■ 7% ■ 7% ■ 3% ■ 0.5%

6 months pay for a small animal VS locum Estimated drop in gross profit of practice Accommodation for locum (6 months at £700/month) Recruitment fee for permanent replacement VS (10% salary) Fee to agency Training for locum Practice manager’s time (1% salary)

£32,000 £5,000 £4,200 £3,700 £3,500 £1,500 £270

BUSINESS BENEFITS OF A HEALTHY WORKPLACE ● Improved brand ● Higher productivity ● Improved retention ● Improved client satisfaction ● Improved resilience ● Improved patient care ● Reduced sickness ● Higher commitment ● Fewer accidents

www.vetlife.org.uk

● Consider restriction of unsupervised access to dangerous drugs at times of high risk to minimise opportunities to remove them from the workplace for selfadministration. ● Communicate change carefully ● Stay alert to potential pressures ● Managers need training in the skills and knowledge to support staff mental health at work and respond if people are experiencing a mental health problem. ● Try to manage communication and information flow to reduce stress. ● Provide a range of support measures — ensure that staff know what support is available to them in the local area and from within the profession. Consider buddy systems for new starters to help settle into a practice and mentors for new graduates. Read more at www.vetlife.org.uk/ staff-management

Recruitment fee

Train locum

Agency fee

Recruitment fee

Train locum

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Conditions linked to anxiety, stress and depression are the leading causes of long-term absence from work in the UK. Employees out of work for lengthy periods are also those most likely to drop out of the workforce entirely.

Practice manager's

Drop in gross profit

Accommodate loc

Practice manager's

COST TO EMPLOYER: STRESSED VETS

SUPPORTING AN UNWELL EMPLOYEE IN THE WORKPLACE

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“ When people feel their views

decreased motivation, an increase in burnout, and more people leave. This all leads to poor care and an unhappy workforce.

matter and they are valued and

It’s the Cake not the Icing

trusted, satisfaction improves. More control leads to better work performance, less absenteeism (20-50% reduction), and less turnover of staff.” • Change Inform people of changes, and seek participation, otherwise change leads to insecurity, people disengaging and wanting to leave. • Role Having clarity of expectations of the job role improves engagement and how well people rate their own performance (rather than how they are viewed by others). Ambiguity about role can lead people to want to leave. • Control This is the variable that has the most impact. Having some choice and control over the way you do your job and having input into decision-making improves everyone’s motivation and sense of loyalty to the workplace. When people feel their views matter and they are valued and trusted, satisfaction improves. More control leads to better work performance, less absenteeism (20-50% reduction), and less turnover of staff. It can be a relatively low-cost intervention. • Support Make time to supervise and mentor and discuss difficult decisions and distressing cases. Be approachable so that concerns get dealt with promptly. This includes development of a no blame culture. Encourage the development of social time to improve goodwill and team cohesion. • Relationships and Communication When work relationships are poor people withdraw, and team performance is affected. Create an open communication culture at work of dealing directly with problems, while being respectful. Conflict is not always obvious, it can go underground and then it becomes corrosive. It can result in decreased co-operation with each other, decreased goodwill, www.practicelife.biz z March/April 2014 z Practice Life

Having good communication and decreasing conflict are so important for the teamwork and the individual’s stress levels, so I want to expand more on how to improve this aspect: Have a policy of zero tolerance of unhelpful communication patterns such as • being indirect (complaining to others) • being unhelpful, not co-operating, • being silent – tolerating it while getting frustrated and possibly fuming, (while planning an exit strategy) • being aggressive, intimidating, disrespectful Create a supportive environment and an open communication network by • showing appreciation for each other • doing your fair share of the work • backing each other up • speaking up on behalf of those who are absent • never gossiping, and respecting confidences • dealing with conflict directly with the person concerned • not engaging with conversations about a co-worker • not criticising publicly

How to listen so other people will talk Whether with staff or with clients the use of empathy is a powerful tool in responding to distress, or complaints. Empathy doesn’t attempt to soothe as sympathy does, but rather tries to understand, and further opens up communication. For example: A colleague tells you they are upset about a mistake they made and how they wished they had handled a distressed client better. A sympathetic response would be to say “don’t worry we all find that difficult”. While this may be reassuring, it doesn’t give the other person the chance to talk more about what they find difficult, and it can close something down when the other person may welcome the chance to talk more about it. An empathic response would be simply to mirror the underlying feeling and thoughts: “you are disappointed about how that went and wish you could have done it differently?”

How to talk so other people will listen If you communicate with blame or criticism, people don’t listen, instead they defend themselves. Dealing with conflict assertively means you can address difficulties without the other person feeling attacked and therefore getting defensive. When you hear a complaint, try and listen for the underlying feeling and the need that is being expressed, and respond to those. People will not be ready to listen to you until they think you have heard them first. Eg: I’ve been waiting half an hour and no-one is helping me “That sounds very frustrating. What do you need? ” is very different from “well I have been very busy and I can’t help that”. Instituting some of these changes will improve the health of the organisation and its members.

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WELLBEING IN THE WORKPLACE: IMPROVING INDIVIDUAL RESILIENCE

ometimes the pressure comes from within us as individuals e.g. perfectionism and fear of failure. Stress itself is not a mental illness, but symptoms of stress and depression are hard to differentiate between. Unaddressed enduring stress can lead to burnout and depression.

What does stress look like? Would you pick up the signs in a colleague or yourself?

“ It can be hard to admit when things are difficult. But everyone has limitations. It is normal to

We all react differently, but common symptoms include irritability, feeling anxious, not being able to concentrate, withdrawing and isolating yourself, and trouble sleeping.

have a mix of strength and

What does depression look like?

vulnerability, and it is a strength

Typical symptoms of depression include: • Difficulty getting to sleep, or more commonly waking up early in the morning and not being able to get back to sleep • Loss of appetite (or occasionally eating more than you might normally eat) • Feeling sad, crying a lot, and loss of enjoyment of the activities that you used to enjoy, including loss of sex drive • Isolating yourself and finding it difficult to want to talk to people • Feeling despair or hopelessness about the future • Feeling guilty, self-critical, or feelings of self-dislike • Feeling anxious or agitated • Not being able to make decisions as easily as usual • Decreased energy levels • Feeling more irritable than usual As you can see there is crossover with the signs of stress, and the difference is a matter of severity. If you recognise that you have a number of these symptoms it may be time to acknowledge that you might need to get help. It is a good idea to see your GP for a more thorough assessment and advice.

Strength or vulnerability? Seeking professional help is not an easy step because of the stigma attached to emotional problems. If you link your value and self-worth with being independent, strong, and someone who always copes, it can be hard to admit when things are difficult. But everyone has limitations. It is normal to have a mix of strength and vulnerability, and it is a strength to admit your vulnerability. When one person begins to talk about their anxieties they find they are not the only one, it’s just that no one else is talking about it either! Some people suggest being able to be vulnerable is the heart of relatedness. Without it our relationships don’t work, don’t have depth, and don’t last. “It can be hard to admit when things are difficult. But everyone has limitations. It is normal to have a mix of strength and vulnerability, and it is a strength to admit your vulnerability.” Challenge the belief that friends won’t want to be with you if you’re not entertaining. Some of the best moments of connecting with someone can be when you are able to be honest about how awful you feel. It is great to feel someone

to admit your vulnerability.” else can understand that, without pretending everything is OK, without feeling you have to be cheerful, or entertain. Being able to admit your vulnerability and treat it like it is an ordinary part of being human is the first step to good mental health, and not feeling alone.

How do we define good mental health? Freud said it was “the capacity to love and work”, and I think this captures the essence of it: to do work that feels useful and meaningful, and to have relationships that sustain us. Mental health becomes an issue when problems begin to affect daily functioning or leave you feeling overwhelmed.

Aim to be unhappy Freud’s aim with treatment was “to change misery into common unhappiness”. The suggestion is that it is normal to feel some unhappiness and that it is unrealistic to expect life to be problem-free. While positive thinking is a popular notion, recently people have been challenging this. Oliver Burkeman’s excellent book “The Antidote: happiness for people who can’t stand positive thinking” suggests there is value in expecting the negative – the idea being we are then fore-warned and not disappointed and instead are realistic that life is full of problems. Some would argue that it is our expectations, rather than fortunate or unfortunate life events that make us miserable. For example, if your expectation is that other drivers are going to be inconsiderate and bad drivers, you won’t end up stressed and frustrated by the driving you come across. Whereas the expectation that others SHOULD drive properly will leave you feeling angry and upset.

Being negative is a positive thing This is good news. It is easier to change our attitudes than to change other people! It’s a start to be aware of the “shoulds” Practice Life z March/April 2014 z www.practicelife.biz

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you assume, and challenge them. This managing of your expectations to make them more realistic is different from a form of passive despondency that can develop from always thinking the worst of people e.g. “There is no point asking for something because they are bound to say no”. This is mind reading and is unhelpful, and often inaccurate. Instead the kind of negative thinking that is being advocated is one that helps you be realistic and problem solve. It’s the difference between allowing enough time for a journey and planning for possible delays, as opposed to the unrealistic expectation that it will be fine and getting frustrated when you run into problems. That kind of positive attitude can cause huge amounts of stress!

Let’s Move to France So, feeling stressed may be about your attitude and therefore changing the way you think and the meaning you give events, can reduce stress. However, it may be a sign that something external needs to change. “Life would be better if…. (I had a holiday/moved somewhere warmer/ left my partner)”. This might be a fantasy, as you do take yourself with you! Or it might be right to make a change to your situation. It’s not always straightforward to know whether to change your situation if you are unhappy, or to change something within yourself and the way that you view your life, to reduce stress. In psychology “The Geographical Cure” refers to the fantasy that all your problems would be solved and you would be happier if you moved somewhere different, or if something was changed in your external world. It can be harder to look at you and what needs changing. At other times making a life change can be right.

Face it and Deal with it Dealing with the problems you are avoiding can make an enormous difference to feelings of stress. You might think they are at the back of your mind but they will still be causing you stress no matter how much you try to deny them. Having stressful problems hanging over your head can make the most saintly person feel irritable. Invest some time in thinking through strategies to handle difficult problems, and talk it over with someone you trust.

Get it in perspective People who’ve had an experience of a life-changing or lifethreatening event like bereavement, or being involved in an accident or serious illness, often report that the effect is that they no longer sweat the small stuff. Compared with these larger issues the smaller irritations feel irrelevant. Adopting this attitude – without having to endure the trauma that leads to this realisation – can reduce stress.

Create positive experiences You may not have much control over some of life’s irritations but you can do something about putting some good things in, having fun, making time for friends and the things you enjoy. Making one small change to give you something positive can help. This might be relaxation, yoga, putting your feet up, a weekend break. www.practicelife.biz z March/April 2014 z Practice Life

Get a natural high Exercise is as effective at countering depression as antidepressants are. When you are stressed or depressed it can feel like an effort but it is worth it. Also you’ll feel better that you’ve taken the initiative and done something for yourself. This is empowering and gives a sense of being in control and helping yourself.

Connect with others It’s not just about the support networks that are available to you, but also about your ability to let people know what is going on for you. Self-worth comes from both achieving and feeling loveable. If you define yourself through your work and you get your sense of self-worth through the achievements associated with this, and neglect your relationships, what happens when there are problems at work? You have nothing else to fall back on. Connecting with others and having good relationships prevents burnout. Someone recently said to me “What is the point of talking about my problems – it’s not going to change my situation; surely I’m better to just get on with it?” On one level this is an understandable attitude. Can talking change anything? There is a saying in psychology, “I don’t know what I think until I say it out loud”. This refers to the fact that talking with another person is a completely different process than having worries spinning around inside your head. Talking with someone you trust can be an enormous relief. If you don’t have friends that you can talk it through with seek professional help – after all two brains are better than one! Contact Teresa at teresamulvena@hotmail.com or phone 07967 978398 The Vetlife website www.vetlife.org.uk is a useful source of information on well-being, mental health and positive psychology. It is funded by VBF – the charity that also provides Vet Helpline, the Veterinary Surgeons’ Health Support Programme and the Veterinary Benevolent Fund in order to support veterinary professionals.

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Case Study: CVS encourages well-being and mindfulness Sean Gilgallon, CVS Group Health and Safety Manager, is responsible for 254 surgeries, 6 diagnostic labs and 2 crematoria across the UK. Here, he outlines the initiatives the group has developed to support mental health in the workplace.

hen I joined CVS some 6 years ago, I soon realised that there was a major problem in the veterinary profession with stress and wellbeing issues. Of course, there is a problem in the UK working population anyway, but even more so in this one. As CVS Group Health and Safety Manager I have to look at all aspects of how to protect people from being injured. To my mind, stress and wellbeing issues are as important as fire, radiation, zoonoses, manually handling animals or any other hazard. Employers have a legal responsibility to ensure the health, safety and welfare at work of their employees; this includes minimising the risk of stress-related illness or injury to employees. The law even tells us we have to take all hazards (something that can harm you) into consideration and depending on the risk (the probability of harm occurring) we have to do something to control it. So I had a legal obligation to deal with the stress issue, but also a moral one too; we do not want anyone who works for us to be put at any risk! We now have things in place at CVS to help us in this area. We have a BUPA Employees Assistance Programme, which is a 24/7 telephone helpline that staff and their families can access for help or advice on any issues, work related or not. We also have online stress awareness training as well as regional ‘My Voice’ committees that bring any issues to regional management, and then to the national meeting chaired by our CEO alongside the executive. We have gym flex, helping staff get cheap gym membership in their area, the premise being if you are fitter, your overall wellbeing is better! Then we started thinking out of the box and through one of our CDs, Chris Ridge who already practices mindfulness, we visited Oxford University along with Helen Wiseman our HR Director. There we found out all about the benefits, the scientific facts, and the practice of mindfulness. It is recommended by NICE (National Institute for Health and Clinical Excellence) as an alternative to drugs for the

“I have to look at all aspects of how to protect people from being injured. To my mind, stress and wellbeing issues are as important as fire, radiation, zoonoses, manually handling animals or any other hazard.”. treatment of depression and focuses on keeping you in the here and now and in what is going on at that time. We then ‘sold’ it to our Executive and that is where this journey started. I’ve been told we are the only veterinary company in the world who does this mindfulness course. We have run 3 very successful courses to date with excellent feedback and have 4 more planned this year. All are hosted by TME (The Mindfulness Exchange) who are based in Oxford University and run by founders Mark Leonard and Marina Grazier, both Mindfulness Teachers. The vets, nurses and practice staff who have been on the course, tell us they are more focused on what they are doing, be it a consult, surgery or dealing with practice issues. The stress they once felt is now more controllable and they feel better equipped to work in this profession. It is not for everyone, but for the people who have bought into it, it has brought many benefits. Sean is happy to be contacted about any aspects of this case study on sean.gilgallon@cvsvets.com Practice Life z March/April 2014 z www.practicelife.biz

WELL-BEING

Case Study A CVS Practice Manager based in the South shares her experiences of living with depression and how mindfulness has helped

ou know that moment when all the balls you are juggling are in the air and then someone chucks another one in and you think – that’s ok I’m a woman, I can multitask? Let me tell you, sometimes you just can’t and you shouldn’t try. Mindfulness gives you the freedom to say, “Actually, I’m just going to do this one thing and really concentrate on it and enjoy it and then I will move on to the next thing and I won’t feel guilty.” Mindfulness was not designed to cure depression but it seems like a very good side effect to me and millions of people like me. I have lived with depression on and off for most of my adult life (and I’m not a youngster). I married the first time at 18. Unfortunately it was a huge mistake – I was told

“Mindfulness gives you the freedom to say, “Actually, I’m just going to do this one thing and really concentrate on it and enjoy it and then I will move on to the next thing and I won’t feel guilty.” every day that I was a waste of space. In fact my husband informed me that he had a licence for me, like a dog, so he owned me (for those of you too young to know, you needed a licence to own a dog in those days – pity you don’t now.) This was the first time that I was diagnosed with depression. It was a taboo subject in those days and people didn’t discuss it as they do now. It couldn’t be seen, so it didn’t exist! You were told to “get over it” and my GP at the time put me on my first course of tablets. I eventually had the courage to leave my husband and I was very lucky. I met the man who was to become my second husband. He was appalled that I was on tablets for depression without anyone trying to help me in other ways. I suffered terrible anxiety attacks, regularly panicking and then fainting. He made me see another GP who sent me to see a psychiatrist. I went for a year and it made very little difference. The GP then offered me hypnotherapy and it worked! Suddenly life was brighter and I could be a “normal” person. My husband really believed in me and my abilities, which boosted my confidence. My depression returned with a vengeance when, after 25 wonderful years, my husband died. I fell straight into those evil clutches again and I could not get out. More tablets, more panic attacks, and more days when I did not get out of bed. The worst day was when I came very close

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to hanging myself – I had had enough. The only thing that stopped me was thinking that if I was lucky enough to go wherever my lovely husband was, he would be so cross with me. He had fought so hard to live and had made me promise that I would fight hard to carry on without him. A year later I was lucky enough to be offered a job with CVS. I even checked three times at my interview, asking “Are you sure it’s ME you want?” I enjoyed my job and it gave me hope for a better future. I coped – some days better than others. And then the Mindfulness Course was offered and I asked to attend. I was sceptical; after all, if tablets and psychiatry hadn’t helped, why would concentrating on the here and now help, and what on earth had raisins got to do with it? I was so wrong; this course has helped me more than I could have imagined. The trainers are patient and caring, and they really want you to see the benefits. They don’t force you to feel something; they just help you to find your own way of being in the here and now, and learning to savour each moment. Another unexpected positive outcome of the course is the confidence it has given me. I am now happy to participate in meetings and actually have the confidence to put my ideas across. This has been noted by my managers and it’s really uplifting to have someone acknowledge that actually, you aren’t stupid, and every one is valuable in their own way.

MANAGING PEOPLE

Modern maternity Nigel Lea from Citation plc outlines the proposed changes to shared parental leave

014 sees the 15th anniversary since the introduction of maternity leave and pay for employees in the UK, and by now we are all familiar with the rules governing paid antenatal appointments, ordinary and additional maternity leave, maternity pay, ‘keeping in touch’ days, etc. Additional paternity leave and pay were introduced in 2011, giving parents the option for the mother to return to work early, with the father effectively using up the balance of the mother’s maternity leave and pay. However, with less than one per cent of parents taking up this option it has had little impact on the way parents currently take leave following the birth or adoption of a child. All this is about to change following the Government’s ‘modern workplaces’ initiative to introduce a new system of shared parental leave and pay that both parents can access so that, if they want to, they can share caring responsibilities. The enabling legislation is still working its way through Parliament, but regulations are expected before summer this year giving details of how the system of shared parental leave and pay will operate from next year (probably from April). What we know so far is that the current system whereby the mother can begin her maternity leave at any time from the 11th week before the expected week of childbirth will continue, and there will be a two-week period of compulsory maternity leave (four weeks for factory workers) following the birth. Once the compulsory maternity leave period has ended the mother will be able to either continue to use all her maternity leave and pay or ‘convert’ the unused part of it to shared parental leave and pay. If the leave is ‘converted’, both parents will have the opportunity to take the remaining leave and pay, either separately or together, in blocks or as a continuous period. The outline proposals are that a parent will be limited to three ‘notifications’ to the employer for taking leave, with the

mother’s notification to start maternity leave counting as her first notification. In theory, this means that each parent will be able to take their leave in a maximum of three blocks, and although the government says that shared parental leave will be good for business, businesses say it will be a nightmare! However, as with all employment legislation, we are where we are, and we have to make the best of it. Assuming that fathers will be more inclined to take shared parental leave under the new regime than the 1 in 172 who currently take additional paternity leave, when and where is the new shared leave likely to have the greatest impact? The most likely ‘when’ will be during school holidays. For parents who have school-age children, the father joining the mother on shared parental leave to provide an extra pair of hands for six weeks during the long summer holiday could be an attractive proposition. The most likely ‘where’ is where both parents work for the same employer. Unlike the current provision, where it is most likely that the mother will take all the leave and hers will be the only job that needs temporary cover, if both parents can take up to three blocks of leave, either singly or together, then switching temporary cover on and off for both their jobs could result in real logistical and recruitment problems, especially for a small practice. In the final analysis some claim that shared parental leave is an attempt at social engineering, but that it will take more than rules permitting shared parental leave to change the received wisdom that the best place for a new baby is with its mother, in which case shared parental leave could turn out to be as much of a damp squib as additional paternity leave.

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What do you think? Is this likely to have a great impact on your practice? Share your views – editorial@practicelife.biz or Twitter @PracticeLifeMag

Here’s a quick reminder of current maternity leave and pay rules Statutory maternity leave (SML): • No service qualification • Paid ante-natal appointments • 52 weeks’ leave • Cannot begin earlier than the 11th week before the expected week of childbirth (EWC) Statutory maternity pay (SMP): • Must have at least 26 weeks’ service at the end of the 15th week before the EWC • Must earn at least £109 a week (£111 from 6 April 2014) • 6 weeks’ SMP paid at 90% of normal weekly earnings • 33 weeks paid at the lesser of £136.78 (£138.18 from 6 April 2014) or 90% of normal weekly earnings

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MANAGING PEOPLE

Case Studies – How we manage maternity In this issue’s Managing People feature, we take a look at two different practices and how they manage maternity leave, the first a 3-branch small animal practice in High Wycombe, Buckinghamshire, and the second, a large referral practice in Winchester, East Sussex.

Case Study 1 Simon Cartwright is a director at Crossroads Veterinary Centre, a 3 branch small animal practice in High Wycombe. Staffing consists of 8 full time vets, 8 RVNs and 3 trainee/auxiliary nurses (8 FTE), and 15 receptionists/managers (6 FTE). ‘We’ve certainly had plenty of experience with maternity cover in our practice, having had 13 pregnancies in the last 10 years. These were mainly within the nursing team, but did include 2 vets and 1 of the reception team. We offer a standard maternity package with 6 weeks at 90% of pay then Statutory Maternity Pay for 33 weeks. All of our staff have taken the full 12 months of maternity leave, bar one staff member who took 6 months with her second pregnancy. Holiday accrued during maternity leave is taken as part of the 12 months for nurses and 6 weeks added to the 12 months of maternity for vets. Reception cover is usually made up by spreading the hours around the others. We’ve addressed nursing cover through employing extra trainees or full time RVN cover, which has been made possible by a mix of staff leaving through natural wastage, returning to work part time and practice expansion. We have now 2 nurses and 1 vet going on maternity within 4 weeks of each other so we will see if we can cope! Their pregnancies though, I must say, have caused no problem to the practice at all in this last year – with full credit to them, they have kept things running very smoothly. We have as yet not been able to recruit a vet with several years experience to cover for our vet, but did recruit a new graduate in October to replace a 3 years qualified vet. Because we’ve had at least one pregnancy per year, we’ve got familiar with the juggling required to maintain staffing levels. It’s a constant challenge and I’m sure that our experiences are typical. We do have a lot of female staff, and as the profession becomes increasingly feminised, it’s going to get even more challenging. I’ve found that having had children, female vets and nurses no longer want to work full time or do out of hours work. We struggle with a lack of response to advertising for experienced vets. Over the years we have produced Health and Safety pregnancy protocols which I must say have worked well. However, there three areas that give us on going headaches and because they have ‘always been done that way’, we’ve been unable to change them. www.practicelife.biz z March/April 2014 z Practice Life

• The first of these concerns theatre work during the first 12 weeks of pregnancy. With modern products such as isoflurane, if correct procedures are followed there is no extra risk to pregnant staff. Unfortunately though, despite this knowledge, the spectre of teratogenic disease from the old halothane days still looms, and we cannot get staff to work in theatre or recovery areas during this period. • The second area concerns radiography. We fully accept and indeed enforce that all pregnant staff should not take part in radiography work for the first 12 weeks of pregnancy. But despite hard evidence to the contrary – zero readings on dosimeters for several years, modern equipment, fully leaded doors and solid walls – our pregnant staff are still reluctant to work in the rooms adjacent to the radiography suite while X-rays are being done, even after the first trimester. • The third area is more unusual: after 1 staff member refused to do home visits due to a perceived danger to her pregnancy, this set a precedent which we now seem unable to change. I feel that resolving these issues is made so much more difficult by the fact that Health & Safety laws in these respects are very woolly. Some kind of written guidance from advisory companies clarifying what is and isn’t a risk, and refuting myths would be enormously helpful in helping us to set policy which staff would be required to adhere to. But no such thing exists, and I can’t seem to get our H&S advisor to help us with firm, written advice. As an employer, I feel that I am at the whim of outdated perceptions, and the law does not support me in trying to modernise pregnancy practices. H&S companies tend to sit on the fence or err on the side of the employee to try to avoid conflict. It leaves us vulnerable and unable to enforce change. The financial impacts of the pregnancies have been difficult to measure, as fortunately we have remained profitable. I feel that nurse pregnancies have had less of an impact as they tend to be non-fee charging. However, we have had some instances where vet turnover has dropped significantly during pregnancy due to fatigue and such like. Benefits in kind can be a headache though, and, I feel, open to abuse; we’ve had a particularly bad experience at the hands of one staff member in this respect, who was absent for much of their pregnancy and subsequently did not return at the end of their maternity year, leaving us for the best part of a year with resources that we could not use, and received no benefit from.

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As a result of this, my opinion is that benefits in kind such as use of a company car or free flat use should be reviewed during maternity leave and, perhaps, the employee should pay a rent if they wish to retain the benefit whilst they are not actively working. If the law was more helpful to us in areas such as this, it would encourage us to offer further benefits such as childcare vouchers and salary sacrifice schemes. We don’t offer these currently as we would have to continue paying them during maternity leave. As an employer, I feel that maternity law is very heavily weighted towards the employee and it can make running a small or medium sized business with lots of female employees

very difficult. The fact that we must keep positions open for up to a year during maternity leave, with no requirement for any intention to be declared by the employee, makes forward practice planning very difficult indeed, particularly with the frequency of pregnancies in our practice! My biggest learnings to pass onto any new employer would be to ensure that contracts are solid and clear, minimising benefits in kind. Keep communication between yourself and pregnant employees open clear and regular, and encourage the sharing of intentions during maternity to the greatest extent possible within the law.”

Case Study 2 Nola Gonella is the Operations Director at Anderson Moores Veterinary Specialists in Winchester. She is responsible for managing 91 staff including 5 Directors, 16 Clinicians (3 of whom are directors), 42 nurses, 17 administrators/ reception staff and a number of technicians, kennel assistants and a caretaker. Currently 2 of the clinicians, 3 of the nurses, and 2 administrators are on maternity leave. “With a large team such as ours, there’s nearly always someone on maternity leave and we have quite a few systems in place to help us manage this. We offer a standard maternity package and staff retain their benefits such as healthcare provision throughout their leave (a legal requirement). A risk assessment is carried out as soon as we know a staff member is pregnant, and we have robust health and safety protocols in place to guide us. We still use the health and safety advisory company that the practice started with 6 years ago. Keeping a ‘small business ethos’ in terms of how we deal with our staff helps create a positive working environment, and I would say we have a happy team. There is a lot of goodwill when someone announces they are pregnant as the relationships are caring and not just functional related to working together. We review the H&S protocols every time there is any change in legislation or in practice procedures and make sure that staff are fully updated on risks or have access to advice and information regarding working in and around animals during pregnancy. I believe that coping well with maternity absence comes in a large part from being prepared. The very nature of maternity leave means that we have plenty of notice of future absences and we do our best to be ready. It helps that we allow many of our staff to come back part-time if they wish to do so, and we try to be as flexible as possible. Having part-time staff benefits us as well because it creates a pool of staff who might be able to fill in for sickness and holidays. We make a point of listening carefully to any request for changes in working pattern (at any time in their career) and we try very hard to accommodate these requests, although it isn’t always possible. We get a very good rate of return to work after maternity leave, and indeed our staff

retention is also very good, I think in part due to our flexibility. Creating a good working environment is a key objective for us: our staff know that we will always start out with a positive attitude and we will try our very best to accommodate their needs. Sometimes it’s not possible because of the needs of the business, but it is important to listen and to consider any requests carefully. Being flexible and listening to staff needs means that they are more likely to listen to us when we ask them to help us out if other members of staff are off with sick children, or take leave! Our rotas are done monthly. As soon as a pregnancy is announced we start to forward plan. Being a referral practice means that it can be hard to find staff of a suitable calibre. Many of our nurses are diploma level, and of course, many of those at this level living locally already work for us! However, because we are growing quite rapidly as a practice, specialist nurses that we’ve recruited for maternity cover have usually ended up staying as permanent employees. Specialist clinicians are even harder to find for maternity cover, but so far, clinician pregnancies have been in teams that are already growing due to practice expansion, and we have been able to make additional permanent appointments. I am fortunate in that the Board of Directors all have children themselves and have a very supportive attitude to my initiatives with regard to coping with maternity and paternity leave for our staff. Everyone has an appreciation of how important this part of a person’s life is – starting a family – and there is never any resentment from team members or the Directors at having to adjust to changes due to maternity leave. We are also very supportive of leave for new fathers!”

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CLIENT CARE & MARKETING

TELEPHONES & CONVERSION:

why it pays to take that call Jeff Gascoyne, Director of Business Acquisitions, Vets4Pets offers insights on the importance of call handling

o, we all know that veterinary practices are judged purely on their location, clinical standards and value offering, right? Wrong! Unless you run a walk-in clinic, almost every visit you enjoy in your practice has come about via an initial telephone or online appointment request (usually followed up with a phone call). But how many opportunities are missed? Measuring telephone handling isn’t difficult but it does require the right information and the right analysis to trend the information. This provides a measuring tool that can be easily understood not only by you, but by your colleagues in the practice and particularly by your reception/ healthcare team. As a busy vet or manager (or both!), you probably spend very little time in the waiting room of your practice. Therefore you may not engage with reception from a client’s point of view very often, and you probably rarely hear them on the phone. So how can you best manage performance and in particular one of the most important elements of the reception role: answering the phone? Within Vets4Pets we have always had an appointment system and over 99% of our appointments follow a phone conversation with the practice. We have varying levels of quality with call handling and capacity capability. However, we believe that it’s irrelevant how good your service is, or how competitive your pricing, if you don’t answer the phone well or indeed at all. Clients will never get to know how good you are and any marketing you’ve done to reach that potential new client is wasted. So as a business, Vets4Pets has clear objectives on call handling.

Measuring phone capability and conversion There are of course multiple ways to do this. Within our business we look at incoming calls over a given period of www.practicelife.biz z March/April 2014 z Practice Life

time and we also look at the number of visits. A simple calculation is how many answered calls has resulted in a visit. Clearly this is not absolute in its calculation, but over time you can trend call performance. If we receive 2,000 calls a month (answered) and we have 1,000 visits then we have a 50% conversion rate. So where have the other 50% gone? Well, it is reasonable to expect that some calls will not result in a visit; general enquiries, in-patient enquiries, friends and family etc. will all be included here. But it’s also sensible to assess whether you might have an issue with conversion (or not). My advice would be that any rate below 40% should be investigated. However, before any investigation, it’s prudent to check whether the phone is actually being answered and whether clients can get through. Reports from your phone provider should be able to tell you not only how many unanswered calls you have; it will tell you how many calls have received an engaged tone and the % of overall calls these make up. It can also tell you when unanswered and engaged calls occur. This is particularly useful when resourcing the reception areas. Are we being efficient or do we have a capacity issue? The report can also tell you how long it is taking you on average to answer a call. It’s a less valuable KPI but one that still shouldn’t be ignored. All this analysis might sound like hard work, so to make it happen you need to have quick and easy access to the information you need. Your phone provider will provide you with the call reports, your PMS provider the visit volume, and a simple calculation does the rest.

So what does this information tell us and how do I know what effect it has on the overall profitability of the practice?

Let us follow a hypothetical scenario: In my practice I have found there to be a call conversion issue. Of those 2,000 incoming calls to the practice, we have only generated 666 visits (33%). This has been consistent for the last 3 months, but the conversion rate had been 50% previously on the same level of calls. The

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practice average consult value is £40. I am aware that revenues have decreased over the same period. The lost revenue element is simple to calculate: 2,000 x 50% = 1,000 less 666 actual appointments = 333 missed appointment opportunities in the month. This, at the average consult value of £40, constitutes £13,320 in lost revenue in the period (possibly a month). You can then use your own information to work out the lost profit (cost of drugs and bank charges are really the only variable costs). So now we have something we can measure, how do we best manage it? Without sitting and listening to every call taken by the receptionist, this data allows you to ensure

“All this analysis might sound like hard work, so to make it happen you need to have quick and easy access to the information you need.” first and foremost that you have the right level of cover on your phones (for simplicity I shall assume it is on reception). You then need to assess whether the practice suffers from a technical incapacity: are there enough lines coming in to the practice or is it forcing a log jam? Remember that outgoing calls take up one of your lines; lunchtimes and afternoons often highlight capacity issues.

carried out, they will often be more proactive in engaging with pet-friendly dialogue and offering an appointment. You can identify individual staff members if you wish and direct feedback can be provided to help make improvements or celebrate success.

Does all this effort into conversion make a difference? My personal experience definitely suggests so. In 2008 my business stopped measuring call performance through our third party supplier. We also took our eye off caller reports. We had been achieving a 40% call conversion rate and performance was on track – we became complacent. In June of that year, having not done call coaching for several months, we started to see performance decline: KPIs showed a drop in visits and our conversion rate had fallen to 15% of calls being offered an appointment (these were all appointment related opportunities).We undertook a review of the situation and over the next 6 months we challenged ourselves to get our caller conversion rate above 50%. We achieved it. And in so doing, we took our revenue performance from 95% to 102% for the year. My advice is this: under-estimate good call-handling at your peril!

Training and objectives Once you are happy you have the resourcing and system performance right, you need to monitor it and do ongoing measurement. Team performance should also be assessed. Call coaching can really make a difference to poor conversion rates, and team training in customer service and call handling is vitally important from a business perspective. Does your team have job descriptions and objectives aligned with your practice vision and demands? For reception staff, objectives around client interface make sense. An objective for example might be to achieve call conversion rates in excess of 50% every month. Performance can be measured to help drive business without management intervention on a daily basis. Good performance is easily recognised and remunerated.

Use of mystery shopping Performance measurement should also include checking to see if you routinely offer appointments. Outside help may be required and you can utilise third party providers to call the practice with pet owner queries, all of which should lead to an appointment being offered. This can be invaluable in both identifying training needs as well as helping you to spot good call handling for positive feedback. If staff know that call monitoring is being Practice Life z March/April 2014 z www.practicelife.biz

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CALL HAPPY Demco Communication’s Linda Demetriou gives an update on how phone systems can help you drive footfall...

ust imagine that you have spent thousands on marketing and training your staff to ensure that you increase the conversion % of appointments, but you have no idea how your lines, staff and telephone system are performing.

When we realise that: • 89.6% of all appointments are made via telephone, • 91.8% of emergency cases come in via the telephone and • 92.3% of follow ups from the practice are made via the phone, it’s pretty obvious that the telephone is the doorway to your turnover and your profit! With the average life of a dog being in the region of 10 years, at a £50 spend per visit, 2 visits per year, over 10 years, that’s a potential gross income of £1000.00 per dog from basic consults (although a conservative estimate lifetime value is over £3000 Onswitch).You want to ensure that you reach this potential and in doing this, the telephone is your friend. So let’s look at how we can measure certain Key Performance Indicators using telephone technology.

Network Performance Reports This is the simplest and the most important report you can look at. It is provided directly from the Network Company who looks after your business line(s), and they measure all calls made and received, including time of day, and give graphs and reports. This report is provided once a month with your Monthly Bill. So what are the important facts and figures to look at? 1. When do your clients call you and what is the busiest time of the day? 2. How long are your clients waiting to have their call answered? 3. How many calls are you losing (abandoned)? 4. Do you have sufficient lines to handle your incoming callers? 5. How many callers get an engaged tone? 6. How many outgoing calls do you make and when? Some of the key areas to look at are the number of unanswered and engaged calls. You can work out what your conversion % is by looking at number of incoming calls versus the number of appointments booked for that period. You can find the latter figure simply by running a report on the same time period on your Practice Management Software (PMS) for the total number of appointments booked for your vets. www.practicelife.biz z March/April 2014 z Practice Life

Once you have this %, the findings may well be shocking. At Demco, we speak to many practices each month and some of their comments shock even us, “We do get the (figures) every month, and we put them in the drawer”, “I did look at them at the beginning, but now they sit there...”, “I don’t really understand what I am looking for”, and “I had to pay for them so I cancelled after a month, as we know we’re ok.” When I recently asked a room of about 30 practices how many of them got the performance reports, I was amazed to see only 3 hands go up. I told the rest to wake up! We’re very happy to help anyone analyse their reports, and translate them into meaningful results. Here’s an example of the information you can glean: • You have 4 lines and receive 3500 calls per month. • Your Conversion Ratio is 3:1, so for every three calls you receive, you make one appointment • You have lost (through unanswered or engaged calls) 10% of your incoming calls (this is an average for practices) = 350 Calls. This is a loss of 115 appointments at your conversion ratio • 115 appointments at £50 each is a loss of £5750.00… in just one month. Some callers might have called back and booked, but certainly some will be potential new clients that have now gone elsewhere. So now what is the lifetime cost of that call?

Internal Call Management Reports This software is connected to your telephone system via a PC, and it remembers every call you have made and received. Because it’s in your own system, you can get hourly or daily reports, and where available (if the number has been disclosed), you can obtain a list of all the numbers that called you but you did not answer. This is key: you can call them straight back. Imagine capturing missed calls and acting on them within minutes! Looking at calls out of hours gives valuable information too. How good would it be, that on entering your practice in the morning, you have a report of every number that called you out of hours, irrelevant of whether they spoke to your out of hours service or not? Once again, being proactive in calling your clients back is fantastic client service, it shows you care and is key to increased revenue. (Note that this report does not provide engaged call information).

Internal Wallboard Display In addition to looking at reports, you can get simple but effective display software that gives you instant information on your PC Screen/TV (Fig1.) Data such as the number

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Fig. 1

of unanswered calls is available within seconds, together with how many calls you have received that period, who has answered the most/least number of calls, average caller waiting time, the ‘lines status’ in relation to how many are busy, and much more.

Call Recording Call Recording is useful for training your staff and regulating your practice. You might want to hear how effective your receptionists are; are they representing your practice in the way that you wish to be portrayed; do they offer appointments to each caller; do they show understanding and empathy; are they explaining your services and costs correctly? Whilst you are listening to the calls, you can score each one, and you will soon know exactly where changes are required and what additional training is needed.

“You must always remember your peak hours and ensure you place the correct emphasis on the number of lines you have, where they ring and how you adapt your staff and train them for these peak times. Having phones that ring everywhere does not help you.”

Telephone Systems and other technology Most phone systems offer 90% of these features, but it’s important to know: how the exchange lines are structured; where the calls ring into and overflow to back up staff; how you alert yourself to the fact that you have too many calls waiting; how you successfully route calls away from reception to the correct departments; how adaptable the system is to growth and practice changes, and how important all this is to your business. You must always remember your peak hours and ensure you place the correct emphasis on the number of lines you have, where they ring and how you adapt your staff and train them for these peak times. Having phones that ring everywhere does not help you. For multi-site practices, it’s essential to link them all together, which allows for sharing of reception positions, expertise and

staff resources. You already have your PMS networked, so why not your phones? Finally, imagine the day that with every call you know straight-away who is calling you before you have even answered. The technology to link the caller id to their client record instantly exists right now, and saves you approximately 12 seconds per call, not to mention the warm feeling the instant recognition gives your clients. You can also highlight a number in your PMS and click and dial out. Think about how much time this saves you in a busy reception. Now, get on the phone to your PMS company and tell them that you want this feature; you can’t make this work without them! Linda is happy to discuss any aspects of this article on 02087954444 or lindad@demcocomms.co.uk Practice Life z March/April 2014 z www.practicelife.biz

CLIENT CARE & MARKETING

Why your landline is your practice lifeline Alison Lambert from Onswitch highlights the impact on telephone conversion KPIs from focused training

ou may not give much thought currently to your practice phone – when it rings, someone answers it. Staff give advice, answer queries and book requested appointments and get off the phone as quickly as possible. And that’s efficient, it works, it’s what we’ve always done. Except that today’s pet and horse owner doesn’t want to be treated like everyone else and given minimal time and attention. They expect (quite rightly) to be treated with interest, respect, enthusiasm and care, even on a short phone call. In fact, especially on a short phone call – chances are that this is their first contact with your practice. An owner rings to ask the price for a vaccination, but what she is really looking for is an idea of what it feels like to be a client. Owners rarely choose a vet based on price, and even if your costs are higher than other practices she’s spoken to, if your team are warm, welcoming and interested then she is highly likely to choose you ahead of the practice that simply said ‘£35’ and hung up. Good telephone practice makes excellent business sense Onswitch call around 1,500 equine and small animal practices across the UK every month, on a quarterly rolling programme that will include your practice. From these calls we compile the Onswitch Index, reporting on key parameters of telephone customer care: • Calls answered. 10% of all calls we make go unanswered. To put this into context, with an Average Transaction Value of £50, not answering a call is missing an opportunity • Appointments offered (small animal 35%, equine 27%). Successful practices book procedures for every fourth first consult, so if you’re not offering appointments to callers, you’re missing out on this vital additional income. • Overall Index Score (small animal 46%, equine 36%) • Business basics (small animal 47%, equine 39%) • Information (small animal 51%, equine 36%) • Engagement (small animal 32%, equine 30%) * Percentages are national averages for January 2014 The maths is very convincing. A new owner calls asking for the price of a vaccination. You could just tell her £35, or

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you could use the opportunity to ask after the animal, use its name, and engage the owner in a genuine warm dialogue discussing the services your practice offers in addition – a free health check for example. You choose to do the latter, and she feels good about your practice, so she registers and books a consultation (£45) where you discuss diets and worming. In addition to the consult fee and vaccination, she goes on to purchase a wormer (£15) and a bag of food (£30). She then comes back every three months to do more of the same, and has told her friends about the great service, so two of them register with you too. Conservative estimates have the lifetime value of a pet to a practice at anywhere upward of £3,000 - a fantastic return on those two to three minutes you spent with the client on the phone. Suddenly it’s not just a phone call; it’s an income stream. But it’s also a new way of working - your team must truly engage with callers and offer appointments to every one. High-performing small animal practices routinely convert 40% of their inbound calls into paid consults (up to 80% in equine practice). And a quarter of those calls will also lead to additional investigations or procedures. Forward-thinking practices also manage their calls proactively: • Calling clients when boosters are due • Phoning with details following surgery (how many of us still advise owners to ‘ring anytime after 2’?!) • Booking follow-up appointments rather than saying ‘give us a call if there are any problems’

What gets measured gets better If you haven’t got a call reporting system currently, please get one. You may be horrified at the number of lost calls (and therefore lost revenue) it highlights. And then create a benchmark for where your telephone customer service is now - the Onswitch Index will help here. Then train your team to convert callers into clients - every call represents potential revenue for your practice, so any time and money you spend on fixing your phone service will be a very wise investment indeed. Alison is happy to answer any queries on this article at Alison@onswitch.co.uk or 01476 565343

CLIENT CARE & MARKETING

CASE STUDY – INDEPENDENT VET CARE

ndependent Vet Care are firmly committed to the principle that the telephone sits at the very heart of customer care. So much so that when a new practice joins the group, immediate focus is placed on measuring and further improving call handling and conversion.

sound correlation between mystery shop performance and practice turnover. • The cultural shift amongst the staff has also been interesting, with the Monthly Mystery Shop Performance table always the most popular item on our monthly staff bulletin.”

Working with Onswitch, this focus is three-fold: 1. Call Coaching Programme 2. Index reporting 3. ‘Five step’ customer care training

Onswitch Index data shows that many equine practices in particular have quite some way to go in terms of improving their customer care delivery. The table below compares national average KPIs from the Index with original and latest results from Inverness equine practice, Kessock (also part of the IVC group).

With 90+ practices, IVC’s investment in measuring and improving call conversion is significant, and it is certainly working. Graham Avent, Head of Marketing at IVC, describes the very real results being seen in IVC practices. “We measure our Mystery Shop performance against our turnover over time, and the results are very encouraging. • Our top ten Mystery Shop practices returned an average growth of 10% • The best-performing practice saw growth in turnover of 20% • Four of our top ten Mystery Shop practices were in the group’s top ten for improved turnover, demonstrating a Average overall Index score • Business Basics

Darren Mackintosh, Business Support Manager for IVC Scotland, and General Manager at Kessock explains, “At Kessock we began looking at telephone customer care a couple of years ago, and the continued focus has brought significant improvements to practice turnover and profitability. By routinely engaging with callers and offering appointments, we’re delivering an enhanced level of care that keeps our clients very happy, helps them recommend our practice, and also benefits the bottom line. We can clearly see that our investment in reporting and training has paid for itself several times over.”

Kessock Equine

Index Equine

Index Small

Practice Dec 12

Practice Jan14

averages

animal averages

36%

70%

36% 46%

28%

63%

39% 47%

• Engagement Index

39%

68%

30% 32%

• Information Index

42%

80%

36% 51%

Appointments offered

40%

70%

27% 35%*

*National Average Appointment offer includes Index sites, average score of Non Index sites

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BUSINESS HEALTH & FINANCE

Open Book Accounting: SHOULD YOU SHARE YOUR FINANCIALS WITH YOUR STAFF? Andy Moore, Moore-Scarrott Accountants answers... 25 years ago the answer was “No”. 10 years ago, the answer was still “No”. These days, the answer varies massively between practices but there is an undeniable move towards increased communication with staff about the financials, performance, KPIs and benchmarks.

Why the shift in attitude? There is no doubt there has been an increased focus on performance generally within veterinary practices. This is, in large part, due to: 1. I ncreased competition within the profession leading to pressure on profits. The upshot is that practices have to work more efficiently. 2. A n increase in benchmark data available to help underperforming practices reach benchmark ranges. The result is that staff development is needed to improve results and there has to be some information release to aid that process. 3. The move to species-specific working within the profession. The result of this is to highlight the need to change working practices and the impact of lost profits on the viability (or otherwise) of species-specific work within multi-disciplinary practices. 4. The increase in information publicly available (whether correct or not) giving perceptions to the staff of “fat cat” syndrome, which some practice owners feel they need to dispute. Increased and continued media interest in the profession has also no doubt fuelled some perceptions.The follow on from this is that some look to defend against that perception, through communication of facts and figures, and some simply ignore it. Whatever the drivers, there is certainly an increase in requests for information to be produced for practice owners to share with staff throughout the practice. Advances in technology, clinical systems and financial reporting have provided the framework to enable more useable and relevant information to be extracted with ease, the key being the relevance of the information to the user. This has helped the process of improving the provision of information to staff. True open book accounting for any professional service business is unlikely to become a reality for the foreseeable future. Whilst the open approach might be appropriate in www.practicelife.biz z March/April 2014 z Practice Life

certain corporate, retail or publicly quoted arenas, professional partnerships (whether trading as partnerships, LLPs or limited companies) have always been reserved. Historically, the professions could only trade as a partnership and, as such, one considerable benefit was complete privacy of financial affairs. It is only since 1998 that veterinary practices could trade as anything other than a partnership. Hence there is a natural culture of financial privacy. Part of this reluctance to share information comes from salaried staff sometimes struggling to understand the economic reality of running a business; the time horizons necessary for practices and the commercial or investment decisions practices must take, do not fit well with the mindset of many monthly paid, salaried staff. It is quite common to see assistants, when considering whether to buy in to a practice, wrestling with the figures: the size of the buy in loan required; the increase in income but then the significant loan repayments. Until that point, everything was judged by reference to their take home salary, financial life revolving on a guaranteed, secure monthly cycle. Any release of information therefore must be dealt with sensitively and be appropriate for the target audience. A second reservation often voiced, usually when considering the move to a corporate structure, is release of information that might reach clients. This is usually of particular concern within farm practice and, to a lesser extent, in equine practice. The perception is that if a wider audience (staff) becomes aware of financial performance, then it would follow that others (clients) will become aware of that information. Obviously there are elements of these points which give rise to valid concerns and as mentioned already, great care is needed.

So what are practices doing and what works? Increasingly, there is a demand for extracted financial data to share with staff. Most commonly used are: ‘Pictures’ to illustrate certain key financial information and trends: i) How is every £100 received by the practice utilised? (Fig 1.) ii) What effect does it have on profit when a 15% discount is given to a client? (Fig 2.)

BUSINESS HEALTH & FINANCE

iii) Graphs showing Rolling 12 (R12 - Fig 3.) or Moving Annual Turnover (MAT) iv) Ratio of consult income to procedures for the practice (SA) v) Analysis of Gross Profit % (SA and Equine) v. benchmark ranges vi) Average turnover per MRCVS v. benchmark ranges vii) Average fee turnover per MRCVS (Farm practice) Personal performance data (professional staff): i) Total personal turnover ii) Fee element of personal turnover iii) Medicine sales of personal turnover iv) Comparison for the individual v. best performing vets in the practice and v. benchmark target ranges v) Consult to procedure conversion ratio for the individual v. best in practice This information tends to be delivered in meetings, be that whole practice meetings (for practice data) and individual appraisals (for personal performance data). It is fundamentally important that suitable explanations are given, based on the correct interpretation of the figures. Great care must be exercised when releasing information, as unwanted results can occur. Staff can become divisive over bookings to manipulate their personal performance figures, and some can become focused on personal targets rather than the overall practice and its success. Sometimes clinical decisions can become clouded by commercial drivers, development of other staff members potentially is avoided (as it does not reflect within the figures) and the list goes on. On the other hand, effective communication of appropriate information can have a hugely positive effect on performance; improved invoicing, reduced missed bookings, reduced free-of-charge consults, better charging of surgical time. As with most things in life, itâ&#x20AC;&#x2122;s a question of balance to get it right or, more accurately, not to get it wrong.

Fig. 1

Fig. 2

Where do we go from here? Evolution rather than radical change is the most likely progression. Reporting of information has evolved at a huge pace over the last 15 years. With that, available data and analysis has increased. It is difficult to foresee a situation of true open book accounting within the professions, but certainly evolution of the reporting of information to staff will continue. What is appropriate depends on so many variables; it is a case of finding what is appropriate and what works in each practice. Starting with something straightforward that is easy to ensure happens regularly, is always the first step. The next step is then to build from that foundation.

Fig. 3

www.moore-scarrott.co.uk

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BUSINESS HEALTH & FINANCE

CASE STUDY: SHARING FINANCIALS We hear from a specialist equine practice with 4 principals, about their motivation and journey in sharing financial information with staff… “Historically, we had no benchmarking data, limited management information and no monitoring of KPIs, simply due to the fact that we had no knowledge on the subject and no comparative data to draw on. We appointed a specialist adviser and they put revised reporting systems in place so we could pull out the information we needed. Over the following 6 months, overall practice financial performance, financial performance by individual vet and practice KPIs were monitored, all on a quarterly basis. Within the initial 6 month period, it was identified that certain KPIs were behind benchmark targets; specifically the Gross Profit was below what was expected for equine work, the turnover per vet was also below that expected and salary costs as a percentage of turnover were above the benchmark target expected. With that information, we had to think about why these trends were occurring and, more importantly, what we could do about it! We knew our invoicing procedures were not as good as they could be, but that always seemed to happen, being as busy as we all were. If we were brutally honest, bookings were late, visits and drugs were being missed, invoices were delayed going to clients and clients were late in paying. It was at this stage that we had to make a decision as to how the problem should be addressed. In the past we had spoken to assistants about the effect late bookings were having, primarily to do with our debtors being high, rather than performance being off the pace. After a reasonable amount of discussion, we decided to release certain practice financial information to staff to try and illustrate the problems and start to change our working practices. Practice staff seemed to think that the total amount we invoiced was our personal income. Our starting point was to hold a practice meeting, involving all staff, to explain what the realities were of our practice finances at an overview level and why we were discussing this with them. Amongst other things: 1. We highlighted how each £100 of income coming into the practice was used 2. We explained the effect of a missed booking or a discount being given 3. We outlined the level of capital expenditure needed to stay current with our equipment We got our accountant to produce the figures so staff knew they were not something we had pulled together ourselves! We felt that it gave credibility to the figures for them. We then held a meeting involving just the vets. At that meeting we chatted through: 1. Where we were as a practice in respect of turnover trends, as against equine practices more generally

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2. Where we were as a practice with average turnover per MRCVS (fees, drugs and total income) and how that compared to benchmark targets and what other practices were doing 3. Why we were having to discuss all of this with them and 4. What we needed to do. The difficulty is when everyone is working hard they assume they are generating profits. Our problem was that although everyone was busy, because we were possibly not the most disciplined in our procedures, we were effectively giving away a lot of work and that in turn was putting us under financial pressure at various times of the year. It wasn’t until we had the information at our finger-tips that we realised, as an 8-vet practice, we were underperforming by more than £150,000 per year of lost profits. We didn’t let staff know this, but that level of lost profit is certainly significant to us and would help us in funding new equipment, paying off loans, paying for salary reviews and to give us a more sensible return for the work we were doing. We then went on to adapt our appraisal process so we could discuss individual vet’s performance with each of them on a personal level. We broke some of the information down to a “per day” effect to try and make it a figure they could relate to. So rather than it being them needing to find £15,000 of extra fee income each year, it became them needing to find an extra 30 or 40 minutes to charge for each day. The benefit to us of being more open with some of our financial data is that some staff (not all) now do take more of an interest in the financial aspects of our practice. We have tightened up massively on invoicing and the assistants understand why there is a need for that. All of this has in turn helped us to claw back a good part of the shortfall in performance. We haven’t found the full £150,000 yet but certainly we have found over £100,000 from where we were and that’s without working harder to achieve it. As a practice, we continue to share some financial information with staff and can recommend it.”

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PRACTICE DEVELOPMENT

SPECIAL FEATURE

HARNESSING TECHNOLOGY:

New tools for the job

John Bonner kicks off our Technology Special Feature with a look at recent veterinary applications and urges the technophobes amongst us to jump aboard...

eterinary surgeons will usually take to the latest clinical kit like ducks to water – but when it comes to picking up new management tools, it is a different story. The profession lags some years behind other service industries in adopting the information and communications technologies that would help practitioners to run their businesses more effectively. The reasons are fairly obvious; vet practices have traditionally operated as small independent businesses in competition with their neighbours. They haven’t the cohesion or financial clout needed to fund development of the sort of gadgetry and software that have profoundly changed the way services are provided in areas like the retail sector. That was why SPVS set up the VetXML consortium in 2006 bringing practitioners and technology suppliers together to unlock the potential of new technologies in veterinary businesses. Its goal was to create the technical standards needed to facilitate electronic communications between practices and external companies and allow the data held on the practice computers to be used outside the clinic. Since then there has been progress in areas such the electronic transfer of pet insurance documents and laboratory results. Under its chairman, Devon practitioner Nick Lloyd, the consortium is currently working on developing software which would trace the movement of veterinary medicines from the manufacturer, and through the wholesaler and practice pharmacy to the end user based on a unique coding system. But Nick acknowledges that it may be some time before the partnership overcomes its biggest hurdle, finding an effective solution to allow clinical records to be transmitted and read by different computer systems. In the meantime, some of the more computer-savvy members of the profession have been finding their own ways to tackle some the practical problems facing the profession, such as poor compliance among clients when using worm and flea treatments on their pets. Sussex practitioners Jamie Crittall and Charlie Barton wrote a programme for their own clinic which sends automated text or email messages to clients who have bought a course of treatments, reminding www.practicelife.biz z March/April 2014 z Practice Life

them when they need to give them to the pet. After finding how well the idea worked, they set up a company Virtual Recall which sends personalised messages to clients of subscriber practices which appear to come from their own vet. Launched just over a year ago, the company now provides a service to more than 150 practices. Liz Panter of the Arun Veterinary Centre in Pulborough was an early adopter of the iRecall system. “The service has brought the practice communication into the modern age, yet still keeping the personalised touch that’s so special to our clients; we are able to fully customise what is sent out and when. It works in the background, using data from our existing PMS system and the install was simple and, more importantly, stressfree,” she said. This growth has been helped by having the support of a major supplier of worm and flea treatments, Bayer Animal Health, which has also gathered data on the effects of this technology on practice turnover. The company reckons that the reminders have increased sales of these products by nearly 30 per cent compared with those practices using traditional marketing methods. Other technology providers are also providing novel communications systems that can help practices deal more effectively with their clients. Last year the Oval Pet Centre with three branches in south east London replaced its conventional telephone technology with a VOIP (voice over internet protocols) system. Wayne Gillard, who was the practice manager at the time of the project, explains that the new system offers a number of advantages. Clients are much less likely to hear an engaged signal when they call the practice as the system isn’t dependent on a single line. Calls can be diverted between the different sites with greater speed and precision and there are cost savings in having free internal calls. He says the only drawbacks are the need to provide staff with the training to use the new technology and the need for good support from the technology supplier during the changeover. Thankfully, in this case, the supplier Demco Communications was able to step in and deal promptly with any teething problems, he said. One of the challenges facing technology suppliers is that no two veterinary businesses have exactly the same technology requirements. Eclipse Veterinary Software has chosen to specialise in providing answers to the specific questions posed by equine practitioners. Clients like Julian Samuelson of the Bell Equine Veterinary Practice near Maidstone wanted to be able to use iPads or iPhones

PRACTICE DEVELOPMENT

to access the clinical records and other data held back at the office – but the clinicians were often found stranding in a muddy field far from the nearest phone signal. So Eclipse developed technology to automatically collect and send all the relevant details of clients and their horses to be uploaded and stored on the mobile device at any point during the day’s rounds when there is an adequate 3G signal. Julian says clients are impressed to be able to see X-rays and other clinical information that can be called up immediately. From the business viewpoint, it is much more efficient to record treatments at the time rather than waiting til the end of the day when some details are likely to have been forgotten. However, the IT requirements of some practices are so individual that they are unable to find off the shelf solutions and are obliged to develop the technology themselves. As a major referral practice, Newmarketbased Dick White Referrals had the need to collect clinical records on the cases sent by client practices, and luckily had the in-house expertise to ensure that this could be done efficiently. Its IT manager Richard Baker developed the software to allow referring vets to book appointments over the internet, enclosing all the relevant background material. This has the advantage of saving time for both parties, rather than faxing or posting the material and risk losing key details. The service was launched in November and has been well

received by regular clients although Richard points out that it was designed to supplement rather than replace traditional procedures. Indeed, “Some people still prefer to book their appointments through the receptionist and after talking to the referral clinician. People like different things and for some the human touch is still very important,” he says. There are a host of other technologies that are widely used outside the veterinary profession that are likely to crossover in the next few months – taking payments from clients using mobile telephone applications is one example cited by Nick Lloyd. He believes that the uptake of new technology by veterinary businesses is being driven by the growth in corporate businesses with the necessary in-house expertise to develop or adapt existing systems. But at the same time there are some practices that stubbornly refuse to keep pace with these developments, even to the extent that their clinical records are kept on cards rather than a computer hard drive. He believes that the gaps between the technological ‘haves’ and ‘have-nots’ is growing and that this will leave the latter vulnerable to the shifting expectations of animal-owning clients. So maybe it is time for even the most technophobic members of the profession to get out and surf the wave of novel technologies that are sweeping over the professional landscape – rather than ignoring the call and risk being left high and dry.

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PRACTICE DEVELOPMENT

ONE OF THE CROWD or head in the cloud? Robin Fearon investigates cloud technology and why mobile computing is changing the way we work....

hen cloud computing floated onto the horizon back in the mid-nineties it was already an established data model. Its predecessor, clientserver computing, extends back to the ‘Big Blue’ mainframe dominance era of IBM in the fifties and sixties. Today, the 21st century version has taken on an exciting number of variations shaped by the arrival of mobile computing. Smartphones and tablets have freed up data and allowed businesses to synchronise files and business information across all devices. Among the top reasons cited for using cloud computing – that is, data stored on remote servers and accessed via the net – are increased file sharing, productivity and social business or collaboration. Veterinary practices are free to choose from a range of free and subscription based services including Google Drive, iCloud, Evernote, Dropbox and Skydrive to create shared files and documents. Giving remote access to practice rotas, policies, CPD notes, meetings information, even videos and images, via the cloud has never been easier. Storing data in the cloud offers the ability to sync information as you need it across mobile devices, private and public PCs. While the idea of removing all your precious data to the cloud sounds a little too blue sky, keeping a back up version with a commercial provider may prove less costly than traditional storage. Meanwhile software in the cloud is regularly upgraded for better usability, unlike your current version of Microsoft Office. In theory your practice could ditch its upgrade path to the next version and use a cloud-based service like Google Drive, which includes a free 15Gb of storage for emails, word processing, spreadsheet and database apps. In industry jargon the use of web apps like Google Drive is termed ‘software as a service’ (SaaS) and it is the most popular use of cloud computing. Office applications, virtual storage, memo and web bookmark services are free to anyone with an internet connection. More sophisticated offerings like Salesforce’s customer relationship management systems, Quickbooks’ tax and revenue, and Constant Contact’s marketing services represent the high end for cloud business apps. Price or greater flexibility and www.practicelife.biz z March/April 2014 z Practice Life

“Storing data in the cloud offers the ability to sync information as you need it across mobile devices, private and public PCs.” business agility are often driving factors and companies can use a pay-as-you-go model to scale up or down depending on how much they use. Small and medium sized businesses like veterinary practices and hospitals can save money by choosing to move data to the cloud rather than buying a rack server and a service contract.

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PRACTICE DEVELOPMENT

In farm and equine practices the ability to access data on farm or in the horse yard is already widespread. On top of that the ability to access x-ray or MRI images on tablets or at home allows vets to collaborate on cases or be prepped when an emergency call occurs at 3am. More sophisticated services will emerge and the boom shows no signs of slowing. IBM is building 15 new data centres in anticipation of new business and it estimates the global worth of cloud computing in 2017 to be more than £150 billion “The market for cloud computing services is growing by 26 per cent each year,” says Iain Gray, CEO of the Technology Strategy Board. “It is an area with exceptional potential for growth.” Practice management system and imaging providers are already on board in offering mobile connectivity and cloud storage. You may need to install or update your MRI or CT scanner, but you have a choice of upgrading your image server or making it virtual. Hybrid clouds – on-site private data mixed with off-site archives and non-essentials – are swiftly becoming the norm in many businesses. The cloud computing industry has inevitably invented a term for the complexity that can arise in data coordination: cloud sprawl. On the whole, the industry argues that security is not the issue it once was. Data centres have high levels of virtual security, sophisticated firewalls and intrusion detection that your practice does not have, and physical security, including biometric scans on-site and surveillance. This may lead

“Data centres have high levels of virtual security, sophisticated firewalls and intrusion detection that your practice does not have...which may lead practices to consider moving clinical records into the cloud as well as non-essential data” practices to consider moving clinical records into the cloud and not just non-essential data. Big data is another rapid growth sector. Database projects such as the RVC’s VetCompass and the University of Liverpool’s SAVSNET show the way, but there is no reason that group practices and veterinary hospitals cannot partner up using cloud computing infrastructure to create shared research projects using clinical data. Overall the future trends point to legacy IT systems like PCs becoming less important. Mobile is the driving force and cloud storage will enable practices to save and share more flexibly. Cloud computing has started to shed its fluffy image and realise concrete benefits for business.

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PRACTICE DEVELOPMENT

CASE STUDY: HARNESSING TECHNOLOGY John Goulding is Managing Director of St George’s Veterinary Group a 6 branch small animal and equine practice based around Wolverhampton. Here he outlines why technology is at the heart of managing his practice.

have a keen interest in IT and practice technology – whether that’s the management systems that support us or the array of diagnostic equipment. We’ve developed the digital support systems to enable us to run efficiently and effectively – we have a central hospital, 5 branches, an equine service and a mobile companion animal visiting service all to pull together. Technology helps us to do that without dropping too many balls. Here’s an overview of how we’ve set things up: Practice Management Systems • Our equine vets have laptops and CC terminals to allow accurate billing and payment at the time of the visit. This has reduced debt, improved cash flow and our clients are happier in knowing what they are spending before they are committed. • We export data to facilitate data analysis and benchmarking • We use targeted marketing and reminders – by email, text and letter • We use technology to engage customers - we hope to soon offer client access to our PMS to allow appointment booking and product sales • We have full integration of small animal and equine radiographs, ultrasound and endoscope images into the patients’ records • We use the VetXML system to send insurance claims and microchip registrations electronically.

•O ur equine vets have smart phones so any new visits can be communicated by text rather than telephone ping-pong. Lab reports can be forwarded to them directly and they can email photos to colleagues for advice. •M anagement use apps to synchronise calendars, task lists, notes and documents between portable devices and desktops. Internal & external communications • We have universal access to the internet through practice computers and Wifi. Many caution against this, but I feel the huge benefits outweigh any concerns re security. •M any of the team have St George’s Veterinary Group email addresses for intra and extra practice communication • We use Google to look for information • We email digital radiographs, ultrasound and other images for immediate specialist advice Miscellaneous • We use recording of telephone calls for dispute resolution, quality control and training • We have tried out a/v recording of consultations, although we’ve had difficulty getting adequate sound quality. •C C TV monitors the car park, gates and waiting room at night. (We host an OOH clinic) • We are increasingly moving towards a paperless workplace. We store scanned documents for financial reports, lab results, hospitalisation and consent forms. • We use remote access software to be able to identify computer problems at distant sites, or help team members who are stuck.

Programming I enjoy database programming as a ‘hobby’ (sad I know) and have developed a few useful tools • A phone log for the OOH service to record details of calls and automatically send reports to user practices • An ‘absence tracker’ to monitor holiday and sick leave against allowances • A programme to extract KPIs from our PMS Mobile technology • A key demographic for our practice are mothers in their 20’s and 30’s. An increasing proportion of this group use their mobile phones and social media a lot. • Therefore we have in-practice Wifi to facilitate the immediate mobile posting of photos onto facebook.

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CPD DIARY

Focus on Digital Technology Thursday 19th June, Staverton Park, Daventry ‘Enthusiastic speakers... helpful presentations’ ‘An important area that is hard to keep across... good to have it all under one roof’ ‘Excellent bite size overviews... and very good value’ It can be hard to keep up with the latest digital technology and even harder to decide which new gizmo or piece of software can really help drive your practice forward and which is just so much e-froth! Our Focus on Digital Technology Day, now in its third year is a one day update and refresher on all things digital from social media to effective phone systems; digital x-ray storage to making the most of your PMS. This year we will have speakers from outside the profession alongside those who are making digital technology work for their business. A leading London Orthodontic practice will share their experience of working with Demco Communications to create a dedicated call centre linking 5 sites with instant and automatic access to patient computer records. The impact on business has been so great that they’ve opened a 6th branch on the strength of it. You can book pretty much everything online now, so why not your vet appointment? One Swindon practice offers just that and what’s more their pet owners can book cheaper appointments by choosing less busy periods – evening out www.practicelife.biz z March/April 2014 z Practice Life

demand across the day. The people behind this innovation explain the technology and how it works in practice. Is your Facebook page driving business or just consuming vast amounts of staff time? Social media experts, Vethelpdirect, offer some top tips on how to make every posting count. Alison Lambert from Onswitch will describe how video technology can be used effectively to remotely view consultations as part of vet and nurse training. As well as these, and other workshops, there will be a trade exhibition including PMS providers, website designers, social media consultants, providers of PAC systems and digital telecommunication specialists. This day is excellent value for delegates at just £100 for SPVS/VPMA members; £150 for non-members including lunch and your CPD certificate.

For more information about the workshops and to book your place, visit www.spvs-vpma-events.co.uk or call Jaqui on 01453 872731.

WHAT’S COMING UP

2014 REGIONAL CPD SPONSORED BY

TRAINING THE VETERINARY RECEPTIONIST Wednesday 30th April, Kents Hill Park, Milton Keynes (10:00-16:30) Thursday 11th September, Norton House Hotel, Ingliston Contributors: Brian Faulkner, VetPsychGroup Veterinary receptionists are critical, not only to client satisfaction, but to achieving clinical resolution and optimising profit. Veterinary receptionists need a spectrum of skills, but all too often veterinary receptionist training is ad hoc and ‘on the job’ and can be one of the biggest challenges to running a practice. Poorly trained receptionists will have a knock on to the whole team resulting in inconsistent client experiences. You will be shown how veterinary receptionists are pivotal in ensuring pets, owners, nurses and vets work together to achieve optimum clinical resolution. And how, by getting this right, they contribute to optimum financial resolution. It goes without saying that happy, effective receptionists are key to a positive and productive practice culture. The day will include case studies of practices with successful embedded reception training programmes. Who will benefit: Practice managers, owners, head nurses or head receptionists.

DELIVERING FINANCIAL SUCCESS & IMPROVING COMPLIANCE Wednesday 7th May, Village Hotel, Leeds South (10:00-16:00) Contributors: Mark Beaney, Hazlewoods; Jamie Crittall, Beech House Vets

This course will help you understand financial performance at the Profit & Loss (P&L) level: turnover, cost of sales, staff costs, overheads, debts, and cash flows. Mark Beaney, Senior Partner with veterinary accountants Hazlewoods, will show how identifying the right pricing strategy for your practice will affect your turnover and impact on your P&L. Optimising profitability depends on maximising compliance; Jamie Crittall will share his model which has been very effective in

driving compliance in his two successful Surrey-based practices. This ensures every pet and every client receive the appropriate message and reminder, every time. In this way, clients become the ones driving re-purchasing of products and services. They become more bonded and recommend more friends, and the practice becomes busier and ultimately more successful. The language is accessible and the day is packed full of real life examples of how simple changes to behaviour in the consulting room, reception or operating theatre can impact instantly on the bottom line.

Who will benefit: Practice managers or business owners, who want to better understand how management and compliance affect profitability.

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WHATâ&#x20AC;&#x2122;S COMING UP

MARKETING MASTERCLASS Wednesday 21st May, Village Hotel Solihull (10:00-16:30) Contributors: Nick Steele, Zoetis plus Practice Case Studies

Marketing is not about the next flea or worm promotion. Successful marketing is a complete circle that starts with an audit of your client and potential client base, an understanding of yourcompetition and an audit of what you are already doing. You then need to decide your key messages and the communication methods you are going to use to get your message across to your audience. Good marketing doesnâ&#x20AC;&#x2122;t stop there. It tracks the results of the marketing and uses

communication with clients to inform changes in delivery before starting all over again to complete the circle. This course will introduce marketing basics and help you create your own bespoke marketing plan. Theory from one of our most popular speakers, Nick Steele, will be interspersed with examples of how two very different practices do their marketing; one a relatively new start up, the other a mature practice that has re-evaluated their approach to marketing to challenge new competition.

Who will benefit: Practice managers, owners, head nurses or head receptionists.

MAKING THE MOST OF YOUR NURSES Wednesday 11th June, Village Hotel Solihull (10:00-16:30) Contributors: Alan Robinson and Amber Dunham

Nurse training and their skill base has improved immeasurably over the past decade or so with increasing numbers of nurses accruing qualifications such as animal behaviour or acute care, and practices running clinics on everything from weight watching to managing diabetes. But with qualified nurses sometimes harder to find than qualified vets, you need to use them efficiently. This course, run by business consultant Alan Robinson and Veterinary Nurse Amber Dunham, looks at the evolution of the nurse clinic and describes best practice. It examines how to use nurses efficiently to minimise the non-chargeable time vets spend with clients or their pets and how to ensure that nurse consultations lead to increased footfall, improved compliance and, where appropriate, follow up appointments with vets. It will propose a business model that helps you measure the effectiveness of your nursing resource, helping ensure that you do not have more nurses than you need and that rotas and consultation timetables minimise their downtime. It will also propose how, when and what to charge for nurse consultations. Who will benefit: Head nurses, practice managers or business owners wishing to maximise the use of their nurses.

You can book any of the Regional CPD days online at www.vpma-spvs-events.co.uk or by telephoning 01453 872731

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HEADING

2014 FOCUS DAYS The popular Focus Days are back and are even bigger and better! FOCUS ON DIGITAL TECHNOLOGY Thursday 19th June, Staverton Park (10:00-17:00) Read more about the technology day in CPD Diary Page 49.

FOCUS ON DIAGNOSTICS Thursday 16th October, Staverton Park (10:00-17:00) Workshop streams chaired by Brian Faulkner, VetPysch and Peter Southerden, Eastcott Referrals Following the fantastic feedback on our first Focus on Diagnostics Day, we will repeat this in a bigger venue with more exhibitors and new workshops. If you are trying to decide what equipment or skills to invest in and how to ensure a return on your investment, then this is the day for you. Expertled workshops will offer tips from suppliers and practising vets on everything from making money from dentistry to deciding between in house or external labs. And once you’ve decided what you want to buy, we’ll help you plot a finance model to pay for it. Exhibitors will include laboratory and diagnostic imaging companies, suppliers of specialist equipment such as laser therapy, dental and laproscopes and providers of financial packages. Can you afford NOT to be there?

‘About the best day’s CPD I’ve been to in 10 years!’ ‘Excellent lectures.... good environ ment to talk to suppliers.’ You can book any of the Focus Days online at www.vpma-spvs-events.co.uk or by telephoning 01453 872731

Sit back in the sun (we can only hope...) with our summer issue, coming out 9th June... Special features: Returning to work after maternity leave: flexible working & childcare Online retailing: taking over the traditional model? Planning for profit Getting back on track: what to do about those poor KPI’s

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Accountants, Taxation & Practice Development Specialists to the moore scarrott Veterinary Profession CHARTERED ACCOUNTANTS

Our service is completely flexible which enables us to fit within the practice management team at any level in a cost effective way. We offer a free of charge, no obligation initial meeting and discussion, anywhere in the UK. Financial and management accounts Practice management and development advice Practice structuring, restructuring and finance Full outsourcing service and payroll bureau Taxation - compliance and mitigation strategies Full benchmarking service Forensic services Practice properties Succession planning Sage accountant partners

Veterinary team partners: Andy Moore andy.moore@moore-scarrott.co.uk Steve Headon steve.headon@moore-scarrott.co.uk Marcus Longbottom cmsl@moore-scarrott.co.uk Nick Lawrence nick.lawrence@moore-scarrott.co.uk

www.moore-scarrott.co.uk Calyx House, South Road, Taunton, Somerset, TA1 3DU Telephone: 01823 282100 Fax: 01823 254396

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