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Working Group on Vets and Veterinary Services Final Report

1 Introduction

This report pulls together the work done in five working group meetings on large animal vets and veterinary services held between February and May 2004 which OCP was asked to facilitate.

The factual notes of each meeting have been issued previously, so this report seeks to give some flavour of the balance of views expressed across the five meetings, before going on to express our overall assessment on each of the key issues identified, and our views on a series of possible actions that flow from this.

We recognise the need to build on the actions in this report, with all parties who have contributed to it, and from other contributions, in order to produce a comprehensive and agreed programme of work to address the issues for the government's Animal Health and Welfare and Surveillance strategies .

We would like to record our appreciation of the work put in by all participants.

Organisation Consulting Partnership LLP
22-24 Ely Place
London EC1N 6TE

2 Context

2.1 Animal Health and Welfare Strategy

The outline Animal Health and Welfare Strategy published in July 2003 described the need for an ongoing dialogue with the veterinary profession about the role and future of large animal practices. Consultations during the development of the strategy underlined the importance of the veterinary profession. In response, the outline strategy described a new initiative to set up a working group with the veterinary profession to consider both the EFRA Select Committee report and to look at the future roles and availability of large animal practices.

The EFRA Select Committee Report on Vets and Veterinary Services was published on 15 October 2003. It contained twenty conclusions and recommendations.

2.2 The Government's approach

Government instigated three streams of activity to help it to address some of the serious issues surrounding the provision of large animal veterinary services and the impact of these on its Animal Health &Welfare (AH&W) and Surveillance strategies, and to contribute towards its response to the EFRA report. These were in addition to its internal deliberations and consultations with other government stakeholders. The three workstreams are described below.

2.2.1 The Working Group

As described in its Animal Health and Welfare Strategy, the working group was set up by Defra, the Scottish Executive and Welsh Assembly Government in partnership with stakeholders to look at the future provision of vets and veterinary services, including the EFRA committee report. OCP were commissioned to facilitate the meetings and this document reports on the findings of the working group.

2.2.2 Formal Submissions

A formal consultation notice to gauge stakeholder opinion on the EFRA Committee Report on Vets and Veterinary Services was issued on the 16 January. The consultation period expired on 9 April 2004.

2.2.3 Commissioned Reports

Defra and the Royal College of Veterinary Surgeons (RCVS) commissioned the Institute of Employment Studies (IES) to produce a report on the motivation of newly qualified vets (up to 5 years after graduation) and veterinary students' career decisions, including the reasons behind them. Its report is expected in late May.

Defra has also commissioned a report from Westley Consulting Ltd to investigate the factors underlying the supply of large animal vets. The work was carried out from January to March 2004 and involved discussions with the professional organisations, vets in general practice, vets schools and farm business consultants. It reported in March 2004.

These reports will be available on Defra's website: http://www.defra.gov.uk/animalh/ahws/vservices/index.htm

3 Working Group Approach

3.1 Stakeholder Involvement & Commitment

In determining its approach to the working group, the government took into account the need to balance continuity of representation from the main veterinary and other stakeholder bodies with a desire to allow as wide a group of interested parties, particularly practising vets, their clients, students and others with specific expertise, to make their views known.

A programme of five meetings was designed to encourage contributions from the regions, some of whom have particular issues and needs in relation to large animal veterinary services. Meetings were generally held at Veterinary Schools in order to encourage student and faculty participation. The programme was as follows, and the agendas for each are set out at 6.1:

In all, well over 150 attendees attended the events. A full list of attendees is given at section 6.2

3.2 Agenda Setting process

The working group meetings were intended to supplement, not replace, the more formal submissions. Each meeting's agenda focussed on particular themes and issues, in order overall, to cover the required ground. The coverage of the working group was determined by Defra under guidance from an internal Project Board set up to coordinate and manage Defra's response to the EFRA Committee's recommendations.

3.3 Qualitative Data Capture

The format of the meetings was to hear from selected speakers on key themes, and to follow these speakers with a series of discussions, mainly in small groups of up to 15 attendees. These groups then reported their views in plenary session and their views were discussed further. Views were captured, generally in real time in the plenary sessions, as attendees gave their feedback. Where contrary views were expressed attempts were made to clarify the underlying reasons for the differences, and to record these.

The nature of this process necessarily generates qualitative data. Over the course of the five meetings attempts were made to revisit recurring themes in order to explore, test and validate the views expressed previously. Where instances of data gaps were felt to be critical these were identified, but were few in number.

3.4 Problem Solving Methodology

The approach adopted to the pattern and programme of questions and agendas for each working group, followed a methodology designed to identify possible solutions to problems. So whereas the first two working groups held at London and Edinburgh were generally used to explore and identify the key issues, the later groups were more oriented to focussing on possible solutions or examining in more depth solutions already suggested.

The agendas and detailed note of each meeting (produced in abbreviated form as an aide-memoir for those attending) are to be found at the Defra website http://www.defra.gov.uk/animalh/ahws/vservices/wgroup.htm

3.5 Analysis & Synthesis of Findings

The next section sets out our interpretation of the findings of the working group. We have necessarily had to draw together strands from across the separate meetings in order to present a comprehensive and coherent picture. In so doing we have tried to identify what was said in the working groups, and then to add our own overall assessment of what can be drawn from this, with a particular bias towards looking for helpful actions or initiatives.

This assessment has tried to adopt a pragmatic approach in the sense of identifying actions and initiatives that appear to have a reasonable chance of being carried forward. In other words we have had to recognise some of the (particularly economic) realities of the environment. And the resulting interpretation and programme of actions and initiatives is set out in section 5.

A process is now being designed to engage key stakeholders in examining these proposals and building on them.

4 Findings

This section sets out a summary of the key themes drawn from meeting notes together with an assessment of their implications.

4.1 Demand for large animal veterinary services

4.1.1 Impact of livestock industry changes on demand

Veterinary practices are part of a service industry serving the needs of livestock owners. In common with all service industries there is a need to continually renew and refresh their offering to meet the changing needs of their customers and the challenges arising from competitors.

In the case of GB large animal veterinary practices the prime client base is the farming industry, which has been undergoing major structural change in recent years. There is a trend for instance towards consolidation into fewer and larger farms in order to maintain viability. Whilst this is most marked and has been evident in the pig and poultry sectors for some time, in the beef, dairy and sheep sectors this is a relatively new and accelerating development in some areas brought on by low levels of livestock prices.

There are two main consequences for demand for veterinary services:

1. the larger more efficiently run farms will typically provide a more demanding and challenging customer whose needs will not be best met by a largely passive practitioner offering "fire brigade" services for sick animals.

And we heard from several practitioners whose practices have responded to the opportunities presented by such developments and who have been developing and marketing new services, and establishing more of a partnership model with their clients where the vet is positioned as part of the management team, providing in part an educative role, rather than as purely a professional clinical expert brought in to deal with clinical issues.

These practitioners have found that it is possible to "sell" the case to livestock holders for investing in veterinary advice through, for example, developing farm health plans. And gradually a more informed customer is developing who expects to see some form of cost benefit analysis to support a service proposition. It is in this context that the veterinarian may be able to secure more stable longer-term contracts to provide a range of services over a period of time which enables him to more easily plan and manage his business both operationally and financially.

2. For veterinary practices in these areas consolidation of their client base will tend to lead to consolidation of smaller practices into larger practices, increasingly run along more commercial lines and embracing modern business skills.

And whilst the overall number of practices may be falling there was no evidence to suggest that necessarily there was a diminution in overall demand for large animal veterinary services or large animal vets.

More, that this demand is changing in the ways outlined above and that veterinary practices need to develop different models of operating to meet these demands. These might include on the one hand the employment of (or more loose association with) "para-professionals" in order to be able to offer the client a wider range of assured quality services at an economic price. And on the other hand developing more flexible part-time working arrangements to accommodate the lifestyle choices of new large animal veterinary recruits.

Whilst this is the general picture of healthy and challenging consolidation on both sides of the industry fence, this should be contrasted with the continuing existence of smaller, often family run farming businesses, especially in remote areas, some of which are barely viable and in the longer term may not be sustainable if the current economic climate persists. At the same time there has been the rise of the "hobby farmer" who may or may not be rearing animals for consumption, and the "part time" farmer, who has diversified into other businesses or taken up additional employment. These developments present different and more problematic challenges to the large animal practitioner:

1. the smaller and less economically secure farms find it harder to justify the cost of calling out a vet.

Many times we heard from the farming community that if the cost of veterinary intervention is too high in relation to the economic value of the subject animal, then it makes no economic sense for them to call out a vet to tend the sick animal. And whilst there may be a rational case for selling more preventative veterinary work the economically challenged livestock owner may simply not be able to afford the investment.

It is less obvious how a practitioner can respond in these circumstances Indeed we heard from one practitioner who felt that in the medium term it was hard to see how viability could be maintained without a greater amount of work being sub-contracted from the SVS, under the LVI regime or by other means.

2. in remote areas the problems of maintaining a viable practice are exacerbated by the need to provide on-call 24/7 cover often over a wide geographical area. This scenario makes recruitment of new graduates into such practices particularly challenging, and it effectively places limits on how far consolidation of practices can go.

4.1.2 Impact of Regulatory changes on demand

Most attendees were aware that the upcoming changes to the CAP payment bases, under the mid-term review, were likely to make further changes to the patterns of livestock holdings in this country over the next few years. Ultimately, the impact is not clear, as the vet response will depend on the farmer response. And whilst no quantitative analysis was provided on the likely impact there are two emerging issues that arise:

1. On the one hand the change in payment basis away from the number of animals held may diminish some animal numbers, and as a consequence demand for large animal veterinary services may fall in those sectors affected (primarily beef , sheep and dairy).

2. On the other hand the emerging rules surrounding cross-compliance suggest that there will be a greater need for the livestock owner to demonstrate and document the measures taken to protect the health and welfare of his animals. So there is an opportunity here for the veterinarian, and this is amplified by the emerging food hygiene regulations which will have the effect of moving more of the responsibility for certifying food hygiene away from the abattoir and on to the farm.
There are also some choices to be made here in the drafting of these rules and regulations which range from encouragement to de-facto compulsion with regard to the usage of large animal vets. This choice is particularly key in remote areas and farms with poorer standards that have no contact with a vet, where the absence of veterinary visits seems to raise the risk of adverse hygiene and/or welfare practices going unreported.

The other major change impacting the veterinary profession is the effect of the Competition Commission ruling that will remove the use of drug prices to subsidise the charges levied for veterinary service. Some attendees thought this meant the end of the viability of their practices, whilst others saw this as an opportunity to remove a pricing distortion and as a further driver to developing and marketing their added value services.

4.1.3 Overall assessment

The large animal veterinary profession needs to change to meet the changing demands and challenges arising from its clients. It needs to develop and market new services (and the common features for a successful sustainable practice are described more fully in Section 4.9 ahead). It also needs to accept that the traditional, small, often single practitioner practice is unlikely to be sustainable long term. As these structural changes wash through the profession needs to ensure that barriers to cooperation between practices are removed so as to ensure a smooth transition and as far as possible continuity of provision of some forms of large animal veterinary services in all areas.

See Action 5.2.1

4.2 Para-Professionals

4.2.1 Current position and issues arising

The para-professional term covers a very broad church ranging from farriers to sheep scanners, to foot trimmers, to AI providers, to veterinary nurses. It is used to cover any providers of services to large animals who are not qualified vets.

Livestock owners are prepared to make greater use of para-professionals, particularly if:

• they have some reassurance as to quality,

• the tasks do not require the full range of skills from a vet,

• and costs are lower (which is not always the case)

The more knowledgeable livestock owner will be able to judge when a vet is more appropriate, and it is also up to the vet to make the case for his "added value".

For the less knowledgeable livestock owner there are risks, including biosecurity risks (arising from multi-visits from para-professionals). These may exist already as he may currently be using para-professionals in the "grey" areas which are not strictly reserved for vets by the Veterinary Surgeons Act, nor properly regulated by a professional body (such as the farriers).

In recognition of this, there does seem to be a demand from both farmers and vets that any veterinary tasks currently reserved for vets under statute should either remain so, or be placed within an appropriate framework of qualifications, standards and QA, and that the position of the "grey areas" should be clarified. In other words that the spread of unregulated para-professional services should not be encouraged.

For the vet practice the issues are complex:

• smaller practices may not be able to afford to employ para-professionals, (but might look to share them across practices, or adopt a sub-contract model)

• larger practices fear that an influx of para-professionals taking away part of the vets' current tasks will ultimately lead to a reduction in FTE vets and difficulties in providing an acceptable 24 hour cover rota

• and there is a fear for some that the erosion of the vet's exclusive right to provide certain services will diminish his earning power and potentially weaken his relationship with his clients

From an AH &W and Surveillance strategy perspective less vets going onto farms would probably not be a desirable outcome.

4.2.2 Overall assessment

This is a sensitive area for vets for whom some see the rise of the para-professional as a threat to their livelihood.

On balance it does appear that para-professionals, with some form of quality assurance, do have a useful role to play in delivering some services to livestock owners, sometimes more economically (and even sometimes more skilfully than a vet who perhaps is only called upon to perform a particular service very occasionally).

The model of vet as part of the farm management team, advising the farmer and coordinating different interventions clearly envisages a role for the para-professional more as complementary to, rather than in competition with, vets.

What needs further attention is the development of some models for how the vet/para-professional can most effectively work together, drawn from existing models already operating. These might range from direct employment through sub-contracting, through a loose network", through to a totally at arms length relationship. And the vet will have in mind how he can best serve the interests of his client, and managing and advising him on the appropriate use of para-professionals would seem a useful task.

It would also be in the interests of the vet to build his relationships with para-professionals so that they are more aware of when a veterinary input may be required. Government may also need to develop its relationships with them so as to help secure its health, welfare and surveillance objectives especially where para-professionals are the main point of contact with the livestock owner.

In addition, more work needs to be done on defining the para-professional services (including those in the grey areas), identifying the current regulatory environment, and considering how any services currently reserved for vets might be deregulated in a way that maintains the quality of the service and does not lead to a large and uncontrolled reduction in vets visiting farms.

More specifically the working group thought that there was to be scope for two additional roles within a vet practice to be developed:

• the LA vet nurse, which would mirror the small animal nurse and would be appropriately trained and tested under RCVS aegis

• a vet support role, which would be less medical and more technical in orientation, perhaps taking back some routine tasks currently performed by the farmer (eg de-horning)

These should be further researched.

See actions: 5.2.2 and 5.2.3

4.3 Improving the viability of veterinary practices

4.3.1 Working group approach and findings

The working group heard from a number of practitioners about how they had developed and built their practices and how these had changed to maintain viability and meet the changing needs of their clients. For those that were located in areas of high animal density, the recurrent themes for success were:

1. A critical mass
3-4 vet FTEs were thought to be the minimum required to provide a quality service to clients, an acceptable pattern of work to practitioners, and sufficient scope to be able to support new graduates effectively

2. Amalgamations of practices
This pooling of resources made matching resources to farm work easier and was attractive in the recruitment and retention of assistants who were more able to gain wider experience and an acceptable A&E rota, than in a smaller practice

3. Re-positioning the Vet as part of farm production team
Traditional "fire-brigade" work not seen as cost effective to vet or farmer. It is reactive and hard to plan for. The vet needs to identify more closely with the farmer's economic position and objectives and apply his expertise to improve efficiency, add-value and offer preventative cost-effective solutions.

4. Building Modern Farm Vet practice methods, including:

• Making regular routine visits around clients (3-4 per day)

• Doing repetitive work (eg fertility work, TB testing) to maintain contact

• Recording incidence data (eg lame cows, mastisis, fertility issues)

• Professional report writing - clear, unambiguous, using benchmarks/references where available

• Demonstrating a depth of understanding on a number of dimensions that clients expect (about, for example infectious disease control, animal husbandry; nutrition; welfare; politics; subsidies; gate prices)

• Marketing services

• Developing new services (eg FHPs, as a strategic tool for farm efficiency and developing preventative health programmes based on informed risk based decisions)

• Demonstrating cost-effectiveness of proposals

• Innovative charging policies, such as health contracts based on ppl or headage for routine therapies

• Building links with other professionals, and behaving in a less protectionist way

• Offering at all times a quality service in the areas that the practice chooses to operate in

4.3.2 Overall assessment

The drivers behind the responses described above and the types of responses themselves described above are applicable to many successful service industries in the UK. They describe some of the specific processes and techniques outlined as being required to meet changing client demands (section 4.1).

They are most applicable in areas of high animal density, where there are more vets, there is serious competition and client loyalty is being challenged.

There are benefits but limitations to the applicability of this model in marginal and remote areas, where the marginal viability of farming is a dominating factor that limits the viability of veterinary practices.

See action 5.2.6 and 5.2.7

4.4 Supply and retention of large animal veterinarians

4.4.1 Supply of veterinary graduates from veterinary schools

Whilst there were examples cited of difficulty of recruitment to specific practices a reasonably consistent view emerged that the supply of graduates from veterinary colleges with an interest in exploring and developing a career in large animal work was currently adequate.

There may be a short term shortfall in supply in the next 5 years as older practitioners retire, but it was felt that this can be filled in the short term by recruitment from abroad. The build up of graduate numbers suggests that beyond this period there may actual be an excess of supply.

4.4.2 Veterinary School Training

The technical vet school training was thought to be very good. Some improvements are possible and are being developed by the schools, particularly in the less technical aspects of the role, for example:

• building links with larger and more progressive veterinary practices,

• business skills training

• putting more emphasis on communication skills training

• and promoting the model of the vet as being part of a team.

There is a problem of securing the supply of large animal casework, but this is a function of the economic realities of large animal farming.

The content of these courses should now be such that the newly emerging graduate is much better equipped to meet the changing demands of the vet than perhaps was the case previously. Making post-qualification training available in these newer areas may be helpful for some existing practitioners.

4.4.3 Retention of graduates in large animal practice

However there was perceived to be a problem of retaining new graduates in the large animal sector and a view expressed that many left after only a short time, often to go into small animal work. Retention of new graduates in the early years of large animal practice was seen to be adversely affected by:

1. inadequate mentoring
2. lack of "support" given or available for off-site work
3. out-of-hours work
4. less obvious career progression, and perception of lower financial rewards relative to contemporaries who have gone into small animal work
5. poor allocation of tasks
6. poor reception by farmers

And these adverse factors were more likely to be found in smaller practices which have typically less scope and resources available to support staff development.

4.4.4 Overall assessment

The main problems in this area occur after vet school. There is huge variation in how veterinary practices perceive and use new graduates.

Clearer guidance of best practice in mentoring new graduates in the early years needs to be developed and promoted along the lines of the models described at several working group meetings. This should cover, amongst other things, how technical support is available to the new graduate (especially off-site) and a career development plan, including CPD.

Clearly this is more easily applicable in larger practices, and more consideration needs to be given to how new graduates in smaller practices can be better supported, and how they can be prepared for this experience. Senior vets may need to explain to clients the basis on which work has been allocated to new graduates and the support that is available should the situation so demand to diminish adverse client reaction which can be very demoralising to new graduates. The confidence of new graduates can also be enhanced by starting the recording of practical experience before leaving college, and in having a clear CPD plan.

And there may be more (interesting) opportunities for new graduates to contribute under the model of the vet being part of the farm management team where a wider range of services are provided such as health planning, nutritional monitoring and fertility management.

See Action 5.2.4

4.5 Urban Fringe areas

4.5.1 Urban Fringe areas: definition and problems

Fringe areas are best described as areas where the expansion of urban development and land pressures have reduced the densities of large animals to levels where large animal veterinary cover is spread very thin. They are effectively caught between the urban areas that demand small animal services and the more rural areas with higher large animal densities which are able to support large animal practices. Another feature of the urban fringe areas is the emergence of hobby farmers who typically have smaller numbers of large animals of which not all are being farmed for food production. Hobby farmers often have less of a background in farming and less knowledge about animal health and welfare.

The problems associated with these areas are:

1. a diminishing critical mass of large animal vets within mixed practices, exacerbated by older vets retiring and new graduates spending more of their time on companion animals
2. hobby farmers are often not well informed (or trained) in basic diagnostic skills and may not understand the economic impacts of disease on business farmers
3. hobby farmers expect out-of-hours/weekend support and companion animal style interventions (even though the vet has to travel to the animal)
4. surveillance for diseases is weak [the problem is not only with notifiable diseases]

4.5.2 Urban Fringe: possible solutions

Veterinary practices need to cooperate more to better leverage the available large animal skills and resources across practices. This may demand innovative ways of sharing costs and income. Under the scenario of growth in hobby farmers there may be scope for large animal practices to re-establish themselves by providing services that hobby farmers demand and which they are thought to be prepared to pay higher prices for.

Hobby farmers need training in doing more for themselves and knowing when to ask for help and they are likely to be receptive to this. Promoting links between hobby and professional farmers would also help build the knowledge base of the former.

4.5.3 Overall assessment

Ways of encouraging practices to cooperate more and share resources need to be identified and promoted for these areas.

More work needs to be done to understand the needs of hobby farmers, to establish some projections of their likely growth in numbers, and to develop service offerings to meet their needs.

See Actions 5.2.1 and 5.2.6

4.6 Remote areas

4.6.1 Remote areas: definition and problems

Remote areas are usually geographically remote from veterinary services, and the travelling time from vet practice to livestock in remote areas is often considerable. Farming in such areas is often only marginally sustainable economically, and overall animal densities are low.

The problems associated with these areas are:

1. low animal densities makes the viability of large animal veterinary services hard to maintain
2. problems of recruitment and retention in these areas referred to earlier are exacerbated by isolation
3. gaps are sometimes (part-) filled by para-professionals, many of whom are unregulated and too focussed to be able to provide the farmer with the assurance that an experienced vet can provide. And para-professionals are also thinner on the ground in remote areas than elsewhere
4. as a consequence farmers may, for example, choose inappropriate drug therapies leading to economic loss or build up of resistance
5. lack of vet presence on farms may lead to surveillance and welfare problems.
6. Accident and incident cover is impractical and uneconomic

4.6.2 Remote areas: possible solutions

There were two generic proposals for improving service delivery in these areas identified by the working group:

1. The Team solution - where the vet coordinates para-professionals (scanners, foot trimmers, agricultural merchant reps, vet students; ie 'anyone who goes up the farm path'); the vet would diagnose and prescribe a solution based on data from team, with para-professionals (in the main) delivering services.

Whilst this was seen as attractive in addressing some of the problems, the main drawbacks were seen to be that the vets would not have a full grasp of specific farm situation; that overall fewer vets might be required; and that animal welfare might still be prejudiced

2. The Vet-centric solution - where the vet does most work on farm. But this was seen to be hard to achieve without subsidies.

In addition, farmers should be encouraged to work together to identify and prevent the spread of infectious diseases, with the vet coordinating their activity.

Great doubt was expressed by some as to how far either of these models could succeed in areas where livestock holders are having problems maintaining profitability. Some believe that there is evidence now of market failure.

4.6.3 Overall Assessment

The viability of large animal veterinary services will remain problematic in these areas, largely due to the poor economic situation of many farms that they support. It is hard to see the vet-centric solution working because of this, and more attention needs to be given to vets attempting to manage the provision of appropriate services for farmers by co-ordinating and advising on para-professional usage.

Although this may reduce the cost to the farmer of services that might otherwise be provide by the vet, it is still not clear that this will provide sufficient economic headroom to support and sustain the large animal vet. And this raises the question of how big an impact more farm health planning work can have in these areas, which is discussed in the next section.

And accident and emergency cover will remain problematic and is discussed in more depth further on.

In the longer run the absence of large animal vet services and the economics of farming in these areas may lead to farming being unsustainable. In the short term the absence of the vet may pose animal welfare problems. A partial response to this is greater training for farmers in their responsibilities as livestock owners. Another approach would make the involvement of a vet on a farm a requirement for livestock owners. And government does need to collect and assess the evidence of breakdown in the provision of veterinary services (ie market failure) in particular areas, as this might open the way to other initiatives.

See action 5.2.5, 5.2.9, and 5.2.10

4.7 Farm Health Planning

4.7.1 Types of Farm Health Plan

Farm Health Plans have been in existence for many years, and take many forms. There is now renewed interest in them because of the potential links with the demands of cross-compliance and food hygiene regulations. They are also seen, in their more developed forms, as being a way for veterinarians to offer and promote a more preventative service to their clients.

The working group identified a continuum that relates the existence and quality of health plans to the level of contact with vets:

The quality of plans builds from left to right, through what many referred to as the "tick-box" farm assurance type scheme (which were generally seen as more of a marketing tool often with minimal veterinary input). At the right end of the spectrum are the better "vet-led farm health plans" that have been developed by local veterinarians with knowledge of the farm working alongside the livestock owner.

It was felt that in the main the more intensive industries of pigs, poultry and dairy farming were further advanced and more receptive to FHPs than, generally, the sheep and beef industries.

The better FHPs have the following features:

1. a standardised framework, allowing for priorities to be determined at farm level
2. Cost effective (to vet and farmer)
3. Measurable outcomes
4. Models of best practice available
5. Biosecurity dimension
6. Helps make LA work more attractive (esp to students)
7. Should generate more LA work

There was a particular plea from livestock owners that these plans should be integrated and cover all the key dimensions so as to avoid duplication:

• Animal health

• Animal welfare

• Public health

• Environment

• (the better) Assurance schemes

4.7.2 Increasing the take-up of farm health plans

There were seen to be two main ways of increasing take up of FHPs:

• The "carrot" approach of pump priming schemes (eg the Duchy of Cornwall scheme, where EU funding was available because of its status) and demonstrating the benefits of successful schemes

• The "sticks" of cross-compliance, food hygiene regulations, and consumer demand. These should accelerate the take up over the next few years, and should help to persuade those livestock owners who currently don't see a vet or the need for a plan, otherwise.

Vets are in a key position to influence this take up, make it a business opportunity for them (many have been doing some form of health planning for years) and ensure that the "vet-led" farm health plan is integrated and effective (ie much more than a tick box scheme).

Vets will need training to develop the content, marketing, and delivery of these plans, and farmers need training to understand the benefits and how to make most effective use of them.

4.7.3 Overall assessment

There was a general consensus that FHPs were helpful and if properly designed could:

• make a major contribution to supporting the government's AH&W and Surveillance strategies,

• improve the economic returns of the livestock owner in a sustainable way, and

• provide (for some vets) a new business opportunity.

To achieve this a number of issues raised in the meetings need to be tackled:

1. integrated design: to produce a framework that will satisfy the different statutory and non-statutory requirements
2. Tools need to be developed to help demonstrate the benefits of FHPs, including disease cost calculators, benchmark models for farmers to assess themselves against and case studies
3. Training of veterinarians to market and deliver these tools and plans
4. Communicating and promoting the benefits of these plans throughout the food chain
5. Developing an approach to tailoring the standard framework that will best suit the needs of different types of livestock owners (full time/part time; intensive/un-intensive; hobby; those in remote areas) and sectors.
6. Investigating the scope for further pump priming funds (for some areas), as experience shows that once farms have FHPs they tend to continue to maintain them

See Action 5.2.7 and 5.2.10

4.8 24 Hour Accident and Emergency cover

4.8.1 Current position and issues arising

Currently most vets feel obliged to offer 24 hour emergency cover to their existing clients, and the profession's guidance is that such cover should be provided within 30 minutes. The difficulties and issues associated with this requirement were a recurrent theme of the working group, the main ones being:

1. in practice the 30 minute attendance guidance is not being met
2. the need to provide 24 hour-cover was generally a negative influence on new graduates, as this tended to conflict with their lifestyle preferences and compared unfavourably with their small animal counterparts
3. small animals can be brought into the surgery for attendance by a vet whereas large animals need to be attended on site. This produces logistical strains, particularly for the vet who is covering large geographic areas and for new graduates can be a difficult and challenging experience for which contact/support is essential
4. there is no derogation from the Working Time Directive for employees of vets, though the directive does not apply to self-employed partners
5. larger practices are able to develop rotas across a number of vets, but this solution is of little use to a small practice or single-practitioner|
6. the costs of maintaining a 24/7 capability are very high and although vets charge a premium for emergency and out-of-hours work, none seemed to believe that a fully costed charge could be met by their clients
7. where vets are unable to provide adequate cover there may be animal welfare implications

4.8.2 Way forward

The RCVS has a working group which is looking to lessen the burden of obligation on vet practices to provide 24/7 cover. Though it has yet to conclude, it seems likely that its proposals will:

• Remove some of the barriers to sharing the burden of 24-hour cover between practices and across clients

• Make the obligation to provide the service more reasonable and related to species that the vet routinely treats.

4.8.3 Overall assessment

Clearly the RCVS Working Group's deliberations will help to lessen the "statutory" burden on vets in large animal practice, and will help to foster the co-operation between practices.

The more preventative approach to the vet/farmer relationship should also help to reduce the incidence of emergency call-outs due to health problems that can be avoided by proper planning.

However there will remain the practical issues of service delivery for unforeseeable emergencies, especially in remote areas. Here,

• service expectations have declined following the decline in service provision

• the market solution may eventually make some forms of farming un-viable in these areas - but there may be AH&W issues in the meantime where vet provision is in decline/absent

• there is no financial subsidy available for the maintenance of this service

So there is a need, especially, but not exclusively, in these areas to make livestock owners more aware of:

• what they can do themselves

• when they need to call out a vet

• when the appropriate (and economic) solution may be to shoot the animal.

Some form of helpline ("VetsDirect", akin to NHS Direct, where livestock owners may access a phone based veterinary consultancy service) may also be helpful here.

See actions 5.2.5, 5.2.9 and 5.2.10

5 Potential Way Forward

5.1 Segmentation

The following summary of working group outputs suggests a number of actions and interventions are worth exploring further, and section 5.2 addresses these. Prior to that, this section responds to another theme from the working groups which was that different interventions may be required in different locations and situations. It sets out, as a backdrop to action planning,:

• a segmentation of the client base for large animal veterinary services, and how client issues relate to veterinary issues

• a summary of the problems and issues associated with the segments

• how the ideas and possible interventions described above and in 5.2 map onto the various segments.

The main segments are:

• marginal farms

• urban fringe farms

• hobby farms

• less intensive farms

• intensive commercial farms,

and the table that follows summarises their key features, based around the majority of opinions expressed in the working groups. The features are of course generalised, and there will be individual examples of farms that do not fit the characterisations, and there is some overlap between the categories. Nevertheless we felt this was a useful tool to explore what is going on in the industry, how these issues impinge on the veterinary service requirements, and the relative urgency and applicability of possible actions to the different areas.

5.2 Possible Areas for Action

This section described the main themes for taking this work forward arising from the Working Group findings described above. The contents under each action summarises briefly the background from the earlier sections, probable lead stakeholders, and other key players that will need to be closely involved in taking this work forward.

These actions need developing and refining (not least in conjunction with the stakeholders listed) and linking with the other workstreams identified in 2.2.2 and 2.2.3 in order to produce a robust project and programme structure with measurable outcomes against which progress can be monitored .

Background:

The structure of veterinary practices that support large animal services is changing as consolidation takes place in response to consolidation in the livestock industry. During this period of change greater cooperation between practices may be required, both to aid the process of consolidation and the continuity of services to clients.

This includes the issue of 24 hour cover that the profession is looking at, and ways of encouraging co-operation in urban fringe areas.

Lead stakeholders: Veterinary Profession
Other key players: Government

Background:

The current economic climate for livestock holders and the low-level of large animal veterinary services in some areas suggests that many livestock holders will have to look beyond the fully qualified vet to provide some animal-services.

The development of this "para-professional" market has (in common with other professions) scope to offer the consumer greater choice (possibly at a more economic price), whilst allowing the vet to differentiate his offering by concentrating on more value adding services. There must be systems in place to ensure competence of the individual para-professional, involving training and CPD.

The relationship between vet and para-professional needs to be developed, and could potentially be beneficial to both parties (as well as the consumer). Indeed in areas with thriving farms and veterinary practices there is evidence that vets and para-professionals have developed a mutually beneficial relationship and are providing the livestock holder with a mix of service providers.

Veterinarians and consumers are concerned to ensure that any growth of para-professionals is properly regulated to ensure quality of service. Defra's consultation on proposals for modernising the Veterinary Surgeons Act 1966, published at the end of last year, amongst other issues, sought views on whether (i) only para-professionals carrying out 'acts of veterinary surgery', or whether all para-professionals, should be registered and if so by which body; (ii) there should be a body responsible for maintaining standards of professional conduct; and (iii) there should be provision fro re-accreditation. The Government is currently analysing the responses to the consultation.

Lead stakeholders: Government and Veterinary profession
Other key players:Para-professional bodies

Background:

The role of the Veterinary Nurse, and their training, has recently been enhanced. With the introduction of an amendment to Schedule 3 of the Veterinary Surgeons Act 1966, in 2002, Veterinary Nurses are now permitted to carry out medical treatment and minor surgery on all species of animal (previously only companion animals). The directing vet must be satisfied that the Veterinary Nurse is competent to carry out the delegated procedure.

There appears to be scope for developing the large animal veterinary nurse (similar in role and training to the small animal nurse) and a less medically- and more technically oriented vet support role. Both roles need further research to explore the possibilities.

Lead stakeholder: Veterinary profession
Other key players: Government; The British Veterinary Nursing Association

Background:

There is huge variation in how veterinary practices support new graduates in their early years. There is a need to establish and communicate best practice for both larger and smaller practices. Established practitioners need to understand the role that CPD plays in developing careers. Vet schools and students can assist by creating a formal record of practical experience gained before leaving college.

Lead stakeholders: Veterinary Profession
Other key players: Veterinary Schools

Background:

In areas where the level of large animal veterinary service is stretched particularly thin it is important that clients or potential clients are informed about how to make best use of the services that are available and are aware of what they are capable of doing themselves and when they should ask for help.

This information could be provided in many ways, from web-based solutions, fact-sheets, one-to-one advice, a "Vets-Direct" helpline, through to seminars for groups of clients. It is likely to be particularly effective when developed locally.

The nature of the information provided will vary, ranging from pure "awareness" training of available services, through to much more practical "what to do in certain situations" courses.

Obvious priority categories of potential clients are: hobby farmers, and farmers in the urban fringe and remote areas.

Lead stakeholders: Veterinary profession
Other key players: Farmers/livestock holders; Government(re welfare issues)

Background:

Hobby farmers are a relatively new, but growing body of livestock owners. Relatively little is known about them as a group and there may be particular issues and potentially new services that could be marketed at them.

Lead stakeholders: Veterinary profession

Background:

FHPs are a helpful vehicle for developing a more preventative approach to the provision of large animal veterinary services. More work needs to be done to develop effective models that will cover current and future regulatory needs (eg for cross compliance and meat hygiene regulations) and link these to farm assurance schemes. Marketing tools (eg disease cost calculators) are required to help market and sell these, and work should also be done to develop a low cost plan that may affordable to marginal farms that are barely profitable.

Lead stakeholders: Veterinary profession
Other key players: Farmers/livestock holders; Government

5.2.8 Improving veterinary practice viability

A range of approaches have been described to improve veterinary practice viability. These have typically been developed by practices in areas of high animal densities, and their successful application in areas of marginal farming is less assured.

Whilst the specific application of these approaches may be commercially sensitive, the broad principles and drivers that lay behind them are common to many service industries. There may be scope for codifying and communicating some of the approaches and/or establishing some performance benchmarks against which practitioners can measure themselves.

Lead stakeholders: Veterinary profession

A recurrent theme has been the difficulties of ensuring adequate animal hygiene and welfare standards in farms that do not adopt best or even good operating practices and which have no contact with a local veterinarian. Recent experience has shown that some diseases have started in such environments. There is also a concern that, particularly in remote and marginal areas, the diminishing presence of the large animal vet and low livestock prices, may combine to increase the incidence of practices that do not meet the government's health and welfare standards.

More needs to be done, by government and the veterinary profession to ensure that livestock holders are aware of their AH&W responsibilities, including when they need to call out a vet, and the consequences if they neglect their responsibilities. Nevertheless, there will remain a minority of livestock owners who either fail to hear or heed the messages, and addressing them remains problematic.

Blanket compulsory vet attendance across all livestock sectors runs the risk of alienating those livestock owners and companies who already adopt good/best practices, or who are persuadable to improve. And there are obvious issues for government of resource and cost. However this must be balanced against the current lack of effective leverage/inspection processes of those owners who for whatever reason fail to come up to AH&W standards, and put other others at risk.

The AH&W Strategy Implementation Plan makes the case for effective delivery and enforcement measures to ensure strategic outcomes are achieved. It is clearly important that government develops the right set of indicators and targets to provide evidence of progress in respect of these outcomes, and processes to address areas of weakness. At a local level these measures should be use to support a more targeted and risk based use of existing inspection powers including random inspections for welfare purposes. And all of this needs to be supported by continued improvements in government's information on animal keepers

Lead stakeholder: Government/veterinary profession

Despite the adoption of "good practices" referred to elsewhere, we remain concerned that in the medium term and under the present economic conditions the prospects for these practices' clients, and ultimately these practices look grim. And this will potentially further weaken the presence of large animal vets available in these areas, with consequent AH&W issues. Some are highly dependent on LVI work to maintain viability. Para-professionals are similarly challenged in these areas.

There is scope to look at:

1) evidence of market failure in particular areas, and additional initiatives that might then be available

2) at sub-contracting more work from the SVS to private practitioners (which has other potential benefits), although opinions on the viability of this and the scale of additional training required varied quite markedly. And we feel that this might be examined as part of the government's intention to review the contribution of all delivery agents in respect of its AH&W strategy in order to improve effectiveness.

Lead stakeholder: Government

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