Practice Life Issue 6 December/January 2015 by The Magazine Production Company

December/January 2015 www.practicelife.biz

Pet Health Plans A tale of two practices

Conflict Management Styles Which one do you subscribe to?

Integrating Referral Work Could you benefit from expanding your services?

Hot Topic: Stealing A practice shares its story

THE MAGAZINE OF SPVS AND VPMA

In the Spotlight: Congress headlining speaker Ian McKelvie SPECIAL FEATURE:

CONGRESS 2015 MAKE IT A DATE!

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EDITORS’ LETTERS

Editors’ Letters

s I sit here writing this there is a wintry feel to the weather; very different from the sunshine and lovely warm temperatures that I experienced only a few weeks ago when I was lucky enough to be in Barcelona combining a few days’ sightseeing with attending the Southern European Veterinary Conference. It was a first for me both in terms of visiting the city and going to the SEVC and I thoroughly enjoyed the two experiences. Having an interest in architecture I was fascinated by Gaudi’s work; his individual and innovative designs the result of his novel approach to the issues of building construction. In a similar way, I suppose the management stream at the conference aimed to introduce the audience to new ways of addressing some of the issues involved in running a veterinary practice. Some of our readers have commented how much they enjoy the personal input from ‘real people in real practice

’m sat writing this in the departure lounge at Barcelona’s El Prat airport on a Sunday morning in mid-October; en route home following a once-again successful three day visit to the Southern European Veterinary Conference. There is a family opposite and a very small (possibly one/two year old) in a stroller and in his hand an iPhone which is, quite literally, being mauled to death whilst the parents do not appear to give a jot. Now I’ve watched those consumer TV programmes and am very much aware of how fragile such devices can be. True, it does seem to be brand-dependent but Mr Apple’s success always appears to need to be handled with care: I know because my son’s various incarnations of his iPhone seem to have spent more time in the repair shop rather than fixed to his ear! So now the child in the pram is merrily waving the mobile to and fro and, not unsurprisingly I watched it fly out of his fingers making a graceful arc through the air and crash to the marble floor. The child gave a broad beam,

situations’ that we have in Practice Life; such articles are easy for all of us to identify with. In this edition one such article is from a fellow SPVS Council Member and gives details of something that I’m sure we all hope never to have to deal with; the difficult issue of stealing. I would like to thank Andrew Parker for being prepared to share his experience with us. So, as this edition lands on your desk, December will be underway and 2015 rapidly approaching with SPVS & VPMA Congress to look forward to in January. I hope to see some of you at the fabulous Celtic Manor Resort for what promises to be another excellent 2 days of networking and CPD. In the meantime may I take this opportunity to wish all of you a very merry Christmas and happy New Year.

Stephanie Writer-Davies, SPVS editor

the mother a disdained “tut” and the father was totally oblivious to the whole affair. It occurred to me that perhaps technology of this type has truly become disposable. As mum picked up the phone that was amazingly unscathed despite landing glass down, I recalled one of the lectures by Dutch speaker Rene van den Bos at the end of the conference. Opinions have changed regarding the empowerment of veterinary staff with tools to promote your clinic on the hoof, in real time and to a client base that’s diverse and fast-paced. In many practices, far from switching off mobiles and locking them out of sight during working hours, staff are being encouraged to interact with clients and pets in all sorts of ways and with all sorts of apps etc. In forthcoming issues we’ll be looking at (and listening to via the website) some of the communication initiatives from around the world that may well have an impact on UK practice life. Meantime, may I wish all our readers a successful and happy Christmas.

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 www.practicelife.biz z December/January 2015 z Practice Life

Contents Editors

UPDATE: NEWS & VIEWS 5

VPMA NEWS

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.

New business plan and Lunchtime Management Updates g

SPVS NEWS

The state of the veterinary profession g

NURSE TALK

Registered Nurses Declaration

and BVNA Congress highlights g

COLLEGE CORNER

New Practice Standards Scheme and Alternative Dispute Resolution g

VDS NEWS

Problems Down Under g

IN THE SPOTLIGHT

Congress 2015 headlining speaker Ian McKelvie g

WELL-BEING

Something to Laugh About g

HOT TOPIC

The Real Cost of Stealing g

MANAGING PEOPLE

28 22

How do YOU react to conflict? g

CLIENT CARE AND MARKETING

5 ways to really grow your profit in 2015 g

BUSINESS HEALTH AND FINANCE

Pet Health Plans: Two practices share their journey g

PRACTICE DEVELOPMENT

Integrating referral work: Considerations g

CPD DIARY

Congress 2015 Special Feature g

WHAT’S COMING UP

CPD Programme for 2015 and what’s in next issue

46 41 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

Practice Life z December/January 2015 z www.practicelife.biz

News & Views

Press Association Images

LONG STANDING SPVS MEMBER AND PAST PRESIDENT DES THOMPSON RECEIVES FIRST EVER QUEEN’S MEDAL In 2013, Her Majesty approved the RCVS Queen’s Medal and at a private Ceremony in July this year, Des Thompson OBE was its first ever recipient. Des was nominated by John Michael Hill MRCVS, Chairman of Veterinary Northern Ireland, and Anna Mary Judson MRCVS, a council member of the Society of Practising Veterinary Surgeons (SPVS) for his decades of dedication to the profession. As well as the impressive list of associations, committees and awards that are attributed to Des’ career, part of Anna’s nomination stated “Des has a unique talent for saying the right thing at the right time and in doing so gives people hope, encouragement, motivation, perspective and empowerment. He creates a

goodwill ripple effect and everyone who comes into contact with his kindness and wisdom feels better for it.” SPVS President Colin Thomson commented afterwards, “SPVS is delighted that Des has been awarded the Queens Medal. His list of achievements is unlikely to be matched for a long time. He has been an excellent ambassador for the profession, and he has mentored many young vets over the years. We wish him well.” In addition to his veterinary achievements, when asked, people described Des as “friendly, fun, sociable and a Diminutive Dancing Diva”. Congratulations from all of us at SPVS and VPMA to Des – a well-deserved recipient of this prestigious award.

SPVS Launches 5:15 Lunch SPVS is launching a ‘5:15 Lunch’ at SPVS/VPMA Congress 2015 (22-24 January) for those vets who have been qualified for five to fifteen years. The 5:15 Lunch, hosted by members of SPVS Council, was piloted at SPVS Congress 2014 and proved successful, hence the roll-out of the concept. It may also be extended to include lunches at 2015’s BSAVA Congress and London Vet Show. Any vet who has been qualified for five to fifteen years, is not yet a SPVS member and is attending SPVS/VPMA Congress next year, will receive their first year’s membership of SPVS for free, in addition to an automatic invitation to the 5:15 Lunch on 24 January 2015.

For further information or to register for Congress visit www.spvs.org.uk or telephone 01926 410454.

www.practicelife.biz z December/January 2015 z Practice Life

NEWS IN BRIEF

VPMA AND BVNA JOIN FORCES TO CALL FOR PETPLAN VETERINARY AWARD NOMINATIONS

The Veterinary Practice Management Association (VPMA) has once again joined the British Veterinary Nursing Association (BVNA) in calling for nominations for managers and nurses to the Petplan Veterinary Awards which take place in April 2015. Following their appeal last year there was a rise in nominations for both nurses and managers and the associations were keen to build on that momentum. In a reciprocal arrangement, BVNA is calling upon its members to nominate their practice managers, and VPMA is calling for nurse nominations.

Photos: 2014 winners, (left) Sharon Lane-Kieltyka of Shepton Veterinary Group, Somerset who scooped the Petplan Practice Manager of the Year award, and (right) Tina Wright of Warbreck Veterinary centre, Merseyside who was named Vet Nurse of the Year.

All nominations are anonymous and can be done online quickly and easily by visiting: https://www.petplanvet.co.uk/veterinary-practice-insurance/veterinary-awards/. The deadline for nominations is the 16th January 2015.

VET FUTURES – Helping the Profession prepare for and shape its future Vet Futures, a major new initiative that aims to help the profession prepare for and shape its own future, was launched at the British Veterinary Association (BVA) Congress at the London Vet Show on 20 November. The project is jointly funded and led by the Royal College of Veterinary Surgeons (RCVS) and the BVA, and will be a collaborative venture, drawing on the experience and insight of a wide range of individuals and organisations, including veterinary surgeons and nurses, veterinary bodies, farmers, pet owners and other key stakeholders. The project will help understand where the provision of veterinary services is currently heading, whether this is in the best interests of the profession, animal owners and the public at large, and what might be done to shape an optimal future for the veterinary team, keeping animal health and welfare at its heart. In the project’s first phase, independent researchers will gather evidence via focus groups, phone interviews and desk-based

research, in addition to the gauging of opinion through events, the internet and social media. This evidence gathering will be followed by an engagement phase, where the profession will be asked for their feedback on initial thoughts; a period of analysis, where a report will be written by the independent researchers; and, finally, there will be an action phase, where key strategic issues will be identified, together with a clear plan for action from the BVA and the RCVS, as well as other organisations and individuals.

“The RCVS is implementing a programme of reform to make it a first-rate regulator, but how do we also make ours a first-rate profession, that is resilient and agile enough to meet future demands?” asks Professor Stuart Reid, RCVS President. “The Vet Futures project will not just be about horizon-scanning, but getting a fix on those issues over the horizon that we may not yet have considered, such as the use of emerging technologies. “It’s an exciting challenge and I am looking forward to members of the veterinary team getting involved so that, together, we can develop an action plan that will deliver a sustainable future for the profession.” The project has a dedicated website www.vetfutures.org.uk where the latest events, reports and publications will be found. There will also be a ‘topic of the month’ for the duration of the project, with controversial opinion-pieces being posted to stimulate debate from within the profession and amongst animal owners and other stakeholders.

Don’t forget you can send us your press releases on practice successes and initiatives. Suppliers are also welcome to send information on management-related products and services. Email to editorial@practicelife.biz Practice Life z December/January 2015 z www.practicelife.biz

VPMA News VPMA President,

Helen Sanderson

VPMA NEWS

Veterinary Practice Management Association Limited Annual General Meeting 2015 The Annual General Meeting of the VPMA will be held at the Celtic Manor Resort, Newport on Thursday 22nd January 2015 at 5.00pm. Full Members must advise the Honorary Secretary in writing of any business to be raised by them at the AGM at least 28 days prior to the meeting. Please submit any items of business to be raised at the AGM to:-

Winter is well upon us and the shorter daylight hours often mean we leave our homes in the dark and return in the dark without much seeming to happen other than work. The quiet evenings have however given me time to reflect on my two years of VPMA Presidency, of which I have enjoyed every minute. It has been my privilege to have met and worked with some wonderful people, not least my colleagues on VPMA council and many of our members along the way. As we draw 2014 to a close, we’re pleased to announce some more additions to our member benefits, which have been a key focus for us this year. Firstly, I am delighted to announce the launch of our member webinars, “Management Updates” which will take place over lunchtime on a monthly basis and hopefully be accessible to most of you. The webinars will focus on current veterinary issues and need-to-know management information. We are also working on an additional fantastic member benefit which will be launched at congress in January (with a sneak-peak in this issue!) My thanks go to our Member Services Group for all their hard work and especially to group leader Julie Beacham. I was delighted to be invited to SEVC again this year and thoroughly enjoyed it. The management streams were excellent again - a report from Practice Life editor Ian Wolstenholme can be found in this issue together with links to interviews with some of the world-class speakers. I also had the opportunity to visit the congresses of our colleagues at BVNA, BCVA, BEVA and BVA which were also extremely well-run and interesting. I would like to take this opportunity to give a very warm welcome to all the new incoming presidents of these associations. Last but no means least if you have not booked your place at the VPMA-SPVS Congress at the exclusive Celtic Manor Resort in Newport then do be quick as places are filling fast. We have secured excellent and exciting speakers and I am especially delighted to be hosting the Equine Management stream for a second year. Our key note speaker is presenter Monty Halls, a particular favourite of mine; I have even visited his remote bothy in Apple Cross, Sand Bay where he lived with his dog Reuben filming the BBC series Great Escape on the west coast of Scotland. Following on with that theme, our Friday night congress banquet has a “Touch of Scottish” about it, in honour of Burns night, and headed up by last year’s knock-out band the Bogus Brothers. So I think we have a recipe for another fantastic congress! Best wishes,

Helen

www.practicelife.biz z December/January 2015 z Practice Life

Honorary Secretary VPMA Limited 76 St Johns Road, Kettering, Northants NN15 5AZ Tel: 07000 782324 Fax: 0870 836 2250

VPMA Business Plan and Lunchtime Management Updates VPMA Council has been working hard on the new business plan for 2015. The new plan will see the association focusing on its grass roots as well as enhancing its relationships with other groups and industry peers. We’ve put direct interaction with members at the core of our business strategy. Incoming president Howard Brown, together with Regional Coordinator Renay Rickard, will attend as many of our regional meetings as possible, where there will be a discussion session on current and future issues facing the profession. In tandem with this, we’re delighted to announce a series of lunchtime Management Updates for our members delivered via webinar. We know that some of you struggle with time or distance to get to regional meetings, so these short updates have been designed to keep you abreast of changes that could directly impact your practices. The webinars will all take place at lunchtime and will last just 30 minutes with a 10 minute Q&A session afterwards. They’ve been designed to be easily digestible, very specific, bite-sized updates, with the facility to pose questions to the presenter and share your own thoughts. The webinars will be monthly with the first two scheduled for the 9th December 2014 and the 14th January 2015. Donal Murphy, Technical Executive at NOAH will speak on “European threats and impacts on UK medicines legislation” on Dec 9th, and Hannah Reeves from VMD will deliver “Responsible Use of Medicines: what managers need to know” in the January webinar. Members will be sent further details and joining instructions in advance of each talk.

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.

As we rush towards the end of another year, the regions have again been very busy, with meetings and CPD covering the whole country. Moving into 2015, we will be looking to recruit new organisers to cover areas currently vacant so if you are keen to get involved please contact myself or the VPMA secretariat. Our emphasis for 2015 will be very much on providing meetings where we can all get together to informally discuss the issues we all face in practice. Officers from VPMA council will also attend some of the events, so we can get directly involved in the discussions, and learn exactly what you need from your association. Our annual Regional Organiser’s meeting will be held at VPMA-SPVS Congress in January and all ROs attending congress will be invited to attend the networking event on Thursday 22nd as guests of the VPMA council. The networking event is open to everyone attending congress and it’s a great chance for our members to meet up with their RO on a fun and social basis. Early in 2015 the new practice standards will be released for consultation. I ask that all the regions get involved with this and let me know what they think. This has very much been a collaborative effort with myself and Rita Dingwall representing you on behalf of the VPMA – so your comments and ideas would be very much appreciated. I will keep you informed about where the information can be accessed nearer the time. So I’ll end by wishing you all a very Happy Christmas and New Year and hope to see lots of you at congress in January.

Renay

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

DENISE WHITHAM Herts/Beds/Northants Tel: 07837 058155 ro4@vpma.co.uk

SUSAN LUNN Stoke on Trent/South Staffordshire Tel: 01543 424100 ro17@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 & HELEN MANNING 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

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

LIZ LA-PAGE Essex Tel: 07772 382465 ro22@vpma.co.uk

VPMA offers new resource for personal support People join the VPMA for a variety of reasons but many say that networking and support are top of the list for those in such a solitary and demanding role. Sometimes life gets complicated, not just with the demands of the job but also the needs of home or family life, or worries about health or debt. For this reason, we are delighted to announce a new member benefit offering professional advice and support for those personal problems impacting work performance, health and wellbeing. The services of Health Assured (www.healthassured.co.uk) are now available to all VPMA members and their immediate families. They offer advice on health, stress at home or work, financial problems including debt, family & relationship matters and legal & consumer issues. This confidential service is accessed by calling a Freephone number available 24 hours a day, 365 days a year. Face-to-face counselling, cognitive behavioural therapy and serious illness & accident support are also included for those in need. More details will be announced at SPVS/VPMA Congress 2015.

Practice Life z December/January 2015 z www.practicelife.biz

VPMA NEWS

A 5 minute chat with… Runner-up in the Petplan Practice Manager of the Year Award, Chris Gudge Chris, you are practice manager at Highcroft Veterinary Group, a large multi-site practice with first opinion and specialist services in the Bristol area. How many people do you have responsibility for? Across the group (12 sites) we employ around 200 people! I used to be responsible for all staff but as there are so many now they are split into teams and we have managers for each. I still have some overall responsibility though on a day to day operational basis. I am also directly responsible for the referral department and am Line Manager to eight full-time referral vets (a mix of Certificate and Diploma holders), visiting specialists and three support staff. How do you divide your time between the first opinion hospital and clinics and the referral hospital? I divide my time 1:3 between first opinion and referrals respectively and good time management is really important to be able do this. As I am based at our main hospital in Whitchurch, which is the hub for all our first opinion and referral services, it’s easy to be closely involved. And having other managers involved in the first opinion teams means I can share that workload. Describe a typical day. Highcroft is a fast-paced, busy practice. The workload can vary greatly. On any one day in the hospital alone we can have 20 to 30 out-patients as well as in-patients, and this is on top of a busy list of consults. I like to be active in the practice and not desk-bound. Every morning I conduct a ward round with the vets and nurses to make sure all the patients are well looked after and the clients are informed of and happy with ongoing treatment plans. This helps to flush out any queries or issues and means I can address them quickly. I also spend a lot of time talking to the staff to make sure they are happy and performing well. This includes regular one-to-one meetings with my team members. For the rest of the day I can be involved with anything from patient care to business performance, finance to people management. You are a veterinary nurse by profession as well as holding a post-grad certificate in anaesthesia and critical care. Tell us a little about your journey into practice management. I started my career as veterinary nurse because of my love for animals and wanting to do the best for them. I really enjoyed being able to treat them at the high standard of care that Highcroft provides. As time went on I wanted to take this experience and knowledge even further. Moving into management was a natural progression for me. I am now able to use 10 years of nursing experience to make sure the practice is able to offer the best care to our patients and clients. www.practicelife.biz z December/January 2015 z Practice Life

I started out in a junior management position and, with the help of a personal and business coach, I continued to take on more responsibility. My role grew in this way until the position of practice manager became available. You have a large team of back office support staff and administrators. Describe how this is set up and managed. We are still owned by two veterinary surgeons, Richard and Robert, and have a great managerial structure here with a mixture of clinical and non-clinical managers; this is very unusual for a vet practice. The admin teams are run by the non-clinical managers – these include the insurance department, customer services, marketing department, accounts etc. The clinical managers focus on the day-to-day operations as well as the development of staff and services. This allows us to make the most of everyone’s personal strengths and has helped us to develop a high performing support team. We have weekly management meetings with both the non-clinical and clinical managers, which helps ensure we are all working toward the same goals and gives us the opportunity to discuss ideas. What is (are) your biggest challenge(s)? Describe how you deal with them. My biggest challenge is juggling day-to-day tasks along with business development. It is easy to get bogged down in the day job and forget about progressing the business. Prioritising my objectives is key and I use a 90-day plan to make sure the important things are carried out and ticked off. This is a great way to measure my progress and success and it helps to keep my mind focused. Your practice was described as ‘exceptional’ by your RCVS Practice Standards Inspector. What aspects of the practice do you think led to this assessment? The staff! Everyone who works for Highcroft is devoted to the cause and works so hard to maintain a high standard of professional care, from keeping the practice clean and tidy to delivering excellent clinical services and client care. The partners invest for the future; we have extremely good facilities and the latest equipment to hand. The benefit of having quality first opinion and referral services within the same business means we can cater for all our client and patient needs. Tell us a little about what’s next for you in terms of your own development and that of the practice. I am currently undertaking an ILM Level 5 qualification in leadership and management. This course is providing me with the necessary skills to manage a high performing team. I am using these skills every day to improve both my own managerial style and also to get the most from my team. The practice has recently gone through great expansion, going from 6 to 12 sites in 12 months. We are now looking to develop each of these sites to their full potential.

VPMA NEWS

Barcelona Banter! As mentioned in my editorial this edition, I spent a few days away from practice in September once again at the Southern European Veterinary Congress which this year was celebrating its 8th anniversary. It’s always a pleasure to attend this superb event and following some interesting discussions, I hope Ian with Wendy Myers that VPMA will have some exciting plans for the 2016 conference so watch this space! As present VPMA editor I feel honoured to (a) have the chance to hear some of the finest international practice management speakers at SEVC and (b) also get to chat to them offpodium for Practice Life. Following last year’s review of the Congresso I had some encouraging comments from readers who found the short interviews I conducted just as useful as the printed interviews. For that reason and in the interests of getting some thought-provoking words to as wide an audience as soon as possible after this year’s gathering, I would like to share some audios with you of conversations with Rene van den Bos from the Netherlands, Dr Andy Roark (NAVC Practice Management Speaker of the Year), Wendy Myers, CEO of Communication Solutions for Veterinarians in Denver, Colorado and former Editor-in-Chief of Veterinary Economics magazine, and finally Dr Carin Smith who is President of Smith Veterinary Consulting in Washington State. All these luminaries have some interesting things to say and maybe you can spare a few minutes out of your own busy days in practice to have a listen. Just type the link for each into your browser. Enjoy! Rene van den Bos: http://1drv.ms/1tPu8xK Andrew Roark: http://1drv.ms/1tPxlxs Wendy Myers: http://1drv.ms/1tPvatS Carin Smith: http://1drv.ms/1tPy8yw

Renay Rickard, VPMA PSS representative gives us a practice manager’s view of the new Practice Standards Scheme After two years of discussion and hard work the new RCVS Practice Standards Scheme is due to be launched towards the end of 2015. Rita Dingwall and I, together with Carole Clarke who stepped down as PSS representative earlier this year, have represented the VPMA in the Practice Standards (working) Group, joining others from the major veterinary associations. The outcomes therefore represent a wide range of opinion, including those of our association. The group has been focussed on addressing the concerns from feedback given by practices in 2013. These included the perception that the scheme was a box-ticking administrative exercise, that it was inflexible and not inclusive of all types of modern day veterinary practices. It has also addressed the need to make the scheme easier to understand from a client’s perspective, and therefore useable as a powerful marketing tool, with a clear pathway to improve and excel. Consideration has been given to what actually matters – the impact on veterinary care, and not just facilities and equipment. When the new scheme is introduced the base groups of ‘Core’, ‘General Practice’ and ‘Hospital’ will remain broadly the same. The main new development is the introduction of the award “good” or “outstanding” in specific areas – Small Animal & Equine – Team & Professional Responsibilities Client Service, Patient Consultation Services, Diagnostic Services, In Patient Services, Emergency & Critical Care services. Farm Animal – Team & Professional Responsibilities Client Services, Diagnostic Services, Advisory & Consultation Services. These awards will enable practices to demonstrate areas in which they excel and will also give a clear pathway for improvement. From a practice manager’s perspective it will enable us to delegate responsibilities for certain areas to teams within the practice to take responsibility and develop themselves – encouraging ownership of the awards and contributions from everyone! The other main development is that the new scheme will be underpinned by a dedicated online IT system that will look similar to the current RCVS Nursing Progress Log. From a practice manager’s perspective this is really useful as there will be a step-by-step guide to requirements and more importantly, we will be able to upload evidence prior to the inspection. This means that instead of wading through piles of paperwork on the inspection day, the assessors will be able to spend more time giving guidance and advice. More emphasis will be put on the training of inspectors (who will be known as assessors under the new scheme) to ensure that high standards and consistency are maintained. A lead assessor will be employed by the scheme to monitor and guide Practice Standards Assessors. The RCVS also has plans to develop a website for the public to go to for information on the scheme, and practices will also be provided with a “toolkit” to enable them to market their awards. Early in 2015, a period of formal consultation on the new Scheme will open. This will be publicised on the RCVS website and will include details on the awards, inspections, assessors, and the IT system and fee structure. The VPMA will host a Lunchtime Management Update on the new scheme in February 2015. Please feel free to contact myself or Rita through the VPMA secretariat if you would like any more information in the meantime. Renay Rickard RVN CVPM, Council member and VPMA PSG Rep. Practice Life z December/January 2015 z www.practicelife.biz

SPVS NEWS

Presidents, Progress, and Puzzles Colin Thomson I’m nearing the end of my year as President of SPVS. I hand over the baton to the capable hands of Nick Stuart at our AGM at the joint VPMA/SPVS Congress at the Celtic Manor in January. If you haven’t heard about our congress, the details are herein. Sign up to join us – the lecture and the social program are excellent, the commercial exhibition is packed, you’ll be made very welcome. It’s been a busy Presidential year. Lately much of my time has been devoted to finishing the move to SPVS becoming a Company Limited by Guarantee. It has taken a lot of effort from many of us on SPVS Council, but at least we got there in the end. Not so elsewhere. In my presidential year I had hoped to throw some light on the trials of becoming a practice owner, and investigate some technological aids to ease the difficulties of safe dispensing. Progress has been slow and I’ve not got as far as I’d like. But my desire to find answers hasn’t been diminished. Persistence is required. I’ll carry the work forward into next year. Recently, I had a lesson in persistence from my 3 year old granddaughter. She had come to visit. As usual, when she arrived, the house went from being relatively tidy to an obstacle course of toys and teddy bears. Not so bad when she only pulls out the toys, but, of course, she got her hands on much else as well. One item she shouldn’t have had was a wooden puzzle – the flat kind, where you have to fit the pieces into a wooden frame. After the initial arrival mayhem she settled down and started to try to do the puzzle. For a three year old she amazed us with her tenacity and patience. She tried to get all the pieces into the frame, and when she realised they all weren’t going to go in, over and over she would take them all out and start again. Every time, as she started, she said – “Now this one goes here…” with every confidence that, this time, she was right. Ultimately she failed, but then so did her grandfather. At the end of the evening, I had to look on the internet to find the right order to get all the pieces in. To my chagrin I discovered there were over three thousand different ways to do it right. In practice we face many puzzles. Some we’ve seen many times before, and we approach them with the same confidence that we can solve them that my granddaughter had. Others are new, and there are even those that look like we’ve seen them before, but turn out not to respond to the solutions that have worked in the past. Often the answer isn’t on the internet. Why for example, does it currently seem difficult to get experienced vets for positions when we’ve been complaining for years that we’re producing too many graduates? If SPVS’ main role is to provide benefits for its members, it also has a remit to look at some of these practice puzzles, to see if we can shed light on them for the benefit of all of us in practice. Although we’re not always as successful at finding solutions as we’d like to be, we will have the persistence to keep trying. As SPVS President, I’ve attended and been involved in many things I otherwise would never have been near. There has been hard work, but it’s been great fun. I am very grateful for having had the opportunity. To SPVS members in general and those SPVS Council in particular, thankyou for the opportunity and the support. See you at Celtic Manor.

www.practicelife.biz z December/January 2015 z Practice Life

Society of Practising Surgeons Annual General Meeting 2015 The SPVS AGM 2015 will be held at 4.00pm on Thursday 22nd January, at the Celtic Manor Resort, Newport. The election of Officers and Councillors will take place at the AGM and all SPVS members are invited to take part in these elections. Nominations for Councillors and Officers need to be received in writing, duly proposed and seconded 15 days before the AGM, 7th January 2015. Such nominations should contain the signature of the nominees and their proposers and seconders. All proposers and seconders must be members of the Society.

SPVS Dates For Your Diary 2015 January 22nd to 24th SPVS VPMA Congress at the Celtic Manor Hotel, Newport See the SPVS Website for more details or contact the SPVS office. March 7th to 14th Snowscene at the Col Altro Hotel, Covara, Italy For more details and to book see the SPVS website or contact the SPVS office. May or June Cyclescene, France Exact details (dates and venue) to be confirmed – Watch this space!

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SPVS NEWS

The state of the Veterinary profession –

where are you now? Adi Nell, SPVS Past President, highlights issues and asks for your feedback. The state of our profession has never been more topical. The rate of change we face is unprecedented: from the latest diagnostic discoveries to the next bit of musthave equipment, from the requirement to have an online presence to the challenge of recruiting vets, or from trying to meet the increasing expectations of clients while achieving some semblance of work life balance. The challenges are all around us. And it’s happening so fast that it’s starting to feel normal – like the fish in the sea that don’t notice the current… This change has been recognised with repeated meetings and discussions held to look at the challenges we face. So, what are these issues? How do we agree which are the most pressing? How do we find a way to engage with them? And, crucially, how do we agree a way forward? We’ve learnt a great deal from these previous meetings and discussions, including: • 20/20 Vision in November 2013 – large delegate panel drawn from pharmaceutical industry, insurance, accountancy firms, private practice and corporates. • 20/20 Vision Jan 2014 – delegates from independent and corporate practice with audience questions, held at SPVS/VPMA Congress • BVA-led discussion on the future for veterinary graduates • John Sheridan’s meeting at the RCVS looking at the need for improving the business skills of practice owners and across the profession. These meetings were fascinating and gave real insights, with some common themes emerging around the requirement for practices to be run as businesses, not hobby shops; the growth of corporate practice; where veterinary market growth might come from; how to maintain standards; and how to address the changing needs of the veterinary job seeker. London Vet Show hosted the latest in this series of meetings at BVA Congress 2014, with an invited panel including BVA President, John Blackwell; Mark Welch, Group Operations Director at Vets4Pets and Companion Care; Stuart Reid, Principal of the Royal Veterinary College; Penny Watson, Senior Lecturer at Cambridge Vet School; Myfanwy Hill, RVC Junior Clinical Training Scholar; and Martin Alder, Editor of the Veterinary Record. We listened to our panellists’ thoughts, heard from the

audience and fielded questions from the floor. At the conclusion of each theme, questions were put to the audience and feedback obtained through the use of a live voting system by which attendees could register their thoughts. We’d very much appreciate the views of Practice Life’s readers too – see the link at the end of this article!

1. On Business Knowledge & Skills Veterinary practices are businesses. They need to earn a profit. In fact, they have to. The author’s own experience organising businessrelated CPD for SPVS, a review of the press and the discussions at some of the earlier meetings all confirm that vets want and need to know how to run a business, not just treat sick animals or look after herd health. If we accept that vets do need business skills, what are the options available to them to acquire these skills? What cost is involved in acquiring them (direct cost of training and indirect cost of taking attention away from the practice)? What is the cost of not acquiring them? There are two main options: • Individual vets should learn these skills at the time they’re moving into ownership, or shortly after, OR: • Vets should source these skills from elsewhere: consultants, accountants, specialised partnerships, buying groups, etc. Linked to this: if vets are to learn the skills themselves, where would they do so? There is much talk of universities teaching these skills at undergraduate level, but can our universities meet these needs? Follow the link at the end of the article to give your views on the following: Do you feel that your current business skills are adequate to address the future needs of your business? 1 (Totally inadequate) ←-------→ 10 (More than adequate) To what extent do you envisage needing outside help to run your business in the future? 1 (Do it all yourself) ←-------→ 10 (Fully dependent on outside help) How realistic is it to expect the undergraduate curriculum to address deficiencies in business skills without impacting on course quality? 1 (Entirely realistic) ←-------→ 10 (Totally unrealistic)

2. On Corporate Practice Corporate practice has grown dramatically over the past decade. Corporates, according to one estimate, now make up around 30% of all practice sites in the UK. This is expected to increase to between 50% and 60% by 2020. Practice Life z December/January 2015 z www.practicelife.biz

SPVS NEWS

What does the rise of corporate practice mean to the profession? Are they a threat or an opportunity to independent practices – and why? Follow the link at the end of the article to give your views on the following: How has the growth of corporate practices impacted on the profession? 1 (Very negatively) ←-------→ 10 (Very positively) To what extent do corporates represent a threat or an opportunity to you? 1 (Threat) ←-------→ 10 (Opportunity)

3. On how to Grow the Market Pet numbers have fallen in recent years. Cattle numbers, while rising slightly since 2011, had fallen in each of the previous years since 2004. Pig numbers have dropped hugely since 1998. Only sheep numbers have risen in any significant way. And, added to this, there’s competition from non-vets, too, for work that used to be the preserve of veterinary surgeons. Yet the number of vets has increased. In order for practice incomes to remain stable, practices must therefore either earn more money per patient or pay their vets less. Neither situation is sustainable or desirable. One way around this is to increase the number of clients a practice has (grow market share) by enhancing the customer focus. These clients could, for example, come from competitors’ practices – a zero-sum game for the market overall. An alternative is for practices to maintain their current share of the total pet owning market and to grow that market’s size. Follow the link at the end of the article to give your views on the following: Where do you feel the profession has the best likelihood of succeeding? 1 (Increasing market share) ←-------→ 10 (Growing the market)

4. On Maintaining Standards The number of new graduates has been a concern at many of the earlier meetings. This is something that is pretty well out of the control of the practising profession. We can seek to influence government and lobby via the RCVS or BVA, but even if the numbers of UK graduates did fall, there is an almost unlimited supply of vets from the EU who have treaty rights to work here. This is not something we can address either easily or quickly. A concern raised by attendees at earlier meetings was around new graduates, EU vets and the maintenance of standards. Every year, fabulously knowledgeable young vets join the job market, together with our colleagues moving over from the EU. Their practical ability is, on occasion, limited, as is their knowledge of the UK market and our clinical and ethical standards. It’s traditionally been the job of EMS and the first employer to give them the training they need. Practice owners’ time, however, is more and more limited: marketing, practice standards, accounts, staff management, health and safety, maintenance, the fight for business share – not to mention consulting, operating, doing CPD and looking after inpatients! www.practicelife.biz z December/January 2015 z Practice Life

How do practices provide the on-the-job training that new and EU graduates need in order to meet the UK clinical standards as well as UK client expectations? How does the curriculum need to change in order for universities to continue to provide day one skills that are in line with practice and client expectations? Is it even possible for them to do so? Follow the link at the end of the article to give your views on the following: To what extent will you be able to continue to support the in-practice training of new graduates or foreign vets in the future? 1 (No time to do this) ←-------→ 10 (Fully able to support)

5. On Work-Life Balance Veterinary staff turnover is a growing concern. The 2013 RCVS survey showed that a worryingly high number of new graduates remained in their first job for only a short period. Many cited lack of support, with others blaming long hours and lack of training. The number of women in the profession presents challenges, too: are too many women lost from practice when they take family breaks? Is it too difficult for them to re-enter the job market – or is the nature of practice simply incompatible with their needs? It’s not all about women, though: what are the values of a veterinary practice, and are they in conflict with those who wish to work part time? Men and women, alike, seek part time or flexible working more and more. How do practices need to adapt to this challenge? Follow the link at the end of the article to give your views on the following: To what extent will future veterinary practice have to accept part time working as the norm? 1 (Not at all) ←-------→ 10 (Completely) How ready is your practice to adapt to the challenge of part time working? 1 (Not at all ready) ←-------→ 10 (Completely ready)

Summary The sheer number of discussions on the challenges facing the profession give an indication of how topical this is, and how many vets are concerned about it. Your feedback on the questions raised will help to inform that debate. Please give us your views on the following link:

https://www.surveymonkey.com/s/326QKHP It’s really important to get as much feedback on these questions as possible, so please do pass this link on to all your colleagues too!

SPVS NEWS

SPVS announces new member benefit We are delighted to be able to announce a new Partnership that SPVS has recently established with Carefree Credit. Carefree Credit provides interest-free and low cost payment options for veterinary clients so that their pets can receive the best possible treatment, without delay and without worry over the costs. Vets are free to carry out optimal patient care, knowing that they will be paid for the work without the worry of chasing debts. The practice receives the full fee (less a small payment to Carefree Credit) directly into its bank account in a matter of days. The loan agreement is between Carefree Credit and the pet owner; the practice is not liable for any default in payments. The Carefree Credit system is fully electronic and supported by a 24 hour, 365 days a year, online system – crucial for afterhours work. Online applications take less than 5 minutes, with instant decisions. Applications are usually carried out within the practice, although there is also a facility for the client to complete the application at home. With no more waiting for bills to be paid, no paper insurance claims to be processed and no debt to be chased, cash-flow for the practice is improved and evidence shows a reduction in debtors on the practice books as well as an increase in turnover, since clients are able to take up treatment options they previously couldn’t afford. With Carefree Credit approved financing providing an affordable alternative for the pet owner, vets can concentrate on treating the patient, rather than reducing service costs or providing in-house credit terms that hit cash-flow. Carefree Credit already receives a large number of pet owner enquiries for finance via their website on a daily basis which confirms the need for facilities like this in veterinary practices. However, since they do not provide loans direct to pet owners, these enquiries are referred to the closest practice that uses the Carefree Credit facility; a referral service to Carefree Credit practices. Founder and managing partner Stewart Halperin BVMS MRCVS ACIARB comments: “Finding the right online system has been paramount to the success of the business. The only way a credit facility like this works is if it is seen by front office staff as a help not a hindrance – a tool to make their lives easier rather than just another piece of admin to do. Vets love it as they can do gold standard work, get paid properly for it and receive the funds straight away. Owners love it as they can spread the payment at no or very low cost to themselves – and of course, patients can be treated immediately!” In order to be able to provide these facilities to clients, practices must have Financial Conduct Authority (FCA) authorisation. The Scotland based Carefree Credit office team is there to provide guidance on this and authorisations are currently being granted in around 4 weeks.

Once registered, Carefree Credit provides practices with a suite of ‘how to’ videos and downloadable PDF’s (although the system is so easy to use that no one has looked at them yet!) and training, either onsite or remotely. Point of sale material is also available in the form of client leaflets, window decals and posters. Special terms are available for SPVS members – to find out more please visit the SPVS website or contact Carefree Credit on 020 3697 8439 or make an enquiry via the website www.carefreecredit.co.uk.

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SPVS NEWS

SCUBASCENE 2014 Richard Weston reports on a week of sun, sea and CPD in the Red Sea.

29th May saw a group of 10 of us meet at Manchester airport and 16 meet at Gatwick; this was the start of the annual CPD diving trip to Egypt. We’re often ridiculed when we say we are going away for a week of CPD; surely this is just a holiday jaunt on the taxman! Well let me reassure those sceptics that this is anything but an enjoyable jaunt... Firstly there’s the three hour wait at the airport; this is murder for those silly enough to take their spouses and their credit cards! Duty free is not that free especially when a group of divers get together and are provided with the opportunity to enjoy some pre-flight refreshment! Then there’s the five hour flight to Hurgada and if that isn’t bad enough, there’s a three hour transfer at the other end. So it’s an eleven hour journey which means a 1AM arrival at the boat. Finally there’s no allowance for the late night with a morning lie-in and leisurely breakfast – the wakeup call comes at 06:30AM to check our kit. And so the scene was set for the next six days. We committed ourselves to four hours of diving, three hours of lectures and three hours of meals a day, surely a hard week of CPD by anyone’s standards! Filippo de Bellis taught us about Dermatology and Peter Gripper of Anval about Business Management. Sixteen of us attended the lectures the content of which was deep and meaningful and we all came away with more knowledge than we arrived with. And so did the presenters... despite not advocating its use or even mentioning it until the end, Filippo discovered that Ovarid can be a very useful drug in feline dermatitis (probably because the average age of the audience was over 50!). Peter’s interactive presentation asked for audience participation in various aspects of practice management. It demonstrated that while there are many varied methods of running a practice, it’s surprisingly how close the final result usually is. Nevertheless, regardless of the differences of opinion in some quarters, we all came away with some new ideas to implement in our practices when we got home. The diving this year did not include any wrecks. The sites were widely dispersed with up to 8 hours sailing between sites. We did not see land for 3 days. The weather was excellent as always (though quite windy) making the boat trip somewhat rough in places causing a few to spend their nights on top in the fresh air and near the side. The first dive of the day was usually at 07:00AM before breakfast and there was a night dive each evening. The sea flora and fauna were beautiful. An additional benefit of diving in Egypt is that mobile phones are out of service most of the time and you can’t take them diving, resulting in an enforced true absence from work. Unfortunately this year there was an issue with Egyptian tummy for 23 of the attendees which hampered diving for some of us. Poor Filippo was quite badly affected so we had www.practicelife.biz z December/January 2015 z Practice Life

Peter Gripper, Richard Weston (author) and Filippo de Bellis

to manoeuvre the dermatology lectures around his bowel activities but it all added to the entertainment of the week (though Filippo may disagree!) All in all, it was a productive week with several people managing to enhance their diving qualifications. What little spare time there was during the day was spent sunbathing, sleeping and reading and in the evenings doing what vets do: putting the veterinary world to rights over a drink or two; we all know that no-one has a more valid and exacting point than a vet in conversation with a group of vets. At the end of the week we said our goodbyes with promises to go again next year; the boat is booked and at least half full with 6 months to go. So if you think this exhausting experience is for you and you’d like to join us in 2015, contact the SPVS office for more details.

Nurse Talk 16

NURSE TALK

In association with

Highlights from BVNA Congress 2014

Top: Gemma Hunt (on right) Bottom: Lyndsey Barratt

This year’s BVNA Congress got off to a great start with a mention on the Chris Evans Breakfast Show on BBC Radio 2. He described the congress held in Telford, Shropshire, as “three days packed with talks and tips to ensure our prized pets are kept healthy and happy”. He wasn’t wrong; with a combination of interesting CPD, evidence-based nursing in our abstract submissions and the chance to catch up with fellow veterinary professionals in the commercial exhibition – there really was something for everyone in the pursuit of keeping the nation’s pets healthy. The scientific element of the conference is now in its third year with the overall aim to raise the profile of veterinary nurse researchers and improve the evidence base within the profession. Gemma Hunt, a recent graduate from Harper Adams won the Best Student Undergraduate Research Project award with ‘An investigation into the effects of heat and moisture exchanger on hypothermia in dogs with a body mass of above ten kilograms and below ten kilograms, undergoing an MRI scan.’ Lyndsey Barratt won Best Poster for her project entitled ‘Postoperative pain in Cats: A preliminary Investigation into the Recognition and Validation of Behaviour-based Indicators.’ During Friday Happy Hour, BVNA Senior Vice President Kirstie Shield, was tasked with judging the best stand awards. With so many impressive stands it was a tough decision but 2 winners were chosen. One was awarded to Onswitch whose team were actively engaging with delegates to introduce their new Bertha training bus. The second award was given to the RCVS who were also engaging with delegates by asking them to take part in a vote to help identify the next project VN Council should focus on. Out of the four options, ‘Raising awareness of the RVN status with the public’ received the most votes. The Saturday dinner dance had a Super Hero theme with many people dressing up. To choose a winner, Dan Marley of Protexin decided to the let the delegates and exhibitors vote for their favourite Super Hero by way of a clap monitor. The votes were unanimous and both Inspector Gadget and Super VN won! As well as a full CPD programme the exhibition hall provided a great atmosphere for delegates to gain valuable information about products and services available within the industry. BVNA would like to thank all the exhibitors for their huge support during the three day event. So after another successful congress, look out for information about BVNA congress 2015 early next year so you don’t miss out!

Practice Life z December/January 2015 z www.practicelife.biz

NURSE TALK

BVNA appoints new President The British Veterinary Nursing Association was delighted to announce Fiona Andrew RVN as its newly elected President during its Annual General Meeting (AGM) held on Sunday 12th October during Congress. Fiona said “I am humbled and excited to be the figurehead for the BVNA which is the voice of veterinary nursing in the United Kingdom. Together with the amazing group of council members I am excited about the future of both the association and the veterinary nursing profession”. During the AGM Samantha Morgan DipAVN (Med & Surg) RVN was elected as Vice-President and Honorary Treasurer.

BVNA Congress hosted RCVS Declaration of Registered Veterinary Nurses Ceremony For the first time, the RCVS gave approximately 20 nurses who qualified before 2012 the opportunity to make their professional declaration in a short ceremony at BVNA congress this year. The declaration not only sets out the rights and responsibilities of Registered Veterinary Nurses but also endows a great sense of belonging. Outgoing president Kirstie Shield commented that as a profession, veterinary nursing should hold its head up high.

Date For Your Diary! The BVNA CPD Roadshow 2015 kicks off in March. Book now by calling 01279 408644 or emailing bvna@bvna.org.uk Saturday 21st March Ambassadors Bloomsbury Hotel, London Ultrasound Richard Doyle Anaesthesia Sam McMillan Stress and compassion fatigue Rory O’Connor Fluids – why, which and how Lisa Lines The nurses role in dog bite prevention and the law Anne McBride

www.practicelife.biz z December/January 2015 z Practice Life

COLLEGE CORNER

College Corner

The new Practice Standards Scheme In June 2013 RCVS Council gave approval to the development of a new structure for the Practice Standards Scheme. Since then the Practice Standards Group, comprising amongst others the BVA and its specialist divisions, including SPVS and VPMA, has been working hard to lay the foundations for a new Scheme. Aim of the new Scheme The new Scheme has been designed to provide a pathway for practices to improve and to demonstrate where they excel. Under the proposals there will be greater differentiation between accredited practices and there will be additional opportunities for members of the Scheme to market themselves. Additional benefits of the proposed new Scheme include a professionally-trained team of assessors and dedicated IT system that will save practices time by allowing them to make applications online and to upload all the documents they require for accreditation prior to inspection.

Introduction of Awards Under the new Scheme the accreditation levels (Core, General Practice and Veterinary Hospital) will remain the same and practices in the current Scheme will migrate to the new Scheme at their existing accreditation level.

Anna Judson

Rita Dingwall

Renay Rickard

The most significant change is that practices will also be able to apply, but are not obliged, to be inspected for additional Awards in specific areas. Based on the number of points achieved in stated criteria practices could be designated as ‘Good’ or ‘Outstanding’ within each Award and practices would be able to promote themselves as such. The Awards mirror the terminology used by Ofsted in the inspection of schools. So, for example, a practice might be General Practice – Small Animal with Outstanding Awards in Client Service and Diagnostic Service. The Awards do not focus on facilities and equipment, but instead place an emphasis on outcomes and behaviours, and other aspects that impact upon the veterinary care of animals. Under current proposals Small Animal and Equine practices will be eligible to apply to be inspected against six Awards, namely: Team and Professional Responsibility, Client Service, Patient Consultation Service, Diagnostic Service, In-patient Service, and Emergency and Critical Care Service. Farm Animal practices will be eligible to be inspected for four Awards: Team and Professional Responsibility, Client Service, Diagnostic Service and Advisory / Consultation Service.

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On 28 October, Jacqui Molyneux, Chair of the Practice Standards Group, and Anthony Roberts, PSS Senior Manager, held a webinar to explain the proposals for the new Scheme and how it would benefit practices. The webinar, hosted by The Webinar Vet, is available to listen again at: http://www.thewebinarvet.com/rcvs-webinars/

Next steps In early 2015, the RCVS will be launching a consultation exercise to ensure that the entire veterinary and veterinary nursing professions have an opportunity to comment on the detailed requirements of the Scheme. Practice Standards Group (PSG) Representatives: SPVS is represented on the PSG by Anna Judson and VPMA by Rita Dingwall and Renay Rickard.

Practice Life z December/January 2015 z www.practicelife.biz

Finding a new way to resolve client disputes

COLLEGE CORNER

Complaints from clients about service or a member of staff can be difficult for practices, for example, having a detrimental impact on staff morale, as well as for clients who have no mechanism for redress other than through the courts. This is why, from the beginning of November, the RCVS has begun a six-month alternative dispute resolution (ADR) trial as the first step towards developing a consumer redress system which would aim to find outcomes amenable to both clients and the profession. Although, as a regulator, we are responsible for dealing with concerns raised by members of the public about individual veterinary surgeons and registered veterinary nurses, we are limited to dealing with only the most serious of complaints about their fitness to practise. This means that many of the concerns we receive, for example about cost or poor service, are closed with no further action because they do not meet this threshold. This can be unsatisfactory and frustrating for both parties because it leaves the complaint unresolved and there is no further remedy. With this trial we hope to determine what a fully developed ADR scheme would look like and how it would work as well as building up a picture of the type of concerns that will be referred and likely outcomes. The free and voluntary trial will be limited to no more than 150 concerns raised about a veterinary surgeon in relation to the treatment of a small animal (e.g dog, cat, hamster or guinea pig) which will be identified by our Professional Conduct Department. The concerns will Medivet_PracticeLife_051214.pdf 10:58 only be referred to the trial with consent from 1both06/11/2014 parties and the

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majority of the concerns will have no arguable case for professional misconduct, but neither will they be trivial. Ombudsman Services, an independent and not-for-profit consumer dispute resolution organisation, will be administering the trial and will work through conciliation between the two parties, rather than arbitration. This means it will only be able to suggest, rather than impose, solutions. Recommendations can be accepted, or not, by either party and could include, for example, financial accommodation up to the small claims court limit of £10,000 (although recommendations are likely to be in hundreds rather than thousands of pounds), issuing of an apology or other practical remedial action. However, according to Gordon Hockey, RCVS Registrar, the trial might often find in favour of the veterinary surgeon or practice, particularly if some action has already been taken to rectify the situation. He says: “What we found during our training with the Ombudsman Services staff was that it is equally likely that recommendations will exonerate the veterinary surgeon or find that the vet or practice had taken the necessary steps to resolve the complaint.” The trial will end in May 2015 and RCVS Council will consider steps towards developing a permanent scheme at its June meeting. For more information visit www.rcvs.org.uk/adr

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VDS News

Problems

Down Under Kate loved her job in practice but was now looking forward to her forthcoming maternity leave, not least as she was finding it increasingly difficult to concentrate on her clients’ ‘little’ concerns. Her male colleagues had rather predictably, but unkindly, attributed her obvious air of distraction to her physiological condition. She was therefore relieved to have reached her last evening surgery, but surveying the waiting room her heart sank as she clocked Mrs Knowbest seated with an air of selfimportance, apparently oblivious she sported all the facial characteristics of the Affenpinschers she bred. After all, ‘Affe’ means ‘ape’ in German… Mrs Knowbest was known to be a difficult client but, as a regular source of income for the practice, her foibles were tolerated. A scrappy Affenpinscher puppy was curled up in the breeder’s lap as she held court in the waiting room to her captive audience. A glance in the diary indicated the appointment was for a blood test, prior to export to New Zealand. Pausing briefly only to ponder why any All-Black worth their salt would seek to own an Affenpinscher, Kate took the puppy through to the prep room to perform the procedure in order to avoid Mrs Knowbest’s monologue on the failings of the veterinary profession and the finer points of Affenpinscher breeding. The sample obtained, the pup was returned safely to Mrs Knowbest who transferred it to her husband waiting patiently outside, presumably wondering how his life had come to this sorry state of affairs. The client came back into reception afterwards and produced an official-looking form to be signed. Kate had not come across such a certificate before, but it was clearly produced by the Kennel Club and sported the grandiose name of an ‘Application for an Export Pedigree Certificate Form’. Apparently, Kate had to confirm that young Adolph had two normally descended testes, not something she had thought to check during today’s appointment. Her polite enquiry regarding his manhood was greeted by a narrowing of Mrs Knowbest’s slightly crossed eyes, accompanied by the brusque comment ‘there is certainly no history of cryptorchidism in the Knowbest line, my dear’. Noting a previous entry in the clinical records – ‘two testicles palpated today’ – Kate decided to sign the form without stopping to examine Adolph again. And anyway, who in their right mind would send a cryptorchid puppy to New Zealand and judging by the mutinous atmosphere of the crowded waiting room, she couldn’t afford any further delays or for that matter, miss an allimportant late night shopping date with her partner at Mothercare. Three months later, the practice manager called Kate at home on the context of enquiring after the well-being of the recently arrived, bundle of trouble, Toby. Kate strongly suspected there was another reason for the call and eventually her colleague explained

she had received an e-mail from no less an authority than the VicePresident of the Affenpinscher Appreciation Society (Christchurch branch) accompanied by a certificate confirming little Adolph had followed in the footsteps of his dictator namesake. Hurtfully, the correspondence alleged Kate had been in cahoots with Mrs Knowbest, actively participating in a fraud of gargantuan proportions. A further inspection of the clinical notes revealed that Kate’s colleague had identified an inguinal testicle, albeit one that could be palpated... hence the misleading entry ‘two testicles palpated today’. The distant purchaser explained in the email that Mrs Knowbest had resisted their claim for a full refund as she had relied on the veterinary certificate confirming the pup was entire and in her opinion she was blameless. The new owner was therefore seeking recompense from the practice knowing they would be ‘fully insured’ for such eventualities. At this phrase, Kate felt a shiver shoot down her spine as she thought the practice might not have continued her insurance cover from the moment she cheerfully walked out of the door on her last day, clutching the mass of garish Babygro outfits presented by all and sundry at her leaving do. Financially, given the number of Practice Life z December/January 2015 z www.practicelife.biz

VDS NEWS

nappies Toby delighted in using already, she could ill-afford the fees involved to retrieve Adolph from New Zealand. Panicking, Kate called the Society and spoke to a claims consultant who, while reassuring, explained liability would clearly have to be accepted for Adolph travelling unnecessarily halfway round the globe in a packing crate, because of her signature certifying entirety. Unfortunately, in the circumstances, admitting liability would inevitably lead to a significant financial claim. At this juncture, an understandably agitated Kate voiced her concerns regarding her apparent lack of insurance cover, but the reassuring answer supplied both surprised and delighted her. The consultant explained that the Society’s practice insurance package with the VDS does indeed provide cover to the practice for members of staff who have moved on to other roles elsewhere. Had the practice ceased to trade, or moved away from VDS there could be problems, but in this particular instance, Kate could dismiss any worries about the claim for damages. The new VDS policy also includes an extended reporting period (ERP) for individual members like her embarking on her career break to enjoy a spot of maternity leave. Members retiring from practice to sip cocktails in the sun also benefit from a similar ERP. In plain English, it meant Kate (or the practice) was therefore fully covered for the civil claim from ‘Middle earth’ or anywhere else for that matter and the consultant would happily take up the cudgels on her behalf without delay. Kate was mightily relieved to learn her practice manager had been up to speed with this generous provision in the VDS package

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and had therefore fulfilled the simple policy requirement to notify the Society of her intended career break. The practice manager, an experienced mum, had even enquired about the part time options within the policy in the hope Kate would return to the practice once the novelty of Toby wore thin… The good news did not stop there, however, as Kate was also relieved to learn that should Mrs Knowbest, or Adolph’s new owner, disingenuously decide to report her to the College for ‘false certification’ she would find herself covered for any subsequent complaint. The aforementioned ERP even extends to personally protect the individual should allegations alleging misconduct arise while that vet was not working. This would enable her to avail herself of the gold standard moral support and complaint handling experience, so valued by all members of the Society. A settlement was negotiated swiftly with the distant owners for just over six thousand pounds, including all the transport costs and Adolph’s suddenly rather inflated value for a one stoned dog. The RCVS never got wind of her little faux pas anyway, so fortunately there were no sorties from that quarter and the file was closed. Kate was mortified by the expensive consequence of her actions, but on a more positive note the information she had gleaned about the generous extended reporting periods newly enshrined in the VDS policy had cemented her already firm view, that the Society’s 150 years’ of continued success was undoubtedly founded on a clear understanding of the profession’s ever evolving needs. Undoubtedly another advantage of insuring with a mutual organisation, run by vets for vets, is it leaves members to concentrate on the simpler matters of life, rearing a child..!

IN THE SPOTLIGHT

in the Just to whet your appetite, leadership expert and inspirational speaker Ian McKelvie gives us an exclusive interview prior to his headlining appearance at VPMA/SPVS Congress in January. Ian, you’re CEO at BECAUZ, a global consulting firm that specialises in accelerating breakthrough change and transforming leaders and teams. Tell us a little bit about your personal journey. IM: In every business role, I’ve always had the privilege of running teams of people and taking on big challenges. I’ve worked for large global corporations and also developed 4 successful startup businesses. I became known as the ‘team turnaround exec’ because I had a knack for hiring smart people and boosting team performance, especially within businesses that were desperately underperforming. About a decade ago, I took stock, and realised I wanted to align my purpose with my work. I’ve always been very curious and driven but frequently the human stuff didn’t make sense to me. I’m amazed that even with all the potential we have, we often find ourselves not living into what’s possible or getting ourselves into a mess with each other. So I wanted to throw myself into changing that and BECAUZ was born. I’m not naturally a ‘soft-edge’ person; but it takes working at both the soft and hard edges of a business in which I want to transform people and organisations. We certainly haven’t got it all figured out but we believe that learning from every experience creates that strategic edge for ourselves and our clients. You specialise in leadership for large corporate organisations. How does that translate down into our SME’s and vet practices? IM: In my experience of many different businesses across many different cultures

(I’m British by birth, have lived on four continents, hold a Canadian passport and spend a lot of time in India and Singapore). And what I’ve found is that although people and businesses might have different objectives, they still have

to deal with each other, collaborate, compete, communicate and grow. Business and life are a series of processes where everyone has an opportunity to grow and reach their potential. Whatever the end result looks like, the principles

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IN THE SPOTLIGHT

of this growth are the same at both a human level and business level. Growth takes guts; we need to get out of our comfort zone and challenge the edges that are holding us back. If we don’t stretch and push our comfort zone, it shrinks. If I’m running a business, say a veterinary practice, chances are I don’t hear what’s really going on or what’s holding the business back. People aren’t going to tell me what’s rubbish about the practice, my leadership or my strategy, and I will travel along in a bubble – in large part because I am afraid of asking the team, delegating and challenging everyone to bring their best. For the sake of my team and my business, I’ve got to push myself out of that reverie - ask questions and listen. The more you do it, the easier it gets. If you don’t push the edge, your team will eventually sell out on itself; by this I mean that everyone gets numb – and sweeps things under the carpet and boy does it get lumpy. And you know what – everyone feels it – if there’s something wrong, or the culture has taken on a negative feel, then your staff will feel it, your patients will feel it and your clients will feel it as soon as they walk into your business. And for small businesses this risk of a poor culture developing is more prevalent because of the internal politics and human dynamics within a small team. This is often complicated by spouses working in the business and new players which can upset team dynamics. What are your tips for maintaining a positive culture? IM: OK. Let’s list them: 1. Strategic Alignment. If you own/ run a team, make sure all your people are aligned and pulling in the same direction – even a few degrees off will cause issues. You need to have conversations on alignment and commitment. 2. Leadership Development. Look at how we develop ourselves as leaders. It is through our leadership that we provide direction to the business. We need to be open to listen to feedback on ourselves and our business. That’s the hardest partno-one likes to be told they have an ugly baby! 3. Executional Excellence. Learn to execute with excellence. All systems must be set up to interact and continually improve.

4. Sustaining Health. Look at how you sustain momentum and health and vitality in your team. You can’t create any level of care in your practice that’s greater than the level of care for your people. And we’ve got to take care of ourselves too. Being a leader or owner of a business is hard. We all think our boss is the one getting all the goodies and having a fantastic time. So it can be a lonely place. Having healthy relationships provides confidence. 5. Innovation and Creativity. Get innovative within the team – especially in the tougher roles. Being a practice manager for instance is a hard role. They’re the jam in a sandwich and need to pull everything and everyone together. It’s doubly difficult if you’ve been promoted up through the practice ladder. Suddenly there’s a lot of conversations going on that you’re not being included in. Again we need to move out of our comfort zone to make this better, and open ourselves to questioning the status quo and listening. 6. Master Change and Transition. Think about change from a different perspective: As a consultant I spend a lot of time looking at change. We think that humans in general don’t like change. But in fact what they don’t like is loss. They don’t like the psychological aspects of transition. It makes them feel vulnerable. But we need to acknowledge this and face this if we are to grow. You manage quite a large team, yourself. What qualities do you look for when you’re recruiting and selecting people for a role in your team? IM: We have a profile of a person that would make a great teammate as well as represent our company well to our clients. We are going out and getting under the bonnet of team dynamics and it’s important for our business that our people are the right fit. It’s the same for vets. People bring their beloved pet to you – it’s a cherished relationship that we must maintain. So we ask ourselves: does this person represent our brand; do they have authenticity, curiosity, integrity and the edginess that is vital? Will they represent what’s special and unique about us? Sometimes you get a niggling feeling – is this person right for us? And you have to address this question with a mix

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of the head and the heart. My biggest mistakes have come when I haven’t listened to both. And it’s an expensive mistake to bring someone in and then have to ask them to leave. One of the biggest challenges in growing a vet practice, is that vets are primarily clinicians who are more psychologically geared towards analytical problem-solving and working in isolation, rather than being naturally business-minded and people-focused. How can this be best addressed for a vet who manages their own business? IM: Soft skills are the hardest skills to master. It’s especially tough when you have an expertism mind-set. If we are an expert in our field then it’s tough to get into a learner mind-set. We don’t want to put ourselves into those situations where we might look stupid. It’s the tyranny of competence that holds us back. Sticking to what you’re competent at tends to make you reluctant to develop new business or people skills. The first step is to get into a learner mind-set. If the edges that are hurting you are not on the technical side but on the people-skills side, then you need to look closely at what’s going on. Experiment a little. Put yourself into that uncomfortable zone to learn and grow. And this is a good lesson for our teams. Demonstrating behaviours like vulnerability and humility is amazingly powerful. Showing that you are willing to risk that discomfort to grow and widen your perspectives and skills is truly leading by example. Finally Ian, you’re a bit of an extreme sports enthusiast. Simple question – why do you do it?! IM: I tend to do things that force me to be ultra-present. Whether that’s flying a helicopter or white-water rafting. These things demand my attention fully- I’ve got to be hyper-focused and from this I get an altered state of flow. It’s not even the adrenaline rush. These activities give me brief moments when time doesn’t exist. These are precious moments. Ian McKelvie is speaking at VPMASPVS Congress from the 23rd to 24th January. The full programme and synopses can be viewed on www.vpma-spvs-events.co.uk

WELL-BEING

Something

to laugh about :D Happylicious coach and trained laughter therapist, Denny Bond runs workshops and team-building sessions for veterinary staff. She also happens to be a fitness coach and realised that clients worked harder during her classes if she could make them smile during exercise.

he healing properties of laughter have long been acknowledged in the most ancient of cultures – from North East Asia to South America – and now it would seem we are finally catching on and have found something to really smile about. Research shows that laughter can combat stress, fight disease and actually improve our health during these crazy times we find ourselves in today.

The power of positive Laughter has a range of physical and psychological benefits. It’s a great way to boost your heart rate, put a smile on your face and burn calories! Laughter stimulates the circulation and respiratory tract as we inhale more deeply and breathe faster, bringing more oxygen into the blood and energising the lungs. It increases blood flow which releases dopamine and serotonin, both neurochemicals with powerful feel-good effects. It also stretches muscles throughout our face and body, giving our organs a ‘gentle jog’ and tones muscles we didn’t even know we had! Even better, ten minutes of laughter burns around 50 calories – so laughing makes you feel and look great! When we laugh, endorphins (or as I like to call them, “Happy Dolphins”) are released. Endorphins react in the brain in the same way as opiates do, giving us a feel good factor. In contrast, when you are stressed, your body releases the stress hormone cortisol to prepare you for a fight or flight situation and your body stops working normally. Stress puts strain on your heart, causes an increase in blood

pressure, your digestion slows, and blood sugar levels rise. Stress also lowers immunity and slows the release of antiaging hormones. With so many illnesses being stressrelated it would seem that laughter really could be the best medicine. If you don’t have anything to laugh about; the good news is that you can fake it. Fake laughter has the same positive effects on the body as real laughter as your brain can’t tell the difference... funny eh?! Although we can’t always control what happens in life, we can control the way we react to events. Laughter helps us to see an alternative view and keeps us in balance when we are at a loss or in despair. It’s an excellent coping mechanism and can get us through the most adverse situations.

Working on laughter Already this year, over 300 veterinary staff have attended Laughter Workshops

with me. During these workshops, delegates look at how laughter eases tension and how it helps us relax; we become calmer and form clearer perspectives about what’s actually going on around us. Funny hats and dancing (as if no one is watching) helps find ways to release negative emotions that contribute to stress. We also explore some of our own laughter triggers and share them with others. The workshops are specifically geared towards the vet practice environment. In many of our workshops, from the laughter therapy came creativity and many ideas on how to implement it in the practice... a ‘joke of the week’ on the notice board, a place designated for jumping up and down, the use of puppets and even starting a laughter therapy session for dogs! Often sessions proved an excellent way to bond a team and most felt it helped them to connect with others and improve communication skills. Back in practice, many workshop attendees reported that while hysterical laughter and jokes in front of clients were both improper and unethical, some humour and the odd joke behind the scenes really helped to quickly change their state of mind and in doing so enabled them to give full attention to the next patient. Being able to interrupt a negative thought or distract ourselves from a stressful situation using humour is powerful armour. How we feel affects how others react to us and if we feel better emotionally we tend to think more constructively too; enabling us to deflect negative emotions can help us deal with that difficult client.

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WELL-BEING

In Association with the Veterinary Benevolent Fund

CHOOSE HAPPY

Denny’s De-Stress Top Tips:

On average children laugh 400 -500 times a day. Adults sometimes struggle with 10-15. So it’s time to find something to laugh about; think about what and who makes you laugh? Reflect on the last time you had a really good belly laugh and how it made you feel. Think of things you can do to bring this laughter in to even your darkest days. If you can’t think of anything, or you haven’t got time, then you need the laughter medicine most! Whilst this kind of therapy may sound a bit daft; even a bit cringe-worthy, with all its health benefits how can you not take this laughter thing seriously? Laughter helps relax and rejuvenate us and releases our ‘happy dolphins’!

STOP… Even if it’s just for 1 minute BREATHE… Big inhalations & big exhalations – in through the nose and out through the mouth PAUSE… Take control of your emotions – don’t let them control you SMILE… Your brain will think you are happy LAUGH... Think of one of your laughter triggers and it will help change your mood and possibly that of those around you – laughter is contagious and universally understood MOVE… March it out; Dance it out; Stretch it out Learning to laugh at yourself as often as possible is an excellent start – you don’t have to be happy to laugh, but laughter could just make you happier. For more information on Denny’s workshops and team-building sessions, email dennybongo1@gmail.com

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02/12/2014 09:15

HOT TOPIC

THE REAL COST of stealing Andrew Parker, Director of Clifton Villa Veterinary Surgery, a 4 clinic mixed practice in Cornwall, shares a recent experience and urges practices to safeguard their cash.

o you handle cash in your practice? Do you have checks and balances to ensure that cash does not go missing? We did, or at least we thought we did, but the loss of £75,000 made us realise that our checks were not as good as they should have been. This account of our experience will hopefully alert you to the possible pitfalls in handling cash and the trauma that is experienced if it happens. Our practice was started 30 years ago and has grown into a nine-vet practice employing 35 people, a turnover of £12,000 in the first year growing to a £2m turnover currently. There are four standalone surgeries each handling their own cash. Banking is done by two of the practices, with one of them banking their own transactions and three practices banking from another one. The cash is sent to this particular banking clinic in sealed envelopes from the other two surgeries with a signature across the seal to prevent any tampering. A copy of the computer printout of the takings for the relevant surgery is also faxed through. When the money arrives one of the receptionists is tasked with checking that it is correct and reconciles it with the printout from that branch surgery. The money is then banked. In July 2012 our longstanding receptionist (responsible for banking cash for the three clinics) retired. Her duties were taken over by another receptionist who had been working for us for several years. She was given the same instructions for the handling of the cash. One week after the new banking receptionist started her duties, having brought back two envelopes from one of the branch surgeries, I instructed one of the nurses to give the two envelopes to her. However, the nurse was unable to find them. When I asked the banking receptionist to check the takings from that branch surgery over the last three months and reconcile it with the monies banked, she found that £5000 was missing. This was a shock and confirmed my worst fears. I considered all my staff to be trustworthy, but my suspicions were on the branch surgery. The bank reconciliation for the three other branches over the same period were exact to the penny. I then tasked the banking receptionist and head nurse to check the banking at the suspected branch as far back as it would take to find no monies missing.

I contacted the Police to inform them of the missing monies, but without any hard evidence they could not act. Our own investigations discovered approximately £75,000 had gone missing over the past four years. We were able to pull out the daily till rolls and by checking the staff attendance at the branch surgery, a pattern developed where the books balanced when one particular receptionist was on holiday. Due to the poor response from the police I decided to set a trap for the thief myself. Having discovered one of the envelopes missing after the suspect had gone into town ‘to buy some new files’, I phoned the police, who again were unwilling to act. When she returned to the surgery, I informed her to stay on the premises after her morning shift but gave no reason. After calling the police again, and even going down to the station in person (where there was no-one available to come back with me) I returned to the surgery. There, I was met by one of the nursing staff, who exclaimed that the money that was missing had been found. Apparently it had been found in the bin below the till in the reception area by the suspect. On examination I noticed that the envelope had been folded, which we have never done before. I pointed out this fact to the staff and told them that the money had been taken and the person responsible had returned it to the bin to make it look as though it had fallen from the till. I asked the guilty person to come clean and said I would not stop until I caught the person responsible. I then asked each person individually if they had taken the money with all of them denying the offence. Two days later I received a phone call from the offender, who was the person I had suspected from the start of my investigations. She met me in my office where she confessed to stealing the money. I then typed a confession on the computer and asked her to read it carefully, make any amends, and sign it. I told her that if she paid the money back immediately I would not give evidence in any court proceedings. However, she was not in a financial position to do this. I handed the confession to the Police who arrested her that afternoon and she received a formal letter of dismissal from the post at our surgery. Thereafter the police did their investigations. We had constructed a spreadsheet detailing all banking against all receipts. Fortunately we had kept all the till printouts. The total that we had lost over a four-year period was Practice Life z December/January 2015 z www.practicelife.biz

HOT TOPIC

£75,000, according to our records. The police then seized all the bank accounts associated with the receptionist and it then took them several months to check where the money had gone. Nine months after she admitted to the crime she was charged with stealing and appeared at Truro Magistrates Court. After this the case was referred to Truro Crown Court, which would be one whole year after her confession. I learned that she was going to plead guilty at the Crown Court, but only to stealing £35,000. I was informed that the crown prosecution would accept this plea. Despite them arguing that the sentencing guideline for £20,000 - £120,000 was the same whatever the amount within this range, and that I should accept this plea, I was outraged and refused to agree with this approach. A claim for £75,000 should have no difficulty being proven with all the evidence the police had amassed. On the day of the Crown Court hearing the police and the crown prosecution advocate informed me that they had decided not to accept her plea. A Newton hearing was agreed (where the two sides offer such conflicting evidence that a judge sitting alone- that is, without a jury - tries to ascertain which party is telling the truth). Finally, one week before the Newton hearing (4 months later), she pleaded guilty to stealing £75,000. She was given a 17 month prison sentence. Ever since it came to light that this money had been stolen from us, I have asked myself: what could we have done to stop this and what should we do to prevent this happening the in the future? Here are my thoughts. www.practicelife.biz z December/January 2015 z Practice Life

Our systems were good but we were cursed with an opportunistic thief and an incompetent receptionist. Lesson 1 Always allocate the right job to the right person. This is down to having the ability to gauge a person’s competence. Once someone is in place, assessment of his or her performance is essential. Lesson 2 Check your procedures on a regular basis. Reviewing your practice protocols and ensuring they are followed may seem like a chore but will pay dividends. Lesson 3 Involve several people in handling cash. We have to trust people to perform different tasks in practice. That trust can be betrayed and was in our case. By involving several people in your money handling protocol, where there is a problem, another will spot it. Lesson 4 Make random checks on balances. Random checks by the owners of the practice will find out fraud quicker. A high standard of reporting of cash handling with several systems of reporting will make it more difficult for someone to take cash. Your accountant is the obvious person to ask to review your checks. Lesson 5 Retain a degree of suspicion. For any business to function it has to trust people. 99% of people are trustworthy, but the 1% that aren’t ruin it for everyone else. Trust your staff but make it difficult for the one individual that potentially could disrupt your business to do so.

MANAGING PEOPLE

How do you react to conflict? Dr Ben Hardy qualified from Edinburgh Vet School in 1995. After working in academia, general practice and the pharmaceutical industry he studied management, completing his PhD at Cambridge. He now lectures at the Open University and researches morale in organisations, the effects of hormones on decision making and the role of language in surveys.

HIGH

Concern for Others

HIGH

Concern for Self

Integrating

LOW

Obliging

Compromising LOW

n her piece in September/October’s Practice Life Teresa Mulvena offered some advice as to how to manage conflict. This focussed on the things that you could do to help manage conflict. But sometimes we’re not managing conflict, we’re living it. What can we do to help understand how we handle conflict and so manage our own personal conflicts better? Before we go any further, though, we need to think carefully about whether we want conflict or not. Your initial response might be ‘no, of course not, we don’t want conflict’. If it is, then you might want to think again. The research on conflict makes a distinction between task and relationship conflict. Task conflict is about how resources should be used, procedures, policies, decisions and the interpretation of facts. Relationship conflicts, by contrast, are about personal tastes, politics, values, personality and so forth. Relationship conflict is always bad news as it makes people do a less good job and it reduces the enjoyment they get from their job. Task conflict, by contrast, can be beneficial if carefully managed. Too little conflict and people can be disengaged, too much and they are so irate that they can’t engage with one another. Goldilocks-like, the level of conflict has to be just right. People differ in the ways in which they respond to conflict. Understanding how you respond to conflict can help you better understand yourself. Understanding how others respond to conflict can help you understand them better – and also understand why you might be in a state of conflict. Researchers have identified two different components in response to conflict. One of these is the degree of concern for yourself and for achieving your objectives. The other is the degree of concern for others and their objectives. The questionnaire opposite assesses how you measure on each of these components. By putting them together we get a 2x2 matrix. The INTEGRATING style, with high concern for both your own and others’ interest, is one which is associated with problem solving. Using this style demands the free exchange of information, looking for multiple alternative solutions and carefully unpicking the cause of conflict to try and devise a

Dominating

Avoiding

Fig 2. Adapted from A theory-based measure of conflict management strategies in the workplace, C. K. W. De Dreu et al. J.Organiz.Behav. 22, 645-668 (2001)

solution which works for everyone. This style needs to be given time to work and may well be the best style for dealing with toxic social conflict. It is also useful for working out practice policies and long range planning. The OBLIGING style is one where people put others’ interests before their own. This style tends to play down differences and emphasise what people have in common. People using this style tend to neglect their own concerns to make others happy. It can be useful where something is much more important to the other person than it is to you, or where you are in a weak position but want to preserve the relationship. Sometimes this style is used when people hope that, by giving something up now, they will benefit in the long run. This approach can be disastrous when you believe that the other person is wrong or behaving unethically. DOMINEERING is a where you have to win at all costs. As a consequence you may steamroller the interests of others. It can be appropriate when the issue is vital to you and if someone says ‘no’ then it is disastrous. Bosses can use this style if deciding on routine things, when a speedy decision is needed, when dealing with someone less senior who is very assertive or when the other person does not have the necessary expertise to make the decision. It can also be useful in implementing unpopular decisions. Practice Life z December/January 2015 z www.practicelife.biz

MANAGING PEOPLE

What Is Your Primary Conflict-Handling Style? Indicate how often you rely on each of the following tactics by circling the number you feel is most appropriate. When I have a conflict at work, I do the following: Not at all

I give in to the wishes of the other party

Very much 3

I try to realize a middle-of-the-road solution

I push my own point of view

I examine issues until I find a solution that really satisfies me and the other party

I avoid a confrontation about our differences

I concur with the other party

I emphasize that we have to find a compromise solution

I search for gains

I stand for my own and the other party’s goals and interests

I avoid differences of opinion as much as possible

I try to accommodate the other party

I insist we both give in a little

I fight for a good outcome for myself

I examine ideas from both sides to find a mutually optimal solution

I try to make differences loom less large

I adapt to the other party’s goals and interests

I strive whenever possible toward a 50-50 compromise

I do everything to win

I work out a solution that serves my own as well as the other party’s interests as well as possible

I try to avoid a confrontation with the other party

Scoring Key: To determine your primary conflict-handling strategy, place the number 1 through 5 that represents your score for each statement next to the number for that statement. Then add up the columns. Your primary conflict-handling style is the category with the highest total. Your fall-back intention is the category with the second-highest total. Obliging

Compromising

Dominating

Integrating Avoiding

1 ______

2 ______

3 ______

4 ______

5 ______

6 ______

7 ______

8 ______

9 ______

10 ______

11 ______

12 ______

13 ______

14 ______

15 ______

16 ______

17 ______

18 ______

19 ______

20 ______

Totals ______ ______ ______ ______ ______

That said, it can be the wrong style when making complex decisions where there is enough time to make a good decision. It can also produce a stalemate when both parties are equally powerful. If this style is used on people who know what they are doing it may breed resentment. AVOIDING is associated with buck-passing or sidestepping the issue. It can, however, be useful when damage from confronting the other person outweighs the benefits of solving the problem, or when time is need to allow the situation to settle down before tackling the problem again. This style is www.practicelife.biz z December/January 2015 z Practice Life

inappropriate when the issues are important to you and where it’s your responsibility to make decisions. The COMPROMISING style involves give-and-take, with everyone giving something up to resolve the situation. This style is useful when it is impossible for both sides to fully satisfy their demands or when an impasse is reached. It avoids protracted conflict and can be useful when other styles have proved unsuccessful. It’s not a good approach for dealing with complex problems which need a problemsolving approach. It may also be a bad idea when one person

MANAGING PEOPLE

has much more power than the other or is completely convinced that they are right. Most of us have a style that we naturally tend to use but it is possible for us to ‘flex’ our style and approach conflict using a different approach. This means that we can approach situations differently and, potentially, reach better outcomes. But, when the pressure is on, we slip back to our natural style as that’s the one we feel familiar with. The matrix shows you how you tend to respond to conflict. Another useful thing to think about is how you actually handle conflict. The diagonals on the 2x2 matrix give you some idea of the approaches that you use to resolve conflict. The diagonal which runs from integrating to avoiding i.e. top left to bottom right, is concerned with how likely you are to problem solve. By subtracting your integrating style score from your avoiding style score you will get a number between 16 and -16. The higher you score, the more likely you are to problem solve. Lower scores suggest that you are likely to try and avoid the problem and not use a problem solving approach. The other diagonal, running from dominating to obliging, is concerned with your bargaining style. Again, if you subtract your dominating style score from your obliging score you will get a number from 16 to -16. Higher scores mean that you tend to try and drive a hard bargain, imposing your will on the other person. Lower scores suggest that you are more likely to compromise with the other party, potentially damaging your own interests. This tool gives you some insight into how you tend to handle conflict and also possible approaches that you could take to do things differently. This tells you quite a lot about yourself and gives you some thoughts as to what you might do differently. By getting others to fill in the survey you can compare yours and others’ approaches to conflict. Bear in mind that people who approach problems differently to you may just look odd. For example, if you adopt an integrating approach and the other person is avoiding then they are just going to look weird

to you. They look like they are running away when you are trying to solve the situation. By contrast, you look to them like someone who’s obsessed with a problem that really doesn’t need to be addressed. Understanding that someone else’s world is not the same as yours is key to resolving conflict. We tend to assume that other people are very much like us. This isn’t a bad starting point but the problems start when we don’t update this in the light of the behaviour of others. Seeing the situation from another’s point of view is a useful skill. As an exercise in understanding the views of others you might want to do a two box exercise. This is a simple way of forcing you to think about the other person’s point of view. My view of the situation l

The

dog was discharged without proper instructions I was angry as aftercare is very important his is not the first time T that this has happened

Other’s view of the situation l

e were incredibly busy and W I had to discharge 3 dogs at once I know aftercare is important but I was swamped here is only one person to do T the discharges and everyone comes at once. It’s not surprising this happens

When we do the two box exercise we start to think how our actions look to other people. This helps us understand their point of view and think about how we might solve the conflict. By understanding how we handle conflict we can help handle it better. When we know our natural style and the styles of others then their behaviours may not seem so odd to us. When we make strenuous attempts to put ourselves in others’ shoes, we also understand their world a little better. So their behaviour isn’t odd or bad, it’s likely to be perfectly rational in their opinion. It’s just that, like the source of the conflict itself, their opinion differs from ours.

In a new series of short inspirational articles on Leadership, Mark Hedberg, of the College of Animal Welfare asks…

“Why won’t my minions do as I say?” If you’ve been watching movies and trailers recently, you may have heard of ‘Despicable Me’ – starring an evil genius with a host of small yellow Minions, getting up to wacky hijinks and crazy adventures. Some of you may even have been a little envious – who wouldn’t love an army of hyperactive helpers to do their nefarious bidding? Photo:Wikipedia While the official definition of ‘minion’ is “a follower or underling of a powerful person, especially a servile or unimportant one” – the Minions in the Despicable Me franchise are actually anything but unimportant minions – they’re a vital part of Gru (the antihero’s) success. What is their secret? Why is it that his minions perform miracles, while you can’t even get your staff to take care of the ops list?

For those of you who haven’t seen the movie, when Gru needs something done, he gives the task to his minion army and lets them get on with it, only judging the final product. Some of the finished concepts are rejected as being unsuitable (or even dangerous!) but others prove to be key to the success of the mission. The secret, of course, is trust. Trust is a vital part of any employee/employer relationship, because if you can’t trust each other, you can’t work together. Gru gives his team a task and gets out of the way. So how can you get your team to trust you? Start by simply trusting them more. Give them clear (not simpleminded!) tasks with measurable goals and standards, and get out of the way. If it gets the job done well and makes the team happy, go with it. As time goes by, you can delegate more complicated work, giving you the time to concentrate on the jobs you love. (Oh, and don’t call them minions!) Practice Life z December/January 2015 z www.practicelife.biz

CLIENT CARE & MARKETING

5 WAYS

to really grow your net profit Paul Green looks ahead to 2015, and the 5 New Year’s resolutions we should all be making. What would it take to make 2015 your practice’s most successful year ever? What would you have to do differently to move your practice into advanced growth, despite the continued economic depression (the successor to the now-dead recession)? How can you see off the threat of competition and the rise of veterinary medicines websites? Many practice owners have had a flat 2014. And as always at this time of year, we feel compelled to look back at what’s happened to us in the last 12 months, and then decide what www.practicelife.biz z December/January 2015 z Practice Life

we should do differently next year. Many business owners start a new year with good intentions to change their business for the better. Realistically, few ever actually do it. Who knows why. Maybe it’s just human nature. Maybe it’s the desire to avoid the pain of change, or a preference to stay within their comfort zone. Most people are more motivated by the fear of pain, than they are the opportunity to gain. But as Albert Einstein explained: “Insanity is doing the same thing over and over again and expecting different results.” Growing your practice will mean making changes in order to see better results from your practice. It’s not about one big idea. There is not always the need for dramatic change (although that is necessary now and again). Mostly, improving an established and mature veterinary practice requires a continual stream of tweaks. Fixing what’s broken. Improving what works. Constantly testing new ideas; then throwing out the ones that don’t work in that location and trying new ones. This month I’ll be challenging the practice owners I work with to change the way they think and act even more in 2015. And I’d like to share that challenge with you, in the form of five suggested new habits.

1. Spend at least 1 hour a day working ON the business There’s a big difference between working IN your business and working ON it. Doing a consultation or an operation is working IN it. Yes, it puts money in the till, but it doesn’t help you with the long-term demands of your business. Every practice owner – even one man bands with help – need to regularly find time to step back and look at what’s happening in the business. What’s going well. What’s going badly. What the opportunities are. What the threats are. Look for trends, in clients, pets, the geographical area and the local corporates. Trends are a warning of change. The practice owner who spots change and reacts to it the fastest is more likely to weather a storm, or maximise an opportunity.

2. Make your marketing utterly watertight There are only three ways to grow your practice. Firstly you get more new clients; secondly you get them to ethically buy from you more often; and thirdly you get them to happily spend more at each visit. Your marketing needs to be optimised in all three of these areas. The best website you can produce, that converts

CLIENT CARE & MARKETING

more prospects to clients. A better and more comprehensive reminder sequence, that makes it really hard for a client to just drift away. A more robust way to find out what people need and want, and then deliver. Just because a client said no to your health plan in 2010, doesn’t mean they will say no today. People buy when they’re ready to buy. An efficient practice marketing machine is in front of them at right moment every time.

3. Focus on adding value everywhere Value and increased sales go hand in hand. Don’t sell vaccinations and chipping for a new pet separately – bundle them together and give the client a discount. Make them feel like they’ve got a deal. Show that your health plan actually saves them money and is better for the pet. Put on free nurse clinics to encourage them to use the practice more often (and give nurses a chance to spot potential dental work). This is the modern equivalent of the bonded client. The more someone uses your practice; and the more they spend with you, typically the happier and more loyal they will be.

4. Forget the past So you are the best vets in town? And have been for 20 years. Well done, that’s quite an achievement… now get over it and focus on the future. The sector is changing faster than ever before. If you don’t have dramatic new competition biting at

your ankles, you will do… it’s just a matter of time. Oldest or biggest or best is no longer enough to win. These days you need to be the fastest to win. Fastest in front of the prospect; fastest to give them what they want; fastest to be there at the exact moment they need you or want you.

5. Be picky about your clients I work with a practice that gives its staff a lovely Christmas present. They are allowed to go through the client records and pick three clients they don’t want to work with any more. And then the practice fires those clients! The staff love it as you can imagine. This is quite an extreme way to looking at the Pareto Principle, or the 80/20 rule. This says that the cause and effect of something rarely match. So typically, the majority of the hassle in your business will come from the minority of clients. And bad clients attract… more bad clients. Firing the worst clients is scary but should increase your profits. Paul Green is the founder of Vets Practice Growth UK, a practice growth and marketing organisation. He is the author of “The Game is Changing”, a free paperback vets marketing book now owned by more than 1,800 practice owners and managers. You can get a free copy posted to you by visiting www.vetsmarketing.co.uk/5ways

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CLIENT CARE & MARKETING

CALLING ALL

Young Marketeers! Are you a marketing rising star or do you have one in your team? The Veterinary Marketing Association (VMA) is calling all young marketeers or their colleagues for nominations for the VMA Young Marketeer Bursary Award 2014. With generous sponsorship from British Dairying magazine and supported by the VMA, the successful candidate will receive £500 cash as well as a £2,000 bursary for their on-going marketing training and development, and two runners up will also each receive £100. Last year’s winner, Justin Phillips, marketing manager for White Cross Vets, says the award has opened up a number of fantastic opportunities for him: “Winning the title has enabled me to spend time with leading figures in veterinary marketing, including the inspirational Dr. Jeff Brant, DVM, MBA learning about the Banfield approach to marketing veterinary practices. “Jeff is co-founder of Banfield, the world’s largest veterinary group with more than 950 practices! Banfield has annual revenues in excess of $1 billion and is now co-owned by Mars and PetSmart. Jeff also founded the Optimum Wellness Plan, the original veterinary healthcare plan which today covers 1.8 million pets.” Justin is also attending the North American Veterinary Conference in Orlando, Florida in January 2015 where he has been invited to spend time with Dr Marty Becker – “America’s Veterinarian” and author who has sold over 22million books. “I also had the privilege of speaking at the VMA’s “Branding in a Digital Age” annual seminar in November, which I really enjoyed.” With the financial winnings from the award, Justin put the £500 cash prize towards a three week holiday scuba diving in Vietnam and seeing the Temples of Angkor Wat in Cambodia. “I plan to use the £2,000 bursary for a two day negotiation skills course and several quality courses on digital marketing. “In addition to the highlights above, the accreditation has helped me on a day to day basis raising my profile amongst suppliers and within White Cross Vets,” adds Justin. “I would encourage anyone who is passionate about their veterinary marketing role, or who has a rising star in their organisation to enter this year’s award,” he says. Award organiser and one of the judges, Mo Gannon from MG&A, explains that the award is designed to recognise a young marketer who, in the view of the judges, has demonstrated an excellent grasp of marketing products and/or services in the veterinary sector. “The successful candidate will also receive ongoing support and advice from a VMA committee of industry professionals,” she adds. A shortlist of three candidates will be selected to meet a panel of judges from the industry to discuss their nomination in more detail and complete a short case study on 24th February 2015, In London. The awards event takes place on Friday 13th March 2015 at the Lancaster Hotel, London, where the www.practicelife.biz z December/January 2015 z Practice Life

winning candidate will be announced. Candidates must be 34 years or younger on 13th March 2015. The winner will receive a £500 personal award and a £2,000 bursary for marketing CPD/ongoing training. Two runners-up will each receive £100. Submissions must arrive at the VMA no later than Friday 30th January 2015 at 12 noon. In fairness to those who do submit on time, late submissions will not be accepted. A short list of a maximum of 3 candidates will be drawn up and finalists notified by 5pm on Friday 6th February 2015. For further information on this and all the awards visit www.vma.org.uk or contact VMA secretary Colin George on 0844 561 6157 or 07845 141 171 or email, secretary@vma.org.uk.

Steve Wright (PR winner) and Justin Phillips (R) with George and Lenny

About The VMA The VMA is the national organisation devoted to the professional enhancement of its members. It is a non-profit organisation comprised of marketers from over 50 companies. VMA membership is drawn from companies involved in all areas of animal health including Veterinary Pharmaceuticals, Animal Health, Pet Nutrition, Insurance, Advertising & Media, Marketing and Market Research.

BUSINESS HEALTH & FINANCE

Too busy to read your HMRC Employers Bulletins? If so, we have it all in a nutshell for you... Robert Lorrimore, Payroll Options, summarises recent updates • £2000 employment allowance: This giveaway was announced for this tax year, and most practices should have been able to claim it. It was to set against the employers National Insurance Contribution (NIC) and if you have not claimed it yet, check if you are eligible and claim before the end of the tax year. “Use it or lose it” as the saying goes. • Late RTI submission fines. RTI (Real Time Information) submissions are to be made by payday. RTI was introduced in April 2013 and there has been some controversy about HMRCs ability to deal with the technology. In October 2014, fines were introduced for all companies with over 50 employees for late submissions. In March 2015 all companies may be fined if submissions are late, including those with less than 50 employees. • Minimum wage has increased. The minimum wage increased in October, for an employee aged 21 or over this is now £6.50 per hour. You will have to take care if using a salary sacrifice scheme for pensions, as low paid workers could fall foul. • P800 errors. This is linked to RTI errors and is regarding P800 tax underpayment notices, issued to around 20000 people in error. Of no interest unless you, or a member of staff, are one of the 20000. • Tax coding notices to recover underpaid tax. This is nothing new but the amount that can be reclaimed this way has been increased for higher earners. The amount starts at £3000, raising to £17000 for those earning over £90000pa.

• Changes to under 21 NICs. This is of interest. The exact details need to be finalised but there will be no employers NIC to pay for employees below the age of 21. This will be processed through a different NI category applied to those individuals that comply, and covers earnings up to the upper earnings limit (currently £3489 per month). This will come into force in April 2015. • Auto-Enrolment. Find your staging date and do not delay. It is not straightforward and you need to give yourself plenty of time. You can follow the conventional assessment route or you could explore a contractual option. Seek advice, act upon the advice and it is probably better to treat AE as an additional employee benefit, rather than yet another bureaucratic burden. Also, see the note about the minimum wage above. • The tribunal has moved in favour of incorporating overtime payments in holiday pay calculations. This means we may need to incorporate overtime payments to find an average rate of pay, and so increase holiday pay. This looks unlikely to be able to be applied retrospectively but it is difficult to predict. The implication seems likely to be where overtime payments follow a regular pattern. There could still be an appeal so this could be the proverbial ‘storm in a teacup’. I think the message is not to panic yet, but review staff work patterns and see if there are members of staff working the same amount of overtime every month. For further details on any of the above talk to your payroll provider or visit www.hmrc.gov.uk.

Practice Life z December/January 2015 z www.practicelife.biz

BUSINESS HEALTH & FINANCE

Pet Health Plans: A tale of two practices In this issue’s Business Health and Finance section, we look at health plans, hearing from two small animal practices, one offering an off-the-shelf service from a major provider and the other their own bespoke version.

CASE STUDY: PROVIDER HEALTH PLAN

aven Vets started running a Denplan health plan in their small animal practice earlier this year in Llanelli, South Wales. Here Susie Ackroyd, Partner and Receptionist Debra Williams, talk about the setting up of their plan and their experiences with it. We are a 4 branch, 5 vet practice offering routine treatments and surgery. Our client base is varied and our clients are very loyal to our practice. In addition to our routine treatments, we have been offering health plans since April 2014. In the first six months of launching our plans, we have recruited over 300 pets with the help of our plan provider, Denplan, and hopefully we will continue to increase. Our staff were always very pro health plans and enthusiastic about giving clients the opportunity to manage their pet’s routine treatment in a different way before we even introduced them in to the practice. We also had been getting lots of questions from clients when we first suggested the idea, so we knew that they would be wellreceived. The plan is a really good deal for both clients and their pets, and we haven’t found it a hard sell.

Keeping it going We wanted to ensure that the enthusiasm for the idea of plans continued once they were launched and it was with this in mind that we opted to work alongside a provider rather than do the plans ourselves. We felt that working with a provider would be more convenient for us, especially not having to deal with the direct debit collection from clients. We also wanted a provider to help us promote our plans and Denplan were very accommodating with this – they even helped us design a new logo for our practice, which we were very pleased with. Having a provider working with us helps to keep us motivated and reminds us to promote it. It would be easy to let it slip when things get really busy. They give the practice team realistic targets and incentives for hitting these targets as well – we were recently able to take the whole team out to see Rock of Ages! We feel that the success of our health plans is really driven by this support as it would be a full time role for a member of staff to make it work otherwise, and we just couldn’t manage that. www.practicelife.biz z December/January 2015 z Practice Life

Susie Ackroyd (L) and Debra Williams

BUSINESS HEALTH & FINANCE

Client benefits We talked to many providers when we decided to look at plans but we wanted the reassurance of a well-known brand. Denplan came across as very professional and, together with the promised help of promotion of our plans, this seemed to offer the best package. As a practice, it was also important to us that our clients remained enthusiastic about the idea of plans to make them sustainable, and we wanted to make sure that we included the right treatments at the right cost. Ensuring our clients could really see the value in the plans hopefully meant that they would continue with them long-term. The quality of our veterinary care is paramount, and we wanted to make sure that our high standards were kept up while having our clients’ pets covered throughout the year, helping drive repeat business. This has seemed to work; since having our plans, we’re in touch with our clients more frequently as they come in more often and we feel we are forming better relationships with them – and with their pets – as a result.

Ironing out teething problems We had a few teething problems getting used to administering our health plans on our Practice Management System. But we were well-supported by our Business Development Consultant, Ashley, during this time, and we made good use of the Denplan customer service team on the phone. The issues were quickly smoothed out. Chasing clients who don’t keep up their monthly payments is one potential drawback of a health plan and would mean us having to spend precious time trying to contact them. Having a provider means that they help us with this. Marketing is essential to promote the plans, and again we felt there was an advantage in going with a provider here

for their expertise in this area. As part of our health plan membership, we received lots of posters for our waiting areas – these are often updated seasonally which maintains interest. We also got a large banner for our waiting rooms plus several e-mails sent to our clients informing them of our new service. These were all very professionally done and helped give clients the reassurance that our plans were really well thought out and of a high quality. We would definitely recommend practices that are looking to launch plans to use a provider and we found Denplan very good. We’ve found that running health plans has so many benefits including helping to keep clients loyal, so it’s worth making the effort to ensure that all your staff are on board and behind the idea 100%. It’s very much a team effort.

CASE STUDY: INDEPENDENT PRACTICE HEALTH PLAN SPVS Editor, Stephanie Writer-Davies, director at Mimram Veterinary Centre in Welwyn, Hertfordshire, recently introduced an independently-designed Health Plan to her privately owned, single centre, 100% small animal practice.

Practice Health Plan is something that we have considered introducing for some time; I’ve always thought that they were a good idea for client bonding and retention and it was just a case of finding the right type of plan for our practice. When we looked into it there seemed to be a lot of different options of varying complexity and cost both from the point of view of set-up and ongoing administrative charges, and also monthly fees for the pet owner.

In making our decision there were a few particular points we considered: • The practice has a relatively large number of staff, many part-time. Since we wanted every member of the practice to be able to encourage client sign-up we felt it had to be simple, straightforward and easy to explain to our customers. Even those working only 2 sessions a week should feel as confident talking about the plan as the full-timers. • Although we are lucky enough to be in a reasonably affluent area there has been a recent increase in competition with new practices opening in local pet shops and a couple of our main competitor practices joining corporate groups. Most of these practices offer relatively low cost Health Plans and so we felt it was important that ours was keenly priced. • Whilst as veterinary professionals we understand that very regular preventative parasite control is a good thing for animals, statistics show that pets rarely receive such treatments Practice Life z December/January 2015 z www.practicelife.biz

BUSINESS HEALTH & FINANCE

at the frequency advised by the manufacturer. I believe that this is partly due to owners forgetting to treat their pets, but certainly, at our practice, there is also a feeling even amongst some of our most bonded and committed owners that they don’t want to ‘overuse’ chemicals on their pets. With this in mind we didn’t want to ‘overload’ clients signing up to the plan with parasite control that may Stephanie Write-Davies not get used, the inclusion of which would increase the cost of the plan. • We hoped that if we offered the plan at a low monthly cost and included only a relatively small amount of ‘freebies’ with discounts offered for additional costs and services, that it would encourage repeat business and facilitate client sign-up. In the end we asked our buying group, Premier Vet Alliance (PVA), to assist with the setting up and administration of the service; we managed to price all our plans at under £10 per month with the exception of Giant Dogs (those over 40kg) which is £12.50. Our plans include: • The full cost of the annual health check and vaccination •O ne 3-pack of Broadline for cats or one 3-pack of Advocate plus a single dose of Drontal for dogs given free at the time of the booster visit •O ne other consultation with a veterinary surgeon during the year free of charge • Unlimited nurse consultations free of charge • 1 0% discount on additional parasite control, merchandise or food purchases (including prescription diets) • 1 0% discount on all dental work, neutering procedures and longterm medications We are flexible with parasite control, so should a client particularly want alternative products, we accommodate that and whilst the additional free consultation is intended to be used for a routine health check after approximately 6 months, we allow clients to use it for a sick animal if they wish to (but it is made clear that there is only one free consultation with a vet allowed per year). We launched the plan on 1st July this year and by the end of October we had 240 pets enrolled (our target of 100 to be rewarded with a meal for all staff at a local Indian restaurant was achieved after only 6 weeks) and we are signing up approximately 15 pets per week; if it continues at this rate we should have nearly 40% of our ‘active in the last 12 months’ clients on the plan after a year. At the moment it’s having a slightly negative impact on monthly turnover when compared with last year because those who sign up at the time of booster vaccination pay only the first instalment of the plan instead of the £70 or £80 they may otherwise have paid but, over time, as the monthly direct debits increase, we should see a levelling of cashflow with a www.practicelife.biz z December/January 2015 z Practice Life

nice regular monthly lump sum coming from the health plan. It’s too early to measure the effect it may be having on repeat sales of the discounted products but I know of two patients that I have been trying to get to enrol on our nurse weight watching clinics for many months who were recently converted – they signed up to the plan to get the discount on the food which made it feel more affordable. Overall it’s been a very good thing and we hope it will continue to go well. As for lessons learned, I’d make the following comments: • Discuss your ideas with your PMS company first to make sure that the system will accommodate what you want it to do. • Make sure all staff know how to set the plans up on the computer so that no one person has to do all the work. • Make sure all staff are equally committed to the idea and sell the plan in the same way • Have marketing materials that are simple, clear and attractive (actually this is one area that I’d like to see improve with ours). • Don’t be afraid to tailor-make a plan for your own practice; there’s no ‘one size fits all’ and some providers seem to be more flexible than others.

PRACTICE DEVELOPMENT

Integrating referral work into your practice Alan Robinson has been a veterinary surgeon in practice for over 20 years and a successful business consultant for 15 years to over 600 practices. As a director of Vet Dynamics his mission is to help independent practice owners improve performance and quality of life in practice.

ver the last 20 years, veterinary medicine in the UK has seen a massive rise in referral practice in every clinical field, providing an unprecedented level of expertise available to first opinion practices. This has been driven mainly by advances in technology, veterinary diagnostics, medicine and surgery, specialisation – in the form of Certificates and Diplomas at the practice level – as well as the widespread availability of pet insurance. Equally the threat / fear of litigation and the orientation of new graduates from commercialised academic institutions may also contribute to a ‘culture’ of early referral. This, alongside a second trend of the widespread outsourcing of Out of Hours (OOH) services and concurrent reduction of in-practice hospital care, means that first opinion practices have been able to simplify their offering to a more lifestyle friendly version of 9-6 (-ish) provision. This means better hours, no oncall, and a lower investment in equipment and expertise, whilst providing a front-line mix of preventative, medical, surgical and retail services for the pet owning public. At the same time they have gained access to expertise and equipment not affordable or viable in most practices. However, there is a financial and clinical downside to this trend, particularly with increased competition in the first opinion market with independent and corporate expansion. Referred work and OOH services can often provide valuable clinical experience for graduates and practitioners that is not readily available in the 9-6 routine, as well as high-profit income for the practice. One or two high level surgical or medical cases in a month can substantially add to the clinical expertise and interest of the practice, as well as driving profitable work above that covered by vaccinations, neutering and consultations – much of which is competitively priced to be non-profitable in the first place. Some analyses show that 50% of practice income comes from Preventative Healthcare – neutering, vaccinations and associated product sales. Much of this is priced, bundled and discounted into Preventative Healthcare Schemes and focused on creating and retaining clients at either low or no profit. This strategy is useful only if the created client base yields a body of higher profit clinical work to subsidise the low-profit ‘front-end’ marketing that created it. Consultation fees are still relatively low due to competition, a fear of charging adequately for professional services, and are then also subsidised through drug mark-up, injection and

dispensing fees and retail sales. The only really profitable work we do in first-opinion practice is diagnostics, medicine and surgery generated from the consultation process. The culture and practice of then referring much of our higher profit work to third parties may make good clinical sense but makes little commercial sense for our businesses. Referral practices are, by their nature, expensive to run and therefore require a high fee structure to be viable. The relatively high uptake of pet insurance has been the mainstay of referral practice. Typically first-opinion veterinary practice is subject to inflationary costs of 5-6% whereas referral practice is 10-12%. The resulting escalating insurance costs are causing concern for insurance companies as well as the insuring public. Referral centres are geographically spread and often do not cover all the disciplines required by a practice. Referring vets have a tendency to refer to the expertise they know, like and trust which often means a complex referral process, significant travel to an unfamiliar practice and dealing with an unfamiliar practice and processes for the client – all while dealing Practice Life z December/January 2015 z www.practicelife.biz

PRACTICE DEVELOPMENT

with the stress and uncertainty of their pet’s health and the financial implications that it incurs. The downside of referrals for the first opinion practice are: • Loss of potential practice income and profit • Loss of experience in some fields of veterinary medicine and surgery • Lack of advancement in surgical, medical and diagnostic skills • Escalating costs for clients – even with insurance • Client resistance to travel or dealing with ‘another’ vet Is there then, an argument for practices to consider taking back some – not all – of the referral work currently being sent out to referral centres? The aim would be to provide patient care at a sufficient level of expertise and retain as significant an amount of the referral income as possible. Three options are possible: 1. In larger practices individuals can develop clinical expertise in areas of interest that allow the practice to offer higher level of treatments in specialist medical and surgical areas. These are ‘peaks of expertise’ above the first opinion level. To maintain this requires a clear strategy of investment, training, resources, equipment and marketing to create sufficient caseload to make it viable, e.g. ophthalmology, cardiology, behaviour, acupuncture, dermatology, etc. On-line and off-line CPD provision and accreditation in the UK allows willing practices to develop rapid and high quality practice expertise.

involves paying the specialist for their time and travel, but retaining the caseload and the income in-house. Again the practice needs to be set up and staffed to accommodate these services. A simple strategy to assess your practice’s capability to integrate your referral income would be to • Review all current referrals • Categorise them into disciplines e.g. orthopaedic, soft tissue surgery, internal medicine, diagnostics (CT/MRI/US) and body systems e.g. cardiology, ophthalmology, dermatology, dentals etc., • Work out the potential (lost) income • Determine your resources to manage caseload • Define your protocols for referral. Is there an opportunity to develop any of the above strategies? 1. Develop practice expertise and resources to do the work 2. Do more of the pre and post referral clinical management 3. Invite peripatetic specialists into the practice. Whatever is best for your practice will always depend on delivering the best clinical care for the patient, the best client experience, the best financial return and the development of your team. Good luck. www.vetdynamics.co.uk

2. A second and perhaps easier strategy involves looking at the referral process and the two end-points of referral. Much of the diagnostic work prior to the referral as well as the after-care could and should be the domain of the referring practice (providing they have the facilities to deliver the care).

The Ultimate Microchip Solution

A referral consists of: • Pre-referral diagnostics and stabilization, • The referral work, surgery, diagnostics or opinion • Post referral recovery, treatment, medication and monitoring The referring practice is in the best position to provide much of the end-point services for the client’s convenience, compliance and continuity. This is particularly important in managing the client’s costs and insurance budgets. Repeating work already done, or managing misdiagnoses is expensive and reflects badly on both the referring practice and the referral practice. This requires a good working relationship between referring and referral practice and individual clinicians – even to the point of the referral practice providing the relevant CPD to the referring practices. This may mean reduced income per case from the referring practice, but good relationships ensure continuity, quantity and quality of future referrals.

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3. A third option is to use peripatetic visiting specialists to the practice to manage a non-urgent case load such as ophthalmology, cardiology, dermatology, etc. This www.practicelife.biz z December/January 2015 z Practice Life

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PRACTICE DEVELOPMENT

CASE STUDY: S URGICAL REFERRAL SERVICE INTEGRATED WITHIN FIRST-OPINION SMALL ANIMAL HOSPITAL Cat Arthurs is a partner at Towcester Veterinary Centre, a 22-vet mixed practice based in Northamptonshire.

“

We operate out of 3 sites – soon to be 4 – consisting of a main Small Animal Hospital based on the same site as our Large Animal Department. Then there is another dedicated Equine Department operating out of a different site, as well as another small animal clinic 10 miles away. We are about to open a fourth clinic which will be equine only. I work specifically within the Small Animal Hospital and with my partner Helen Pope we run a surgical referral service that operates in tandem with our first opinion clinic. Our Referral Unit services both local and distant practices and we specialise in orthopaedic, soft tissue and keyhole/ endoscopic surgery. We’ve built the referral service up slowly. This has been deliberate to keep our standards high, and it’s grown mainly through recommendations and word of mouth. I’ve always enjoyed surgery and did my certificate, building up the case load from within the clinic, and then subsequently from referred cases. I spend about 90% of my time doing surgery now with just a few consulting sessions a week to keep my hand in. We are a big practice now and we generate a large number of surgical cases in-house. We’ve pretty much split our vet team, so that everyone is working to their strengths. Helen and I handle the surgery and the other vets are generally very happy not to have to do it! The idea of a referral centre was always in my mind after getting my cert, but when I became a partner it became more of a focus. We wanted to find a way to keep those difficult surgical cases in-house, to benefit the practice both professionally for staff development, as well as financially. And we could see a clear niche in those ‘middle-ground’ clients who could not afford the fees of larger referral sites or who weren’t insured to the tune of thousands of pounds, but still wanted to do the very best for their pets. So the idea of offering an affordable referrallevel specialism was born. We supplemented our in-house skills with the visiting services of an RCVS-Diploma holder Gareth Arthurs who also lectures at Cambridge Vet School and who comes in to do our more challenging cases like arthroscopy and spinal surgery. It’s meant that we don’t have to turn any cases away and can handle even the most complex of ops. The referral service grew as neighbouring practices saw the advantages of having somewhere close to send their clients to, where they would have easy direct contact with the surgeons for case discussions, and after-care could be done with a joined-up approach. The clients also benefit from that closeness, and often find that coming here is less-intimidating than visiting a big referral centre. We branched out into keyhole surgery as we saw real benefits to our patients in terms of minimising pain and reducing recovery times. We really believe it is the future – in the human world this is the gold-standard now. We invested heavily in equipment that allow us to carry out laparoscopies,

cystoscopies, key-hole enterotomies, arthroscopies and noninvasive biopsies. This investment has been well-worth it, and we’ve even had clients self-referring to benefit from it. We’ve found it’s of help to our equine department too, as we can do standing surgery, joint flushes etc. Financially it has been rewarding, but we haven’t had a chance to sit down and look at it in terms of a separate income stream yet. On a personal note, it’s been incredibly rewarding in terms of developing my confidence personally and professionally. The downside, if there is one, is that once you go down this focused route into one discipline, it’s harder to keep on top of the other more general stuff. Switching your brain between the two is hard! But as a woman and a mum, I’m pretty used to that! Our biggest challenge now is marketing the service: getting the message out that helping clients to access specialist services doesn’t always mean having to go to a big referral centre. Our local practices now have the confidence and faith to refer to us, and we need to grow that word-of-mouth to reach more distant referring practices. So we’re working with a social media and marketing coach every month, and I’m learning another new skill which keeps me happy!” Practice Life z December/January 2015 z www.practicelife.biz

CONGRESS SPECIAL

DON’T LEAVE IT TOO LATE!

VPMA/SPVS Congress 22nd - 24th January 2015 Celtic Manor Resort, Newport

Time is running out to book yourself on what will probably be the best investment of your CPD budget this year! VPMA/SPVS Congress is looking to be a sell-out. Don’t miss this opportunity to gain new insights, make new friends and come away inspired!

Feature talks and speakers Straight to the Heart of Practice If you know anything about practice, you’ll know that your clients are your centrepoint. In recognition of this, we’re majoring on the theme in our two day stream ‘The Client Journey’. Every aspect is covered, from health plans to marketing, client mapping to experiential feedback. Bring your front-of-house team and make congress your go-to for best practice in client management. NAVIGATING THE BERMUDA TRIANGLE Brian Faulkner, VetPsych BSc (Hons) BVMS MBA MSc (Psych) Cert (GP) SAM MRCVS Having observed over 3000 veterinary consultations, Brian realised that approximately 50% of the commercial opportunity that ‘walked in the door’ walks back out again. This is usually because of a break in the sequence of thoughts and behaviours which can convert financial opportunity to cash in the bank. In this talk he focuses on a common weak-link within this sequence of events; the space between the consultation room door and the reception desk. He calls this the ‘Bermuda Triangle’ because all too commonly this is where ‘good things’ like booking in follow- up consultations and ops, and taking certain payments like re-check fees often disappear without trace. Find out how to stop this leak and get your processes and people aligned.

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CONGRESS SPECIAL

Straight to the Heart of the Practice continued CONNECTING WITH CLIENTS IN THE 21ST CENTURY – Bashore Halow, CVPM, LVT, Halow Tassava Consulting Author of the online publication and website Veterinary Business Model of the 21st Century will take attendees through the essential steps of creating meaningful, caring interactions with clients using the latest and most impactful communication tools. Great insights into language, client and team member generational differences, and industry best practices are all shared in this two-part presentation filled with communication examples, how-to guides, and engaging anecdotal stories.

CLIENT MAPPING AND FOCUS GROUPS: A PRACTICE CASE STUDY – Bradley Viner, Blythwood Vets Bradley Viner has run successful London practices for over 30 years and thought he understood his clients. But in the past 2 years he’s embraced formal market research via Experian client mapping and professionally run focus groups. In this session he describes how these worked, shares the surprising things he learnt and explains how he’s used them to change the way he operates.

Learn to be a Leader Defining culture, performance, change management, strategic thinking. A leader needs to be able to pull all these things together to effectively develop their business. The good news is that these skills can be learned. This stream is a must for anyone with the responsibility of growing a practice or managing teams. DEFINING AND SHIFTING CULTURE – Ian McKelvie, Becauz Whether you intend it or not, your business already has a culture of its own that is determining the experience your employees and clients have each day. As a leader, it’s important that you shape your culture with intention–set and reinforce the behaviour norms that will deliver the results you want. The culture you create is integral to how you operate as a business and how you attract retain staff and clients.

LEADING THE CLIENT EXPERIENCE – Nick Steele, Zoetis Defining a vision and a strategy is one thing, but how do you translate this into the tangibles of the client journey and levels of service? How do you define and explain it to the team so they can deliver it? How do we set goals around it? How do you assess the team’s capability to deliver it and how do you identify skill and knowledge development needs? As a leader and manager, how do you address performance gaps? In this Masterclass, Nick Steele and the Business Consulting team from Zoetis will illustrate how to connect all of these together to enable you to cascade your vision throughout your client journey, clearly defining it for your team and allowing you to manage their performance in its delivery.

Mental Health Continuing the associations’ focus on mental health and well-being, Friday’s stream covers topics from recognising mental illness, through to stress and bullying. RECOGNISING AND TACKLING MENTAL ILLNESS – Dr Max Pemberton One in four of us will experience a mental illness at some stage in our life and yet would you be confident of recognising the symptoms of depression or anxiety in yourself or a work colleague? Feeling low because of a change of circumstances such as a bereavement or divorce is normal, as is a certain level of work stress or anxiety, but what are the warning signs that this mindset has developed into something more serious and what can you, as an individual or a manager, do to help. This session from writer, broadcaster and practising psychiatrist, Max Pemberton, gives a short introduction to the most common forms of mental illness, how they present, their prognosis and the options for treatment.

Practice Life z December/January 2015 z www.practicelife.biz

CPD DIARY

All Things Equine

Social Highlights

Julien Samuelson, MD of Bell Equine chairs the Equine Management stream for our second year of equine-dedicated business talks. Times are challenging for many equine practices and a ‘one size fits all’ approach often doesn’t work. Attendance is a must for equine businesses who want to buck the trend and go for Gold. HOW WE WON BACK THE DENTAL WORK Chris Pearce, Equine Dental Clinic In the late 1990s, Chris Pearce had worked for 10 years as an equine vet, building up his practice from 2 to 8 vets and with an expertise and busy case load in dentistry. Then like many other equine vets, he lost much of it almost overnight to a local ‘equine dentist’ who set up on his doorstep. Chris fought back. He was the first vet to take the British Association of Equine Technicians’ exam and went on to develop the very successful Equine Dental Clinic in Dorset which has both first opinion and referral clients. In this talk, he makes the case for winning back your dental work with excellent tips for how to go about it and why it makes sense to do it.

Join us for a bumper social agenda that is sure to have people talking for months afterwards! Our Thursday night Networking Dinner promises fun and frivolity and is a great way to break the ice with fellow attendees. Friday night’s banquet has a ‘Touch of Scottish’ theme with the return of last year’s sensational Bogus Brothers. There’s plenty of time built in for mingling, and

EQUINE BENCHMARKING AND STRATEGIC DEVELOPMENT Steve Headon, Moore Scarrott & John Goulding, St. Georges Vets The use of key performance indicators is a vital tool for monitoring financial performance.

an exhibition competition to win some great

Veterinary Accountants and Business Development Specialists Moore Scarrott have one of the most significant pools of benchmarking data in the UK, amassed across a wide range of different equine practices from ambulatory practices covering large geographical areas, to specialist practices and mixed practices with a significant equine client base.

it will be live-streamed into the Exhibition

In this session, Steve Headon, a Partner within the Veterinary Team at the firm, will provide an overview of current trends and headline benchmarks and uses this to discuss strategies to improve practice performance.

EQUINE PRACTICE IS DIFFERENT: DISCUSSION INCLUDING PRESIDENT OF BEVA What is the future of equine practice? Will it be even more specialised with even larger practices? Will there still be a place for equine vets within largely small animal practices? Can you afford to invest in expensive facilities and equipment (such as £300K on an MRI scanner)? Is a multipartner practice better than employing vets? How do other practices manage to recruit and keep qualified nurses and 3 -5 year qualified vets? How do they manage their out of hours? Three very different Equine Vets describe their practices and their ethos followed by a Q&A session chaired by Julian Samuelson.

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prizes for you or your practice. The Big Debate will be centred on Maintaining Standards in a Changing World, and for those of you who want to view it in a more relaxed environment, during Happy Hour.

So, go on – book now! Visit www.spvs-vpma-events.co.uk or call 01453 872731

CONGRESS PROGRAMME

Practice Life z December/January 2015 z www.practicelife.biz

CONGRESS PROGRAMME

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HEADING

WHAT’S COMING UP... 2015 REGIONAL CPD, SPONSORED BY

11 February

Training the Veterinary Receptionist, Brian Faulkner

Surrey

4 March

Video-Making for Social Media, Martin Ison

Midlands

5 March

Stress Management for Productive Practice, Carolyne Crowe

Staverton

15 April

Moving Up, Zoetis

Bristol

30 Apr

Focus on Facebook, Susie Samuel

Staverton

6 May

Marketing Masterclass, Nick Steele – Zoetis

Surrey

20 May

Improving Your Bottom Line, Mark Beaney

Milton Keynes

4 June

How to be a Fair, Reasonable and Legal Boss, James Cronin

Midlands

1 July

The Consulting Nurse, Brian Faulkner

Preston

8 July

Appraisals and Recruitment, Helen Frewin

Staverton

15 July

Moving Up, Zoetis

N. Ireland

9 September

Moving Up, Zoetis

Scotland

7 October

Coaching Skills, Nick Steele – Zoetis

Surrey

21 October

Training the Veterinary Receptionist, Brian Faulkner

Preston

4 November

The Colourful Consultation, Brian Faulkner

Harrogate

FOCUS DAYS SPONSORED BY ZOETIS 17 June

Focus on Technology

Staverton

14 Oct

Focus on Human Resources

Midlands

PSS UPDATE IN PARTNERSHIP WITH RCVS 24 September

PSS Update

Coventry

Jump straight into Spring with our March/April issue (out March 6th) Special features: Managing meetings for maximum efficiency Succession Planning Maximising word-of-mouth

Practice Life z December/January 2015 z www.practicelife.biz

just got

Withced an ER h n e K LIV PORavour! fl

NEW Noroclav® Chewables Range Noroclav®, a broad spectrum antibiotic, is now available as a choice of standard or new Chewable Tablets to allow for practices and owners to find the most suitable product for simpler administration. The new pork liver flavour Chewable range includes 50mg, 75mg and also 250mg presentations approved for use in both dogs and cats, whilst the 250mg and 500mg tablets are both suitable for larger dogs. The Noroclav® range can be used to treat the following conditions:

• Skin Infections • Urinary Tract Infections • Respiratory Infections • Enteritis • Dental Infections (Chewable tablets only) 2823-SA(D/C)-v1-UK-06/08/14

For further information please read the product data sheet or contact the manufacturer. Manufactured and distributed in NI by: Norbrook Laboratories Ltd, Station Works, Newry, Co.Down BT35 6JP. Distributed in GB by: Norbrook Laboratories (GB) Ltd, 1 Saxon Way East, Oakley Hay Industrial Estate, Corby NN18 9EX. Legal Category: POM-V Noroclav® contains Amoxicillin (as Amoxicillin Trihydrate) and Clavulanic Acid (as Potassium Clavulanate).

www.norbrook.com

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

Head Office: Calyx House, South Road, Taunton, Somerset, TA1 3DU Telephone: 01823 282100 Fax: 01823 254396

Incorporating:

Bertram Kidson & Co A