LARGE ANIMAL VETS

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					                     LARGE ANIMAL VETS



                      REPORT TO DEFRA

                           MARCH 2004




       ‘Survival of a species depends on its ability to adapt to
       an ever changing environment’




                       Disclaimer
This report was produced by Westley Consulting on behalf
of Defra. The views contained in the report do not
necessarily reflect those of the Department
                                  Contents



Section        Issue                                                                     Page
               Acknowledgements                                                             4
               Executive Summary                                                            5
A              Background                                                                   7
B              The market for large animal veterinary practice                              8
C              Is there a shortage of large animal vets?                                   10
                        Views of the profession                                            10
                        Manpower planning                                                  12
D              Overseas experience                                                         14
E              Why do UK graduates not wish to remain in large animal                      16
               practice?
F              The feminisation of the profession                                          18
G              An alternative approach – the viability of large animal                     21
               practice
                        What factors affect viability?                                     22
                        A programme to improve viability                                   25
H              Charging for services                                                       27
I              Structure of the profession                                                 29
J              Areas with poor veterinary coverage                                         31
K              Emergency cover                                                             32
L              Veterinary education                                                        34
M              Information                                                                 39
N              Summary of conclusions and recommendations                                  40
Annex 1        Organisations and individuals who have contributed                          44




          Large animal vets. Report to Defra by Westley Consulting Limited, March 2004

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Acknowledgements

A large number of individuals and organisations have helped me in the
production of this report. They have been generous with their time and
their information, and made every effort to answer my questions
comprehensively, even when they did not share my point of view. I should
like to express my sincere thanks to all of them for their courtesy and their
helpfulness.

                                  Henry Brown, Westley Consulting Limited.




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Executive Summary


1. Defra asked Westley Consulting Limited to investigate the factors underlying the
supply of large animal vets in order to inform the Government’s response to the
EFRA select committee report on vets and veterinary services. The work was carried
out from January to March 2004, and involved discussion with the professional
organisations, vets in general practice, vet schools and farm business consultants.

2. Farm animal work represents a small proportion of the total time spent by vets in
general practice. It is closely connected with the future of the livestock industry,
particularly the cattle sector. The Government should commission an analysis of the
impact of the decisions recently announced on the Mid Term Review of the CAP on
the likely demand for veterinary services.

3. There is a range of problems affecting the supply of large animal vets, and it is
these which drive the number of vets willing to work in the sector. There appears to
be no shortage of veterinary graduates, and most of these are willing to give large
animal work a try as part of mixed practice in their first job. At this stage many young
vets move away from large animal work for good. More targeted research is needed
into the motivation of graduates and young vets.

4. Young vets, male and female, are more concerned about work/life balance than
their elders. The proportion of female vets has increased rapidly in recent years, and
they need family-friendly working patterns. There is reluctance on the part of many
senior vets in large animal practice to face up to the implications, and the profession
needs to find ways of turning this challenge into an opportunity.

5. The future of large animal work depends on the viability of individual practices.
Increased viability means being more efficient and earning more. Clients are likely to
have to pay more if the service is to be maintained. The professional organisations
need to help practices understand the factors driving viability and to take action to
improve their position.

6. Many veterinary practices need a more businesslike approach, both in their
relations with the client and in their internal management. Innovation is needed on
charging, and this requires a new range of supporting information at sectoral,
regional and farm level to demonstrate the benefits of veterinary intervention.

7. Changes in CAP support and in the livestock industry may result in bigger areas
opening up with poor veterinary coverage. If this happens the Government will need
to consider the wider implications for the farmer, disease and welfare surveillance,
and the rural economy and environment.

8. The current obligation on vets to provide emergency cover places heavy physical
and financial burdens on large animal practices and vets. The Government and the
Royal College of Veterinary Surgeons should review the workings of the obligation

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with a view to transferring the financial burden to the farmer. A trial should be
conducted of the feasibility of providing a dedicated large animal emergency service.

9. The education stage is critical to the future of the profession. Vet schools should
review their entrance criteria with a view to selecting more candidates likely to be
interested in a career in large animal work. The curriculum should include more
emphasis on communication and business skills, and students should be required to
pass in these subjects as well as the technical aspects, in order to obtain their
degree. The Royal College and the vet schools should re-examine the pros and cons
of streaming students into broad areas including large animal work.

10.   There would be wide benefits from more formal networking between vet
schools and practices, and the professional organisations and schools should
consider how to set this up.

11.   There is a need for better information about the structure of the profession,
and the Royal College should consider how to obtain it.




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A. Background

12.    The House of Commons Environment, Food and Rural Affairs (EFRA)
Committee reported on Vets and Veterinary Services in October 20031. Its key
finding was that an impending shortage of vets with large animal experience could
leave the United Kingdom vulnerable in dealing with a future major animal disease
outbreak and make it difficult for the Government to implement a prevention plan as
part of its proposed animal health and welfare strategy2. The Committee went on to
express concern that shortages of large animal vets would affect delivery of
Government strategies on veterinary surveillance and animal health and welfare;
recommended that the Government should be proactive in encouraging student vets
to enter large animal practice, and if necessary intervene in the market to ensure that
large animal vets were adequately paid; and warned that the consequences of the
Competition Commission report into prescription-only veterinary medicines might put
further pressure on the numbers of large animal vets. It made a series of detailed
recommendations based on these points.

13.     Defra is preparing a Government response to the EFRA report, and has
invited the views of interested parties. As part of this work, the Department
commissioned Westley Consulting Ltd in January 2004 to research the supply side
drivers for the provision of large animal vets. The remit included compilation and
review of evidence; summary of ongoing research; influences on decision-making of
student vets; and a review of veterinary practices’ opinions. The report was to identify
whether there is objectively a shortage of large animal vets and, if so, what are its
main drivers, and to provide any recommendations to address the shortage if it
exists.

14.    The work has been carried out by Henry Brown, and has involved discussions
with:
      The veterinary professional organisations;
      A range of veterinary practices;
      Veterinary schools;
      Officials of Defra and of the Scottish and Welsh administrations;
      Farm business consultants.

15.         A list of the organisations and individuals who contributed is at Annex 1.




1
    Sixteenth Report of Session 2002-2003, HC 703.
2
    EFRA press notice No 87 of 22 October 2003.


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B. The market for large animal veterinary practice

16.    Defra asked me to look at the supply, rather than the demand for large animal
veterinary work in the first place. Nevertheless, I have briefly reviewed the market in
order to orientate the work on supply drivers.

17.     The RCVS survey of employment 20023 analysed returns from 5,917
Members (29% of total membership). The percentage of time spent on different
activities in general practice was:

       Small animals                                              73.5%
       Horses                                                     8.4%
       Cattle                                                     7.5%
       Sheep, pigs, poultry                                       1.9%
       LVI work                                                   2.7%
       Meat hygiene                                               1.1%
       Exotics & fish                                             1.1%
       Practice management & other                                3.4%

18.    This shows that even if LVI and meat hygiene work are included, large
animals account for only 13.2% of total time spent in practice. We need to be
realistic about the extent to which professional systems can be adjusted to
give more attention to farm animal work.

19.    The RCVS survey shows that cattle take up the largest proportion of large
animal veterinary time. The Quo vadis? survey of cattle farmers 20024 interviewed
303 farmers (24% dairy, 51% beef, 25% mixed beef and dairy). Although there was a
wide spread between the sums spent, the average annual spend was:

    Dairy farms                       £2,830, of which             £1,120 on professional services;
    Beef farms                        £1,040                       £400
    Mixed beef+dairy farms            £4,600                       £1,510

20.    If a survey were conducted today, it would no doubt report a different balance,
particularly following the Competition Commission’s report, which has tended to bring
down the price of prescription-only medicines5. The economics of large animal vetting
are therefore intimately connected with the future of the cattle industry, particularly
the dairy sector. I recommend that the Government should commission an
analysis of the likely implications for the demand for veterinary services in the
light of the decisions on the Single Farm Payment announced in February. This
should distinguish between sectors and identify any likely regional shifts.




3
  A Survey of Employment in the UK Veterinary Profession in 2002, RCVS, September 2002, figures summarised from table 11.
4
  Quo vadis? 2002, Survey Results, Cattle Farmers. Veterinary Business Development Ltd, Peterborough.
5
  Veterinary Medicines. Cm 5781 (I-II), Competition Commission, April 2003.


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21.      Vets enjoy a very high degree of loyalty from farmers. According to the Quo
vadis? survey, 80% of cattle farmers rate them 7 out 10 or higher on value for
money; 98% are very satisfied or quite satisfied with the service provided; and 63%
say there are no aspects of the service or advice causing dissatisfaction. Vets are to
be congratulated on achieving these results, which demonstrate a close working
relationship with their clients at a time when the Government is keen to encourage
partnership. Nevertheless, this is a period of change for the industry and the
profession, when the economic climate is becoming ever more bracing, and there is
no room for complacency. There is a risk that some practices will carry on as they are
until it is too late to change. The professional organisations need to alert vets to
the need to modernise their ways of doing business, and to develop and
promote ways of helping them do this.




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C. Is there a shortage of large animal vets?

Views of the profession

22.     In talking to vets and their professional organisations, I began each interview
by asking whether they believe there is a problem, and if so what it is. None has said
it is a shortage of vets per se. Instead, they report a range of issues which they say
shows that there is a shortage of vets with large animal experience able and willing to
do the work. Many of the following views are widely held.

23.    Recruitment. The principal issue mentioned is the difficulty in recruiting
experienced large animal assistants. In the Quo vadis? survey, 28% of the 300
practices interviewed said that ‘not enough vets/new graduates’ was one of the
greatest challenges facing the profession.

24.    The Veterinary Record is full of job adverts every week, but many practices
say the response is very poor. Most of those who apply for UK large animal posts are
trained overseas, and are seen by practices as being very short of hands-on
experience, even when the advert has specifically asked for this. Some practices
have told me that they have made an appointment only with reluctance.

25.    A notable exception is practices who have direct links with vet schools, eg by
doing occasional lecturing. These practices say they get plenty of UK trained
applicants, sometimes even without advertising. I will come back to this in section L.

26.   The scepticism I have encountered over foreign vets applies to virtually all
sources – EU, Eastern Europe, Australia and New Zealand. It suggests that one
obvious course – if there is a shortage, we could import more vets – is not a
convincing solution. However, I have not seen any specific research on this, and it
may be worth examining whether there are suitably experienced foreign vets
and how they might be encouraged to come to the UK.

27.    Experience of UK graduates. A second issue widely mentioned is that recent
graduates have little hands-on experience of large animal work. It is said they come
out of vet school ‘full of knowledge but with little experience’. This reflects both the
education they receive, and the experience they gain outside vet school doing Extra
Mural Studies (EMS). I will come back to this in section L.

28.    UK graduates not prepared for realities. This is a separate issue from
technical experience. In the Quo vadis? survey, 21% of practices said that ‘new
graduates unprepared for reality of general practice’ was one of the greatest
challenges facing the profession. There are two aspects. First that graduates don’t
empathise and communicate well with farmers. This is partly an issue of selection
and education that I will discuss in section L. Second that they do not recognise fully
the long hours, particularly those on-call, and relatively menial work sometimes
required. This raises issues of education (section L) and practice management
(section G).

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29.    Young vets not willing to stick with large animal work. This is a complex
issue. A high proportion of students aim to go into mixed (large/equine/small animal)
practice. 44.5% of the 2939 students responding to the BVA/AVS survey 20026
envisaged that they would do this. (By contrast the figures for large, equine and small
animal practice were 8%, 16% and 15% respectively.) All the students I met said they
wanted to go into mixed practice, explaining that they wanted to keep their options
open as long as possible. Whilst this means that there is a large supply of new
graduates willing to give large animal work a try, the numbers are greater than the
volume of work available, and it is inevitable that many will move on to small animal
work. The concern, however, is that an excessively high proportion of young vets
drop out of large animal work at the earliest opportunity, before they are 30. The
issue is often linked with the feminisation of the profession, eg 19% of practices
responding to the Quo vadis? survey thought that the high drop out rate of female
graduates was one of the greatest challenges facing the profession.

30.    Feminisation of the profession. It is a fact that the proportion of female
veterinary students has risen steadily in recent years. The BVA/AVS Survey 2002
reported that 72% of students were women. The RCVS Survey of Employment 2002
stated that 38.6% of vets in UK practice are female, and that in the age group 20-29,
women already outnumber men (1.07:1 in the sample). It therefore seems inevitable
that the proportion of female vets in practice will continue to rise. Female students
and vets are very clear that they are interested in family-friendly working, particularly
opportunities for part-time work (23.9% of female vets work part-time, compared with
9.5% of men, according to the RCVS survey) and are generally reluctant to work
heavy on-call rotas. This has two clear effects. It exacerbates the problem of young
vets moving out of large animal work, where the on-call rota is heaviest, into small
animal work, where it is less of a burden. And it means that despite the increase in
graduate numbers, a larger number of vets will be needed to deal with a given
workload. This would tend to increase any shortage of vets.

31.    Age profile of the profession. Veterinary practices are generally run by the
partners, who are older than their assistants. Many partners have been in practice for
20-30 years and have seen the proportion of their business switch over from
predominantly large animal to mostly small. There is said to be a tendency for large
animal work to be handled by the older vets, who have always done this. And I
suspect there may also be a tendency for practices to stay in this field, because the
partners are familiar with it, even though small animal and equine work may be more
profitable and less troublesome to service. If this is correct, the retirement of older
vets over the next few years may lead to a big reduction in large animal manpower
and expertise, and in the willingness of many practices to carry on with it. The
demographics of the profession need fuller examination and I recommend in section
M that more information be collected.

32.    Succession in large animal practice. It is widely believed that the two
factors of large animal vets getting older, and younger vets being less interested in

6
    BVA/AVS Survey 2002, published by BVA February 2003. Question 45.

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this area of work are leading to a shortage of vets interested in taking practices over.
42% of the 166 practices responding to the BCVA Manpower Survey 20037 said that
succession was a problem. It appears that career progression is an issue for both
practices and individuals.

33.      Closure of practices. In all parts of the country there is anecdotal evidence
that practices have closed down or have ceased doing large animal work. This is
seen as a direct consequence of the contraction of the livestock industry, and of the
difficulty of finding vets willing to work in the sector. It has enabled the existing
practices to expand, or at least to hang on to reasonable volume of large animal
work, which is in many ways desirable. But this natural process of amalgamation runs
up against the difficulty of travelling longer distances to deal with emergency work.

34.    Contraction of the livestock industry. Most vets think the contraction of the
industry has a major bearing on the buoyancy of large animal practice, and that the
recently-announced decisions on the Mid Term Review of the CAP will have a further
unhelpful impact.



Manpower planning

35.    The RCVS has commissioned workforce modelling from the Institute for
Employment Studies8. The Institute has developed a model of the workforce for vets
including general practice and other places of employment, based on starting stocks,
inflows, outflows and linkflows between sectors. It is a global model that looks 10
years ahead, and does not deal with individual sectors such as large animal vetting.

36.    Applying a range of assumptions about changes in the market for vets and in
vets’ working practices, the Institute reaches conclusions about the number of vets
that need to be trained in the UK.

37.     For the present numbers of UK students (intake of 720 in October 2003) to
find jobs, it concludes that, taking males and females together:

           The number of career break outflows would need to double, and 85-90% of
           these people return;
           A higher rate of vacancies would need to be filled by UK graduates;
           The working week would need to be reduced from 47 to 40 hours;
           Demand for services would need to increase by at least 1% per annum.

38.     A more sophisticated forecast, considering males and females separately,
finds that for the present numbers to find jobs:

7
    Cattle vets consider future Veterinary Review, January 2004.
8
 Workforce Modelling Revisited 2003: A Report for the Royal College of Veterinary Surgeons. The Institute for Employment
Studies, Brighton, 2003.


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     Career breaks would need to double for women, but stay the same for men;
     A higher rate of vacancies would need to be filled by UK graduates;
     Working hours would need to be reduced from 47 to 36 hours per week over 10
     years for women, and from 47 to 42 hours per week for men.

39.    The report does not discuss in any detail the realism of these various
assumptions, but it is clear that they would represent quite significant changes,
particularly the increase in demand for services. The report concludes that ‘the
annual intake of veterinary students is sustainable, but only just’. A ‘small year-on-
year increase is required in the demand for services, together with increased career
breaks and a reduction in the working week, plus an alteration to current replacement
behaviours to favour home-qualified veterinary surgeons at the expense of those
trained abroad. If the demand for services stabilises or even decreases, the current
number of student places could lead to future surpluses of qualified veterinary
surgeons.’

40.   Only a minority of the vets I met expressed optimism about increasing the
demand for large animal services. (I will come back to this in section G). I have not
examined small animal work at all, but the following statistics are adapted from the
Quo vadis? survey:


                   % of vets in general practice
                   expecting work to
                       increase      decrease                           Increase-
                                                                        decrease
Dairy farmers               5%                     37%                    -32%
Beef farmers                4%                     32%                    -28%
Equine owners               26%                     3%                    +23%
Dog owners                  45%                    14%                    +31%
Cat owners                  64%                     2%                    +62%
None                        4%                     31%                    -27%


41.   As I have said, the Institute’s analysis does not deal specifically with large
animal vets, but it is hard to avoid the conclusion that student numbers,
globally, are adequate.




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D. Overseas experience

42.   The research for this project has been conducted solely within the United
Kingdom, and it has not been possible to do more than look take the briefest of looks
at experience in a few other countries.

43.    In Australia, a review of rural veterinary services in 20039 found there was no
current crisis in the supply of vets, but that practices were hit by factors that will
impinge on vets’ willingness to live in rural areas. These included rising costs,
farmers’ reluctance to employ vets, long working hours, and the limited social
opportunities and schooling in rural areas.

44.    Similar issues were raised to those in the UK, particularly the rising proportion
of female vets (now 39%) and their preference for fixed and/or casual hours, and the
tendency for new graduates to go into mixed practice only to leave this for good
within 5 years.

45.    The report recommended demand-based, rather than supply-based solutions,
and measures to improve practice efficiency. Amongst a broad range of
recommendations, the reviewer suggested that the profession should develop a best
practice model for rural mixed practice; develop enhanced mentoring schemes and
other forms of professional assistance to improve practice management and working
conditions; and develop extension programmes that encourage rural practitioners to
broaden their skills base as a way to stimulate producer demand for their services.
46.     There are some similarities with the situation in the UK, although the problems
in Australia are due more to the difficulties of living in, often very remote, rural areas.
The need therefore is seen to be for means of encouragement and the Government
allocated A$2 million for such initiatives in the 2002-2003 budget, a couple of months
before the review was announced. At the same time, but in addition to that
commitment, the Government offered to fund bonded scholarships of $25,000 each
to veterinary graduates - primarily with a view to employment in the Australian
Quarantine & Inspection Service, which administers the program - although it could
also open pathways into rural practice for many. There is a private practitioner
involvement in this programme through the Australian Veterinary Association. The
first four scholarship recipients were appointed in February 2003.
47.       The Australian Government’s formal response is expected imminently.

48.    In the United States the National Veterinary Medical Service Act passed at
the end of 2003 authorises the Department of Agriculture to provide student loan
repayments to recent veterinary graduates who agree to work in underserved parts of
the country. Eligible students will enter into agreements with the Secretary for
Agriculture for a period of time and amount of loan repayment in exchange for the
veterinarian’s service in a shortage area including rural regions and inner-cities. This
scheme responds to concern that graduates’ debts (repayment of which can require
9
 Review of rural veterinary services. Reviewer Peter T. Frawley, January 2003. Department of Agriculture, Fisheries and
Forestry – Australia, and Commonwealth Department of Education, Science and Training.


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up to one third of their income) affect their choice of jobs, and that low pay in some
inner cities and agricultural regions discourages them from working there10.

49.    In Canada, Prof Otto Radostits11 has drawn attention to a steady decline in
student interest in food animal practice, at the very time when food animal industries
are becoming larger and more intensified and need veterinarians competent to
provide health and production management. When students are able to make
elective choices, up to 65% select the small animal options. He recommends
introduction of veterinary undergraduate tracking programs, as in the engineering
sector, with quotas for the number of students in each track. More specialised
courses would permit a much more rigorous assessment of competences than in the
past.




10
  President signs bill assisting veterinary graduates with debt load. Journal of the American Veterinary Association, 1 January
2004.
11
  Engineering veterinary education: a clarion call for reform in veterinary education – let’s do it? Journal of Veterinary Medical
Education 30(2). The author is professor emeritus of large animal clinical sciences at the University of Saskatchewan.


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E. Why do UK graduates not wish to remain in large animal practice?

50.    If numbers of graduates in the UK are adequate, and most are willing to give
large animal work a try as part of mixed practice, why is there concern that so many
do not want to remain in large animal practice?

51.   It is worth noting first that 83% of large animal and equine vets said they
enjoyed their job, compared to 77% for small animal vets, according to the Quo
vadis? survey.

52.    The survey reported that the issue giving least satisfaction to vets in general
practice was on-call work (41%, rising to 52-55% for graduates since 1991). The next
highest issue was shorter hours (36%, or 35% for graduates since 1991).

53.     42% reported that it was not very easy to combine work with social and family
life, and 28% said it was not at all easy.

54.   Asked what should be done to reduce the drop-out rate of new graduates,
especially females, respondents mentioned:

                                                                  All responses           Graduates
                                                                                          since 1995
Reduce      expectations/prepare       for           working 43%                          33%
conditions
More support from seniors                                         24%                     42%
Shorter hours/less on call                                        40%                     58%
More part time, job share, flexibility                            34%                     35%

55.     Other factors mentioned by students in my discussions included:
      Little intellectual stimulation in farm work until you get to senior level;
      Social isolation is daunting in rural areas. Young graduates prefer to go into
      large practices where there are other young vets;
      Difficulty of striking good relationship with farmers, and their tendency to be
      unforgiving if you don’t do a good job first time;
      High admission standards produce bias towards academic types. However
      ‘you’ll never get in unless you can show you grasp the realities of farm work’.
      Small animal work is more rewarding and challenging – ‘you can do surgery’,
      ‘you can use all your skills’.
      Partners won’t involve assistants in management: ‘we had a weekly vets’
      meeting at my foster practice that was partners only’.


56.    Older vets in practice see that young entrants are more interested in work/life
balance than they were. This change affects society as a whole, not just the
veterinary profession. It applies to men and women: they want to be able to see their
friends at the weekend, they want to be able to travel, and the work is not seen as a


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job for life. They note that contemporaries in medicine and dentistry are better paid,
with little or no on-call.

57.    Distinct from these lifestyle issues is that of experience. I have already noted
in section C that new graduates are seen as short of hands-on experience of large
animal work. In mixed practice they may not get enough large animal work to develop
their skills. In some practices they say they get a disproportionate share of difficult
on-call cases (though the Quo vadis? survey reported that partners and principals did
the most demanding rotas), which may mean that they get less chance to develop
proactive services.

58.    I think it would be helpful to carry out more targeted research on the
views of young vets, ie those within 5 years of graduation, as this stage of their
career is the point where many turn away for good from large animal practice.

59.   I believe that there is a need to address the issues that are putting young
vets off:

     Poor preparation during training for large animal work;
     The weight of on-call work in large animal practice;
     Poor practice management that demotivates young assistants;
     Need for better networking between vets in different practices;
     Need for young vets to get balanced skills development in their early
     years;
     Resistance to part-time working in large animal practice.




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F. The feminisation of the profession

60.   This subject produces vigorous comment, and it is worth considering how it
has come about.

61.    It is generally accepted that the image of the veterinary profession has
switched over in recent years from the rather macho large animal world portrayed in
James Herriot’s early books12 and the TV programmes based on them to the more
cuddly small animal work shown in Rolf Harris’s Animal Hospital. These are of course
media stereotypes, but they do have a powerful influence, particularly on young
people considering university options. I think the key point is that small animal work is
seen as indoors, in civilized working conditions, with good support and the vet in
control. Whether or not this is a fair representation, it is a long way from conditions on
the average farm, where the vet is on their own, the only backup is by phone, and
working conditions can be difficult.

62. Popular TV programmes have stimulated demand for vet school places to the
extent that this subject now requires the highest possible A level/Higher grades. Vet
schools tell me that the image appears to be particularly attractive to girls. Boys seem
to look more sceptically on the veterinary profession, and tend to apply for university
courses that will fit them for other better paid occupations. As a result, far more girls
than boys apply to study veterinary medicine.

63.    Girls also tend to perform more strongly than boys at the sixth form stage and
the result is that vet schools get more qualified female candidates, on an academic
basis, than males. The proportion of qualified females is even higher than that of
applicants (80% as against 75%, in the case of Bristol).

64.    Vet schools understandably wish to recruit the most motivated candidates with
the best grades, and so the proportion of women has increased. At the Royal
Veterinary College it is 75%, and at Cambridge nearer 80%.

65.    The proportion of women in the profession is therefore rising steadily, as the
following female percentages show:

Vets working in full-time practice                             38.6%                    RCVS Survey of employment 2002
40-49 year olds who are principals/partners                    46% (men 87%)            ditto
Ratio of 20-29 year old women to men                           1.07: 1                  ditto
Veterinary students                                            72%                      BVA/AVS Survey 2002

66.   There is little doubt that they will dominate numerically in a few years time if
present trends continue.




12
  As a matter of interest, his later books, written for children, have small-animal related titles. See
http://www.thirsk.org.uk/herriot1.html


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67.    When asked whether there is a shortage of large animal practitioners, many
existing vets (most of them male) cite the feminisation of the profession as an issue.
They say that:

      Farmer clients are less willing to deal with female vets;
      Women vets want to work part-time, and this is not compatible with the way
      they run their practices.
      Female vets don’t want to work the rota.
      Pregnant women cannot work with sheep because of the risks associated with
      toxoplasmosis, chlamydiosis and listeriosis.
      Women are thought to drop out of large animal work at the earliest opportunity.
      As currently organised, small animal work suits women’s lifestyle requirements
      better.
      It is hard enough for men to get enough experience to become confident with
      large animals, even harder for women taking account of all the above.
      Women are reluctant to take on the financial burden of partnership.

68. When questioned further, views are more mixed. Very few vets say that
women cannot do the job well. I have been told that some of the top cattle vets in the
country are women. Female vets working part-time represent a resource that could
be mobilised in a time of crisis. At one meeting, I was told of an old Welsh saying,
which translates roughly as – you should measure a man from the head up. The
physical nature of the work is sometimes mentioned, and the fact that cows are
being bred larger, which makes it difficult for smaller vets to carry out some
procedures.

69.     I conclude that there is a reluctance on the part of many vets to face up to
the implications of the increasing proportion of women in the profession. For
historical reasons, most partners dealing with large animal work are older and male.
They have not caught up with the changes to society that affect the profession as
much as other parts of the economy. Most young people – men as well as women –
are more concerned about their work/life balance than their elders. If women are to
form a large part of the profession and want more flexible working patterns
than men, the profession will have to find ways of accommodating to this, and
of turning the challenge it poses into an opportunity.

70.   The Quo vadis? survey asked about the advantages and disadvantages of
employing part-time vets. The main pros and cons were seen as:

                                                                     To the practice      To the individual
Advantages
Greater flexibility of manpower                                      60%
Allows more time off for FT vets                                     49%
Allows female vets to combine career & family commitments                                 61%
A chance to have a life outside work                                                      37%
Less stressful                                                                            31%
Disadvantages
Less continuity for cases or clients                                 58%
Came out of on-call rota                                             28%

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Less job satisfaction/not seeing cases through                                             47%

71.   Of a small sample of 22 large animal/equine vets, 18% said they were likely to
employ more part-time vets, 14% said fewer, and 64% expected no change.

72. I believe there is scope for the professional organisations to look more
closely at the opportunities and practical benefits of more flexible working in
large animal practice.




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G. An alternative approach – the viability of large animal practices

73.    It appears to me that the number of students being trained is adequate for
current UK needs, and that most of them are at least willing to give large animal work
a try as part of a mixed practice in their first job. But there is concern that large
animal veterinary services may disappear in some areas because of changes in the
livestock industry itself, because of problems of retention and succession, because of
the feminisation of the profession, and because of the way that practices operate.

74.    It can be argued that the number of vets in large animal practice is a response
to these factors. In other words that the ‘shortage’, if there is one, is a symptom of a
range of underlying problems, rather than their cause. These issues can be looked at
in another way, as aspects of the viability or sustainability of large animal practice.

75.    Where large animal practices are viable, veterinary services will continue to be
provided, and there will be no problem over a shortage of vets. If practices are not
viable, vets will be unable to continue providing services, and problems will emerge.

76.    The advantage of this approach is that it enables us to drill down to the key
issues that determine the future of veterinary services and propose solutions that will
help to forestall problems.

77.    Parallels can be drawn with the policy on farming. The Government has taken
a close interest in Sustainable Farming and Food since the Curry report was
published in 200213. Similarities between the position of farmers and large animal
vets include:

          Traditional occupations with strong technical skills, but relatively poor
          marketing;
          Uncertainty about the future when present generation retires;
          Younger generation reluctant to enter/take over;
          External environment changing fast, and little ability to control it;
          Difficulty in charging fully economic prices for traditional products/services;
          Main opportunity to increase returns is to diversify and/or supply added value
          products/services;
          Scope for improving structure, management and commercial drive.

78.    In agriculture, the Government is withdrawing production-linked subsidies to
encourage farmers to seek their returns from the market place. There are many
things that farmers can do to improve their own competitiveness, and the
Government’s Strategy for Sustainable Farming and Food14 sets out a framework for
this. But ultimately the Government believes that if society (as represented by
consumers, supermarkets et al) wants UK agriculture to continue in anything like its
present form, it will have to pay a fair price in the market for it.

13
     Farming and Food, a sustainable future. Report of the Policy Commission on the Future of Farming and Food, January 2002.
14
     The Strategy for Sustainable Farming and Food. Facing the Future. Defra, December 2002.


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79.    In the veterinary sector, increased viability is likely to mean being more
efficient and earning more. Much of the responsibility for this lies with vets, but
customers, particularly farmers and Government in the case of large animal
practice, are likely to have to pay more if the service is to be maintained.


What factors drive viability?

80.   From my discussions with vets, and information in the various published
surveys, I believe that the following factors are important.

81.    Enthusiasm. The practice needs to believe that it has a future in large animal
vetting and for its people at all levels – partners, assistants and support staff – to
communicate this to clients. Statistics are encouraging. In the Quo vadis? study, 23%
of vets thought they would be very likely to be in general practice in 5 years’ time,
and 36% thought this was quite likely. The BCVA manpower study asked:

                                                                                                       Yes   Don’t   No
                                                                                                             know
 Do you expect practice to be undertaking farm work in 5 years’ time                                   80%   12%     2%
                                                 … in 10 years’ time                                   57%   30%     8%


82.    Practice size (number of vets). Peter Orpin, a past-president of the BCVA,
has suggested that ‘a farm practice needs at least three vets with adequate skills to
provide an effective service. They need not be full-time large animal vets, and may
equate to, say, 1.5 FTEs of farm vets.’15 The BCVA manpower survey correlated the
question above by practice size. It reported that:

 Still providing farm services?                                                        FTEs                  Vets/FTE
 5 years; Yes                                                                           2.9                     1.6
 10 years; Yes                                                                          3.4                     1.5
 5 years; No/Don’t Know                                                                 1.0                     3.1
 10 years; No/Don’t Know                                                                1.5                     2.4

83. This shows that the larger the practice, the more confident it felt about its future in
farm vetting. The BCVA believes that it supports the 3-vet minimum. It also shows the
greater concentration of farm work per vet in these larger practices. It is not
surprising that practices firmly committed to farm work are confident about continuing
in it – most businesses in a mature market would feel similarly – and it is
understandable that practices where farm work is already a minority occupation feel
least confident about continuing with it.




15
     Farm practice in areas of low stock density: a blueprint for survival. In Practice, March 2003.


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84.    Volume of work (livestock numbers). There may also be a minimum size in
terms of livestock numbers. I am not aware that there is any consensus on this, but
one suggestion I received was that 5,000 adult dairy cattle will provide enough work
for one FTE vet. This may be worth further examination.

85.     Age structure. In the past, larger practices aimed to recruit assistants every
year or two with a view to grooming a younger vet to take into the partnership as the
older partners retired. This process of renewal seems to have been interrupted by the
contraction of the industry and the feminisation of the profession, with the result that
some practices have ageing partners and a number of younger, including part-time,
assistants who do not aspire to become partners. 42% of respondents to the BCVA
manpower survey reported that succession was a problem, and that practice size
had little bearing on this. The Quo vadis? survey questioned the ambition to become
a partner or buy a practice in due course among 174 vets who were not already
principals or partners. The responses show a clear divergence between the views of
men and women:


Ambition:                                                               All               Male                Female
To become partner or to buy a practice                                 33%                47%                  26%
To do neither                                                          36%                22%                  45%
Don’t know                                                             13%                12%                  13%

86.   It would be useful to have more information on the age structure of the
profession as a whole (see section M). It is clear that individual practices ought to
have vets of different ages, so that their future is not jeopardised when the leading
partners retire.

87.      Range of services. Veterinary work is becoming more specialised, even
within farm animals, despite the notion of ‘omni-potential’. In a practice with several
vets this presents an opportunity to specialise in particular areas, eg nutrition, fertility
or lameness, and thereby to provide a higher quality service to the client.
Paraprofessionals can also be employed by practices to do more routine operations.
If this is kept within the practice, it provides the opportunity for a degree of veterinary
supervision, and it also enables abnormal conditions to be reported back to the vets.
It has been said to me that nurses and others will do certain jobs better because they
are ‘working up’ than vets will do them if they are ‘working down’. Although it was not
targeted at large animal work, the Quo vadis? 2002 report on Veterinary Nurses16
nurses thought they could additionally carry out a range of procedures, and gave the
main reasons for wishing to do so as ‘because we are good at it’, ‘to give me more
incentive/interest’ and ‘to ease vets’ workload’. For all these reasons, there is scope
for veterinary practices to see themselves and promote themselves as a multi-
disciplinary team – not just ‘vets R us’, so much as providers of a broad range of
solutions to the farmer.


16
     Quo vadis? 2002 Survey Results – Veterinary Nurses. Veterinary Business Development Ltd, Peterborough.


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88.    Active programme of CPD. The third of the ten guiding principles in the
RCVS guide to professional conduct17 is the responsibility ‘to maintain and continue
to develop your professional knowledge and skills’. Vet schools and the professional
organisations lay on a range of development activities. The RCVS recommends an
average of 35 hours per annum. A viable practice will consider CPD strategically –
what skills do we need to develop in the business as a whole? - and this will link in to
providing a range of skills, as suggested above.

89.     Good internal management. Veterinary practices doing farm work are all
small and medium-sized enterprises, and they face much the same challenges as
other SMEs. One of these is the need for effective internal management – particularly
financial, human resources and operational. But it tends to be a feature of
partnerships, not confined by any means to vets, that management is the
responsibility of all, and none, of the partners. Lines of responsibility and job
descriptions can be unclear (one practice mentioned to me that they all now had
clear responsibilities, which was seen as a major innovation). A few are Investors in
People. Where practices had employed a practice manager, the skills and functions
of this person varied widely. I believe there is scope for veterinary practices to review
and improve their internal management arrangements.

90.     Proactive commercial approach towards clients. Few vets see themselves
as businessmen, even though many are running quite substantial businesses by rural
standards, and even fewer see it as their job to sell services to farmers. It was said to
me more than once that ‘this is not what we went into vetting for’. Traditionally, vets
did fire brigade work, and were highly valued for their skills in dealing with problems.
In today’s economic climate a reactive approach is not sustainable. The farmer rightly
wants to cut down on his ad hoc costs, including the vet’s bill, but he may be
persuadable that veterinary services will – even if they cost more than before – raise
his overall profitability. The vet is in a unique position to convince him of this, as no
other expert or advisor has the same insight into animal health and welfare. Yet
many vets are not well equipped for this job, either with the information to convince
the farmer or with the right commercial skills. I think vets need to be supported with
the right technical material, and helped where necessary to develop their marketing
skills.

91.    Pricing. Most businesses give a lot of thought to their pricing policy. Vets are
having to rethink their approach in the light of the Competition Commission’s report
on prescription-only medicines. Some practices now review the prices of drugs
available from Ireland or through the Internet, and set their prices accordingly. As in
all sectors, suppliers of standard commodities can only expect to receive the market
price. Even allowing for farmer loyalty, prices in future will have to be realistic.
However, I am told it is still possible to make an attractive return on drug sales, of the
17
     Guide to Professional Conduct, RCVS, 2004.




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order of 25%, albeit this is less than in the past, when the practice got most of its
farm income from medicines. Where the vet has more discretion on pricing is in the
sale of new services, which only he/she can provide. Some practices are developing
novel charging regimes for these. Others need advice on the best commercial
approach.

92.      A balance of work. Although there are a few dedicated farm practices, most
farm vets work in mixed practices that do some farm, equine and small animal work.
There is useful complementarity, in that large animal work is conducted mostly off the
premises, so that the practice mainly needs to provide administrative support and a
base for drug sales, while small animal work requires high quality on-site treatment
facilities. Overheads can be shared. Most farm vets welcome the income from LVI
work, and some are also enthusiastic about OVS work. I am sure that it is beneficial
for practices to have a balance of different workstreams, even if the vets themselves
specialise mainly in one area or another.


A programme to improve viability

93.     There is nothing radically novel about the viability factors suggested above,
they apply to all businesses, and most veterinary practices are wrestling with some of
them even now. What is perhaps new is the idea that practices need to look at them
all together as a package, in order to achieve optimum viability.

94.    There is an important role here for the professional organisations, led by the
BVA in partnership with its farm species divisions. They can help individual vets and
practices to understand viability, to see where they need to improve, and to support
them through the process of change.

95.   I recommend that these professional organisations should consider
launching a three-stage process:

• First, they should encourage an open debate in the profession about
  viability and the factors affecting it, drawing on the above suggestions and
  teasing out any other issues that are deemed important. Leading vets
  should be prepared to share some of their business principles.

• Second, they should draw up a best practice model for the viable large
  animal practice. This would set out the key success factors in simple
  practical terms, accompanied as far as possible by real-life examples.

• Third, they should set up a process of benchmarking, so that individual
  practices can easily see how they shape up against the best practice model.
  Experience from other sectors shows that most participants are good at some
  aspects, but very few are good at everything. Almost all players can benefit from
  an exercise of this kind.


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In the light of this programme, the development needs of large animal practices
should become clear. The profession’s channels of CPD should be utilised to
support the necessary development.




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 H. Charging for services

96.   The RCVS guide to professional conduct states that fees are essentially a
matter for negotiation between veterinary surgeon and client (unless they are so
extreme as to constitute disgraceful conduct).

97.    Large animal vets have traditionally charged the farmer for work done job by
job. Until recently, the larger part of practice income came from the sale of drugs,
rather than from veterinary services per se. The Quo vadis? survey of cattle farmers
reported an average annual spend by dairy farmers of £2,830, of which £1,120 was
for professional services. Since the Competition Commission’s report, the markup
which can be achieved on prescription-only medicines will have fallen, and many vets
have told me that it is difficult to charge the farmer more for professional advice while
the industry is in a depressed and contracting state.

98.    If vets are to retain, and if possible improve, their viability, they will need to
earn more fees from their clients. The problem is that veterinary services are seen as
part of the farmer’s variable costs, charged to a particular enterprise (eg the dairy
herd), and are not seen as an investment in the business as a whole. Costs like this
are a target for savings when farmers and their business advisers look at the
accounts. Defra’s own advice, recently published, ‘Using the Farm Accounts to Point
the Way’18, shows farmers how to review their variable costs and check whether they
are too high.

99.    The solution is to persuade the client that the benefit of veterinary services will
exceed their cost, so that both farmer and vet can gain from them. I think this
requires action on two fronts.

100. First, there is a need to develop and publish convincing information at
sectoral level to demonstrate the benefits of veterinary involvement. I was
pleased to hear that Defra has already supported research of this kind at Reading
University.

101. Following on from this, the professional organisations should work with
industry and advisory organisations (eg the Milk Development Council and the
British Institute of Agricultural Consultants) to develop advisory material to
show how the benefits can be achieved at individual farm level, and at what
cost. I gather that Defra is also planning to encourage the production of such farm-
level material.

102. The professional organisations should make this material available to
banks and other consultants who advise farmers on their business costs.

103. The second broad avenue is to develop new charging mechanisms, to help
the client look at veterinary support as a contribution to his business efficiency, rather

18
     http://www.defra.gov.uk/farm/fbadvice/farm-accounting/index.htm


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than just a cost. Some large animal vets are already charging clients on a pence per
litre or pence per head basis, so that the fee is performance-linked. Others are
setting up an annual maintenance contract, where a certain package of services is
provided for a fixed fee (and more is charged for additional work). It would be helpful
for individual practices to understand how to innovate on fees. The professional
organisations should review novel charging mechanisms, and provide
guidance to practitioners.




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I. Structure of the profession

104. Work on the best practice model proposed above would include considering
the ideal size range for practices delivering large animal services.

105. RCVS evidence to the EFRA Committee19 states that there were 9,000 vets in
practice and 2,375 practices. Of these, 964 were known to carry out large animal
work. Although these figures are not further broken down for large animals or for Full
Time Equivalents, they show that the average number of vets per practice was 3.8.

106. The BCVA Manpower Survey provided responses from 166 practices (26% of
BCVA membership of 454). The average number of FTEs on farm work was 2.6,
provided from an average total of 4.5 vets, ie 1.7 vets per FTE on farm work. These
cattle practices were therefore slightly larger than the average for the profession as a
whole. The survey also showed that 60% of practices had fewer than 3 FTEs on farm
work, and 21% fewer than 1 FTE.

107. These figures suggest that a significant proportion, perhaps a third, of
practices dealing with large animals falls below the level of 3 vets or 1.5 FTEs on
farm work suggested as a minimum by Orpin (section G). Even those around that
level may not remain viable in the medium term.

108. There is much anecdotal evidence about practice closures and mergers, and a
suggestion from many that remain that this process is a bad thing. Amalgamations
are often inhibited by personal factors and distrust between practitioners, eg over a
lost client in the past. I do not think that mergers are undesirable if they enable a
larger practice to emerge with better more specialised services. In many
circumstances, mergers are to be encouraged. This is an ongoing process driven
by and possibly best left to the market.

109. Nevertheless the Government does have one lever that it might consider
using. At present, most vets in practice apply to become LVIs because this offers
them a further source of income. The Government could consider whether its
appointment of LVIs or its delegation of work to them could be operated in a
more targeted fashion since it is in the interest of all parties for the profession
to have a viable structure.

110. Under present arrangements, the ability to provide emergency cover is a
limiting factor in practice amalgamations. The suggestions I make in section K could
allow more flexibility for both small and large practices.

111. It is traditional in the veterinary profession for vets to organise themselves in
partnerships, a business format that has worked well for many years. Practices are
owned by the partners, and all other staff are employed. It is costly to buy into the
partnership, ‘like taking out a second mortgage’, and women in particular are

19
     Published with the EFRA report, Ev 23.


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reluctant to take on this burden (45% of female vets who are not principals or
partners have no ambition to buy a practice or become a partner, according to the
Quo vadis? survey). Partnerships create a two-tier structure for vets in practice,
where the assistants have a lower status. It is not usually possible for non-vets to
own a share of the business. In the small animal world, there are some substantial
corporate practices, and in the large animal sector, some principals are converting
their partnerships into limited companies, citing operational and financial flexibility as
the justification for taking this step. I recommend that the professional
organisations should carry out or commission a review of business structures,
to identify the pros and cons of different models, and provide guidance to
practitioners.




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J. Areas with poor veterinary coverage

112. It is generally reckoned that areas with the greatest livestock density,
particularly the main dairying areas in the south west of England, Cheshire and West
Wales, can still support a good coverage of veterinary practices. In other areas – eg
the Midlands, South East and Eastern England, Mid and North Wales, Highlands and
Islands and the urban fringe - livestock densities are lower and it is considered that it
may become difficult to maintain large animal coverage.

113. There is concern in the profession that the recent decisions on the Mid Term
Review of the CAP will have a significant effect on the extent and distribution of
livestock production. Fears have been expressed that suckler beef production will
fall, and that milk production will migrate out of England.

114. To some extent we can only wait and see what the cumulative effect is of
individual farmers’ decisions. But uncertainty about the future is always unsettling,
and the BVA have emphasised to me the profession’s concern about the pace of
change. There is a real feeling that while Government and industry sort out new
structures, vets are voting with their feet and moving out of large animal practice.

115. The best way to allay these concerns is to provide as much information as
possible about likely developments. A major uncertainty has been removed with the
February announcements on the MTR. I have recommended in section B that the
Government should commission a review of the implications for demand for
veterinary services of the recent decisions on the Mid Term Review of the CAP.

116. There are already some areas, eg in East Anglia, where livestock density is
very low, and veterinary coverage correspondingly thin. Farms can be serviced by
vets at a distance, particularly for pre-planned proactive work, where visits can be
scheduled in a logical order, but this is not possible for emergency work. If the
review suggested in section B shows that bigger areas may develop with very
limited veterinary coverage, I believe that Government needs to consider the
wider implications, eg for:
      The farmer, and for any future system of licensing animal keepers;
      The capacity for surveillance of animal disease and welfare, and the need
      to find ways of maintaining it;
      The rural economy and environment, if livestock production in sensitive
      areas were jeopardised.




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K. Emergency cover

117. The RCVS guide to professional conduct requires vets in general practice to
make adequate arrangements for provision of 24 hour emergency cover for all
species including attending away from the practice premises on the rare occasions
when in the veterinary surgeon’s professional judgement it is necessary. This is
interpreted, for large animals, as meaning that a vet who takes responsibility for a
farmer’s animals must see to it that emergency cover is available. The vet can
arrange for the cover to be provided by another practice, but fears over ‘poaching’ of
clients mean that it is normal for the regular vet to provide the cover from his/her own
practice.

118. For an ordinary practice, emergency calls are bound to be less economic than
normal, pre-planned work. Vets have to be kept on-call, whether they are summoned
or not, and it is difficult to schedule visits in the sort of logical sequence that
minimises travel time and costs. Some vets charge a premium for ‘out of hours’ visits,
but even those who do keep it low because they do not want to cause a welfare
problem by encouraging the farmer to wait for cheaper daytime rates.

119. As far as I can see, the result of these arrangements is that veterinary
practices place themselves under an obligation that impacts on their ability to run
their regular work:

     Large animal emergencies normally require a visit to the farm. This is not ‘on
     rare occasions’, as the RCVS guide envisages, and as normally applies for
     small animals;
     Emergencies are less remunerative than regular work;
     Young assistants object to the burden of doing ‘on-call’ work in addition to their
     normal daytime caseload;
     The cumulative burden encourages vets and practices to give up large animal
     work altogether.

120. Emergencies occur 24 hours a day, and I accept that veterinary cover has to
be available to deal with them. But I am not convinced that the present arrangements
are right. It is illogical to allocate responsibilities in such a way that demand for this
cover is encouraged, while supply is depressed.

121. It would be better if responsibility for ensuring that there is emergency cover,
indeed all veterinary cover, rested with the animal keeper. It follows that the costs
should be similarly allocated, not absorbed largely by veterinary practices on the
basis that the farmer cannot afford to pay them. If the cost makes it uneconomic to
keep animals, then the farmer needs to review his options, and the Government may
have to consider the consequences.

122. I recommend that the Government and the RCVS should review the basic
obligation on the vet to ensure that emergency cover is provided, with a view
to transferring the financial burden to the farmer.

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123. In the small animal sector there are some dedicated emergency practices,
which handle cases in a particular area on behalf of the regular practices there. The
main requirements are a degree of separation from daytime practice – separate
teams of vets, who are not handling daytime work as well – but also a degree of co-
operation, eg a group of practices willing to delegate their emergency work, and
possibly sharing premises and administrative support to keep costs down. Students
have said to me that emergency work is actually quite exciting, and that an
emergency service would be an attractive job, if it was not necessary to do daytime
work as well.

124. It would be worthwhile to arrange a trial of a dedicated large animal emergency
service, to test out the economics and see whether these are as unfavourable as
many vets fear. It would be essential to find a region where a group of practices
would support the trial, and where an interested vet was prepared to take
responsibility for organising it. The trial could be organised as a research project for,
say, 12 or 24 months, and full management information published over the period. It
may be that one of the vet schools could provide administrative support. I
recommend that the Government should encourage the professional
organisations to set up such a trial, and be ready to underwrite any losses as a
research cost for the duration of the project.

125. Vets frequently say that the best managed farms in their practice make the
least demand for emergency call outs. This seems to be because good standards of
husbandry mean that there are fewer problems, and stockmen are better trained in
dealing with emergencies themselves. I think that the professional organisations
should work with the livestock industry to train farmers and stockmen in
dealing with emergencies, including when and how to employ DIY euthanasia.




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L. Veterinary education

126. The education stage is one of the most important parts of the system. It
determines who comes into the profession, how they view the work, and how they
are prepared for it. I have looked at this exclusively from the large animal viewpoint,
though of course students are taught all branches of the subject.

127. Vets in large animal practice have expressed several concerns to me about
the selection and training of student vets.

128.   Student selection. It is widely believed that:

• Candidates are selected above all for their academic performance at A Levels or
  Scottish Highers.
• Other characteristics that might be beneficial to large animal vets, particularly
  practical skills, are given less weight.
• Entrepreneurial attitudes, which would be useful in large and small animal
  practice, are not considered either.
• Candidates’ background tends to be urban and middle class, which makes them
  less likely to want to work with farmers.
• The gender balance is now tilted too far towards women, who are less likely to
  stay in large animal work.

129. I have discussed these concerns with vet schools. They accept that entry
standards are high. Veterinary medicine is a demanding scientific discipline, and
there are many applicants for every place (5 to 1 in the case of the Royal Veterinary
College in London, the largest school). High entry standards are the universities’
normal way of distinguishing between candidates in these circumstances. But the
schools deny that academic performance is the only criterion or that it is incompatible
with practical skills.

130. In all cases, applicants are required to demonstrate that they have spent time
looking after animals. At London, students have to show that they have at least 6
weeks’ practical work experience, including two weeks with a vet and two weeks in
livestock husbandry. A student at Bristol told me ‘you’ll never get in unless you can
show you grasp the realities of farm work.’

131. All students are interviewed, and their experience and motivation towards
working with animals probed. Exceptionally good candidates may be offered a place
with less than the highest A Level grades. This confirms that academic standards are
not the only measure.

1321. Entrepreneurial attitudes do not seem to be taken into account at the point of
selection.




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                                                   34
133. There is no UK equivalent to the psychometric testing carried out at Utrecht
vet school, which examines candidates’ suitability for small animal, large animal,
equine, research and state veterinary work.

134. The social background and the gender balance largely reflect that of the
applicants. Far more girls apply than boys, and even more of the girls get the top
grades (at Bristol, girls make up 75% of applicants, and 80% of those qualified). The
vet schools believe girls are attracted by the ‘caring’ image of the profession, an
aspect that appeals less to boys. Boys may perceive that they will not get in, though
the RVC at least believes that more suitable candidates would be found if more
applied. There is some suggestion at the vet schools that boys are already more job-
focused in their university choices, and that they look for courses that will prepare
them for jobs in business and IT, sectors that are seen to offer more pay, a better
lifestyle and less stress than veterinary medicine. This view is consistent with recently
published research that suggests that boys are leading society into the internet age,
and have their sights set on the ‘knowledge jobs’ of the future; far from being behind
at school, as measured by academic results, they are in front when it comes to
preparation for their careers20.

135. I think that the vet schools should review their entrance procedures with
a view to selecting candidates with a positive motivation towards one or other
branch of the profession. The Royal College might encourage them to set up
psychometric testing like that carried out at Utrecht. For the present purpose,
there is a need to find more candidates interested in a career in large animal
practice. The schools must continue to seek candidates of a good academic
standard, but I think the characteristics they should be seeking include:
     A practical orientation;
     An entrepreneurial attitude and an interest in business;
     An interest in agriculture and the rural economy; and
     A more even balance between male and female students.


136. Content of the curriculum. This is based on the principle of ‘omni-potential’
in order to ensure that graduates are fitted for Membership of the RCVS. This broad
training also appears to respond to students’ clear preference for mixed practice, and
desire to keep their options open. Staff believe there are real benefits in comparative
teaching across the species (eg dog and horse for anatomy, pigs and dogs vs
ruminants for digestion) which stimulates the students’ understanding. They see
themselves as providing ‘an education, not an apprenticeship’ and believe they are
preparing students for a career in veterinary medicine rather than a specific job. They
say that many vets change specialisms every few years, and this would be difficult if
they did not have the rounded training.

137. All students therefore go through a similar basic training in large animal, small
animal and equine medicine. Communication skills are taken seriously, and students
20                                           st
  Nine Shift: work, life and education in the 21 century, Draves and Coates, quoted in
http://news.bbc.co.uk/1/hi/education/3494490.stm


                      Large animal vets. Report to Defra by Westley Consulting Limited, March 2004

                                                             35
take part in role playing consultations with actors playing the part of animal owners.
There is an introduction to business skills at some schools, and this is being
considered also at Edinburgh and Glasgow.

138. In addition, students have two ways to get wider experience:
• They all have to spend 26 weeks in Extra Mural Studies, formal placements with
   veterinary practices, where they accompany the vets in their day to day work. I
   was told by students at Edinburgh that this is where they get their real hands-on
   experience.
• They have to choose between a range of more specialised ‘elective’ courses. At
   Bristol, I was told that the final year electives on farm animals and equine are the
   most popular. At the RVC, a new elective on entrepreneurship had attracted 15
   students – more than expected - in its first year

139. As I see it, vets in future need to get back to the underlying rationale for
veterinary intervention. They need to have a real appreciation of farm economics and
the workings of the food market, so that they can understand properly the
contribution they can make to the farmer’s bottom line. They will then be able to
make recommendations to the farmer in the knowledge that they make technical,
economic and business sense.

140. I think the curriculum should include more education and training in
business management issues. Vet schools already address many of these
issues, but I think they should be made an essential part of the course, and
that students should be required to show reasonable proficiency in them in
order to gain their degree. These issues include:
     Communication skills;
     Farm economics;
     The workings of the food chain;
     Marketing and sales principles for veterinary practices;
     Internal management principles – financial, human resources, operational
     – for veterinary practices.

141. It may be argued that it is just not feasible to add this much material to an
already crowded curriculum and to give it the priority I am proposing. There is an
obvious solution to this.

142. The principle of ‘omni-potential’ has wide support in the profession. However,
the RCVS recognises that veterinary work is getting ever more specialised, and is
currently working on a new framework for education, training for 2010 and beyond21.
On leaving vet school, graduates would have ‘Day 1 competences’ which would
enable them to become MRCVS and to receive a ‘provisional’ licence to practise.
The new graduate would work in a registered practice for approximately 12 months

21
  Veterinary Education and Training. A Framework for 2010 and Beyond. A consultation paper prepared by the RCVS
Education Strategy Steering Group July 2001, http://www.rcvs.org.uk/vet_surgeons/pdf/esg_consultation.PDF. See also the
presentation by the Education Strategy Steering Group dated June 2003,
http://www.rcvs.org.uk/vet_surgeons/pdf/essg_pres.pdf


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                                                            36
until ‘Year 1 competences’ had been gained. He/she would then be able to obtain a
definitive licence to practise in a defined area, eg production animal medicine and
surgery. If they later wanted to work in another specialism, eg companion animal
medicine and surgery, they would have to undergo conversion training.

143. The Royal College’s proposal recognises the reality that most vets end up
working principally in one specialism. It would indeed to force them to do this in the
future unless they held multiple licences to practise, though I am told that this would
not stop vets from one specialism helping another in an emergency. In that case, I do
wonder why they cannot specialise from the outset, as I gather is the case at Utrecht
vet school.

144. I recognise that early specialisation would lose the benefits of comparative
teaching. But it would enable courses to focus more deeply on the issues that matter
in particular branches of practice. As I have indicated above, these include a wide
range of non-veterinary matters, as well as the key veterinary skills.

145. A change of this kind might well have an impact on candidates for vet school
places, and it is possible that there would be some reduction in demand. I am not
sure this is necessarily a problem, and I suspect that it might provide an opportunity
to work on the issues of candidate selection that I have discussed above.

146. For all these reasons I think the RCVS and the vet schools ought to re-
examine the pros and cons of moving to a system of streaming students into
broad areas such as large animal, small animal and equine medicine.


147. Networking between vet schools and practices. I have been struck by two
issues that could be addressed by stronger networking between vet schools and
large animal practices.

148. First, most of the practices I have talked to report considerable difficulty in
recruiting suitable assistants. The exception is those that have some link with one or
other of the vet schools. Students get to know or hear about these practices, and
may apply for jobs even before an advertisement is placed. I think there is much to
be gained from setting up a more formal network, which would benefit vet schools as
well as practices.

149. Second, it has been said to me that there is no link in large animal medicine,
akin to that in the NHS between GPs and specialists. Even in small animal work
there are vets in general practice, and others who specialise more. Networking
between practices and vet schools could provide a good opportunity for a two-way
flow of information, whereby vets could access specialist advice, and the schools
could rapidly gain information about conditions in the field.

150. Existing networks include the National Animal Disease Information Network
(NADIS), which brings together 40 veterinary practices and the six vet schools to
monitor disease in cattle, sheep and pigs, and also the system for Extra Mural
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                                                   37
Studies, where most practices take students on placement. I recommend that the vet
schools and the professional organisations should examine the potential
benefits of more general networking, with a view to setting up a comprehensive
network.


151. Impact of top-up fees. Veterinary science is a long course, and students rack
up significant debts by the time they graduate. The BVA/AVS survey reported that
the average total debt of final year students was £7,695. The survey was carried out
in 2002 and younger students expected debts to be higher in the future. 32.8% of
students were reckoned to have serious financial problems. For comparison, the
Department for Education and Skills says that the Student Income Expenditure
Survey finds that the average anticipated debt is currently around £8,666, and that
average student debt is likely to be nearer £15,000 once deferred tuition fees of up to
£3,000 are introduced22.

152. Against this background, concern was expressed to me that the Government’s
recent decisions on top-up fees would substantially increase veterinary graduates’
debts. There was dissatisfaction that medical and dental students would have their
top-up fees met by the NHS in the last two years of their course, whereas there was
no such arrangement for vets.

153. The students I have spoken to thought that debts would make graduates more
reluctant to buy into partnerships. However, it was said to me that debts would not
have such a large effect on their choice between sectors of the profession, since the
work was so vocational. I have heard it said that debts could be a particular
disincentive for male vets who traditionally aim for partnership.

154. This is an area where students and practices can be expected to report any
ongoing problems. I recommend that the Government should keep the impact of
top-up fees on veterinary students under review, in case any significant
problems emerge.




22
     http://www.dfes.gov.uk/hegateway/henews/rebuttal/index.cfm?articleID=171


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                                                              38
M. Information

155. At a time of change there is always a need for reliable information and
statistics. I have reviewed several published surveys (RCVS, BVA, AVS, BCVA, Quo
vadis? etc), which have thrown much useful light on the availability of large animal
vets.

156. Each of these surveys has been conducted for its own reasons, and I have
seen no particular evidence of co-ordination. The Government is itself interested in
the findings, but I have not seen any evidence of involvement on its side either. I
think it would be useful for the Government to make contact with organisations
conducting surveys, to offer its advice on the questions to be asked.

157. One area where more data is needed is the age structure of the profession,
given the concerns expressed that many large animal vets are in the older age
group, and that their practices do not have enough younger vets coming on to
succeed them. The Royal College’s Register of Members lists dates of registration,
from which ages can be roughly inferred, but I think the Royal College could collect
specific information about ages, and use it to forecast future numbers.

158. A further area of uncertainty is the involvement of individual vets in large
animal work. The Royal College publishes a non-statutory Directory of Veterinary
Practices, which lists all the practices they are aware of, and the species and areas
of work that the practice deals with. This information is also used in the Find a Vet
section of the Royal College’s website. Practices update this information themselves,
and the College circularises them every 2/3 years. This information does not reveal
whether individual vets work (or still work) on large animals, and it would be useful to
obtain more information about this. This could be achieved by a more detailed
questionnaire to practices, or by a telephone survey. I recommend that the Royal
College should work out the best way to obtain information on the work of
individual vets, and consider whether it should be published.




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                                                   39
N. Summary of conclusions and recommendations


The market

159. Even if LVI and meat hygiene work are included, large animals account for
only 13.2% of total time spent in practice. We need to be realistic about the extent to
which professional systems can be adjusted to give more attention to farm animal
work.

160. The Government should commission an analysis of the likely implications for
the demand for veterinary services in the beef and dairy sectors in the light of the
decisions on the Single Farm Payment announced in February. This should
distinguish between sectors and identify any likely regional shifts.

161. The professional organisations need to alert vets to the need to modernise
their ways of doing business, and to develop and promote ways of helping them do
this.


Is there a shortage?

162. It may be worth examining whether there are suitably experienced foreign vets
and how they might be encouraged to come to the UK.

163.    It is hard to avoid the conclusion that student numbers, globally, are adequate.


Why do UK graduates not wish to remain in large animal practice?

164. It would be helpful to carry out more targeted research on the views of young
vets, ie those within 5 years of graduation,

165     There is a need to address the issues that are putting young vets off:
       Poor preparation during training for large animal work;
       The weight of on-call work in large animal practice;
       Poor practice management that demotivates young assistants;
       Need for better networking between vets in different practices;
       Need for young vets to get balanced skills development in their early years;
       Resistance to part-time working in large animal practice


Feminisation of the profession

166. There is a reluctance on the part of many vets to face up to the implications of
the increasing proportion of women in the profession


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                                                    40
167. If women are to form a large part of the profession and want more flexible
working patterns than men, the profession will have to find ways of accommodating
to this, and of turning the challenge it poses into an opportunity.

168. There is scope for the professional organisations to look more closely at the
opportunities and practical benefits of more flexible working in large animal practice.


Viability of large animal practices

169. In the veterinary sector, increased viability is likely to mean being more
efficient and earning more. Much of the responsibility for this lies with vets, but
customers, particularly farmers and Government in the case of large animal practice,
are likely to have to pay more if the service is to be maintained.

170. The BVA in partnership with its farm species divisions should consider
launching a three-stage process:

• First, they should encourage an open debate in the profession about viability and
  the factors affecting it, drawing on the above suggestions and teasing out any
  other issues that are deemed important. Leading vets should be prepared to
  share some of their business principles.
• Second, they should draw up a best practice model for the viable large animal
  practice. This would set out the key success factors in simple practical terms,
  accompanied as far as possible by real-life examples.
• Third, they should set up a process of benchmarking, so that individual practices
  can easily see how they shape up against the best practice model.

171. The profession’s channels of CPD should be utilised to support the necessary
development.


Charging for services

172. There is a need to develop and publish convincing information at sectoral level
to demonstrate the benefits of veterinary involvement.

173. The professional organisations should work with industry and advisory
organisations (eg the Milk Development Council and the British Institute of
Agricultural Consultants) to develop advisory material to show how the benefits can
be achieved at individual farm level, and at what cost.

174. The professional organisations should make this material available to banks
and other consultants who advise farmers on their business costs.

175. The professional organisations should review novel charging mechanisms,
and provide guidance to practitioners.

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                                                   41
Structure of the profession

176.   In many circumstances, practice mergers are to be encouraged.

177. The Government could consider whether its appointment of LVIs or its
delegation of work to them could be operated in a more targeted fashion since it is in
the interest of all parties for the profession to have a viable structure.

178. The professional organisations should carry out or commission a review of
business structures, to identify the pros and cons of different models, and provide
guidance to practitioners.


Areas with poor veterinary coverage

179. If the analysis suggested in section B shows that bigger areas may develop
with very limited veterinary coverage, I believe that Government needs to consider
the wider implications, eg for:
     The farmer, and for any future system of licensing animal keepers;
     The capacity for surveillance of animal disease and welfare, and the need to
     find ways of maintaining it;
     The rural economy and environment, if livestock production in sensitive areas
     were jeopardised.


Emergency cover

180. The Government and the RCVS should review the basic obligation on the vet
to ensure that emergency cover is provided, with a view to transferring the financial
burden to the farmer.

181. The Government should encourage the professional organisations to set up
such a trial, and be ready to underwrite any losses as a research cost for the duration
of the project.

182. The professional organisations should work with the livestock industry to train
farmers and stockmen in dealing with emergencies, including when and how to
employ DIY euthanasia.




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                                                   42
Veterinary education

183. The vet schools should review their entrance procedures with a view to
selecting candidates with a positive motivation towards one or other branch of the
profession. The Royal College might encourage them to set up psychometric testing
like that carried out at Utrecht. For the present purpose, there is a need to find more
candidates interested in a career in large animal practice. The schools must continue
to seek candidates of a good academic standard, but I think the characteristics they
should be seeking include:
      A practical orientation;
      An entrepreneurial attitude and an interest in business;
      An interest in agriculture and the rural economy; and
      A more even balance between male and female students.

184. The curriculum should include more education and training in business
management issues. Vet schools already address many of these issues, but I think
they should be made an essential part of the course, and that students should be
required to show reasonable proficiency in them in order to gain their degree. These
issues include:
     Communication skills;
     Farm economics;
     The workings of the food chain;
     Marketing and sales principles for veterinary practices;
     Internal management principles – financial, human resources, operational – for
     veterinary practices.

185. The RCVS and the vet schools ought to re-examine the pros and cons of
moving to a system of streaming students into broad areas such as large animal,
small animal and equine medicine.

186. The vet schools and the professional organisations should examine the
potential benefits of more general networking, with a view to setting up a
comprehensive network.

187. Tthe Government should keep the impact of top-up fees on veterinary
students under review, in case any significant problems emerge.


Information

1887. It would be useful for the Government to make contact with organisations
conducting surveys, to offer its advice on the questions to be asked.

189. The Royal College could collect specific information about ages, and use it to
forecast future numbers.

190. The Royal College should work out the best way to obtain information on the
work of individual vets, and consider whether it should be published.
               Large animal vets. Report to Defra by Westley Consulting Limited, March 2004

                                                   43
Annex 1 : Organisations and individuals who have contributed


Professional organisations
Royal College of Veterinary Surgeons                   Prof Richard Hallewell, Roger Eddy, Jane Hern, Geoff Gill
British Veterinary Association                         Tim Greet, Peter Jinman, Bob McCracken
British Cattle Veterinary Association                  Graham Hibbert, Carl Padgett
British Sheep Veterinary Society                       Kate Hovers
Society of Practising Veterinary Surgeons              Mervyn Harris
Association of Veterinary Students                     Rowena Merrick

Practising veterinary surgeons
Meurig Evans                                           Anglesey
Ceri Daniel                                            Bridgwater
Neil Hubbard                                           Caernarvon
Phil Hyde                                              Cardiff
Edward Jones                                           Cardigan
David Black                                            Carlisle
Louis Webb                                             Carmarthen
Philip Williams                                        Carmarthen
Trefor Pritchard                                       Denbigh
Iwan Parry                                             Dolgellau
Andy Lewis                                             Haverfordwest
Anton Lowe                                             Havorfordwest
Robert Anderson                                        Kelso
Hugh Jardine                                           Kilmarnock
James Thomas                                           Lampeter
Peter Orpin                                            Leicester
Colin Baxter and Neil Howie                            Nantwich
Rick Irons                                             Neath
Barry Johnson                                          Preston
Geraint Jones                                          Pwllheli
Gwyn Jones                                             Ruthin
Keith Cutler                                           Salisbury
Roy Anderson (retired vet)                             Stirling
Nic Blayney                                            Stratford on Avon
Sandy Clark                                            Thurso
Frank Stephen                                          Thurso
Dick Sibley                                            Tiverton
Rob Drysdale                                           West Sussex
Paul Sharples                                          Wrexham
Barry Dickinson                                        Wrexham

Veterinary schools
Edinburgh                                              Prof Elaine Watson, Colin Penny, David Whitaker
Glasgow                                                David Barrett (attended Edinburgh meeting)
Bristol                                                Prof Avril Waterman-Pearson, Ian Cumming, Andrew
                                                       Bailey, David Main, Prof Philip Duffus
Royal Veterinary College, Hawkshead                    Prof Michael McGowan, Prof Stephen May

Other
Veterinary Business Development Ltd, Peterborough

Farm business consultants
Roger Seed                                             Roger Seed Professional Services
Paul Henman                                            Promar International

Government departments
Department for Environment, Food & Rural Affairs       Jim Scudamore, Diana Linskey, Alick Simmons, Kate
                                                       Richards
Scottish Executive Environment & Rural Affairs         Ian Anderson, Neil Ritchie, Mike Lamont, Anthony Bates
Department
Welsh Assembly Government                              Norma Barry, Tony Edwards
                   Large animal vets. Report to Defra by Westley Consulting Limited, March 2004

                                                       44
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                       Artillery Row
                    London SW1P 1RL

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