I WELL remember hearing the news that “Alf” Wight (aka James Herriot) had died. I was in second year at Liverpool and the news went round during a practical of some sort in the red brick part of that red-brick university.
As the news disseminated there was a feeling that something dear both to us, as aspiring vets of an age who would have watched Herriot on TV and read the books, and also to the wider profession, had died.
Not just a man but the legend of that whole rose-tinted world of vets in practice where, for example, you really could run to the pet shop and replace a dead budgie with an exact replica for an old lady’s companion and you would be loved for it by the watching world, not sued.
Many of us have had the pleasure of working in general practice and having days or experiences that still could appear in a Herriot book. However, much of our world now would be unrecognisable to anyone other than us practising in the 21st century.
I felt a similar feeling of loss of an era as I did with the passing of the semi-fictional Herriot when I read a headline in the veterinary press that ran along the lines: “Chain of veterinary practices sold to American venture capital group”.
I had a picture of the loyal clients to the practices coming and going just as before, unaware that the profits from their spend were going off to a distant shiny office a long way from the practice, and ultimately the raison d’etre for that business is to make profits for distant shareholders, no longer to function as a part of the economy and life of a local community.
Money made by the owners would no longer be spent back within the practice’s catchment, the reputation of the practice no longer something held as an object of real value by the people it serves.
That was the start of a recent period where my usual positive and optimistic view of practice life took a few knocks, and as such I thought it would be jolly to devote this month’s column to having a general moan and “bah humbug” session. It may be a sign of being in the job too long, but there is also a feeling that the profession is changing from being a vet-owned patient-and-client centred profession to being a corporate owned shareholder-centred one.
Current corporate ownership currently is at about 20% of all practices. I am sure that they are well run, probably more efficiently than independent practices, and staffed by the same vets and nurses who would work in any practice. But I do think that something is lost when no one in the building owns or has a stake in the business, even more so if the ultimate master of the vets and nurses is a distant business empire or the company is on the stock exchange.
I was contemplating this distribution of wealth within a community, and having a buck with who (whom?) the buck stops, when I was further driven into a state of morbidity by another dreaded internet prescription request by a client.
This is still a fairly infrequent request for us, but what particularly annoyed me in this case was the client is quite demanding, a very nice guy but someone who expects quite a lot of input. Now that is fine if he is helping us pay the rent, phone bill, insurance, receptionists, wages and the million other overheads that are incurred whilst having a “free” (free to the client, not to the practice) chat on the phone or over the desk.
A little hard done by
If a client does not wish to buy products from us but source the absolute cheapest, then I feel a little bit hard done by when I am still expected to provide the absolute top level of customer service that we, and every vet practice I have ever seen, provides. Much of which is unbillable, e.g. the long advice phone call, the nurse’s advice, the out-of-hours telephone service, etc., informed chat with the receptionists.
They expect the service of Herriot’s practice but are only prepared to pay discount eBay prices.
We are currently caught between two worlds. Of course, we do get a revenue from services and try to maximise practice income from services compared to stock (we currently are at about 62% so good to average for a small animal practice), but to just put up service prices would drive clients away and make veterinary services even more of a luxury for the well-off.
There is much service provision by all vet practices which is free to the client but which we have to find the money for from somewhere, e.g. profits from drug sales. The most costly one is just being there, fully staffed, stocked and trained ready to go the day or night they need us.
As I sometimes say to clients, “If your dog gets run over at 3am on a weekend it won’t be the guy from the internet pharmacy coming to sort her out.”
Extension of existing schemes
We have been pondering this at our practice and were thinking that what could work is an extension of the loyalty schemes and health schemes that many practices operate. Put simply, a different service charge scale for people who shop online.
If they don’t want to pay “traditional” prices for medicines but still expect traditional services, then the way they are charged should reflect that: they can buy products at internet prices and can be charged fees at a realistic professional rate, rather than bene ting from the cross-subsidy from medicine sales that more loyal/traditional clients do.
Before we go any further, we needed to find out who regulates vets’ fees. I asked the VMD which told me: “Thank you for your enquiry but the area of veterinary fees is not a matter within the remit of the VMD’s role as regulatory authority for the authorisation of veterinary medicines. The appropriate body is the RCVS.”
That at least made me smile as I knew the RCVS would say this: “In answer to your first question – the RCVS has no specific jurisdiction under the Veterinary Surgeons Act 1966 to control the level of fees charged by practices unless they are so extreme as to constitute disgraceful conduct in a professional respect. There are no statutory fees and so, like any private business, they are essentially controlled by market forces. However, the RCVS does give some guidance on fees which can be found at www.rcvs.org.uk/fees.”
I went on to ask the RCVS about the differential charging idea.
The response: “In answer to your second question, the RCVS considers it unacceptable to discriminate between clients in this way as far as charging fees is concerned. Under the RCVS fair trading requirements, agreed between the College and the Office of Fair Trading, it clearly states that ‘A veterinary surgeon must not discriminate between clients who are supplied with a prescription and those who are not, in relation to fees charged for other goods and services’ (this is point 10.4 of the supporting guidance to the Code of Professional Conduct). This information can be found at www.rcvs.org.uk/fairtrading.”
Just for your information, the Office of Fair Trading (OFT) used to enforce consumer protection and competition law and acted as the economic regulator to ensure competition between fair-dealing businesses and prohibiting unfair practices. The OFT and the Competition Commission have now been superseded by the Competition and Markets Authority (CMA, established this year), which combines many of the functions of both.
So that was that idea out. But can I say thanks to the RCVS for its prompt and clear reply.
I came out of my depression by realising that you can’t turn back the clock and we all enjoy the benefits of living in a free-market economy as consumers, so we will just have to survive as retailers and service providers too.
We just need to navigate our way through the competition. Competition from online sales for medicine costs, competition from the neighbouring practice for fees costs, and for many of you competition from the local corporate with its marketing might and competition from discount vet practices offering everything from £60 bitch spays to free consults.
We need to keep our eye on online prices and watch our fee to drug ratios. Most of all, we need to keep our current clients happy and their animals well.
Still it could be worse: I could own a record shop.