Practice Life Magazine Issue 19 March - April 2108

March/April 2018

THE MAGAZINE FOR VMG & SPVS MEMBERS

Blame Culture

Social media

FEAR-FREE PETS

CREDIT CARDS

Your practice can embrace and benefit from the concept

What does the surcharge ban mean for practices?

A look at the alternatives for veterinary practices

How to manage tweeting… from your staff not the pets

THE MAGAZINE FOR VMG & SPVS MEMBERS

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EDITORS’ LETTERS

Editors’ Letters

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well remember sitting in the audience some years ago at the SEVC in Barcelona, listening intently to celebrity vet Dr Marty Becker extol the virtues of what he called ‘fearfree’ practice. The concept was gradually gaining momentum in US veterinary hospitals and I recall feeling enthused that day in Spain but subsequently deflated on returning to the UK when the idea was treated as completely unrealistic and unworkable in a typical British small animal clinic.

Fast forward a few years and I’m en-route to our 2018 Congress where the subject is once again on the agenda and looks set to take UK practice by storm. You can meet Jonathan Bloom DVM in these pages later. This is just one topic on a packed programme at a congress that pleases all.

The rebranding of VPMA to VMG and all that entails will be launched at Celtic Manor and will doubtless cause some consternation.

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elcome to the latest issue of Practice Life magazine, following another phenomenal SPVS-VMG (formerly VPMA) congress in January. We warmly welcomed our new president, Peter Brown, so there’s a new face to our presidential column.

Inspirational speakers covered a multitude of approaches to improving our practices by considering the health, happiness and success of practice owners, managers, employees, clients and, of course, patients.

This issue draws on some of the topics covered including the avoidance of a “Blame Culture”, which directly impacts

By the time this edition of Practice Life hits the stands the changes will be embedded in the industry and VMG will be de rigueur. Our VMG board continues to reflect the way that practice management has changed and improved over the past few years and there is a skill set like never before that promises to offer support and advice along the way for that diverse PM role. Just ask! A personal word of congratulations to our 2018 (and first) VMG President Julie Beacham who I know is really going to relish the challenges ahead.

As ever I hope you enjoy your magazine – can you believe it’s now in its fifth year?

Ian Wolstenholme, VPMA editor

on another hugely important matter, the wellbeing of vets and the practice team. The tragic consequences of failing to deal with these has become all too real for too many of us and, having been deeply affected on a personal level this year, I applaud all the efforts we are making to improve our profession and commend this issue of Practice Life to the thousands of us investing in fixing our amazing profession.

Leigh-Anne Brown, SPVS editor

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

March-April 2018 z Practice Life

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Contents g

UPDATE: NEWS & VIEWS 5

Leigh-Anne Brown, MRCVS

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SPVS NEWS

VPMA

A welcome from new president Peter Brown

Editors SPVS

Ian Wolstenholme, Practice Manager

VMG NEWS

Editorial Team

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Emma Dahm

Julie Beacham –

Publisher Libby Sheridan Mojo Consultancy Ltd Suite 15, STANTA Business Centre 3 Soothouse Spring, St. Albans Herts AL3 6PF Tel +44 (0) 1727 859259 info@mojoconsultancy.com www.mojoconsultancy.com Advertising and Sales Enquiries Libby Sheridan MVB MRCVS Tel:01727 859259

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.

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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.

NURSE TALK

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6

BVNA Council nominations open g

COLLEGE CORNER

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Key strategy milestones reviewed g

WELL-BEING

16

SPVS Wellbeing Awards winners g

VDS NEWS

18

An unfortunate slip of the rug… g

IN THE SPOTLIGHT

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12

Jonathan Bloom on ‘fear-free pets’ g

MANAGING PEOPLE

23

A look at the alternatives to a ‘blame culture’ g

CLIENT CARE AND MARKETING

26

18

Social media policies for practices g

BUSINESS HEALTH AND FINANCE

29

Navigating the credit card surcharge ban g

PRACTICE DEVELOPMENT

29 26

What’s the point of practice strategy? g

© 2018 Practice Life All rights reserved.

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new president, new look for VMG

Sales Administrator Eva Lambe

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CPD SHARED

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US perspective on vets’ wellbeing g

CPD DIARY

Focus Day: Practice Profitability

34 31 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 March-April 2018

News & Views

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Recipients of the RCVS honours awards announced The RCVS honours awards, introduced last year, acknowledge veterinary surgeons at all stages of their career who are undertaking projects and initiatives that have a discernible impact on the profession and/or animal health and welfare and who inspire others with their actions and words.

Jade Statt, founder of the StreetVet project that provides free and accessible veterinary care to homeless pet owners in various cities, is the recipient of the Impact Award. She was nominated by StreetVet volunteer Dr Gabriel Galea, who said her authoritative yet friendly, caring and non-judgemental attitude has made her a favourite with often vulnerable owners, who have grown to trust her unconditionally with their sole companions.

Professor Derek Knottenbelt and Dr Ebony Escalona are the recipients of this year’s Inspiration Awards. Professor Knottenbelt, who is Emeritus Professor in Equine Internal Medicine at the University of Liverpool and Director of Equine Medical Solutions, has been recognised for inspiring generations of veterinary students, residents and specialists within the profession.

Dr Escalona (pictured, speaking at RCVS Day 2017) was recognised for her work as a veterinary advisor at the Brooke equine charity, as the founding member of the Vets: Stay, Go, Diversify Facebook group, which encourages veterinary surgeons to share their experiences and ideas, and for her involvement in the Learn Appeal Project that provides basic veterinary, farriery and husbandry knowledge to rural communities without access to internet connections.

The two recipients of this year’s International Awards are Dr Alemayehu Hailemariam, an Ethiopian veterinarian who does much of the Brooke’s clinical and educational fieldwork in that country, and Rachel Wright who trained as a veterinary nurse in the UK and founded the Tree of Life for Animals (TOLFA) animal hospital in Rajasthan, India in 2005.

The Queen’s Medal, the highest honour the College can bestow on a veterinary surgeon, was given to Professor Peter Clegg, FRCVS, an equine vet who is Head of the Institute of Ageing and Chronic Disease at the University of Liverpool, a multidisciplinary institute engaging in veterinary, medical and biomedical research relating to musculoskeletal biology and ophthalmology.

All awards will be bestowed at RCVS Day 2018 on Friday 13 July. This year no nominations were received for Honorary Associateship or the Veterinary Nursing Golden Jubilee Award.

ROYAL CANIN® Pet Health Counsellor of the Year Announced ROYAL CANIN’s Pet Health Counsellor of the Year was named as Cheryl Aslett, a Registered Veterinary Nurse from Whitstable Bay Vets. 13 finalists celebrated at a special award ceremony earlier this month.

Cheryl was applauded for building up a practice from nothing to over 1,500 active clients in one year. Her role has seen her coordinate information evenings for customers, set up Skin Club; for which she also won the Most Innovative Clinic Award, L-R - Claire Hansley (Regional and organise a Christmas market in the Sales Manager, Royal Canin), Cheryl Aslett (RVN & Winner grounds of the practice. Her outstanding of PHC Award) & Kamala entry was praised by the judges for its Beasley (Veterinary Business Manager, Royal Canin) presentation and interesting content.

Along with taking the top title of the night, Cheryl was awarded £1,500 prize money.

Clare Hemmings, Scientific Communications Manager at ROYAL CANIN, said: “This year’s Pet Health Counsellor Awards were bigger than ever before. We received many entries across eight categories from individuals and practices who go above and beyond to help educate owners and improve the lives of their cats and dogs.”

The ROYAL CANIN Pet Health Counsellor Awards saw Veterinary Nurses across vet practices around the UK submit entries to categories including; Most Innovative Clinic, Practice of the Year, Brand Ambassador and Biggest Client Impact. The finalists all celebrated with a glitzy event at Crewe Hall Hotel in Cheshire.

2018 winners: Pet Health Counsellor of the Year 2018 – Cheryl Aslett Outstanding Contribution to Pet Health Counselling – Clare Cartwright PHC Practice of the Year – The Laurels Veterinary Group, Georgia Bristow and Emma Collins Most Innovative Clinic – Cheryl Aslett Biggest Client Impact – Claire Grant Biggest Business Impact – Leanne Bond Most Promising Newcomer – Charlotte Turpie Best Use of Social Media – Natalie Weston

For more information and to register interest for next year’s competition, visit https://vetportal.royalcanin.co.uk/cpd/he/

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SPVS News President’s Welcome

Peter Brown

Following the excitement of the SPVS/VMG Congress, February feels like a relatively quiet month. I’ll be glad of the opportunity to get used to the role of President and have seen that Claire has already been busy posting my picture on the SPVS Facebook

and Twitter pages.

Anyone who has had dealings with the SPVS Office will already appreciate that Claire, Sally and Sarah between them do an awful lot behind the scenes to make sure everything runs smoothly, including patiently and tactfully chasing up board members who have a duty to perform. An example is writing this column! The Society would grind to a halt without this fantastic group in the office.

In April 2017 the office team was joined by Nichola, our Executive Director, and I hope some of you were able to make her acquaintance during Congress. Nichola has experienced a steep learning curve, with the realisation that the phrase ‘like herding cats’ did indeed originate in the veterinary profession, but she is already enhancing the value of our office team.

Nichola’s appointment led us to look at the structure of SPVS Council too. It was originally intended that Council members would undertake tasks such as planning CPD and producing our journal, but they had to juggle this around practice commitments, and we have increasingly found it more efficient to outsource the work to specialist companies.

At this year’s AGM we voted to reduce the size of Council and restructure it as a single-tier board. This will not only reduce the costs associated with Council meetings, but also help us deliver services to our members in a more effective and transparent manner.

The restructure will certainly make my job as President a lot easier, and one of my tasks will be to ensure that the new structure beds in well. Good communication is the key, of course, and I am particularly keen to ensure that not only do we keep you, our members, informed of what the board is doing on your behalf, but also that we listen to your comments and concerns, so we can adequately address your needs and accurately represent your views to the various veterinary bodies with which we meet throughout the year.

You can find me on the SPVS forum hosted by Vetpol and our email discussion list and of course there’s Facebook (@ SPVSvets) and Twitter (@SPVSPres) too. Or if you prefer, you can email me on president@spvs.org.uk As a board, we want to ensure that SPVS serves all its members well, and we look forward to working with you over the coming year.

SPVS Dates For Your Diary 2018 May 8 - 9 SPVS Leadership Academy SPVS Leadership Academy covers important areas for business success, such as financials, understanding clients, performance management, recruitment and retention, culture and operational effectiveness.

President’s Peaks Join SPVS President Peter Brown as he climbs five of the highest peaks around the UK, meeting local SPVS members and raising money for Vetlife, Vet Trust (Scotland) and Vet Support NI. May - Walbury Hill June - Kinder Scout and Snowdonia July - Scafell Peak

July 6 - 8 Lancaster Student Seminar July 17 SPVS board meeting For further information about any of these events visit www.spvs.org.uk or contact the SPVS office by email office@spvs.org.uk or telephone 01926 840318

Peter Brown, SPVS President

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SPVS NEWS

Nichola Watson, SPVS Executive Director AGM, awards, academies and a new president! It’s been a full few months since my last column; I attended my first SPVS-VMG Congress, which was extremely interesting, and I was grateful for the opportunity to meet many members and stakeholders face to face.

The costumes for the banquet were fantastic, and I must say that I felt very welcome by everyone I met and chatted to.

The highlight for me was Brian and Renay’s Tango – now that must have taken some serious practice!

As many of you will be aware, at the AGM a proposal for a council restructure was passed. Thank you to Kathleen Robertson, Stephanie Writer-Davies and the secretariat for working with me in getting this off the ground. We will be holding our first official ‘board meeting’ in April and look forward to letting you all know about the progress made.

Also, thanks to the hard work of our team and our now SVP, Brian Faulkner, we have two new member services on offer: our Leadership Academy, to be delivered by Mike Claire and Carol Foussat – sponsored by VetShare. This is a great opportunity to receive a high-level education in business and leadership within the veterinary industry, giving vet practice owners the vital tools needed to compete in this rapidly shifting landscape, with the aim of bridging the skills gap between veterinary and business expertise.

Also new to 2018, GradTrack! A Graduate Academy we’re running in conjunction with VDS. A programme of eight specialised workshops for graduates working in independent practice, which includes an initial one-day coaching and mentoring workshop for employers who have a graduate on the course. Information about these academies are available via the SPVS website so please take a look.

With the enforceable GDPR date approaching in May, many of you may be questioning how you will be tackling this. We have information available on both our website and our forum for you to see, please contact me via the office if you would like to talk through our current member support options for GDPR. My year anniversary is fast approaching and when I sit and reflect on this, I can’t believe it has been that long. The learning curve has been steep and continues to grow – but I have truly enjoyed the opportunity to work with such supportive and professional teams and individuals.

I will endeavour to keep pushing forward with the development of member benefits and hope to see many more of you over the coming months at our various CPD events.

In the meantime, if you would like to get in touch, have a chat or pose some questions, please email me!

Keep smiling Nichola nichola.watson@spvs.org.uk

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Peter’s Presidential Peaks

SPVS’ new President Peter Brown is determined to scale new heights this year, but following in former president Brian Faulkner’s impressive 10-marathon footsteps means he’s facing a steep climb ahead…

It’s a tough act to follow, and running just one marathon, let alone 10, didn’t exactly appeal to incoming president Peter Brown.

“I wanted to do something to mark my presidential year. SPVS has a new Executive Director and a new board and it is important to me that they communicate effectively with our members,” he said.

Thus, the idea of reaching out around the UK while simultaneously raising money for charity was born.

Peter enjoys walking, so a friend suggested he could climb the highest points of each of the UK’s four countries. However, as he pointed out, they’re all concentrated towards the north of the UK. “So we decided to include the highest points in the Midlands, the south-east and the south-west as well, effectively covering each of the UK’s main regions,” he added.

Peter’s aim is to visit each of the peaks between Spring and Autumn of 2018 and he will be raising money for Vetlife and Vet Support NI. But he would love other vets and practices to be involved too.

“Details of the walks will be on the SPVS website so if you’d like to get in touch to fundraise, join a walk, or get together afterwards, please let us know via the online contact form.”

Peter hopes that as well as raising funds for a very worthwhile cause, the event will provide an opportunity to meet up with SPVS members up and down the country.

“I’m very happy just to have a sociable chat over a drink, but it’s also a chance for us to talk about what the new board is doing on their behalf and ask what members need from their Society.”

SPVS will be emailing its members as the various walks are organised, but if you’d like to find out more about the President’s Peaks fundraising event, visit the website www.spvs.org.uk/presidents-peaks

VMG News President’s Welcome This is my first column as Veterinary Management Group (VMG) President and there are two important things to say at the outset. Firstly, a very big thank you to Renay Rickard for all her hard work and many achievements as President over the past two years. I have big shoes to fill but I am honoured to be chosen and will do my best to carry out my role in leading the VMG during my time in office. The second is to thank those who work tirelessly for the organisation, namely the members of the VMG board, and Maria and Cath who make up the VMG office team.

In case anyone is puzzled by the sudden change in name, the newly rebranded VMG was launched at Congress in January and VMG is now our trading name as this best represents who we are and what we do. The incredible changes in the veterinary industry in recent years have created new and diverse management roles and we want to appeal to everyone involved, not just practice managers but also those leading client care, nursing or vet teams.

For those of you who don’t know me, I joined my veterinary practice in 1995 as a part-time member of the reception and admin team when I ventured back into work after maternity leave. It was supposedly for a year before returning to a ‘proper job’ in human clinical research but I had always wanted to work in the veterinary world and knew instantly it was where I belonged. Over time, I took on further responsibilities, joined the VPMA, became Practice Manager and studied hard to gain my CVPM. I was asked to join VPMA Council in 2011 and the rest, as they say, is history.

In the run up to becoming VMG President, the question I have often been asked is whether I have a particular aim or theme for my time in office. With some new board members, our rebrand, new website (www.vetmg.com), and GDPR to contend with, no extra projects are required, but the subjects closest to my heart are education and mental health.

Encouraging VMG members to build their management skills has been a particular passion since I gained my CVPM in 2010 and I was a member of the Certification and Training Committee from 2011 to 2017.

My interest in mental health stems from my former life in human healthcare and also from seeing the toll that veterinary life can take on talented and dedicated people, including some good friends. I represent the VMG on the RCVS Mind Matters Initiative Taskforce and feel proud to be part of something that is already making a difference in educating practice managers, who are so often the gatekeepers of wellbeing for their teams, and making us all think and talk about mental health much more openly. More flexible working patterns and increased access to support will hopefully enable people to stay in the profession and enjoy their chosen careers.

The popularity of the mental health stream at our joint VMG/ SPVS Congress every year is testament to how important this has become.

It is hard to believe that it is already a month since Congress, at the time of writing, and I’m sad it’s over for another year.

The feedback from so many people who attend is very positive and I would like to thank Jenny Stuart and the team from Keystone who make it such a fantastic event, with CPD to suit all tastes and levels of experience, plus a great social programme. If you missed it, you missed a treat, but we at VMG have many other events planned throughout the year and I urge you to join in and meet fellow members.

There are not only the joint CPD days with SPVS, which are held at venues across the country, but also a programme of Regional Roadshows where you can network with other local members while learning about some key topics at very reasonable prices. We hope to meet you at one or more of these events.

My first official duty as VMG President was as part of the judging panel at the Petplan Veterinary Awards. It was an inspiring and enjoyable day, although it was so difficult to choose with so many great nominations. In judging the Practice Manager category, I felt very proud of those shortlisted and the difference that we as managers make to our practices. We don’t often get thanked as so much of our work is behind the scenes, but we are often key to enabling everyone else to do their jobs and creating efficient and successful practices.

So keep up the good work, but do have a break to read this issue of Practice Life! There is always something interesting and new to learn.

Julie Beacham, BSc(Hons), CVPM VMG President

Find out more about the CVPM! Have you thought about taking the Certificate in Veterinary Practice Management but were unsure what was involved or if you were ready?

Visit www.vetmg.com for more information.

VMG is pleased to offer the following opportunities to find out more about the qualification and ask questions of the examiners. The workshop is also a

great opportunity to meet like-minded managers and share ideas and thoughts on management training needs.

Join us on our workshop, free of charge to attend.

The workshop starts at 10.30am and finishes by 1pm.

Saturday 19th May – register by Friday 11th May 2018 Goddard Veterinary Group, Claygate House, Manor Road,

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VMG NEWS

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CATH GRIMSEY REGIONAL COORDINATOR

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ince the launch of VMG at Congress 2018 there has been a real buzz and excitement around how the regional structure will look! A new initiative, the Regional Roadshows, has been introduced and engagement is at an all-time high.

The concept is that three topical lectures will be delivered across our regions, throughout 2018.

Our first Regional Roadshow, Effective Credit Control within the new GDPR Regulations, presented by VMG and Mike Brooks of dsl (UK) Ltd, is well underway with meetings in Basildon (Essex region), Newton Aycliffe (North East region), Grantham (East Midlands region) and Bury St Edmunds (East Anglia region) having gone down a storm. Before the middle of April 2018 this roadshow will also go to Stockport, Bromsgrove, St Helens, Rotherham, Cardiff, St Asaph, High Wycombe, Worthing, Maidstone and Aberdeen. Don’t miss out as some meetings are selling out quickly, so visit www.events-by-vmg.co.uk to register.

VMG members of course get a preferential rate.

Our Regional Organiser for East Anglia, Tamsin Swain, shared her experiences of this session: ‘A very animated meeting was held by the VMG East Anglian region on February 16 at the Active Business Centre in Bury St Edmunds. Mike Brooks of dsl (UK) Ltd was an extremely knowledgeable and approachable speaker who could relate directly to the veterinary management setting – providing countless examples and suggestions that everyone found useful. The advice offered regarding the new data protection regulations was welcomed but daunting; many quizzical and terrified glances between delegates were exchanged with eyebrows well exercised!

‘As this was only a relatively small group with confidentiality assured, delegates were happy to share suggestions, experiences and concerns, which provided an excellent support framework to all.

Requests for a review were put forward so that mutual support could be provided, particularly for those in independent practice, who were the majority represented, and may not benefit from group or corporate support.

‘Feedback at the end of the event was good and all questions were answered with attendees being thoroughly involved in the meeting and appreciative of the learning and networking opportunity.’

From April to July 2018 we will be ‘road showing’ the next topic, Practice Performance and Culture, with the assistance of the professional ladies at VetLed (see page 34) and finally, in autumn 2018, we will be partnering with the Blue Cross to bring you support in delivering gold-standard client care in that hardest of situations; end of pet life.

Registrations are open via www.events-by-vmg.co.uk for roadshow two and keep an eye on our wonderful new website www.vetmg.com for all the latest dates and more info on roadshow three!’

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: secretariat@vpma.co.uk EAST & WEST SUSSEX Liz Panter Tel: 07877 672351 ro7@vpma.co.uk

CHESHIRE/DERBYSHIRE Kate Mincher Tel: 01663 745294 ro2@vpma.co.uk CHILTERN HILLS Jerry Crick Tel: 07771 573762 ro24@vpma.co.uk EAST ANGLIA Tamsin Swain ro6@vpma.co.uk March-April 2018 z Practice Life

ESSEX REGION Liz La-Page Tel: 07772 382465 ro22@vpma.co.uk THE MIDLANDS Julia Barham Tel: 07974 794687 ro3@vpma.co.uk KENT REGION Siobhan Park Tel: 07849 773 152 ro23@vpma.co.uk

NORTH EAST/CO. DURHAM Claire Bake Tel: 01388 602707 ro16@vpma.co.uk NORTH WEST REGION Janet Hughes & Janie Clare Tel: 07964 505226 ro17@vpma.co.uk SCOTLAND NORTH EAST Michelle Murphy & Stephanie Simpson Tel: 07841 417610 or 07900 923398 ro25@vpma.co.uk

SOUTH WEST Suzanne Headington & Renay Rickard Tel: 01242 680000 or 01208 872254 ro20@vpma.co.uk WALES Linda Mogford Tel: 07891 176572 ro5@vpma.co.uk WEST MIDLANDS Rebekka Fiorani ro1@vpma.co.uk YORKSHIRE Lisa Winter Tel: 0777 268 2617 ro8@vpma.co.uk

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VMG NEWS

A tribute to Iain Lorraine

NEW YEAR, NEW LOOK

AS VPMA REBRANDS AS VMG

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he Veterinary Practice Management Association (VPMA) has changed its trading name to the Veterinary Management Group, or VMG. The organisation’s new branding was revealed during Congress in January, after members were informed of the change in December.

The group’s Board, led by outgoing president, Renay Rickard, and in-coming president, Julie Beacham, made the name change to better reflect the diversity of the organisation’s membership and promote inclusivity.

VMG has a new logo and strapline, Learn, Share, Grow, to emphasise the values at the heart of the organisation.

An accompanying website has been launched, which includes a dedicated members’ area, where CPD resources and management protocols can be accessed. VMG has expanded its social media presence to include LinkedIn in addition to Facebook and Twitter.

Renay said the group has seen veterinary business management models evolve and its membership expand to include a wide range of skills and experience from inside and outside the profession.

‘We are seeing a trend where the veterinary practice manager role is now complemented by – and in some cases superseded by – tiers of team leaders, many with management responsibilities and interests. This is reflected in our membership, which is increasingly diverse. We have growing numbers of members from the clinical side of practice, such as head nurses and vet team leads, as well as involvement from front-of-house and administration teams. In larger group practices, we have operations staff, marketing managers, finance teams and so on all joining up.

‘Part of the success of our organisation is that we have attracted and catered for these diverse roles. Our New to Management series of CPD webinars last year was one example, and we will build on this in 2018, adding new content. This year will also see a new structure for our regional group meetings, with roadshows and day events.

‘This diversity in membership brings vibrancy and new ideas with it, vital to the life-blood of any organisation. Our aim is to be inclusive and cater for the needs of anyone with an interest in management through development and support.’

Visit the website for more information www.vetmg.com

Iain was a past president of VPMA and served on council for many years. Sarah Hibbert, VPMA pastpresident 2007-2009 pays tribute.

VMG was saddened and shocked to learn of the death of past president Iain Kennedy Lorraine. Iain was VPMA president in 2009-2010 and served on council for eight years. His time as president was particularly notable for seeing council adopt incorporation at the 2010 AGM and launch a new member benefit in the form of an online forum hosted by Vetpol. Iain will be sorely missed by his friends, family and colleagues but he will always remain in my memories as the ‘gentle giant’ of council.

Iain had a great physical presence, being well over 6ft tall, well-built and strong. In manner he was gentle and careful – always listening, being considerate to others and never jumping to conclusions. He had a talent many of his council were envious of – he not only understood IT but he also loved it! This love came in handy in 1999 when Iain was practice manager at Penbode Vets in Devon.

Andrew Cobner, one of the partners, said: ‘There must be a better way to do this, Iain. We seemed to be wading through a sea of paperwork that is threatening to swamp us at every turn.’

And so, over the next two years, Iain and Andrew worked together to develop an easy and efficient way for both vets and practices to record TB results. The result was TB Master from Lilac Technology and the dream became an integral part of farm practice life.

Iain was my junior vice-president for two years (20072009) and during this time we worked closely with our fellow officers – one of whom was the diminutive Glynne Davies, MRCVS, treasurer. The sight of Glynne and Iain walking together would always bring a smile to faces and their differences in stature led the pair to be nicknamed ‘elf & safety’! Sadly Glynne too is no longer with us but the thought of Glynne and Iain being reunited is something that many of us will enjoy.

Iain will be sorely missed by his friends, family and colleagues but will always remain in my memories as the ‘gentle giant’ of Council. He died on December 30, 2017, aged 65 and our thoughts are with his friends, family and colleagues.

Practice Life z March-April 2018

PHOTO ROUNDUP: SPVS-VMG CONGRESS 2018

Louise Brennan, Royal Canin discusses making the most of your nurses

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Brian Faulkner, outgoing SPVS President, and Renay Rickard, outgoing VMG President in the opening ceremony

Cabaret act Dylan Townley from Peablossom Cabaret

RCVS’s Chief Executive Officer Lizzie Lockett and Catherine Oxtoby discuss learning from excellence

Opening speaker Benjamin Mee from Dartmouth Zoo

SPVS Board council members do the can-can at the Moulin Rouge themed banquet

Banquet guests Jacqui Molyneux and Nick Stuart

Leadership guru, Andy McCreadie

March-April 2018 z Practice Life

Nurse Talk

In association with

NOMINATIONS OPEN FOR BVNA COUNCIL The British Veterinary Nursing Association is calling on its full (RVN) and student members to stand for election to BVNA Council. There are two full council and three student places available on the 2018-2019 Council.

Attributes for candidates include a strong commitment to promoting BVNA ideals as well as the veterinary nursing profession in general and a willingness to devote time and effort to representing fellow members. Potential candidates are encouraged from all aspects of the profession – clinical practice, industry, research, corporate and the charity sector.

If necessary, an existing BVNA Council member will second your nomination. In the event of a second nomination being received for the same nominee, this will be accepted as also having seconded the initial nomination.

Nominees will be contacted to confirm their willingness to stand for election and will be asked to submit a brief manifesto and a passport-sized photograph. The nominees, their

manifestos and photographs will be published within BVNA’s publication, VNJ, and on the BVNA website. The results will be announced and ratified at the BVNA’s AGM to be held on Sunday October 14 at Telford International Centre, Telford, Shropshire.

An online nomination form can be found by vising the BVNA website www.bvna.org.uk and nominations must be submitted no later than April 30, 2018.

Please consider joining BVNA in shaping the future of our profession!

SCHEDULE 3 CONSULTATION The RCVS has conducted a consultation into Schedule 3 to find out how vets and nurses understand and interpret this part of the Veterinary Surgeons’ Act in everyday practice, how it could be clarified and how it might be amended to bolster the veterinary nursing profession.

Around 35 per cent of RVNs and SVNs responded to the College’s survey, along with 21 per cent of veterinary surgeons. This was considered a great response to what is a highly talked about and debated aspect of the role of veterinary nurses in practice.

The consultation report has been published and the results indicate that an overwhelming majority of both RVNs and veterinary surgeons agreed that veterinary nurses should be able to undertake additional areas of work.

The top five most frequently performed tasks as cited by respondent veterinary nurses were as follows: 1. infection control; 2. administration of medicines by subcutaneous injection; 3. administration of medication; 4. monitoring of anaesthesia; and 5. administration of medicines by intramuscular injection.

Other results from the survey indicated there could be a general lack in confidence when it comes to understanding what tasks can be delegated to registered veterinary nurses and student veterinary nurses.

BVNA would like to see the tasks currently listed under Schedule 3 incorporated into the day-to-day role of RVNs instead of being listed as an exception. BVNA is also delighted to see the results of the consultation as discussions around Schedule 3 were a big focus

BVNA is calling for Schedule 3 tasks to be incorporated into the daily role of RVNs.

in the VN Futures project last year. The association will continue to represent its members’ views on the RCVS Legislation Working Party, which will be looking at potential changes to the framework of veterinary legislation, including how it applies to veterinary nurses and paraprofessionals.

Practice Life z March-April 2018

NURSE TALK

13

VN Knowledge BVNA would like to take this opportunity to remind members about VN Knowledge, an online platform that offers VNs help with CPD. The BVNA’s platform contains a range of webinars available to members to watch at their own convenience in just a few clicks!

There is something for everyone, whether a small animal VN, equine VN or exotic VN. A selection of our latest webinars include: • setting up a foal ICU; • breed-specific legislation and dog bite intervention; • VN’s role in supporting owners caring for elderly cats; • working as a locum VN; • how to set up and market nurse clinics; • the nurse’s role in colic workup; • anaphylaxis; and • development of feline behaviour.

If you are a VN who has missed the BVNA Congress over the past few years, the VN Knowledge platform also hosts recordings of some congress streams. There is a chance to hear excellent speakers on topics such as surgical nursing, behaviour, ECC, infection control and anaesthesia.

Even if you are not yet a BVNA member, you can register for free webinars that include the Merial sessions: worrying worms, Preventive health and the role of the VN, and Troublesome ticks.

CPD hours gained can be securely recorded on the RCVS VN PDR site – there is even a webinar tutorial on the VN Knowledge portal on how to do that!

MATERNITY MATTERS FACTSHEET UPDATED BVNA Council has updated the association’s fact sheet on maternity matters. This is part of a series of employment factsheets produced by BVNA in association with its Members’ Advisory Service.

According to BVNA, if you are pregnant or a new mother, you should be able to continue working and developing your career as a vet nurse should you wish. The BVNA’s updated factsheet provides advice in relation to health and safety issues at work for new and expectant mothers, maternity rights and advice on returning to work. The factsheet details maternity and paternity leave, shared parental leave and unpaid parental leave.

For women who have just discovered they are pregnant the factsheet includes details on the following: • regulations that protect the health and safety of new and expectant mothers; • when to tell your employer that you are pregnant or a new mother; and • risks that you may be exposed to including x-rays, anaesthetics and handling animals.

The information sheet also includes a section on frequently asked questions to cover many of the more common topics raised around maternity matters.

For this and other factsheets from the series visit the BVNA members-only section of the website, where they are available for download https://www.bvna.org.uk/ members/members-area March-April 2018 z Practice Life

Buying groups’ memberships declined by 5%* this year, predominantly through the sale of veterinary practices to acquisition companies. The impact of a shrinking member base means less purchasing power for most buying groups.

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(*5% decline from GFK data)

College Corner

BUSY YEAR KICKS OFF AT SPVS/VMG CONGRESS Much of the RCVS’s work that has been set out for 2018 was reflected in the agenda at this year’s SPVS-VMG Congress at Celtic Manor, where technology and practice culture were key items being discussed.

T

his year is a crucial point for the College’s three-year Strategic Plan 2017-19 – not only is it the half-way point, we are also poised to start fulfilling some of our most ambitious aims and root-and-branch reviews of many of our core services.

Key priorities for the College include developing an evidencebased series of actions that the veterinary team can undertake to establish a learning culture; reviewing the impact of the Mind Matters Initiative to ensure it is mitigating the effects of blame culture and is well-resourced and thus able to address issues around mental health; and, establishing a regulatory framework for the management of new technologies and innovations.

Improving practice culture and reducing stress During a Mind Matters stream hosted by Dr Max Pemberton, a psychiatrist, journalist and author, speakers addressed a number of issues, including recovery from mental ill-health, team cohesion, building resilience and team management.

The stream also saw the launch of a new joint publication between the Mind Matters Initiative and Dr Elinor O’Connor, senior lecturer in occupational psychology at the Alliance Manchester Business School, which aims to increase the accessibility and acceptance of mental health support and encourage a culture that better equips people to talk about stress and other mental health issues.

Using case studies of practices that won last year’s MMI/ SPVS Wellbeing Awards for their dedication to improving their work culture and environment, the Guide to Enhancing Wellbeing and Managing Work Stress in the Veterinary Workplace also provides practical tips on how to intervene if someone is experiencing high levels of stress, how to manage high workloads and personal and career development.

A digital version of the publication is available to download from the Mind Matters Initiative website (www. vetmindmatters.org) and which also signposts readers to relevant resources and organisations that can offer assistance, such as Vetlife, Mind and the Health and Safety Executive.

RCVS’ CEO Lizzie Lockett participated in a group discussion, entitled Learning from Excellence, which looked at how the veterinary professions can develop a learning culture that allows professionals to learn from mistakes and improve their practice.

Campaign anniversary On the mental health front, February was the first anniversary of the ‘&me’ campaign – a joint endeavour between the Mind Matters Initiative and the Doctors’ Support Network, which

encourages senior figures from the veterinary, medical and other healthcare professions to talk openly about their experiences with mental ill-health. By speaking about their own struggles, it is hoped that senior professionals will encourage students and more junior members of staff experiencing or worried about mental health issues to seek appropriate support.

The campaign was launched at the Palace of Westminster last year by Labour MP Kevan Jones, who has spoken about his own experiences with depression. The occasion also saw testimonials from Dr Louise Freeman, vice-chair of the Doctors’ Support Network, and RCVS Council member David Bartram who spoke candidly about his former history of suicide attempts.

Following the campaign’s launch, a number of other medical and veterinary professionals have stepped forward to share their stories, including Rob Pettitt, senior lecturer in small animal orthopaedics at the University of Liverpool and Steve Carter, director at Priory Veterinary Surgeons. After being posted on Facebook, Rob Pettitt’s story hit a nerve and reached almost 25,000 people, drawing lots of supportive and positive comments from current and former students of his as well as colleagues.

The campaign is continuing to roll on and we are still looking for veterinary contributors who are happy to talk about their own experiences to encourage others not to feel stigmatised and to seek appropriate help. If you are interested in sharing your experiences email Dr Louise Freeman on vicechair@dsn.org.uk Further information about the campaign – including a full list of blogs – is available to view at www.vetmindmatters.org/ we-all-have-mental-health/ Practice Life z March-April 2018

COLLEGE CORNER

Tech talk Following the launch of the College’s ViVet innovation project last autumn, we are now in the process of looking in-depth at how technological innovation impacts veterinary practice and the role the College can play in both encouraging veterinary innovation and ensuring that it does not have a negative impact on animal health and welfare or public health.

The driving mission behind ViVet is enabling creative veterinary solutions for the good of animal health and welfare by ensuring that the veterinary professions are at the centre of innovation in the animal health sector. To do this we are using the project’s dedicated website (www.vivet.org.uk) to showcase examples of best practice in both innovation and regulation and feature expert blogs from those at the coal-face of innovation.

The site will also host resources that will help innovators better understand the veterinary professions and veterinary professionals to engage in innovation.

At SPVS-VMG Congress our senior vice-president Chris Tufnell, who is responsible for running the ViVet project, spoke about his personal experiences of disruptive innovation within equine practice. Chris cited the impact of ‘disruptive’ ambulatory practices on traditional equine practice and offered advice on how practices can turn disruption to their longterm advantage.

If you have examples of how disruptive innovation has had an impact on your practice and how you have either adopted or adapted to it, we would be interested to hear from you as a potential contributor to the ViVet website.

Contact Anthony Roberts, director of leadership and innovation, on a.roberts@rcvs.org.uk

Promote your PSS practice And last but certainly not least… we also have an exciting development for practices within our Practice Standards Scheme (PSS) with the launch of a dedicated Communications Toolkit. This document is intended to help the veterinary team tell their local community all about their hard-won RCVSaccredited status and what it means in terms of the quality and standard of service they can expect from a practice that has been through the PSS approval process.

The toolkit includes guidance on how to communicate with local media, how to effectively use social media to promote services, organising events and the best use of pictures and video as well as promoting a range of marketing materials (including signs, literature and newsletters) that can be displayed by practices to show off their RCVS-accredited status. It is available to download from www.rcvs.org.uk/pss

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WELL-BEING

VET WELLBEING AWARDS WINNERS The winners of the four Vet Wellbeing Awards categories were announced during the SPVS-VMG Congress in January. The awards, now in their third year, attracted record entries, which increased by 50 per cent on last year.

The Awards, run by SPVS and the RCVS Mind Matters Initiative, were created to acknowledge practices that demonstrate an understanding of the importance of motivating and engaging their teams and that demonstrate their commitment to becoming a better place to work.

Winner of the small practice category was Meadows Farm Vets, Bromsgrove, the medium practice award went to Viking Vets in Bristol and joint winners of the large practice accolade were Blacks Vets in Dudley and White Cross Vets in Leeds.

Group shot of all the awards winners.

Lizzie Lockett, RCVS CEO, was one of the judges. “What came through, particularly with our four winners, was the authenticity of their approach. We really felt these practices had created a culture of wellbeing in their teams rather than just ticking boxes,” she said.

Awards founder Nick Stuart said he was impressed with both the quality and quantity of the entries this year.

“Excellent communication and a supportive workplace are essential elements and the winners were able to demonstrate both of these attributes. We were delighted to see entries up by 50 per cent compared to last year, which I hope shows that more and more practices are putting their team’s health and wellbeing high up the agenda,” he added.

Joint winners of the large practice award were White Cross Vets and Blacks Vets.

The awards were presented during the opening ceremony of the SPVS-VMG Congress on January 26 and the winners took part in a panel discussion about how to build team cohesion and resilience in practice.

Full results and case studies are available on the Vet Wellbeing Awards website, www.vetwellbeingawards.org.uk

Bristol’s Viking Vets won the medium practice category.

Meadows Farm Vets won the small practice category.

Practice Life z March-April 2018

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VDS News

RUG DOCTOR Fred was steadily working his way towards the end of evening surgery when he spotted an odd-looking character sitting in the corner of the waiting room clutching a wicker basket. Beyond a fleeting hope that his colleague might draw the short straw, he thought no more about it until the said gentleman entered his consulting room, the basket still firmly embraced.

I

t was his exceedingly black hair which aroused Fred’s curiosity, as the face underneath it suggested the he was past the first flush of youth. The owner explained that his cat was very flighty and had almost succeeded in escaping from the basket on the way to the practice, so Fred summoned one of his nurses to provide additional restraint. As he prised open the lid the cat rose vertically, as if rocket propelled, shot up onto his shoulder and then leapt onto the top of the cupboard when he kept various drugs and instruments. It wedged itself back against the wall, and howled the feline equivalent of, ‘Come on, if you think you’re hard enough!’

Without really thinking quite what he was going to do next, Fred reached for the floor brush in the corner, with the intention of dislodging the cat back into the playing area.

At the same time the owner stepped forward making comforting noises, and the cat promptly leapt on to the owner’s head. It was at that point Fred’s suspicions were confirmed.

The owner was wearing a wig. What happened next seemed to unfold in slow motion. The wig slipped one way and the cat scrabbled the other, then launched itself towards the venetian blinds which covered the window. The nurse instinctively lunged forward, beating the cat by a whisker, and pulled the string which closes the louvres. This caused it to lose its grip on the blind and it fall to the floor with a thud. It was immediately very lame on a hind leg, and Fred succeeded in catching it in a towel and transferring it to one of hospital cages.

Unfortunately, it transpired that the cat had fractured its tibia, which was going to require surgical repair. However, the owner flatly refused to pay for the operation on the grounds that it was Practice Life z March-April 2018

VDS NEWS

Fred’s fault it had escaped in the first place. Moreover, he was also threatening to sue for the cost of a new wig. Fred had no idea what to do next, so he rang VDS for advice.

The consultant he spoke to was sympathetic and advised that this was one of the well-known but unpredictable hazards of small animal practice, although not perhaps often involving the dislodging of hairpieces. However, under the circumstances, it was hard not to have some sympathy with the plight of the owner, who had brought his cat in to have its tail examined, but was now faced a bill of several hundred pounds. However, should the matter end up going as far as a court hearing, it was difficult to see how Fred could be considered negligent, it had to be admitted that in the consulting room the veterinary surgeon is in charge, and in this case might have been expected to have anticipated an explosion of fireworks, as the owner had warned. Fred said he was intending to offer to repair the leg free of charge, but was concerned that it would automatically be construed as an admission of liability. The consultant advised that it is perfectly acceptable to waive or reduce fees, as long as it is made clear that it is purely a goodwill gesture, without any admission of liability, and the client could be asked to sign a consent form to this effect.

Thankfully, the cat made an uneventful recovery, and a couple of months later Fred rang his VDS consultant to tell him he could safely close his file. He also imparted the information that The Rug had not been seen since. His client had elected to remain as bald as a coot.

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March/April 2018

THE MAGAZINE FOR VMG & SPVS MEMBERS

Blame Culture

Social media

FEAR-FREE PETS

CREDIT CARDS

Your practice can embrace and benefit from the concept

What does the surcharge ban mean for practices?

A look at the alternatives for veterinary practices

How to manage tweeting… from your staff not the pets

THE MAGAZINE FOR VMG & SPVS MEMBERS

March-April 2018 z Practice Life

19

If you’ve picked this magazine up in the practice office but aren’t yet a SPVS or VMG member, then why not join? You’ll receive lots of benefits, enjoy meeting a like-minded bunch of friendly people and help support your colleagues!

READ MORE AT WWW.SPVS.ORG.UK and WW.VETMG.COM

20

IN THE SPOTLIGHT

in the Interview with Jonathan Bloom

Fear-free pets Jonathan Bloom regularly delivers speaker tours around the US helping vets understand the concept of ‘fear-free pets’ and how doubling consultation times can bring financial gains to practices. He talked to Libby Sheridan at the SPVS-VMG Conference Background Jonathan is a practising vet based in Toronto and, despite spending time delivering lectures across the vastness of North America, his true love remains his clients and routine veterinary work back in practice. He also owns six practices in the Greater Toronto area together with several partners.

The success of his veterinary hospitals has led to his public speaking engagements, which focus on reducing anxiety and stress for pets, owners and staff to create ‘the best experience imaginable in practices.’

He explains how that concept came out of general practice and seeing what was going on in real life and realising that there’s a problem in veterinary medicine.

‘There’s a lot of what we’re doing that we could be doing a lot better and, just because we’ve been doing it the same way for 20 years, doesn’t make it right. Look at how we do nail trims… veterinary medicine is the only industry with a 100% injury rate. People love to get their nails done and it’s a beautiful experience that you pay lots of money for, you feel relaxed, your nails look wonderful.

‘But in veterinary medicine you claw away and you hiss and spit and urinate on the person cutting your nails… what happened? The cat isn’t objecting to its nails being trimmed, it’s objecting to the process.’

According to Jonathan, it is a situation practices have created themselves. Those cats are not nervous at home, they’re nervous when they visit the vet, and it’s a learned response. Jonathan looks at how we create better experiences for pets, so we can take blood samples and do disease screening rather than send a pet home without that test being done.

Also, he says, physiological changes occur within an animal as a result of anxiety and stress experienced while visiting the veterinary practice. For example, elevated blood sugar – you often hear that a cat might be diabetic and that it will need special food, requires regular tests and will need to be on insulin for the rest of its life. Or, as he sees it, the cat may have just been really stressed when the initial blood sample was taken.

His response is to create the best experience imaginable for the animal when brought into a practice.

‘If we can change that piece we can create better healthcare and we can create a better experience for the owner, so they will want to come back to the practice. It’s also better for staff – and I know in the UK you have a very serious shortage of vets and nurses – and if we can make it much better for them we can make them much more excited about their careers.

‘And it’s better for the business as you have new profit centres and returning patient visits and you can have all the people who say their dog hates going to the vet, but he loves coming to see Dr Bloom.’

Client and staff retention ‘There are smaller practices that are measuring retention and finding their businesses are getting much more profitable since instigating this model. And in our largest practice we know it’s getting busier and it is probably multi-factorial.

‘The number-one cause for complaints for vet practices in North America comes down to ‘the vet wasn’t caring’. Owners Practice Life z March-April 2018

IN THE SPOTLIGHT

21

Why would you take an animal away from the owner for a blood sample; the owner then fears the worst. I always ask my staff, ‘would you continue doing that procedure if the owner was watching over your shoulder and if the answer’s no, then you shouldn’t be doing it. This is part of the dishonesty thing – I’m not saying vets are dishonest, I’m just saying it’s time to reflect and do some soul searching. If we’re taking a pet away from an owner because we don’t want them to see what we’re doing to their pet, these are the things that grind away at an owner’s mind, and this is why the career span is so short.

You might not want to call it dishonesty, but we’re hiding it but know we’re doing it. Therefore, there’s disconnect between us wanting to provide the best care we can and having to hide what I’m going to do from the owner because it’s not right. might say they didn’t like how the vet handled their pet, they might say the vet didn’t know anything, didn’t spend any time with their pet, didn’t take a blood sample. But when you pursue it, it’s that the pet wasn’t having a good experience.’

There are ‘hidden’ reasons why the owner perceives the above issues to be the case, he says. It could be that pet was trying to bite the vet, so he or she didn’t spend much time with it, or that the pet wasn’t cooperative as it was extremely fearful and therefore taking a blood sample wasn’t possible.

‘When you look at the complaints they all stem from the pet’s mental wellbeing, which is what it’s really all about,’ he says.

It’s a transition from looking after the pet’s physical wellbeing to looking after both its physical and emotional wellbeing. He suggests that owners have always wanted this and that they are very sensitive to and aware of the concept of emotional wellbeing. This is because a lot of pet owners suffer from it themselves and they’re acutely aware of anxiety issues in themselves and their kids.

‘And I know from reading the studies by BVA and RCVS in the UK that there are concerns for veterinary staff, with increasing anxiety and depression and mental health issues,’ he adds.

‘Everyone’s talking about it and everyone’s aware of it, so why do we think pets are somehow immune. It’s happening in all your practices, all of them tomorrow will see, say, 20 pets, and anxiety and fear are way more common than obesity or those things. A study from Italy in 2017 showed that 77 per cent of pet owners feel their pet was nervous before even entering the practice.’

Anxiety in pets is now such a common problem that vets have become immune to the condition and it’s accepted as the norm, he says.

He used the example of the resting heart rate of cats – if you audited the medical records of vet practices in the UK the March-April 2018 z Practice Life

average heart rate when monitoring vital signs would be about 160. But it would not be 160 when the cat is at home, it would be around 120, he suggests.

Creating the best experience you can starts with partnering with your client in advance of the appointment. His advice is to take that pet and set it up for success so it arrives at the practice in a calm state of mind.

‘When I walk into an exam room and that cat is hiding by my computer monitor or the dog runs to the far corner or jumps on the owner’s lap, I’ve lost the battle. And all I’ve done is walk into the room. Now I’ve got to do all the other stuff.

Last resort?

Vet hospitals are becoming the ‘last resort’ for pet owners, according to Jonathan, and they’re turning to other sources of healthcare. They’ve turned to the internet for information, or the breeder, or the pet store where they buy their dog food.

For example, if they have a pet with itchy skin, the pet store will say ‘oh, we’ve got a food for that’ or a shampoo for that…’

And when the condition doesn’t go away as a last resort they go to the vet.

Get the patient to arrive in a calm state of mind for their visit to the vet. Get the cats used to the carriers first, for example. Your dog can skip a meal before going to the vet so it can have treats when it’s there.

‘Lots of people have to pull their dogs into the veterinary practice, but in our practices, they have to be pulled back out to the cars, they will not leave!’

Practices need to move towards pets and owners coming for visits because they want to, not because they have to, he advises. Vets should rethink their procedures, for example, an arthritic dog is brought in because it is having difficulty on the stairs, but then what vets do is bend all its joints and

22

IN THE SPOTLIGHT

it bites… This procedure should be changed to be a less negative experience, one way is to give pain relief before the appointment.

‘The people most aware of this are the clients, they’ve always wanted it but didn’t know how to ask or that they could ask for it. We know owners are prepared to pay for this and they do – we see the products flying off the shelves.

‘The vet should just ask ‘how was your trip in today?’ and listen to the stories ‘he doesn’t like coming here but we bring him because we know it’s important’ – you start talking about it and realise there are a lot of issues.’

Owners are willing to pay Jonathan believes it’s a perception only among vets themselves that people won’t pay, and that owners are actually prepared to pay for something that helps their pet be more comfortable.

It is the perception of value that matters to owners.

‘There are huge opportunities and you have a very willing audience,’ he says.

In Jonathan’s practices 20-minute appointments are the norm, and this could be the model adopted by UK practices, in order to increase practice profitability, he suggests.

‘Here in the UK you have big issues with profitability, it seems you’re stuck in this rut of volume. I believe we can slow down our appointments. We can actually work half as hard but earn the same money, because I don’t think we deliver good healthcare when we see appointments every 10 minutes.

‘I think we can slow down these appointments and provide much better care and increase our sales in a very ethical and productive way and increase the profitability of our practices significantly.

‘There’s no way in 10 minutes you can talk about pet insurance, nutrition, oral health, obesity, vaccines, parasites, all of those issues, so let’s just slow it down. I see every patient in my practices twice a year. They’re pre-booked appointments to come back in six months.

‘Pet owners will pay a lot for the things in their life, they will certainly pay it for their pet so I never want to hear ‘I can’t afford it…’ from an owner, as they have just come back from a cruise or they’ve got the big car parked outside.’

Where an owner perceives something to be better value, they will gladly pay for it, in his experience. Offering something different and addressing a need that another vet [down the

road] isn’t, means those owners will have a natural attraction to your practice for which you can charge a lot more.

This, he suggests, will help with the profitability issues in UK practices. Good practices in Ontario are showing 20-25 per cent profit under this model and so could UK practices.

‘You’re going to have to do something different to solve your problems and this model of healthcare will go a long way to solving a lot of them. I think it’s a very ethical thing to do and it’s a moral obligation and I think it’s a practice imperative, it’s good for the pet, good for an owner, for staff, and good for your business.

‘Why wouldn’t you do it? Tell me what the barrier is?

‘What’s the mechanics of how you use your staff, how do you manage this process?

‘Connect with your clients before/when they book the appointment, via email or other ways, about how to deliver their pet in a calm state of mind. You could start when in the practice, saying ‘Today’s not going so well, why don’t we stop here, I’ll share some information and why not come back next week when your pet’s better prepared and calmer.’ You then have a fresh start.’

Delivering a pet in a calm state of mind is an education process that will create the best experience for all parties.

‘As an example, when doing a blood sample, putting a bit of numbing gel on the skin in advance might cost an extra 10 pence, but it’ll save five minutes of nurse time, so actually it’s a money saver.

‘Owners want their pet to be calm and relaxed, they are familiar with the idea of paying for it, they’ve recognised it’s a problem. And when they see the difference and when vets see the difference, there’s no turning back.

‘These owners would certainly pay £70 for a massage at a spa. Pet owners don’t see what goes into the care that you give, they only see what it looked like when the pet came in and when it left, and if they look worse when leaving, it wasn’t a great experience. And then you are expected to pay for that bad experience.

‘Those two mutually exclusive concepts are what really grate on the minds of owners and staff.’

The website Fearfreepets.com has more information about the model and runs modular courses to become accredited.

This is not endorsed by Jonathan.

Practice Life z March-April 2018

MANAGING PEOPLE MANAGING PEOPLE

BLAME CULTURE AND THE ALTERNATIVES: WHAT ARE THE BEST WAYS FORWARD? While a ‘blame and shame’ culture may have been the traditional way of dealing with mistakes in veterinary practice, the profession is starting to take a fresh approach. Adrian Pratt, Catherine Oxtoby and Dan Tipney examine the alternatives.

T

he Collins English Dictionary defines blame culture as the tendency to look for one person or organisation that can be held responsible for a bad state of affairs or an accident. As a clinician, the assumption becomes that if you make a mistake, you will be blamed and shamed for it.

In March 2017, the RCVS conducted a survey to help gauge the extent to which blame culture might be present within the veterinary profession. The results are yet to be reported, but this signals a clear intent to assess and improve veterinary culture.

Indeed, this is the first pillar of the RCVS 2017-19 Strategic Plan1 and encompasses multiple parts of the Vet Futures Action Plan2. These include a Veterinary Leadership Programme and a Veterinary Workforce Study, already underway, and being led by Professor Michelle Ryan from the University of Exeter.

At the SPVS/VMG conference in January, the talk on blame culture in the profession was standing room only. The VDS, in partnership with the University of Nottingham, has been looking at the barriers and facilitators of discussion and reporting errors. This will be submitted for publication shortly.

Evidence has been gathered around the existing culture predominant in veterinary practices and the factors that may surround it – but is the opposite of a blame culture a no-blame culture? The RCVS talks about moving to a learning culture, one that ‘has a great focus on learning and personal development’. In an industry where patient safety is paramount, where does accountability feature in this proposed learning culture?

Significance of a blame culture The significance of a blame culture on our profession, or on us as individuals, is largely related to the feelings associated with potential mistakes and their consequences. If professionals feel as though there is a blame culture this will often result in fear and anxiety, which is neither healthy nor conducive to a high-performance emotional state. This may lead to a greater likelihood of error, which could negatively impact patient safety.

Fear also creates a reluctance to openly share information, whether post-incident, post-near miss or when there is a safety concern, leading to missed learning opportunities.

A blame culture therefore impairs professionals’ health and wellbeing and reduces their ability to give patients the best care.

If we’re too afraid or ashamed to talk about our mistakes, then we can’t learn from them.

In fact, there is a well-recognised condition in human medicine called second victim syndrome, which acknowledges that the clinician who made the mistake is likely to have March-April 2018 z Practice Life

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been emotionally affected by the incident. A blame culture reduces the ability of the affected clinician to discuss, analyse and seek support when a mistake is made and may lead an organisation to be less transparent, cover things up, or close ranks. Consistently, victims of medical error report that they want to understand what has happened and to know what steps have been taken to prevent it happening again, rather than to punish the doctor or nurse involved and pursue a financial claim against them.

While a no-blame culture could be considered to be the opposite of a blame culture, such an opposing extreme, while solving some problems, may also create others. It is crucial that professionals believe and feel that they will be treated fairly and that they can openly communicate concerns, thoughts and events at all levels of severity without fear of unnecessary reprimand. The key word here is unnecessary.

Unfortunately, there are very rare incidents in all industries whereby certain behaviours are not acceptable and some form of action is necessary. A no-blame culture suggests that whatever the actions of a professional, they can always blame ‘the system’ if something goes wrong. This is not always appropriate.

Examples of this might be sabotage, reckless behaviour or a violation for personal gain. It sends a very bad message both within the profession and to the public if such actions are treated as acceptable, so it’s important that the alternative to blame culture strikes a balance.

A just culture An alternative is a just culture; one of trust and that balances learning with accountability. It is a recognition that professionals make mistakes and acknowledges that even competent professionals can develop unhealthy norms (shortcuts or ‘routine rule violations’), but in which reckless behaviour and destructive acts are not tolerated. Finding a balance between the extremes of punishment and blamelessness is the goal when developing a just culture.

Accountability also applies to the organisation responsible for designing and improving systems in the workplace.

Just culture recognises that most individuals come to work intending to do their best and that ‘bad apples’ are extremely rare. Responsibility for mistakes is shared between the person, team and organisation and the driving impetus is to learn from it rather than punish an individual.

Aviation as an example Aviation is commonly cited as the industry that has led the way in creating a just culture, but most safety-critical industries, such as nuclear power, NASA, offshore oil and the military, seek to understand their failures rather than bury them by punishing an individual.

Other industries have also acknowledged that most mistakes happen because of human factors. Aviation regulators understand that planes tend not to crash because pilots don’t know how to fly or were being careless. Mistakes happen because of human limitations and the effects of systems on human performance. These industries ensure that feedback from discussions result in real change on the ground and commitment to acting on knowledge gained from errors, failures and safety concerns.

This helps to hugely reduce blame culture because it minimises the knee-jerk assumption that someone made a mistake and makes it accepted practice to look for system issues.

In commercial aviation, a system known as ‘Mandatory Occurrence Reporting’ was introduced in 1976. Over time, this system has developed to include voluntary safety reporting.

However, it was found that for this to be trusted and adopted, a just culture is an essential foundation without which the system falls down. More recently, various healthcare organisations have also tried to implement a just culture, for the same reason as the aviation industry did; to reduce fear, thus, encouraging open communication and to promote learning. However, history indicates that this was easier to achieve in aviation than healthcare.

The NHS has been espousing a no blame culture for 18 years, but the recent case of Dr Bawa-Garba illustrates just how hard this can be to implement.

In 2015, Dr Bawa-Garba was convicted of manslaughter by gross negligence following the tragic death in 2011 of Jack Adcock, a six-year-old boy with Down’s Syndrome and a heart condition. She was given a suspended sentence and was later also suspended for a year from the medical register by the Medical Practitioners’ Tribunal Service. The General Medical Council appealed this decision wanting Dr Bawa-Garba to be struck off the medical register and the High Court last week ruled in the GMC’s favour.

On the day in question, Dr Bawa-Garba, a trainee paediatrician, had only recently returned from maternity leave.

She was dealing with a large number of patients, in a unit that was understaffed.

That serious mistakes were made in this case is not in question. But what has sparked so much debate and concern is the context and systemic pressures under which doctors work, and mistakes are made. Working in an understaffed, underfunded health service, this has led to an overriding and uncomfortable sense among doctors that ‘this could have easily been me’.

Undoubtedly, the position of the Civil Aviation Authority and their complete jurisdiction over the sector has helped in the successful implementation of a just culture. However, we have since learnt that the organisations that have the most success are those that focus on developing trust.

Implementing a just culture Successful implementation of a just culture requires all of the following conditions to be met: • Effectively communicating the what, the why and the how.

• Just culture policy should be documented, publicised and training given.

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• Clear communication around how actions will be assessed as either acceptable or unacceptable and by whom.

• Demonstration of consistently fair treatment.

• Direct and clear connection made between the just culture policy and that of reporting, with feedback and evidence of change following reports.

It is vital that everyone within a profession understands the true benefits and how a just culture fits into patient safety as a whole. When this culture is combined with open reporting, informed analysis and an openness to change, real learning and improvement can occur across the whole profession.

This has widespread implications for vets and their patients.

A fair and just culture also improves patient safety by empowering employees to proactively monitor the workplace and participate in safety efforts. This empowerment is widely accepted as a significant contributor towards professional motivation.

A fear of change Change can, of course, be challenging to any group of people at the best of times. Any proposal for change can be seen as a threat or as a suggestion that current practices being undertaken are thus ‘wrong’. It’s vital to appreciate this, to focus on the positive improvement that a just culture offers, and to not disparage current professional standards.

The biggest risk is related to how people feel. If a just culture is introduced only ‘on paper’, professionals will quickly establish a negative association and this attitude will be very hard to change. Posters, policies and words can be part of the solution, but if they are not backed by actions the resultant loss of trust can be hard to recover.

Just culture is fragile and it can be hard to build and easy to destroy. But if a real commitment is made across all levels of our profession it could make a great and lasting change.

Just culture in the veterinary profession In the average clinic, the basics of a just culture could be to start reporting and discussing mistakes by running mortality and morbidity meetings (M&Ms). Using the emotional energy from a recent event can also help as can a senior team member telling a story about when something ‘bad’ happened to them. It must include all frontline staff and listening to their experiences and suggestions is critical for engagement.

Our challenge as a profession is to up-skill this area and to include human factors, root cause analysis and improvement science in our learning. Leading cultural change is a specialist area in its own right. Reinforcement of successes and spreading improvements will have knock-on effects for vets and patients alike.

There are a number of tools and organisations that can help with this change process. In other industries and professions it is common practice to use external resources to help implement processes and coach people through change.

The Nottingham Veterinary Safety Culture Survey3 is a measure of safety culture specifically developed and validated for vets and nurses. It assesses the attitudes and beliefs of clinicians around topics related to errors and mistakes. It can be used as a tool to help implement cultural change in clinics March-April 2018 z Practice Life

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and it accurately tracks change over time.

By having a quantitative measure of the four domains relating to safety culture (systems and behaviours, perceptions of management, risk factors and teamwork, and communication in a practice) you can actively engage and develop your clinic team with a change management process.

Later in 2018 the VDS is launching VetSafe, a new error reporting and risk management tool for clinics. An open reporting system is a fundamental requirement of just culture.

VetSafe will facilitate the reporting of errors and significant events in practice, helping clinicians and organisations to learn from mistakes.

BSAVA is also running a series of 12 regional day workshops in 2018. These are free to BSAVA members and look at ways to investigate blame culture and ways to improve.

Issues associated with a blame culture within our profession can be mitigated with the implementation of an alternative just culture. It is essential to communicate why just culture is so important to all veterinary professionals, provide and train staff on the systems integral to a just culture, and consistently demonstrate just culture and provide evidence of positive change.

While organisations and management teams are responsible for setting policies, communicating the message and leading by example, there must be buy-in and engagement by absolutely everyone for true cultural change to occur. It is vital every individual involved in our profession sees the crucial role they play in creating and sustaining a just culture.

References 1. https://www.rcvs.org.uk/how-we-work/the-role-of-the-rcvs/strategic-plan/ 2. https://www.vetfutures.org.uk/resource/vet-futures-action-plan-2016-20/ 3. Oxtoby, C, Mossop, L, White, K, Ferguson, E (2017), Safety culture: the Nottingham Veterinary Safety Culture Survey (NVSCS) Veterinary Record published online first: 07 March 2017, doi: 10.1136/vr.10421 Biographies Adrian Pratt, BVSC, MRCVS Adrian graduated from Bristol in 1995 and has been working in the veterinary profession for 22 years. For the past two years he has run the Veterinary Business Consultancy and been building the Emerge Veterinary project. Prior to this he spent six years in small animal practice followed by a 14-year career at Hill’s Pet Nutrition, where most recently he was Customer Development Director for the UK and Irish vet channels, directing the vet channel commercial team of 30.

Catherine Oxtoby, BVSc, PhD, MRCVS Catherine qualified from Bristol Veterinary School in 2000 and worked as a small animal and equine vet for 13 years. She gained a PhD in 2017 from Nottingham Vet School, in patient safety, co-supervised by the School of Psychology. She researched the causes and types of errors in veterinary practice, the effect of organisational culture on patient safety, and the adaptation of an inter-professional teamwork training programme from human medicine for use in veterinary practice. Catherine works at VDS as a risk manager, implementing human factors principles and developing system strategies and training programmes to help vets and veterinary practices mitigate errors and improve patient outcomes.

Dan Tipney, Head of Evidence and Insights, VetLed Dan provides insights into human performance gained from his perspective across multiple fields; as a semi-professional athlete, sports coach, pilot instructor, cabin crew member and currently as a commercial pilot and human factors trainer. Dan has consistently observed positive change as a direct result of non-technical factors, such as leadership, communication, wellbeing and in particular positive organisational culture. The power of a just culture and the associated growth mindset forms the basis for much of his work.

CLIENT CARE & MARKETING

How to manage tweeting inside and outside the workplace (no… not from the animals…)

With use of social media soaring, a robust use policy for practices is essential. Here Fiona Campbell offers her top tips for keeping everyone safe and happy when engaged in social media for work or personal reasons

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ecent statistics demonstrate that per second globally there are 7,252 tweets sent, 729 photos uploaded to Instagram, 20,000 people using Facebook and 125,406 YouTube videos viewed. With social media platforms gathering more and more followers, the problems for employers in managing employees’ use of social media increases.

There are a vast number of ways in which an employee’s conduct on social media (inside and outside the workplace) could have an adverse impact on an employer – whether it is offensive remarks made about colleagues, the disclosure of confidential or sensitive information, or conduct that is otherwise likely to have a negative reputational impact. For veterinary practices, these concerns are exacerbated due to the personal and sensitive nature of the work undertaken for clients and their animals. For example, a comment from an employee on Facebook that they were “on call so only going to get halfpissed” would undoubtedly be something that managers of all veterinary practices would consider warranted disciplinary action (and an Employment Tribunal upheld a dismissal as fair in such circumstances).

The key to managing employee misconduct online is to have in place a robust social media use policy. It should be clear in any such policy that it applies to conduct both inside and outside the workplace. However, in producing this policy, a balance must be struck between an employer protecting its business interests and the right of employees to privacy and freedom of expression.

Below are our top 10 tips for your policy: 1. Set out prohibited use The trouble with social media is that users have a misconceived tendency to “hide behind a keyboard” and say things which they would not verbalise publicly.

Some comments on social media are so obviously inappropriate that there is no need for a policy setting out specifically that such comments are prohibited on social media.

The Employment Tribunal takes a particularly firm approach against cyber bullying and harassment. For example, an Employment Tribunal held that an employer’s dismissal of a colleague was fair where the colleague had made a comment on Facebook that an Area Manager, whom they had never met, ‘is apparently a c**t’ (don’t you just love the ‘apparently’?

Not even ‘allegedly’, though it is hard to think that it would have made any difference); this was notwithstanding that the colleague had never been provided with a copy of the company’s social media policy. Similarly, the dismissal of a colleague who commented on Facebook, ‘quick question, who in TeleTech has A not tried to f*ck? She does get around’ was also found to be fair, perhaps unsurprisingly.

In contrast, the Employment Tribunal has tended to take a softer approach when dealing with dismissals on the basis of apparent damage to an employer’s reputation. This is where the contents of the policy become more important. For example, the content of Apple’s social media policy was critical to the Employment Tribunal’s decision to uphold its dismissal of an employee who had posted negative comments online about Apple app MobileMe, such as, ‘MobileMe f*cked up my timezone for the third time in a week…once again f*ck you very much work’. The Employment Tribunal was significantly influenced by the fact that Apple had made it clear in its policy that protecting its image was a core value and that adverse comments about its products online were likely to constitute gross misconduct.

For clarity, therefore, consider setting out the sort of conduct that is prohibited and which will, therefore, result in a breach of the policy. Examples include social media communications that could: - damage the veterinary practice’s reputation; - disclose confidential/sensitive business information; - breach client confidentiality, such as by disclosing a customer’s personal information or details about their pet without consent; - amount to bullying, harassment, abuse or unlawful discrimination against a colleague or any other third party; and - be viewed as being made on behalf of the veterinary practice (ie, employees should be told to be clear that any views expressed are their own, to write in the first person and use a personal email address).

The ACAS guidance on social media use also suggests that employers give examples of statements that would be deemed to be damaging to reputation, with an indication of the penalty that would be applied in each case. However, bear in mind this could be seen as overly prescriptive and employees may not appreciate that these are examples and not a definitive list.

Some smart Alec on your staff is also bound to spend some Practice Life z March-April 2018

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A social media policy should make it clear that it applies to conduct both inside and outside the workplace.

time working out just how close he can sail to those boundaries without over-stepping them, and see the examples less as a warning and more as a challenge.

The RCVS Code of Professional Conduct for Veterinary Surgeons also regulates social media use among the profession.

For example, it states that veterinary surgeons and veterinary nurses should not speak or write disparagingly about their peers and the guidance clarifies that this covers all forms of interaction and applies to comments about individuals online.

You could, therefore, specifically reference in your social media policy the Code of Professional Conduct and the Supporting Guidance document.

2. Cover private messages as well as public posts A common misconception by social media users is that comments made on private forums, within private messages or from private accounts will remain private. This is however not always the case; as soon as a comment is written online (even if only to one other person), the writer is no longer in control of who the comment is shared with. Also, an employer needs to be able to take appropriate action in respect of any and all comments made on social media that breach its policies, regardless of whether the comments were intended (or even expressly stated) to be ‘private’, since such comments can be just as damaging and, by definition, if the employer is aware of the comments, they have not remained private. For example, if an employee makes a racist comment about a colleague that the employer becomes aware of, the fact that it was intended to be private (and may not even have been seen by the subject of the comment) does not make the comment excusable.

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It should, therefore, be made clear to colleagues that the scope of the social media use policy extends to private messages (in any form and including Facebook and WhatsApp).

3. Business use At the same time as creating a headache for some employers, social media also offers an immense opportunity for businesses to market themselves. In the veterinary profession especially, social media can be used to reach out to local communities and share knowledge with other professionals. This is expressly recognised by the Code of Professional Conduct.

You may wish to encourage use of social media generally by employees where this could benefit the practice and, if so, you should be sure to set parameters as to what is acceptable.

Consider, for example, inviting employees to come forward if they have any ideas as to how your practice could benefit from social media to provide better customer service, share knowledge and for marketing purposes. Similarly, if your practice is running a promotion of any kind or wishes to advertise a new service offered, you could encourage employees to share the news on social media. However, in this case you should consider setting out clear guidance on how employees should deal with any negative comments they may receive on such posts (for example, that they should not respond and should report the comment to a manager).

If certain employees are asked or entitled to speak on behalf of your practice on social media, you should consider requiring them to undergo social media training. You may also want to consider requiring content to be proof-read by another person before it is posted.

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It might also be that there is a desire to use social media as part of a practice’s recruitment process. The risk of doing so is said to be that information might be discovered from a candidate’s social media profile which could lead to inferences of discrimination should that candidate be unsuccessful in their job application. On the flip side, a person’s social media profile can be a useful insight into their personality that you might not get from a CV or simple interview. Nothing in the law stops you using that information during your recruitment process so long as it is not discriminatory to do so. Therefore, if you do wish to use social media in this context, consider: (i) only using social media as a background check after an initial interview process (ii) verifying information obtained online before relying on it, and (iii) prohibiting employees responsible for recruitment from adding candidates to their social media network.

4. Personal use of social media at work You will need to decide whether to allow use of social media during work, through either the practice’s IT or personal equipment.

While it might be tempting to ban personal use of social media in the workplace completely, such restrictions can ultimately leave a company worse off, as it can undermine employee morale and invite non-compliance. In a veterinary practice, most staff are less likely to have ready access to social media while working in any event than in a normal office environment. It might be, therefore, that you make it clear in your policy that only occasional use of social media at work is permitted, such as during breaks and at lunchtimes.

It might also be worth considering whether access to social media sites should be blocked from company equipment.

5. Re-iterate relevant policies Employees should be made aware that confidentiality, antiharassment and bullying, data protection, equal opportunities and other relevant policies are applicable in a social media context. Consider specifically setting this out in your social media use policy.

Similarly, remember to update other policies where this is relevant, such as including a reference to cyber-bullying in the general policy on bullying and harassment and by crossreferring to the social media policy in other relevant policies.

6. Keep under review The world of social media is ever-changing and employers must ensure that policies keep up to date. The Employment Tribunal will expect an employer to have a ‘living policy’ with regular reminders to staff, rather than one that just gathers dust in drawer.

To enable changes to be made easily (without needing to seek the agreement of colleagues), you should also ensure the policy is stated as being non-contractual.

“Maybe the overriding message to employees is two-fold: (i) if you wouldn’t say something to a colleague’s face, don’t say it on social media, and (ii) if you have to think twice about the post, don’t send it” 7. Training Colleagues should be made aware of the policy and be trained on what is and what is not acceptable.

8. Reporting breaches You should invite employees to come forward should they become aware of any breaches of the social media use policy by other colleagues. You might also consider offering access to an anonymous helpline to ensure employees feel able to raise any such concerns freely and on a confidential basis.

Similarly, you may want to encourage colleagues to report any negative comments posted on social media about your practice by customers (unfortunately, negative comments online are a given for most businesses, despite the standard of service offered to customers). Ultimately, it is better to be aware that the comments have been made, so that they can be addressed where appropriate – such as with a carefully drafted response from a social media account dedicated to your practice.

9. Enforcement You should reserve the right to deal with breaches of the social media policy as a disciplinary issue, with the available sanctions including dismissal for the most serious cases.

You should also deal promptly with breaches of the policy since a failure to enforce the policy in some circumstances could undermine enforcing it in others.

However, be aware of the need to be objective and follow a fair process.

10. If unsure, seek advice The balance to be struck between an employer’s business interests and an employee’s private life is not an easy one.

For example, in a recent case heard by the European Court of Human Rights, the dismissal of a colleague for sending intimate messages to his fiancée and brother using his work Messenger account was found to be unfair, despite the employer having expressly prohibited using the Messenger function for personal use.

Maybe the overriding message to employees is two-fold: (i) if you wouldn’t say something to a colleague’s face, don’t say it on social media, and (ii) if you have to think twice about the post, don’t send it.

If you are at all unsure as to how to approach your social media policy, or whether enforcement of your social media policy is appropriate, you should seek legal advice.

Biography – Fiona Campbell Fiona is a lawyer in the Labour and Employment Practice Group of Squire Patton Boggs LLP, based in the Leeds office. Fiona has significant experience in defending a wide range of Employment Tribunal claims (including unfair dismissal, wage disputes and discrimination), which she runs at every stage. She is also a key adviser to a range of clients on day-to-day employment issues such as disciplinary and grievance matters. More recently, Fiona has advised a number of clients on National Minimum Wage and National Living Wage issues; such as assisting clients to identify and remedy breaches, undertaking full-scale compliance audits and supporting clients subject to a HMRC investigation.

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BUSINESS HEALTH & FINANCE

CREDIT CARD SURCHARGE BAN

WHAT OF IT FOR PRACTICES? The new year heralded new rules for charging clients for paying by credit or debit cards and here Andy Moore, partner at accountancy firm Moore Scarrott, takes a look at what they mean for practices

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n January 13, 2018, new rules came into effect prohibiting businesses from charging customers for paying by credit cards and debit cards. Following the change, Just Eat made the headlines after scrapping its card surcharge of 50p and replacing it with a service charge of 50p.

But is this a storm in a tea cup or do practices need to take positive action to deal with the new rules?

What happened before the changes?

In the past, clients (or customers) paying a business for goods or services could levy a surcharge when paying by credit or debit card. The justification for this charge being that the business pays a fee on credit card payments.

This was the case from 2013 until this year and the surcharge was supposed to only cover the cost to the business. Ironically, the business, while commonly making no additional charge for alternative payment methods, would also pay charges when banking cash or cheques. This seems to have been ignored or accepted as a cost by many, if not all, businesses. Further, there is the cost of the staffs’ time when handling the cash and cheques, recording them, and physically taking them to the bank to pay in, not to mention the risk of theft associated with cash handling.

Costs for credit and debit card payments There are multiple schemes and tariffs offered by a multitude of companies and many practices will have chosen group schemes to further reduce these charges.

Press reports have suggested that the average costs for card or Paypal charges for each £1,000 received by a business are March-April 2018 z Practice Life

between £24 and £44. Reviewing our own business’s credit card charges has shown the average charge per £1,000 received was £17.95. Allowing for the fact that part of each £1,000 received was VAT, the true cost per £1,000 of net turnover would have been £21.55.

On an electronic banking tariff, the cost of those funds being paid into the company’s bank account would be nil.

As a comparison, had that same £1,000 been paid via cheques (assume 10 cheques of £100 each), the fees for banking the cheques would have been £6.50 on the same electronic banking tariff. The same amount paid in as cash would have cost £10. Repeating the same calculation to get to net turnover, the figures are £7.80 and £12.

If we assume that someone has to spend an hour of their time dealing with the same £1,000 by counting, completing the paying-in book, going to the bank and so on, the costs might increase by a further £10 or £11. Clearly, there would be economies of scale if the amount is more than £1,000, but the principle is correct to fully compare the relative positions.

So, in summary, we would probably be comparing costs of £22 for credit cards against £19 for cheques and £23 for cash.

The immediate questions we should perhaps be asking ourselves are: ‘What is all the fuss about?’ and ‘Why didn’t everyone charge extra for all payment methods?’

So what now?

Just Eat hit the headlines by scrapping its 50p credit card surcharge, which was charged only on those paying by credit card, replacing it with an across-the-board 50p service charge.

Good business sense some would say.

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The new rules state that a business cannot discriminate between payment methods. Hence, if a charge applies to card payments, it must also apply to cash and cheques. A business is, of course, within its rights to refuse to accept any specific payment method if it chooses. It may also apply a payment surcharge to all payments.

However, any decision must be considered in the commercial context for that business and the impact it might have on the business and its clients. Consideration should be given to the following.

• Debt management – credit and debit cards are easy for clients/customers. As a result, accepting card payments, while incurring a charge, negates the need for debt collection costs and reduces the risk of bad debt.

The old adage of ‘cash is king’ remains valid and, to accept a small cost to get the bills paid, would seem to make commercial sense. If we were to compare this to the debt factoring that some businesses use, they accept a charge for cash flow improvements.

• Client satisfaction and perception of your business – businesses that only transact by cheque or cash are rare these days and card payments are, in practical terms, the norm.

• Commercial risks – cash businesses are risky; there is a risk of theft, and HMRC views primarily cash businesses as higher risk for incurring incorrect figures due to the ease of manipulation due to a lack of a secure trail of money.

Many clients and customers expect to be able to pay by credit or debit card, Paypal and ApplePay, among others.

Supporting your career dreams for over a decade Make 2018 the year you run and enjoy your own Veterinary Practice We already have over 420 vet partners and nearly 100 nurse and practice manager partners who are making every success of their very own business.

Don’t worry if you missed us at this year’s SPVS/VMG, we’ll be at the BSAVA Congress in April. You’ll find us on stands 820 and 822 where we would love the chance to discuss your next career move, whether it’s practice ownership or coming aboard in a different role.

In the meantime, visit our Partnership page: www.vets4petspartnerships.co.uk

Most businesses simply absorb the cost of being paid, whatever form that may take, within the costings of the service or goods they provide. Most do not charge a credit card surcharge and the online marketplace seems to have forced that across many businesses. Interestingly, the exceptions tended to be Government bodies (HMRC, DVLA, local councils) and the lower-cost budget companies that have little, if any, scope in their price points to absorb additional costs.

Veterinary practices do not, I would suggest, fall into these categories.

Ultimately, getting paid is a cost to any business and we all strive to drive that cost to as low a level as both possible and practical. The key point to address is how to secure payment at the time of treatment in the practice.

The first step is ensuring your staff have the skill sets to enable them to take payment when an animal is treated as they are the front line in this battle.

To help front line staff achieve this, clients must be offered all possible ways to pay – cheque, cash, credit card, debit card or a fee finance facility. This approach minimises the risks of clients leaving the surgery without settling their bill. Even if there is a small cost in achieving that, it is worthwhile in the long run.

Staff should be very comfortable with the phrase ‘How would you like to pay today?’ rather than ‘Would you like to pay today?’ and ensure clients are offered every payment option at your disposal.

If a client does ‘escape’ without paying before leaving the practice, a string of potential costs ensue, which will outweigh any charges that may be incurred: the cost of staff time to ring clients, paper, envelopes, and stamps to send chasing letters, debt recovery costs, legal fees, court fees and, ultimately, the loss of the entire fee itself.

Implications of the new rules for practices Across our client base there were very few practices that were applying a credit card surcharge fee. Those that did so must now stop, but a small increase across the board on charges to clients would probably be a better option in any event.

If businesses continue with the credit card surcharge, Trading Standards is responsible for enforcing the new rules and will deal with any non-compliant businesses.

As a closing thought, it appears ridiculous that a credit card surcharge has been banned by the EU, yet a price increase (surcharge on everything) is completely acceptable. No doubt this will have a minor uplift in the inflation figures and that will give the press something else to write about!

Biography – Andy Moore Andy is a founding partner of The Moore Scarrott Partnership, set up in 2001. He qualified as an accountant more than 20 years ago, becoming a fellow in 1999, and is the firm’s lead veterinary partner. Andy writes for professional journals and veterinary publications and has lectured on behalf of organisations including VPMA and BVA. His veterinary knowledge comes from being the son of a vet and seeing practice for the first 16 years of life, giving him an understanding of practice from a vet’s perspective.

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PRACTICE DEVELOPMENT

Practice strategy… what’s the point?

Jane Headley and Richard Hillman continue their popular discussions under the title of What’s the point of…

Jane Richard Hillman came to me looking for guidance on running his business. Although he’s an experienced veterinary practitioner with a long history of both owning and managing practices (personally and within a national group), he felt some external advice independent from a financial accountant or bank manager might clarify his thinking. We scheduled an hour for the meeting but, as those of you who know Richard will recognise, he likes the sound of his own voice and we ended up chatting for most of the afternoon!

Richard asked me if there’s any point having a strategy given that changes in regulations, customer habits, the economic climate and a thousand other external, non-controllable influences mean that a practice is constantly blown hither and thither by the winds of change…

Well Richard, I’m sure many business owners feel they are so busy in their business every day meeting the needs of clients, dealing with the unexpected, smoothing relationships between the team, and so on, that there isn’t the free time to plan.

So I suggest you ask yourself a question: do you attend CPD events? If so, how do you fit these in? I guess you prioritise them over the other demands on your time because you know the benefits – gaining new ideas, meeting interesting colleagues, learning or refreshing skills and enjoying the experience. There’s also the belief that this will help you to remain the very best vet you can be. All these are of course important to a practising professional.

Richard True, but what how does that help the business…?

Jane If keeping up to date professionally and personally is important enough to be a priority then consider whether taking time to think about your business objectives is also important and needs a time allocation. This should be protected time that you will stick to, not just the time left in the day when everything else is done (as this as an elusive target).

Richard So, if I can find the time, you’re suggesting I need to think about the CPD of the business? I guess I could ask how does it develop or know what direction to take next?

Jane Great analogy there Richard, glad you’re thinking about this!

Businesses are not all aiming to achieve the same objectives.

Consider the different patients you meet; the family pet for a wellness check, the breeding pedigree bitch, the show pony, March-April 2018 z Practice Life

the dairy cow, the backyard chickens. All have a different role and their owners have varying objectives for their animal.

This is also true for business owners, who may have different objectives for their practice. Some are getting themselves established and settling in, others are striving for growth, some seek the newest and shiniest facilities and equipment, another group may be focused on maintaining a steady state while elsewhere other owners may be looking ahead to a retirement plan. These strategies, while varied, are appropriate for each individual owner. There is no single objective that suits all businesses.

Richard OK, once I’ve set a direction are you going to tell me I’ve got to keep reviewing it?

Jane Of course! Our objectives alter as we progress (and age!).

The plans we made five years ago may not be relevant in our current circumstances. New partners may have joined the practice or former partners moved elsewhere. We may be seeking a different lifestyle now or have a young family to support, teenagers needing the latest brand, school or university fees, holidays, wider family commitments. Perhaps the practice plan needs a refresh or new direction. Or perhaps there hasn’t ever been a plan in place.

Setting a direction is the first step. Working towards achieving this is a longer-term process. Planning may appear daunting but avoiding or delaying the process doesn’t help. What do you do when you’re presented with an animal where you’re not sure of the best treatment? You make a decision, measure the result and adjust as required. The same approach works for your business. Decide on the strategy, set the objectives and measure the success. If it doesn’t lead to the expected results, then try a different approach. You do this as a clinician. Try it as a business owner.

We could have talked into the night but decided as we’d both benefitted from the coaching that we’d schedule another session for a month’s time.

If you have a topic you’d like us to consider, let us know at jheadley@harper-adams.ac.uk

CPD SHARED

WELLBEING OF VETS: A US PERSPECTIVE Wellbeing is quite rightly at the front of veterinary politics at the moment. The effects of neglecting wellbeing are widely reported, particularly in the causal way it contributes to anxiety, depression and mental illness. A multitude of issues are cited as contributing factors but are they unique to the UK?

I

was very interested to see a wellbeing stream on offer at the VMX conference (formerly NAVC) in Florida this year. I was fortunate enough to attend the event this year, but predominantly for the surgical streams. However, the fact the wellbeing stream featured so prominently was of great interest to me. I had not really thought about the issues facing UK vets as being transferable to the North American environment before; I had naively presumed the problems we face as a profession were unique to the UK. I attended a very thought-provoking and heartfelt lecture by Seth Vredenberg of Banfield Animal Hospitals, on compassion fatigue. Given the relatively ‘keen’ 8am start on a Sunday morning, the lecture theatre overflowed with colleagues in an interactive session that gave raw, emotional, first person accounts of dealing with compassion fatigue and the impact they identified in both personal and professional relationships.

Mr Vredenberg cited Dr Elizabeth Strand, who coined the definition of compassion fatigue as: ‘Caring very much, working very hard and not recognising and taking care of your own needs.’ I definitely felt that parallels could be drawn with the UK situation, but, given the size and great distances involved in North America, social isolation and sole working seemed to factor more heavily. Having said that, the culture of working relentlessly until the job is done seems to pervade the veterinary mindset on both sides of the Atlantic.

Stress is also a massive issue as well. The definition of ‘stress’ versus ‘pressure’ is key to understanding the mindset behind tackling the issue and Kathryn Cornwell used this mindset change to demonstrate the issues around stress. Her team identified costs to the economy in the region of $300bn – figures proportionately reflected in this country. Taking control of stress through the strategy of reframing goals and

‘The culture of working relentlessly until the job is done seems to pervade the veterinary mindset on both sides of the Atlantic’ expectations, reflects the thinking of many veterinary bodies in the UK. I guess this surprised me to some extent as my impression was that we were following other countries in our approach. While not wishing ill on colleagues across the water, I felt some reassurance that we were taking similar steps toward similar goals, suggesting a common strategy for the greater good.

I understand the dynamic in the rest of the streams was also very well regarded and received. An openness to the conversation in rooms filled with hundreds of people was reassuring and I think firmly cemented in my mind that wellbeing is taken seriously now and mental health is not the elephant in the room anymore. Certainly, in the UK, the RCVS, BVA and SPVS, to name but a few, are on the forefront of this debate and, given my experience in the states, I feel there is a collaborative conversation to be had with a mutual exchange of ideas. Thankfully, suffering in silence is not the default position anymore and it seems that message has a global audience.

Dr Ryan Davis PgC, SAS, BVMS, MRCVS SPVS Council member Director, Severn Edge Veterinary Group

Practice Life z March-April 2018

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0845 070 2498 sales@securos.co.uk www.securos.co.uk

01832 205 622 enquiry@stfrancis.co.uk www.st-francis.co.uk

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01237 459709 office@vetswest.co.uk www.vetswest.co.uk

CPD DIARY

Coming UP

focus on Practice Finance

…attend this day and you WILL leave knowing how to increase your practice profitability Nick Steele

Alan Robinson

SPVS and the VMG will dedicate a day to practice finance and profitability, with a wealth of different speakers spread across two streams. The event will start with a look at business strategy for vet practices and how to shift your productivity, before moving on to, among other things, top tips for stock control, getting the most from your PMS and the science and art of pricing. There will be lots of real case study examples from practice, from a model on dermatology to show how a focused approach can both motivate the team and lift profit, to how one practice is achieving close to 60% uptake of their pet health plans.

Speakers include Colm McGinn, XL Vets; Matt Diffey from the Vet Group; Nick Steele, Zoetis; Mark O’Byrne, Hill’s; and Alan Robinson from Vet Dynamics. Tracey Morley-Jewkes, MD of Blacks Vets, Rebecca Fiorani from Clent Hills and Marcus Evans, Beechwood Vets and CVS, among others, will bring front line practice experience to balance the theory in the sessions.

Tracey Morley-Jewkes

Alongside the excellent speaker sessions there will be an exhibition, including PMS providers, business and marketing consultants, finance companies and others with an interest in helping you lift your bottom line.

The event is being held at the RICOH Stadium, Coventry on June 19.

Visit the website for details: www.spvs-vpma-events.co.uk

Performance in Practice Roadshow, brought to you by VetLed

V

etLed is delighted to be collaborating with the VMG to bring you the Performance in Practice Roadshow. VetLed’s mission is to enhance performance in practice by inspiring and championing positive workplace culture for our people, our patients and our profession.

The roadshow programme is an introduction that will help you to support your teams to enhance individual wellbeing and patient care.

Each three-hour workshop will include an interactive presentation that encourages discussion and reflective learning.

It incorporates a combination of behavioural insights, interactive exercises and most importantly practical tips for implementation in your own practice. There will be plenty of time for your questions and answers to ensure that the workshop meets your personal needs.

During the workshop, the VetLed team will introduce veterinary human factors and patient safety. We will link these to workplace culture to demonstrate our process that supports positive and lasting change to both behaviour and outcomes.

We will also discuss skills such as communication, decision making and leadership as a means of improving patient safety by reducing the likelihood and mitigating the impacts of human error. We will discuss how to mitigate a blame culture and help you to understand the components of consistently high performing organisations, teams and individuals.

We will compare aspects of elite sport and various professions such as aviation and healthcare and put these into a practicebased context.

Who is VetLed? VetLed was founded by Ru Clements, a vet who understands first-hand the inner workings of the profession and the significant challenges that veterinary professionals have to overcome every day. The VetLed team believe that creating a compassionate and professional workplace culture that puts patient safety and employee wellbeing right at the core will, in turn, improve animal welfare, improve customer satisfaction, and help veterinary professionals to realise or reconnect with their vocation. The VetLed performance approach supports veterinary professionals to maximise their own wellbeing and fully utilise their job specific skills to deliver optimal patient care.

“Culture underpins everything. It defines the health of your practice and what makes your teams tick. Every practice has its own unique culture, which can be expressed as ‘the way we do things around here’. Culture has an effect on everyone who touches it; and it affects everyone. Culture is the hidden health of your practice.”

Ru Clements, Head of Performance and People

Book now at www.events-by-vmg.com Practice Life z March-April 2018

CPD DIARY

35

DATES FOR YOUR DIARY 23RD MAY How to Reward, Develop and Retain your People, MILTON KEYNES With recruitment perhaps the biggest challenge for the profession, it is crucial that you retain your existing team members. A key differentiator for you as a manager will be how well you identify and bring new talent into the practice and manage them once they are there to ensure they feel fulfilled and appreciated.

If you do need to recruit, or move existing staff into new roles, then you will need well defined and realistic job descriptions. Margaret will cover this together with tips on induction and mentoring.

She will also give you the tools to have more useful and productive annual development meetings.

This practical workshop offers the opportunity to learn how the best companies do it from a top consultant who has worked both within the veterinary profession and across a wide range of other sectors.

MAY 3 Difficult Conversations, BRISTOL Grumpy bosses, disruptive colleagues and unreasonable clients are all part and parcel of managing a vet practice. But businesses thrive on a mix of different personalities and approaches and sometimes it is just a case of analysing the situations that make people appear difficult.

By understanding different personalities and learning to manage expectations, you can learn techniques to handle those difficult conversations, possibly even turning them to your advantage.

This day is led by Cathie Gregg with a contribution from Stephenie Malone, employment lawyer at HCR Law.

27TH JUNE, BRISTOL PROGRESSING INTO MANAGEMENT Moving into a management role can be daunting, particularly if you are promoted within your practice and so find yourself managing colleagues. But if you make the transition smoothly, it can be very rewarding both to the practice and to you personally. There are some key things you can learn such as how to give positive feedback, the art of delegation and the importance of consistency. This course, from a business consultant with many years’ experience of working with practices, will describe different leadership styles and management techniques. Fiona will include role specific case studies and scenarios to help you tailor the advice to your specific situation.

Contributors are Fiona Nichol, Pet Partners, and Elaine Patterson.

Who will benefit: Nurses, vets or receptionists who have recently progressed or aspire to move up to clinical director, head nurse, head receptionist or practice manager and existing head nurses or practice managers who would like to polish up their management and leadership skills.

For the full CPD and Congress programmes and to book visit www.spvs-vpma-events.co.uk or call Charlotte on 01453 872731 March-April 2018 z Practice Life

National Veterinary Specialists Accountants, taxation & business development specialists Our range of services include: Consultancy

moore

scarrott Accounts and taxation

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Financial and funding structure

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Getting the most out of your systems

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base of over 500 veterinary practices

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indirect taxes

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

Veterinary team partners: Andy Moore andy.moore@moore-scarrott.co.uk Steve Headon steve.headon@moore-scarrott.co.uk Nick Lawrence nick.lawrence@moore-scarrott.co.uk Simon Biles simon.biles@moore-scarrott.co.uk

Offering veterinary practices comprehensive legal support

Legal services for your practice: • • • • •

Commercial law Employment law and HR Debt recovery Commercial property Regulatory law

Partners: James Howell james.howell@msrubric.co.uk Andrew Wareham andrew.wareham@msrubric.co.uk

Legal services for you personally: • • • • •

Wills and lasting powers of attorney Succession planning Inheritance and capital gains tax advice Trust creation and administration Probate services

www.msrubric.co.uk The Cowshed, Manor Farm Aust, Bristol BS35 4AT Telephone: 01454 800008

We offer a free of charge, no obligation initial meeting and discussion anywhere in the UK