VETERINARY CHOICES

Good evening everybody, here we are. Dr. Conor Brady is not with us today because he is swanning it up in the south of France, but we do have the gorgeous, talented, and really quite wise and clever Dr. Alan Robinson with us. You thought I was going to talk about you, Bren, didn't you? Of course you are, of course, all of those things, but today Dr. Conor Brady's done a bunk and we've got Alan Robinson. Now, Alan Robinson, I've known Alan for years and years and years and years, and, and he is nowadays one of the leading gurus for business, veterinary business. He educates vets on how to run their practices, not only to be as efficient and profitable as possible, but how to run them as a as a more coherent and a more happy place to, to, to, to work and derive maximum benefit from being within the veterinary family. So he's a remarkable guy. Alan, it is really, really great to see you. How are you doing?

Really good, Nick. Thanks very much for the introduction. I've had guru before, but I've never had gorgeous. So, um, that's a one up for you guys.

Well, we've got to butter you up, you see. That's, that's the thing. Didn't you just say gorgeous just as the countdown went? You said handsome, debonair, and I was taking your lead, my friend. I was taking your lead.

As you can see, NLP. He was just putting those words in there.

I'm all yours. You've got me. Excellent.

As you can see, guys, Alan is very, he's very relaxed, he's an Aussie, and he's got a very cheeky and profound sense of humor. Okay, so I think we're going to have a good time just now. Brent, do you want to kick off with some questions?

I've got lots of things to ask Alan, but yeah, well, you know, we thought that this was a good opportunity. There's a few things going on in the veterinary sector. Which is to look into what's happening with competition, what's happening with corporatization. There's a few moves by the Royal College of Veterinary Surgeons to change the Veterinary Surgeons Act, which will also encompass a few changes for some of you guys out there in parapathetics. So that means all of the nutrition areas, all of the dog training areas, anything that's animal related. So be aware that that might be incorporated into the Veterinary Surgeons Act, and they may want a little degree of effectively overlooking what you're doing in that, in that sector. So there's some interest in those areas. I think veterinary choices, I've titled it here because we've also had loads of questions from people about, look, how do I choose a good vet? How do I, you know, communicate with them to get really what I want as a service? And what is going on with veterinary pricing? Okay, so I thought it'd be really good that actually Alan's sort of seen it from the vet side quite a lot and has advised a lot of vets on how to make sure the business works.

I've been in veterinary practice for— how long were you in veterinary practice? 20 years or so?

Yeah, 20 years.

All of a sudden the age sort of came in and he said, no, only a few years.

I'm not on Facebook, but I did get the first page and someone on there said, 'Oh, Alan worked in my practice 20 years ago.' And so that was kind of an indicator that was probably when I was doing good. So there was 20 years before that as well.

So I think it's really good that we sort of have a bit of a frank discussion about, look, you know, you've got to be careful what you wish for because you pay peanuts and you get the proverbial monkey in some, in some descriptions. And at the same time, you know, there is overinflation at the other end and we've got to hit a happy medium. So we need a frank discussion about how that works. So any of you guys out there that want to, you know, add some questions, I've got Facebook going live. There's some of us, some of them being followed on YouTube as well, so, you know, you can post and Alan can see those directly, um, uh, on the side of your screen, Alan. Um, but I'll sort of bring any questions that come up, um, if you want to know more. Um, but right now I think we sort of start with you know, choosing a veterinary practice. And yeah, if somebody is out there, how would you say they mainly approach veterinary practices these days, Alan? What are you advising vets that they need to be most visual on in order to attract clients?

The concern with all this is there's no simple narrative here. There's no sort of short soundbite that's going to say this is it, there's an answer. This is the complexity of the world we're in, particularly the veterinary world, is just massive. So, so take all of this with, you know, that we've got to sway it either way and very much so. But you know, what do vets want? Vets are a service industry. They're providing veterinary care for the dogs, cats, rabbits, etc. And don't forget farm and equine out there doing their own thing, though in our world we separate those out as different business models working different ways. I'll probably just focus on the small animal side because that's where I know the world best. What do clients want? Clients actually want to have an animal. They want a companion, and they buy a pet for various reasons. Pet companion, you know, one of the children's sort of thing. Pet parenting is going on. And you know, what we do know is a lot of the younger people now are getting pets before children, and so they are somewhat of a surrogate. So what do you want for your children? You want them to be healthy, You kind of want to be told they're healthy. You kind of want to be told you're a good parent and things are going okay. Okay, involves communication. Vet's training is to diagnose and treat pathology and disease. If you actually read the Veterinary Surgeons Act, it defines the act of veterinary surgery in those terms. Look for, diagnose, and treat pathology, blah, blah, blah. So that's kind of where their mindset is. And I always sort of have this analogy of a vet and a client sitting across the consulting table with this furry biological mechanism in the middle, having two completely different conversations going on. Now, if you make that little animal in the middle something like a Shar-Pei or a Frenchie or one of the more contentious, or a bully for that matter, in the middle, you suddenly get even more distance between those two conversations. So I've got to ask the question then, so what does the vet want? The vet wants to fix things, basically. That's what they're trained to do, and that's what they really enjoy doing. They want compliance. They want the client to take their suggestions and take it on. They probably want to get paid at some point, though interestingly, that's probably the least of the concerns of the vet in the actual construction of it. And they, you know, they want some compassion as well. So we talk about compassion fatigue in the profession. Vets are very much highly compassionate people, give, give, give, give a lot. They give a lot of compassion. They do actually do their best to provide care and compassion to the pet, and maybe not always successfully, but they do try to give compassion to the client. But they do give that. They don't always get a lot back. And so we have this sort of disparity between those two things. Back to your question, well, how do you choose a vet? Um, where, you know, from the external, it's recommendation, it's the website, it's the reviews, it's the Googles. Yeah, I'm, I'm too old to be too concerned with social media, and I believe it's, it's, it's skewed in many ways. But, you know, can we have a conversation with someone? What clients would really like is some continuity as well. So where they go to practice, they get meat of that, and they say, I love this vet, I'm going to want to see them. 'Cause that vet's got a life and rotas and other things and can't be there all the time. So you do have to engage with a practice because you're gonna deal with multiple people there. The key thing's can the practice do the job? They got the skill sets to do it up to a level. I had a little discussion earlier where a lot of vets now have to refer work away to other specialist centers 'cause vets can't do all the work. But you've gotta find out what level of work they can do. Basic primary care is important. Communication systems, um, nursing I think is a really important part of the veterinary team. And I would almost even engage with the receptionist and the nurses as a, as a client to get the feel of the culture of the practice. And you'll get it from those people very quickly. We know there's a thing in the, in the Vet Times at the moment about a practice in Wales who's actually considering going on strike. I don't know if you saw that in the Vet Times today. They're actually one of the few practices in the British Veterinary Union, and they're reacting against their owners, which unfortunately is a corporate, um, because of the pay they're on and the cost. And they're just epitomizing the whole drama of the veterinary profession at the moment. Um, the culture there must just be toxic. Now, would you want to take your pet and put it in there? Um, so short— long answer to a short question. Really try and assess the culture in the practice. Is it somewhere that people are enjoying what they're doing, and that's the job it should be.

Alan, you say that things are very complex these days, but back in the old days, you'd have your local village town vet, you know, James Herriot type person possibly, and you'd take them along to them, and it was pretty simple. Why has it become complex And, and so what changes is essentially what I'm— so what are the changes and why have things changed so much, would you say?

Just the scope of veterinary care. I mean, I was there in the old days, so I kind of know the answer to this one. Um, you turned up and you had a limited number of choices. There are actually a limited number of diseases. We didn't actually diagnose as much in those days. And then the treatments were very much antibiotics, anti-inflammatories, a few clever drugs, and you dispensed stuff and things kind of got better or didn't. In the case surgical capability, we could put pins and maybe plates on bones and things like that. That was the most sophisticated thing you did in practice. And there were a few referral centers, usually the university at some distance away, and people kind of lived with the— we'll do what we can, or euthanasia is an option, or we'll do our best. We weren't really talking about nutrition. We weren't really talking about these other aspects of it. The simplicity was, I'll do my best and fix these things. And don't forget, vets were also multitasking around different species. You'd have farm work and you'd have horse work as well. It was— get back, taking back to the classic, you've missed— oh yeah, of James Herriot. It was James Herriot days in much of that. From the '80s, early '90s onwards, obviously got a bit more complicated. It got busier, but even so, I think it was okay. It's probably been the 2000s that have accelerated lots of things. There's been a shift in the business models. So we know corporatisation is 50-60% of the business. So that's a business model shift. There's a complexity of the veterinary work. And there's the fourth— the things I see vets and nurses suffering from is cognitive overload, just too much to know, just a massive amount of things that no one has done. And that starts with students. It's inefficiency of business and systems because every practice is a small veterinary hospital. If you think of the complexity of an NHS hospital, Crank that down to, you know, 14 people running one of those. Massive inefficiencies are the result of that, and therefore mistakes are made and different things happening. Um, that lends to huge emotional load. Emotional load comes from that, just trying to get the job done in the time available and have a life. Equally, clients are coming in every 15 or 20 minutes and delivering another emotional deposit into the system for you. Okay, and most vets these days are just too busy. Too busy to practice good medicine, too busy to look after clients, too busy to look after themselves, and too busy to make really very much money. Now there's a paradox in this pricing thing in that veterinary care is very expensive. Most vets don't make that much money. It's a really strange thing, and I can explain a bit more of that later. Um, and then the final thing is just the, um The, the things going on in the profession are just creating massive amounts of uncertainty, ambiguity, and confusion that just makes being really difficult, in my view. I think that covered it.

But I mean, everybody's is very concerned with the costs to the, to the client of veterinary medicine these days. Has it actually, you know, so to get something really basic like a a bitch spayed in the mid-'80s, how does that compare, you know, with inflation and what have you? Is veterinary medicine today more expensive than it was in the mid-'80s, or is it just there's more on offer, we do more diagnostics, therefore the bills are going to be higher because you're getting more value? What What would you say to that one?

Um, interesting. I found this only out a while ago. We're doing lots of surveys into practices looking at their prices. We collect a lot of data from practices, so we've got trend data over a lot of years of what's, what's happening. I've got a friend in Australia who does the same sort of data work in the— he's another geek, unfortunately. So we geek, geek out on this stuff, but we look at, um The profitability of practice has remained fairly consistent. It's around about, on average, around about 15 to 18% of your total turnover comes out as profit. Because as we know, in any business, you need some level of profit to reinvest back in the business as return on investment. And that's a reasonable and fair thing. And that has never spiked dramatically in any different commercial environment, economic situation.

But what—

but the— but what— the inflation, the cost of stuff has always gone up. There's always a steady growth like everything else. Is the cost of milk more than in the 1980s? I suspect so. Is the cost of petrol any more expensive? I suspect that everything's gone up. Now people are saying, oh, this consumer price index, it's 5%, so how come veterinary price has gone up so much? Veterinary pricing is based on the consumables of veterinary profession. Consumer Price Index is based on the consumables of going to the supermarket— milk, bread, sugar, eggs. The consumables of veterinary practice are drugs, people, electronic equipment, CT scanners, X-ray machines, etc. So the inflation rate in veterinary practice is virtually double the CPI and has been consistently double all the way through. So yes, the rate of price increases has been greater in veterinary profession because the nature of the business indicates that it is. Now, just as a comparison, what we do know, the rate of inflation of insurance premiums is about 12% for the same reason. It's trying to keep track of the cost of veterinary care. Veterinary care goes up for the reasons you did mention. There's more of it, we can do more, and we've got to use more sophisticated people, drugs, and equipment. And therefore someone's got to pay for those. And a lot of it is in these days right now innovative. So it's at the high end of the cost curve. Over time, the cost of these things drops, but we've had masses of innovation coming. So some of the drugs that we're using for arthritis, for allergies, um, etc., uh, work really well, but they're really 80, 90 quid a pop, uh, to go into. People are putting CT scanners in first opinion practices because it delivers such a far, far better diagnostic tool than just static X-rays. But a CT scanner is, I mean, £150,000. You got to do a lot of CT scans to get that money back, etc. So it's the quid pro quo. Do we want good veterinary care? Do we want the old days of James Herriot where kind of things died if they didn't get better, etc.? And that's probably not that binary.

Yeah, and so on the back of that, I mean, that's a really good analysis, and I really do sort of feel that, you know, a lot of people don't get that there is a difference in those inflation rates just because of the profession. But we then have some confusion that reaches clients because they will then ring round and there'll be a practice putting a vaccine out, or, you know, and that's been named in the thing, and they'll get a price range anything from £30 to £90, you know, for what they perceive as the same service. What, what, how do you justify that in the general veterinary market? Is that that actually, you know, that's a good way for somebody to attract people into a practice. What is this thing about loss leaders? Is that something that works, or is it just a case of differences in area, differences in price points, differences in vaccine that they're using, you know, all of the, the length of time that they're spending with the client? How does this pan out, what is the explanation for these people that are saying, why are you so disparate in your pricing?

Yes, all of the above.

So I mean, you know, is there anything that you would say to the veterinary profession that actually, you know, is it that we should be doing loss leaders? Is that a consequence of market forces coming in? What's the—

well, I would say, Brendan, yeah, but you talk about loss leaders and, you know, that's a marketing tool, that's a tool to gain more clients. If I do a low price compared to my competitors, more people will come to me. It doesn't actually hold in the vet profession. It never works. It never has. Um, it's, it's a false economy in many ways. If people think that neutering on its own, and probably vaccinations— they are what we call shopped around. People do ring around when they're looking initially for a vet, and they might be going for a cheap, but that is a very small proportion of the, of the pet population. I think we're being disingenuous to most pet owners who actually seek good quality services for their pet. Price is part of that, but unfortunately price is probably the only thing— back to your original question— that clients have a process of assessing a practice. If it's— but how do they assess it? It's low price, therefore it's good? Doesn't kind of make sense. It's low priced, Maybe it's not so good. What do you get for your money? It's high priced, but is it good or is it just high price? So it's masses of confusion around that. Bitch spays are still the most highly subsidized— neutering in general is the most highly subsidized procedure vets do. If you actually cost out a laparotomy, which is a full abdominal hysterectomy on a dog, it probably should be 2 or 3 times what most vets are charging. There is this sort of given that we know, but we kind of know that. Other pricing consultation fees, um, are we comparing apples with apples? So some vets do 10-minute consultations, some vets do 15, some do 20, some do 25, some do 30. Okay, now if you kind of put that in basic economic terms, you're kind of running your business on an hourly rate. I've got to earn X amount of money per hour to stay open with this building, all this equipment, all this stuff. And the rates, gas, electric, and all the other things that go with it. To stay in business, I've got to earn a certain amount per day, therefore per hour. Now, if I'm going to offer you 20 minutes of my time, it should be one-third of that hourly rate, is the kind of thinking. Not many vets do that thinking, mind you, but that's kind of how they've come around to what's it worth. What, what actually happens— and I'm not justifying pricing in any way here— but what actually happens 'Let's look at the neighbouring practice.' And they look at that neighbouring practice and say, 'Nick, what are you charging?' 'Oh, that's okay.' 'Brandon, what are you charging?' 'Oh, a bit more.' 'I'll go somewhere in the middle and that'll be okay.' Or, 'I'll be cheaper than both of you.' Or, in fact, I might say, 'I'm going to be more expensive than both of you,' because it's a marketing tool, not a pricing tool in some ways, because I know people are going to ask about that. So there is variation in that. It probably has very little to do with the service you get. Going back to the original question, you really have to assess the practice on your needs, have conversations and speak to them on that, and the money becomes a little bit incidental. Rank that up a little bit to diagnostics like X-rays, ultrasound, etc. How do you compare those prices? They're never really published as such. And then am I doing a 2 X-ray, 4 X-ray, 6 X-ray series? Am I doing a 32-slice CT scan or am I doing 64-slice CT scan? We're not comparing anything with anything. So I, I have an issue around some of the, not the CMA, but probably some of more the media, the newspapers that have jumped onto these surveys and they're just not fair. I took my car to the Mercedes garage today. I'm fortunate enough to own one of those things, but boy, were they a lot more expensive than the bloke down the road. Okay. Who could have done the job. 'But I want to look after my Mercedes warranty, so I made the choice. I'm willing to pay the extra money.' Okay, and it kind of works that way as well. Um, veterinary practices aren't exempt from market forces and commercial decisions.

So what, what, what length? So, so I'm just going to get granular for one second here because people are going, 'Well, I don't know what kind of CTs the vet is doing, they— or they, you know, what's the quality of the drugs they've got in the pharmacy behind? They can't measure that. What's the optimal length of consultation as far as the owner getting the very best value? Okay, because 10 minutes, you think, well, that's good, that's a third of half an hour, and therefore it should be a third of the price. But actually, it's going to be rushed the communication is maybe not going to be too good, the owner is going to be stressed, the dog is going to be stressed, the vet is going to be stressed. And so actually you may be shooting yourself in the foot as, as a, as an owner going, oh, I'll go to them because they have really cheap, really cheap consultations. So what would you say would be an optimal— because obviously a 5-hour consultation would be great, but you're going to lose your way sooner or later. And a 10-minute consultation is arguably a bit too short. 5 is definitely, you know, the typical NHS 7-minute consultation. What can you do in 7 minutes, for goodness sake, you know? So where would you be on that, you know? Because that's something that they can say, right, they bring around 5 practices and they find the one that does the sweet spot, not too long, not too short. Where would you go with that?

I look at that from the veterinary side of things. So you're right, what can we do in a— what needs to happen in a consultation? And now again, it'd nice to be simple, but not all consultations are the same. A vaccination is generally a discussion around preventative healthcare, nutrition, how's the dog doing, behavior, different things. And by the way, we're going to bring it up to date with our whatever vaccine things we do. Equally, what we now do is not give the same vaccine every year. We alternate those because of the needs and worth. And you can get assessments and tighter testing and different things, as you know, to do that. So maybe the price varies on that. But I would say to have a good engagement with a client, I want a good 20 minutes in the room just discussing. But it may not be with me. It might be 10 minutes with the vet doing a clinical thing and 10 minutes with a nurse doing a preventative piece, talking about behavior, clipping the nails, checking the ears, all those sort of things. But the client feels they've got some value. But there's an interesting study done is that if you are in a room and you get a list of closed questions, yes/no questions— is he got this? Has he got this? Have you done this? Have you done this? Have you done this?— the client perceives a much shorter time than actually was constructed and much less value in the conversation because it was Yes, no, yes, no. It was just an interrogation rather than a conversation. If the vet asks at least half the questions as open questions, as we know, open questions are discursive. Tell me more about what you think of what's happened since type question, giving the client a chance to talk to you, even if you consider it nonsense or anything else, but you listen. The client perceives that that time was much longer than it actually was. And they also leave feeling they've had much more value. And that's how they assess it. So time is immaterial. It's what you do with the time in many ways. But I would agree, under 15 minutes, that becomes difficult because vets are afraid if they get the client talking, they won't be able to shut them up again. So tell me what's happened to Freddie. Oh, well, we went on holidays and this happened. And then I'll stop talking. So What, what are the laps or gaps in this whole thing? It's nothing to do with pricing, business model, or anything else. It's how vets are trained to communicate. Some are naturally good at it. Most of us are scientists focused on the science of veterinary medicine. Okay, in your role, Nick, you're much more of a consultant. You've learned the skills of consultation, you've learned the skills of this, and you have much longer consultations as a result of that. That's the nature of your business. For most vets, they're bobbing between a vaccination, something simple like a, you know, a nail clip, or even a repeat injection for a medical condition. Or they might get a very complicated skin or gastrointestinal case that they actually need 40 or 50 minutes. But of course, the system is constrained to a 15-minute window.

Boom.

And so you constantly the vets are getting as stressed as a client but not having the time available. There's another interesting correlation here. What we— the key factor I talk to vets about is their active clients per vet. How many clients do they see per year as a number? So if you've got 4 vets and you've got 4,000 clients, you'd have 1,000 active clients per vet. Okay, and they'll see them multiple times over the year, etc., in various— but it's, it's a broad brush rule of thumb figure. If you're doing 10-minute consultations, you can see 1,200 to 1,500 clients a year because you're banging them through, basically. If you're doing 15-minute consultations, we would suggest around 800 to 1,000 active clients per vet, you're seeing less clients, but you're seeing them for longer. You actually tend to deliver more value, but you'd need to charge more for your time. Okay, now if you're doing 20-minute consultations, we suggest you've got to bring that round to 650, 750 active clients per vet. It's getting less. So a full vet practice would be seeing maybe 2,500 to 3,000 clients is their capacity. If they go over that, they may run out of consulting space or operating space, but they also may stress their vets more as well. Now we're doing some work at Keele University. We've got a different working model. They're trying to address a lot of these factors here, but, but it's a teaching hospital in the university in the veterinary school. So we're running 30-minute consultations.

30, 3-0.

3-0. Okay. Wow. We've got teaching time. We want to, you know, really get the system. We're doing heaps of preventative work, but it's a subscription-based model as well. So we're not charging the clients, okay? They're paying a fee to come in and get this work. But the, the, the beauty of that— but what we've done, we therefore, we, we're restricting active clients per vet to about 5 to 550, okay? But with a subscription that they're paying that covers their cost, etc., that way. Okay, so that's another scale you got to look at. How many clients can I see with my consulting space? Because it's not just consulting, you got to do your diagnostics and your surgery and fit all that in. But that's how the, the heuristics work out. Does that make sense?

Yeah, definitely.

And I think this is so good. And, and for all of you guys out there thinking, oh, this is getting into the business of veterinary medicine and I'm really not interested in, you know, what the problems for the vets are. We have so many people out there that run behaviorist centers, they run, you know, hydrotherapy, they do nutrition consultations, they do grooming. Yeah, this is actually all relevant for them, you know, because actually it's just as relevant to have that communication, the value in you know, talking to your clients, listening to what their needs are, you know, offering value of service, um, and then charging appropriately for that level of care. And if you're, you know, somebody who just wants to spend 5 minutes, give somebody something and say see you later, that's totally different business model to somebody who's really wanting a long-term sort of caring discussion and communication. But they will charge more. So it's, as you said right at the beginning, probably the best thing for anybody to do is to go into that business, whatever that business is, and have a talk to not just the endpoint person who's delivering the top end of the service, but actually everybody within that business, you know, from the person at the till or the reception to the nursing team, which I still see as the clinicians. They're all clinicians now within our practice. You know, it's not there's no vet, nurse, and then reception. It's, you know, you're a clinical team and, you know, everybody has their role to play and has to interact, you know, with the clients, you know, as a team, not just, oh, I do this and they do that and never the twos shall mix, I think is the wrong way to see modern veterinary practice. But that's my personal view. So I think it's really useful to listen to you there talk on those bases, and I hope most of our viewers out there across the world, because this is not just a UK thing. This is, you know, wherever you are in the world, this is really how you take care of effectively, you know, your pet parents, your kids, you know. And this is, you know, so important to understand how to choose.

Here's a question, Alan, uh, the one that I get really pretty frequently, and I'm talking, you know, most days, I would say, is whenever I go to the vets, I never see the same vet twice. So what, what can people do to try and mitigate that? And what can practices do to try and mitigate that? Because I think it's very justified. And it's quite frustrating for all concerned. You know, if you've got a complex case, you've got 10 minutes. No way are you going to get to any kind of depth with that, with that case. And so it's frustrating that you can't deliver the kind of medicine that you want to as a veterinary surgeon. So just so looking at, looking at the never see the same vet twice from both perspectives, the client perspective and the, and the veterinary perspective, what are your thoughts on that one?

Consistency is a really big driver of a service industry. Am I getting the same advice. Because as you know, even in the same practice between vets, there's probably a disparity amongst some of the suggestions and things, which is unfortunate. Good clinical standards should raise that level. A deeper problem within the profession is that over the past 5 or 7 years, we've had massive attrition from the profession. We're actually losing numbers of vets. A couple of things happening. One, Corporates are coming in buying practices. The owners of the practices are taking the money for the purchase, which is great. That's usually quite nice money. And therefore, what's the need to work now? Maybe not. And so they either cut down their hours to from 5, 6 days a week down to 2 or 3 because they can— very sensible as you're getting on— or someone just say, look, I've had enough, I'm out of here, I've got my pension, I'm going. And so there's a skills gap happening at the top end of just experienced vets, not just for your pet but also for the younger vets coming through, the mentors that actually walk them through the stuff that grew them. In, in the old days, Nick, you and I had our mentors, or we learned stuff from our practice, good or bad, but we actually learned stuff on the way. Yeah, from that. So that attrition is really quite serious, and we're seeing students coming through the veterinary education process, 5 or 6 years of education, massively expensive, huge £50,000 to £100,000 debt coming out into the world with that already in place, then landing in jobs where they've not got the support, the mentorship quite so much. Now, the corporates are doing a very good job of trying to build in graduate support systems, mentoring, and all sorts of things, but they— most of them just don't have the numbers to support that. With the best will in the world. Um, and so what might have been, say, a 5 or 6 vet practice running fairly optimally, maybe 6,000, 8,000 clients, but busy but good, is now down to 3 vets, 2 of which might be locums because they can't get permanent employees. And locum kind of work— come in, do the job, go home. That's, that's their, their usefulness. I mean, good vets and do good work, but they, they're not committed to the, the long term of the clients of the practice, just the nature of it. And so you're never going to see, see the thing. But even it's a one-vet practice, you might have a different locum every 3 weeks anyway. Um, so those days are pretty numbered. A good stable practice with good retention, you have a much better chance of seeing repeat business. Now, vets are not— I'm sometimes guilty of just seeing where and not, and then booking them in for someone else to see because that's what suits. Because I'm not here on Wednesday morning, well, if you want to come Wednesday morning, see someone else is the thing. So you've got that little bit. What a good vet would do is say, look, I'm here on next Thursday, let's make it 3 days and I'll see you on Thursday instead. Okay. 'Oh well, I can't do that.' Let's say you have to work it out. It's just two things trying to mesh together doesn't always work, but some attempt at doing it. However, you don't have to be in a consultation to maintain consistency of service. You can do WhatsApp, you can do emails, you can actually do even, God forbid, telephone calls and speak to people that way, maintain contact. Now, if you've got 1,500 active clients, you're not going to do that ever. If you've got 500 active clients, you may well spend the time looking after your clients better. So our— for me, our biggest challenge to a well-run practice is just busyness. And with, um, COVID, the COVID doggy boom, cat boom, with a number of— so we've got less vets massively reduced resource and 10, 10.8 million dogs and 10.8 million cats. So the report tells us this morning out there, massive demand. So those two things will never mesh together across the profession. But in your area, you might just find a good practice with a good owner who's got a good team doing that. And boy, you better be seeking them out. And then you might have to go on a waiting list. Because they, if they've got sense, they might have closed their books and said, look, we've got the peak of our capacity, we can't see anymore, we'll open the books soon. That's happening a lot. Okay. And it's kind of a necessity. I know it doesn't help your listeners that much if that's the case, but that's what they should be list— looking out for, um, and hoping to find. There is a market for someone who doesn't want to pay much. Fine, there's plenty of cheap practices out there. That's where they all go. But if you're actually looking for good veterinary care, you have to go seeking it out.

Brilliant, brilliant. So can we touch— yeah, we've got a few minutes left, and people will have heard of the CMA, the Competition and Markets Authority. So you mentioned it earlier, this evening, and a lot of people are confused about why they're getting involved. Do you know enough about a background of what that's all about?

The vetting world is full of experts on this, and I'm not— don't happen to be one of them. But the CMA originally looked at the veterinary profession in terms of corporate acquisitions. So corporates, like I said, probably 55-60% of them in the UK are owned by one of 5 or 6 large corporate entities. Okay. And the same thing's happened in real estate and chemists and pharmacies and other service industries. Big money comes in, buys them up, and they aggregate and sell them on. That's been going on since 1999 over time, and it's been accelerating. So, but what they decided, what they want, they thought, well, there's so many corporates in certain parts of the country, the corporates own the majority of practices. So they felt it gave clients less choice, particularly if a corporate was consolidating pricing and services and those sorts of things. Was the client getting fair choice or enough choice in a local area that they weren't constricted by whatever a particular company was was promoting. And to be honest, I don't think that— my personal belief— I don't think any of the corporates were organized enough to actually be coercive in, in that way. They just didn't have the time to do it. But anyway, that was the concern. They looked at certain areas, and I think they came up with a criteria that said if you own more than 30% of the territory, the client base, that's too much. So you got to be below 30% in a few areas. So a couple of the corporates VetPartners, obviously many, but one of them had to— were forced to sell off some of their practices to dilute their, their ownership. Okay, so that was a big hit for some of them as well. It left some practices in pretty poor state as well because they've been bought and had— were left in limbo for a good long time. However, you can see the sense of what they were trying to do on the back of that. They then looked a little bit harder at the veterinary profession and they did a review over the past 8 months, and that sort of came out about a month ago. And they were concerned that maybe there was some coercion of pricing, that there was some overpricing, particularly of drug sales, not so much services. They weren't looking at service that much, or didn't— couldn't get their head around services, but they were looking at the price of the drugs that are dispensed. Again, looking at the territory that practices own, they're looking at the choices clients had And then the last thing it says, what's the regulatory body doing around this? And they said, found out, and this is the shocking thing, that we're ruled by a legislation that was created in 1966. It's 60 years old. Then vet nurses weren't even invented then. I mean, half the stuff we do wasn't invented. So we're working under archaic medieval laws basically. And until that change, so the one good thing I would say it comes out of, if we get the chance to get that into parliament and assessed. Careful what we hope for, but that certainly would change the landscape, as you mentioned, Brendan, for a lot of the pet owning and pet industries as well. So the CMA is looking at pricing now. I think there is a culpability in the veterinary profession for price gouging on the sale of drugs because of the nature of the way drugs are sold in the veterinary profession. It's very easy to add markups and professional fees to that that are meant to be hidden. But when you see a paracetamol tablet going out at £25, you start to wonder, not so hidden, what's going on there? And the public had every right to say, whoa guys, what's happening here? Nothing wrong with making a profit from buying, retailing, storing, and distributing and dispensing drugs. There's a whole chain of events that have to be covered by cost, but some of it just seemed a bit excessive. And so that's where the big holdback's going to come from.

And it's interesting, isn't it, because there is this cascade system. So you, you mentioned paracetamol there, and you think, um, that's, you know, paracetamol, I can buy that for 16 pence in the supermarket. But actually it's not paracetamol when it comes out the vet you know, there's some restrictions on what you can buy. You know, you're not a vet that can go into that supermarket and buy the 16p paracetamol and then resell it at £25. You know, you have to get a specific one with a license for the target species, and that often isn't going to be costed at 16p to start with, let alone the storage and all of the other things that you've got, you mentioned earlier. So I think it's It's a difficult one for many people to get their heads around as to why can't vets sell that 16p paracetamol that's otherwise down the supermarket.

So, okay guys, I'm gonna, I'm gonna call a, call a, a, a line under this just for now, but I'm gonna say to Alan, uh, please would you come over onto Patreon just for 10 minutes or so? We like to do some extra special content for our Patreon people because they support us every month, which we're very, very, very grateful for. And the question that I'd like to ask you when we get into Patreon is, how do you see the future of the profession? Yeah, for better and for worse. So if you can bear that in mind for a minute or two, and then you can give us a few thoughts on that, if you don't mind. Amazing.

All right, great, brilliant, brilliant.

Well, everyone out there, that's been an absolute revelation. I think a lot of, a lot of information coming, uh, from Alan there. He's talking mainly about the UK, but I think it's going to apply to Europe, it will apply to the States, you know.

A couple of comments there from me, but as well, so thank you very much for those.

Yeah, yeah, and loads on Facebook. I mean, you'll be able to scroll through those at your will later, and there'll be more than I saw you in practice 20 years ago. So there is, you know, it's wonderful. Somebody wants to know what you're doing next week, Nick.

What am I doing next week?

Yeah, because for all paramedics—

oh, what, me on my own? Yeah, next week I'm on my own. Well, I haven't got a clue. Yeah, you tell me.

I might have to join you.

Yeah, you tell me.

Let's, let's have a little look, shall we? We used to give you—

No, it's fine. Listen, I'll be like a kid in a sweet shop. It'll be great.

He's always like that.

It'll be great.

I think you should do a review of your debate. Tell me, uh, BVNA debate that you've got going on, is that live? Is that going out?

I'm not sure of the details of it.

Um, are they going to send—

I'm just, I'm just going to— I'm just kind of going to negotiate. It was meant to be tomorrow night, but I might just have a little word with them because they haven't actually sent me the questions yet. So I might just say, guys, I'd really like to talk to you, but maybe we can put it off a week or two just so that all parties can get on the same page, for— so that we can deliver better content.

There we go. And Martina says she'll drink, uh, she'll be joining you with a glass of wine next week, um, uh, whilst you give your eulogy, which is usually what it ends up being, to the masses.

You are eulogizing? Surely not, surely not, my friend. Anyway, listen, Alan's time is very, very precious, so I'm going to say thank you, thank you, thank you to Alan now. We're going to go just over to Patreon for 10 minutes. And Alan, fabulous. Look forward to seeing you again soon.

Yeah, see you, see you guys over on A Bit on the Side shortly. Take care. Bye.