Welcome back, everyone. I hope everyone had a good lunch break, and thanks again for joining us for this afternoon's section of colourful CPD's Making Nurse Consulting work for you and your practise. I'd like to welcome back my colourful CPD colleague, Steph, who is the first speaker of this afternoon's sessions, and she's going to be going over common challenges in veterinary nurse consulting.

So I'll hand you over to Steph. OK, thank you very much, everybody. hopefully I haven't got the same technical issue as I had this morning where I couldn't share my screen, but since I've already done that, fingers crossed we're OK.

Thank you very much for joining us again. I hope you had a chance to have some lunch. The immediate after lunch slot is never an easy one because people are sitting there, they've had some food, and quite easy to start to feel a little bit sleepy.

So I've probably got my work cut out to try to keep you all entertained. And I hope that talking about what I perceive as the common challenges in veterinary nurse consulting for the next half hour, well, fingers crossed, to do that for you. I think the reason that I'm talking about these, and it's interesting because Sam, Samantha, in her presentation just before lunch, actually covered a fair few of them, and I'm gonna come at them from a slightly different viewpoint, is that I do get the impression that that nurse consulting is taking off in practises a little bit at the moment, but not as much as we would like it to.

And I think there are barriers and challenges that nurses face. And the next half hour is what I consider my take on the ones that are, are the most likely. So, the first thing that we've got is, sorry, my slide doesn't want to progress.

Wait a sec. There we go. So first of all, time and space we're going to talk about, then we're going to talk about.

Charging, then we're going to talk about getting buy-in from colleagues. Then I'll include practicalities of booking the appointments and then getting buy-in from clients. So, it seems to me that in a lot of practises that there's a sort of feeling that actually, if you don't have a dedicated nurse consult room, you can't run nurse consults.

And I think that that's a bit foolish. It seems to be that there's this kind of, well, we can't do nurse consults because there's no space and therefore we won't run them. And I would like to try to persuade you over the next few minutes that even if you don't have a room in your practise that can become a dedicated nurse consult room.

It is still possible for you to run nurse consults if you're keen to do so. Could you use, for example, a back of house room? There are certainly practises that are designed.

I have some colleagues of mine who have their own practise and their practise is designed in such a way that actually their radiography suite feeds off the waiting room directly. There are no problems with it. It feeds directly off the waiting room.

In there, yes, there's the X-ray machine. Yes, there's the X-ray table. Yes, there's the ultrasound scanner.

But in reality, although the door is usually kept locked, it can be opened. There's no reason why it can't be and why that room can't double up as a potential consulting room for nurses. If you haven't got anything like that, how about dividing off part of your waiting room?

I mean, it's not great, is it? You could use some of those office type screens. They're not exactly wonderful, and particularly if you were trying to deal with a cat, it wouldn't be brilliant.

But it may just allow a really enthusiastic nurse to get some consults off the ground and just kind of show the management team in particular that you have clients who are wanting to see veterinary nurses, and at least get things started. Could you even adapt some storage space? I mean, a lot of our practises, are run in oldish buildings.

They're buildings that have been adapted from homes. They're often our nooks and crannies here and there. And at the end of the day, you don't need a lot of space to run a cons consultation.

You could have something like a fold down consulting table, maybe a little trolley with all of your bits and pieces of kit in it. You don't need lots and lots of stuff, lots of space. So it's worth just using your imagination, having a little look at the space that you have.

But if you look around and there's no backup house room prac dividing a part of the waiting just isn't going to be practical and there's no storage space. Why don't you share the consulting rooms with vets? Ultimately, the consulting rooms that you already have.

Should not necessarily be the entire domain of vets, just because it says vet consulting room or consulting room doesn't mean that it has to be the vets only. And it seems to me that in a lot of practises, veterinary consults are classically booked a bit like this sort of vet diary here, Imagination vet diary, where they're booked in blocks. Perhaps blocks of 2 or 3 hours throughout the day.

And, and often, classically, it seems to me that they're booked, for example, as these are, blocks of 3 hours in the morning, and then they'll often be a real gap until the afternoon. Maybe then they start again at sort of 3 or 3:30. So there is that block in the middle of the day, where the consulting rooms aren't being used.

So why not use them for nurse consults then? Well, of course, you can, but part of the issue with that is that, of course, their nurse consults are only ever available during that quiet time, which may not necessarily be convenient for people to always want to bring their, their pets in for nurse consults at that time. So how about just completely rethinking the diary and offer vet and nurse appointments at varying times throughout the day.

And we actually did this in my practise, because we were in a situation where, you know, clients were saying, well, they wanted to see the nurses, but actually, you know, they couldn't always make it at lunchtime. Equally, there will be clients who would like to see a vet, and who would like to come in at lunchtime. So why not offer blocks of vets and nurse appointments, in different sections throughout the day so that clients have an opportunity to choose the professional they see, regardless of what sort of time of day it suits them to come in.

But what if you're in a scenario where you look at your appointment list and basically your consult rooms in your practise are pretty much fully booked continuously all throughout the day with vets in them. And you've got no extra space, you've got no other consulting room, and you've just got vets filling those consulting slots. What can you then do?

If you're a keen veterinary nurse wanting to do consults, do you then just have to give up? Well, I don't think you do, because I actually think at that point, veterinary nurses could consider taking over some of those vet consult slots. Now, often people will kind of raise their arms in horror at that.

And say, well, he's, that's gonna mean not gonna to be financially viable. We're gonna lose a whole load of money. But the point is, it is financially viable, because if you think about it, if you have no nurse consulting going on in your practise at all, and if your vet appointments continue all day.

Then at the end of the day, veterinary surgeons will be doing many of those appointments that I would consider are typically within the remit of veterinary nurses. So they will be doing the things like the second consults. They'll be doing the things like the repeat injections of things like Cartraphin, giving that second ocernia, for example.

They'll be doing the post-op checks. They'll be doing the maintenance type consults like the nail clips. And it's not as though they aren't being charged by the vet, and many of them may have been pre-charged in advance.

So if veterinary nurses simply swap with the vets to do those, of course, those charges that have already been made, and the, the, nail clips and things. Obviously, we should be charging for those. Realistically, the income is either going to be unchanged, or what often happens is that it can increase.

And the reason that it can increase is, again, if you think about it, If veterinary nurses come in and start taking over the consults that it's reasonable for them to do, well, the vets at that point, if there were no other consulting rooms and consulting slots available, the vets at that point have the opportunity to do some more work that is vets specific. So, for example, it may be possible for them to do some additional operating, or maybe make those phone calls and report those lab results. And if they get that done, patients may be managed a little bit more proactively, a little bit more effectively.

Perhaps they will do better for longer, which will result long term in additional income. So, you might need to adjust the nurse and or vet rotor in order to do this. And potentially, if it does really well, and there's more and more stuff that the vets can do operating wise, or, you know, in the, in, in terms of making phone calls and things like that, you may be in a scenario where actually you end up having to consider taking on another nurse or another vet, even though you might have thought at the beginning, well, there wasn't any space for something like that.

So I think when it comes to time and space, the way to look at it is if there doesn't seem to be any time or any space, think laterally, rethink how you use both time and space in your practise. And I think you'll be quite surprised that actually, you will manage to create either the time and all the space in order to allow nurse consults without it having a deleterious financial effect. So let's have a look at charging now.

Samantha in, in her presentation, really made me happy because she talked about charging what sounded like pretty properly for nurse consulting. I was really frustrated. There was an article in Vet Times in May 2020, which showed that with a survey done of, of information from practise management systems, about 71% of veterinary nurse consults are still being offered as free.

And there does seem to be a perception in the profession that we sort of shouldn't be charging for nurse consults, or that clients won't pay to see nurses. And I think both of those are wrong. And I think we, we really do need to rethink this.

At the end of the day, there should be a charge. Veterinary nurses are qualified professionals, therefore, it's reasonable to charge a fee. We're used to paying to see other professionals.

People pay to see vets, people pay to see lawyers, people pay to see dentists. We accept that we pay to see professionals. And then if we think about the beauty industry, hairdressers, beauticians, we pay to see them.

Why on earth would we not pay to see a veterinary nurse? And I think, you know, in many ways, the profession is part of the problem. We spend a lot of time devaluing veterinary nurses by the language that we use.

I know people may not necessarily intend to do this, but often you will hear people saying, oh, if you come to see the veterinary nurse, it's cheaper, or it's only such and such if you see the veterinary nurse, or it's free to see the veterinary nurse. All of those types of language imply that veterinary nursing time is not worth anything. And then, you know, veterinary surgeons may not necessarily do it intentionally, but if we need to get somebody to help us to hold an animal during a consult, it's, it's quite common for people to sort of say, oh, just go and get someone to help me.

Why are we not saying, I'll go and get one of the veterinary nurses to help. Make it clear that this is a co-professional, who you're getting to come and help you, not just another person. And I think as well, the other thing that we tend to do is we tend not very much to show the value of what veterinary nurses do in terms of when we charge our clients generally.

And we could do this better. So, for example, if we're charging a general anaesthetic, often it is just simply general anaesthetic and a set fee. Actually, maybe we should be charging general anaesthetic and then monitoring of anaesthetic by a veterinary nurse and charge two separate fees.

So that actually it's very clear which professional has done what. I'm not going to labour the point, but I think it is really important if we change the language and we value our veterinary nurses as professionals, clients will at that point, be comfortable charging, and be comfortable paying to see them, and we'll feel a lot more comfortable charging. The other thing we have to remember is that veterinary practises are expensive businesses to run.

There are significant costs included in running a veterinary practise. And this little pie chart is there to demonstrate that of the total amount of turnover that practises create, about 25% of it comes from things like drugs, food, labs, and cremation costs. Those are costs that that the practise has to bear, in order to sort of help to cover that, the turnover.

Now, we can charge those costs directly to the clients. That's fine. We will charge them for the drugs, for the food, the lab and cremation costs.

So we can, as it were, get those costs back. But what about the rest of the costs to the business? But the only way that we can actually make the money from to cover those is by charging for professional time.

And those are enormous costs, if you think about it. They're everything other than the drugs, food lab, and cremation costs. They're things such as all the costs associated with the building.

So the mortgage or the rent, the rates, the lighting, the heating, the insurance, all of those things. Then there are the office necessities. So the computers, the paper, The stamps, silly things like that, the accountant's fees, any legal fees you may have, the costs of of marketing.

The costs of any vehicles you may have. And then we have the costs of all the staff. Of course, everybody who's employed in the practise is going to be being paid a wage, I hope, I hope none of you are doing nothing, but they're going to be being paid a wage.

And as part of that wage, then the practises, the businesses also have to pay other additional costs which don't show. In the members of staff's income. So those will be things like pensions and national insurance, CPD training, all of those things add up all of those, they're enormous costs.

They make up 75% of the costs to the business. And we can only cover those if we charge for our professional time. And we're very good at thinking that we can charge for veterinary professional time, but veterinary nurses, as our co-professionals, are also entitled to charge for their time, and we should be doing that.

So earlier on during his presentation, Brian put up some ideas of nurse consulting opportunities that there were. And I've put my take on these, sorry, I've put my take on these here again. Now, many of them are very similar to Brian's, there may be a few others that are in there as well.

And you may be looking at these and thinking, oh my goodness, we don't do very many of them, or I don't think that's right, or I've missed some off. And I don't intend to go through these in any great detail. I simply put this slide up to to sort of act as a way to introduce the ideas about charging.

So, let's consider perioperative appointments. How might we charge them? Well, I think admit and discharge appointments reasonably have to be included within the overall cost of the procedure.

We probably should allow for them, but reasonably, they should be included. But if we're seeing an animal that's being readmitted, so maybe one that was in yesterday having intravenous fluids by gastroenteritis, and it's made a definitive, a definitive decision has been made by the vet the day before that it is coming back in. We should be charging to readmit those.

If a nurse is readmitting them, the nurse is going to have to check with the client how the animal is, get an update, also examine the animal. It's not just a routine admit. So we should be charging something for that, perhaps a readmission fee with a veterinary nurse.

With post-op checks for routine procedures, so things like dental scale and polishes only or neuterings. Of those, of course, are quoted as a set fee to the clients. And so those are usually going to be pre-charged.

But maybe we should show them on our invoices. Nowadays, a Of course, it's possible with with our practise management systems to create an invoice that's one, total amount, but within that, to itemise where those costs have come from. And so maybe we should make it clear that there's a post-op check with a veterinary nurse included in that.

And if we're doing other post-op checks, again, we should be charging for them for the non-routine post-doc checks, but maybe we should make it clear on our invoices that they're with a veterinary nurse. And what we used to do in my practise is we used to pre-charge all our other post-doc checks because it made it very clear to the client that we'd allowed for two post-doc checks that they were with a veterinary nurse, and that the fee for that was there included in what they paid. So when they paid on the day and picked up their animal, Then, at the end of the day, they didn't have any additional, fees to pay, and that was, was quite useful.

When it comes to things like growth, maintenance and prevention, second vaccinations are almost always pre-charged. I think the vast majority of practises will pre-charge with the first vaccination. But again, maybe we should make it clear that the 2nd vaccination will be with a veterinary nurse.

So perhaps we should charge full course of vaccinations, 1 consultant vet, 2nd consultant vet nurse. If veterinary nurses are doing microchips and kennel cough vaccinations, then we should be charging the same amount for them as we do for vets. There shouldn't be a difference in fees.

And just for clarity here, we have confirmed with the RCVS that veterinary nurses are allowed to give kennel cough vaccines as long as an animal has been seen at the practise within a month. OK? Pre-breeding consults, Brian was talking about these earlier, they're going to be quite long, quite involved, and absolutely we should be charging a fee for that.

If, if a nurse is going to be sitting down, talking to a client, explaining about breeding, explaining about things like any health screening that can be done, complications, possible caesareans that may be needed, then absolutely, we should be charging at least a nurse consult fee for those. For things like socialisation or maybe sort of regular growth checkups where we're just monitoring weight, it may be appropriate to consider offering them as bundles rather than charging a relatively small amount for each one. Or alternately, of course, if you have a health plan, you might want to consider actually offering those complimentary on your health plan, but make it clear to the clients that they're a valuable perk of having that health plan.

What I would consider maintenance type consults, the same as for the microchip, they should be charged the same price for a veterinary nurse or for a veterinary surgeon. After all, a nail clip is a nail clip. It doesn't matter who does it.

So we should be charging the same price. If we're doing things like dental checks or old patients or geriatric health checks, then we should definitely be charging for those. There should be a standard nurse nurse consult fee.

Or again, as Samantha suggested in her presentation, perhaps with the older animals, if you're offering some lab tests and things included, maybe charge a sort of bundle for those. Again, if you have a health plan, it may be that these may be either complementary or specially priced for the health plan. But again, don't talk about them being free if you're on the health plan.

Talk about them these as being a good positive perks. Another good reason to join the health plan, these are valuable perks. When we come to things like follow-up treatments, so things like a second, oceria treatment, for example, or vitamin B12 injection or contraphin injection, then often these will be being pre-charged by the vets.

But again, make it clear that it includes a nurse consult fee, or you may choose to charge it as a meds admin fee and then in brackets, put that with nurse plus the cost of the drugs. Courses of treatment, things like physiotherapy, often they're better priced as a bundle. Some practises do choose to charge them individually, but they could be priced as a bundle.

Clients quite like that, you know, a bundle of 4 physio appointments, for example. But again, make it clear if it's with a veterinary nurse. If you're seeing a patient that's got chronic disease, what Brian talked about is long-term medics doing monitor measure and me and, Medicaid, then certainly a consult fee should be being charged to that, and nurse consult fee.

It's gonna take your time. Or you could consider possibly for Animals with chronic disease, having almost like a special health plan where maybe you could charge them a monthly fee over the course of a year that would cover the cost of the consults with the nurses, consults with the vets, and any lab tests that are standardly included in that. And you could consider doing something like that to make it a little bit easier to spread the costs.

And then for weight clinics, really, we should Be charging for these. Some practises may offer perhaps to include the cost of the clinic in with food, if the client chooses to purchase food from the practise. Or you could consider pricing them as a bundle.

So, for example, again, 4 or 6 weight clinics in a similar way to Slimming World and Weight Watchers and things for people. And ideally, if you're going to do that, then seriously consider trying to encourage your vets to actually prescribe a course of 4 or 5 wait clinics. Now, again, if you have a health plan, it may be that you would consider offering those at a special price.

But again, make it absolutely clear that this is a positive perk, a really good benefit of your health plan and a reason to sign up for it. For things like behaviour consults, nurses, probably need to have some additional training, and they do take time. So the charge should reflect that.

Appointments such as new registration appointments, so for pets recently, clients recently calling and wanting to register their pets, or maybe where veterinary nurses might possibly be helping clients with discussions towards the end of their life, then it may be appropriate to consider offering those sort of appointments for no fee. Let's face it, the registration checkups, the aim behind those, is what we would term, I suppose, a capture and convert. The idea is to convert that initial telephone call from the client inquiring about your practise into the client coming in and having a really positive experience, experiencing the fantastic service that your practise can offer.

And actually investing in, in that with a no-charge consult certainly may be worth it for, for future benefit. Equally, with end of life consults, of course, that's a very emotional time. And it's a time when we can lose our clients if we get customer service wrong then.

So there's a time when we can lose our clients and if we can provide them with excellent service without necessarily fees being associated, that will actually help to bond them to the practise. And then hopefully, when they get another pet, they will remain future very loyal clients and will help to promote the practise to other people. And there are other reasons to charge.

It reflects the professional status of veterinary nurses. We talked about that already, and Samantha mentioned that. It enhances the value of veterinary nurses to the public, which actually makes it more likely that the public will be prepared to pay for, to see veterinary nurses.

It allows veterinary nurses to become fee earners. We have two types of professionals who work in veterinary practises. We have veterinary surgeons and veterinary nurses.

Both of them are able to charge professional fees and become fee earners, and we should allow veterinary nurses to do that. And it also makes the veterinary nurses feel valued and appreciated. They will feel that the management team value and appreciate them.

And interestingly, that often improves their own sense of self-worth, which actually will enhance their, the, the way that they consult often, because actually they feel more confident, they feel that their time is worthwhile, they will be more comfortable charging for their time, and they will deliver generally a more positive service experience to the client. And I think we should make it the norm. Clients should expect to pay to see a veterinary nurse.

It's normal, that's what you do. Now, whilst I, I know I have referred on a few occasions in the last few slides to, to fees being not charged, no charge consults. But please, please, please, please, can I please ask that if you are going to charge, if you're not going to charge for your consults, please, can I ask that they are referred to as complimentary, not free.

Free totally devalues it. Free implies that it's something a little bit kind of cheap and tacky. Free things are not seen as having any value.

People often don't worry about turning up for free appointments. It's not worth it. Why should I bother?

If we call things complimentary, complimentary is different. It has a different feel to it. It suggests that we are giving something of value, something that's a courtesy.

So for example, like free chocolates in a hotel, it actually makes you feel really good. It feels like a really nice thing. If we, if I can just persuade you to do that, then that alone will change people's attitude to whether or not people will, will pay for veterinary nurse consults, and hopefully get you feeling that you should charge for them.

So let's have a quick look at colleague buy-in. Now, Claire in her talk, mentioned that actually there's no point in forcing all colleagues to consult. Obviously, you need your team of veterinary nurses to buy in to your consul consulting clinics, because otherwise there won't be nurses to do it.

But it's much better that individuals are allowed to play to their strengths. If you're in a situation where you've got nurses standing in the consulting room who don't enjoy those clients. Facing roles, then they're not going to necessarily come across very well.

That's not going to be a good experience for the client. That's, that's going to detract from the value of the consult. So if you have individuals who would much rather be doing what we would turn the back of housework, absolutely let them do that if that's their forte.

But encourage those of your colleagues who are very keen to get into the consulting room to be involved and, and get their buy-in. With the management team, the difficulty with the management team is they may well be concerned that you're, you're not going to be able to charge that, you know, nurse consults are, are, are, are, don't make any money, we're gonna lose money doing them. There isn't enough space, and that's going to be particularly exacerbated if there is a reluctance or if there's a necessity to reduce that consulting slots, because the management team are likely to be reluctant to do that.

But I hope that over the last few minutes, all those counterarguments that I provided you with when we talked about time and space, and that I've just gone through about charging, would allow you to say to the management team, actually, nurse consults do make money, and they are worth doing, even if we have to steal some of the vet consults. You're obviously going to need buy-in from the veterinary surgeon team. The difficulty is, sometimes veterinary surgeons do misunderstand Schedule 3.

And again, for those of you who are tuned in this morning, we talked about the legislation. And so veterinary researchers may be a little bit concerned about what they can actually delegate to nurses, what nurses are allowed to do. And they may also be concerned about responsibility, not understanding that veterinary nurses are, in fact, professionals in their own right.

They have their own code of conduct, they have their own disciplinary process. So misconduct. And negligence by a veterinary nurse is his or her responsibility, not that of the vets.

But again, for those of you who are listening this morning, you know, or if you choose to listen again later, the legislation talk hopefully will allow you to explain to the vets that actually, this is what we can do, and these actually are our responsibilities. We have accountability. But you will need the vet's help to work out protocols.

How are you going to manage these cases? What cases are you going to? Transfer to from the vets to the nurses.

What cases the vets feel that it's appropriate for nurses? To see. So it will be helpful to do that and decide where the kind of bounds in responsibility lie.

So definitely you will need to work with the vets, but hopefully work with them to set protocols. And I would say one of the easiest ways to start is start small with those easy-in consults. Encourage your vets to allow you to do the second vaccinations, the post-doc checks, the maintenance type consults like The nail clips, like the emptying anal glands.

And what will happen, particularly as the vets notice that some of these consult slots are being taken off them and that either freeze them up an opportunity to do more consults if you have an additional room, or to do more other work, then actually, that will allow them to recognise the benefits and fingers crossed, as long as there's no disasters, which they won't be, because you'll be great. But as long as there's no disasters, they'll actually be, oh, actually, nurse consulting is useful, it works, it has a positive benefit to me and be more keen then to allow you to perhaps expand the service you do. And of course, you need the buy-in from the reception team.

At the end of the day, the reception team are the ones who have that first point of contact for the clients. They're the ones with the, who have the ability to direct the appointments, which brings me very nicely to the practicalities of booking. And what you will need to do here is provide receptionists with really clear guidance.

They need to know what they can book with whom. And I would suggest that you're going to need to do something like create some sort of information sheet. So that the receptionists know what types of appointments are the veterinary nurses in your practise going to be offering.

What slots are available, make it very defined, have a nice, clear, slot appointments on the diary so that there's no confusion. And which members of the nursing team will be offering which appointments. It may be that not all members of the nursing team are comfortable doing every type of appointment that you wish to offer.

Now, there may be some types of appointment where it will be possible to have very blanket rules that make things very easy for the receptionists. So for example, You may decide that veterinary nurses will do all the routine nail clips. So that would be any animal that's coming in for a nail clip alone, unless it's one that regularly needs to be sedated, for example, which would probably need some veterinary surgeon inputs.

You may decide that nurses are going to do all the admission appointments for routine ops. So that would be classically your neutering and your dental scale and polishes, and equally, that they will do all the routine post-op checks. So with all of those, it's nice to have a, it's easy to have a nice simple blanket rule.

There's no questions. The receptionist hears that that's what the client wants to book. They know that they know they can book it with a nurse.

But there may be other types of appointments where you'll need to sort of perhaps provide more of a sort of flow chart. So for example, with something like a second vaccination, we know that not all animals that are coming for second vaccinations will necessarily have been seen at the practise before. Sometimes puppies will have had their first vaccination with the breeder.

So you're going to need to check the reception. Are going to need to check, has the client been seen at the practise? And has it been seen by a vet?

If it's been seen before, simply perhaps for a weight checkup and just some nutritional advice, and it was a nurse who saw that, or it came for a registration health check, then unfortunately, it will need to be seen by vet. That second vaccination cannot be done by a nurse. So the receptionist will need to ask a few more questions and maybe look at the notes.

They'll also need to find out is the, is the animal doing well? Do the clients have any concerns, because if there's anything wrong with it, absolutely at that point, it'll need to see a vet. And they'll have to have a look and see if there were any specific notes from a vet.

So for example, did the vet notice that it had got a heart murmur and felt that it must see a vet at the second vaccination? So those types of things are a little bit more difficult. It's not quite as clear.

And bottom line is, what you're gonna need to do is work with the reception team so that you can help them to devise what works for them. After all, they know what their, day, day job is. They know how their job role works, and they'll be able to tell you what they need in order to be able to make it work.

And then finally, client buy-in. Well, I think an awful lot of what I've said already, I hope, should help to get that client buy-in. But most importantly, if we book appropriately so there's no confusion, then the clients will be happy.

We don't want to be in a situation where clients are booked to see a veterinary nurse for something that actually they really needed to see a vet. And then there's all the palaver of finding, oh, how can we get you to see a vet? Oh no, I'm sorry, you'll have to rebook it.

So if we book appropriately so that there's no confusion, and actually, this particular type of appointment is absolutely the norm to see a veterinary nurse, then that will help with the buy-in. Again, if we use appropriate language, if we talk about our veterinary nurses as professionals, as our colleagues, you know, don't talk about them or, or you could pop in and see one of the nurses. Talk about booking an appointment to see a nurse.

It adds that value to them. It makes it a more professional arrangement. You probably will need to consider marketing, and you could do that just in the practise.

It may be that there might be posters in the waiting room, maybe that you'll have some leaflets about it. And also, it might be worthwhile doing it, or it will be worthwhile doing it to the wider public. So for example, via your website, talking about your nurse clinics, possibly even maybe doing an article in the local paper.

But I think what you'll found and find, and certainly what we found in my practise was as veterinary nurse clinics start Taking off and as clients start embracing them, which they will do, actually, they will then start talking to their colleagues, talking to their friends, telling people how good it is to go and see the the veterinary nurses. We certainly had clients from other practises phoning us, asking to see my head nurse, who was fabulous with her weight clinics, and actually specifically saying, Can I book an appointment to see Anna? Because I want to join your weight clinics.

So you will find word of mouth will then come. And as I say, if you start small with those easy win appointments, so that clients get used to the fact that veterinary nurse consults are the norm, they will see nurses for second vaccinations, they will see them for growth checkups, they will see them for nail clips, then actually that just becomes part of the practise culture and what clients. And finally, as has been said by a few people during the course of today, Brian mentioned it, Samantha mentioned it.

Communication skills are, are key. And we practise, yes, OK, we are dealing with animals, but it is in, in essence, it's a, it's a people business. We need to able to communicate with our clients.

And you will find that if you can improve your communication skills and have comfortable, confident consult conversations with your clients, you will improve and enhance the value of those consults that they're having, and that will get your client buying as well. So that brings me to the end of this talk. I don't know whether or not we have time for any questions, because I think I may possibly have rambled on a little bit.

Sophie, how are we doing? Hi, Steph, thank you very much for that. That was brilliant and really insightful.

We have got a few questions, but I'm a little bit cautious that we have run over a little bit into, Claire's presentation. Claire. But we can save them for at the end of the day, and we'll, we'll let Claire, come back now and, do her talk on weight clinics, which leads on really nicely from what you've been talking about as well.

So perfect transition. Right. OK.

Thank you very much. I'm gonna take you through this specific clinic, and I know that, I, I chose weight clinics because they're probably the ones that most people are perhaps most familiar with, and they're certainly the ones that will, should be the most full because the latest figures do show that around 60% of animals are overweight. And I think there's an even more, Even more of a need for it, over this last, this last few months as well.

So I'm just going to cover, two ways of doing it, I suppose we're talking about remote consultations, but I want to look at existing clients, so to keep them going and also to recruit new clients because why not? So let's look at pre-existing weight patients first of all. There's a few barriers to weight loss, and I would say during this period, and I know that lockdown is easy and life is getting a little bit back to normal, but it's, it's not really back to normal yet from, from what I can see.

There's going to be shielding owners that will still be shielding people that are too frightened to go out. There's people who are going to have seriously reduced exercise themselves, but also that means they won't necessarily have taken their own animals out. .

You know, and that's, that's a big issue. And we can also sort of say, well, of course, there's this dog walkers around and why don't people, you know, think about their animals exercise, but the bottom line is you can't always make an animal go with somebody that they don't know, and people can't always afford to pay somebody to walk their, their dogs. So many dogs may have in particular dogs found they've got less exercise, they've had less exercise.

They've got lower motivation and let's not forget that the motivator for weight loss generally is the nurse. You know, they, they may agree eventually with the health benefits, they may see the improvements once they've been going for some time and they see, they see the improvement in the demeanour, but the person that keeps them going chivvying them along is you. And if They've not been to see you, it's easy to let it lapse and, you know, anyone who's ever been to a human weight, you know, loss programme themselves knows, you know, if you miss a week, you, you don't have the same motivation as you would have done if you've been to see your, your, your club, club runners, whatever you want to call them a Weight Watchers.

And of course, there's anthropomorphism and this is treating. Treating animals as, as little people, you know, and if you're feeling anxious because of COVID, if you're in, you're stuck inside and you're bored and you, are just smacking it like I can't tell you how many times I've been to the fridge when I've been working from home the last few weeks. If, if you're in that situation, it's very easy to just think that you want to give your, your animal a biscuit as well and, and, and just bring them along your slight weight gain journey.

Now, we always know that, the, the, the animal population mirrors really what the human population is doing. Obesity is a real problem for humans in the Western world. It's already a problem for dogs and cats.

And, there's been a weight issue, I think increasing for people during lockdown in the main because although people are finding time to go out walking, they are just, you know, comfort eating perhaps a bit more. There's also the practicality side of it that, you know, maybe you can jump on the scales with your chihuahua but, or your cat, but very difficult to, to, to find a way to weigh your Labrador if, if you've only got human scales at home and, and perhaps it's, it's, it's easier to not be, You know, to sort of ignore changes. My son very helpfully put some new batteries into our scales for the first time since lockdown a few, about 2 weeks ago, and I was horrified.

So even though I knew I'd put on a few pounds, I hadn't actually had it in black and white, and I think it's, it's just the same thing for patients as well. So now I've had to have to really think about it. And this is a study that Royal Canon carried out over t for thousands of pet owners and they found that on average they were feeding about 54,000 extra calories per year.

This was before lockdown, and this was from human food and snacks and treats as a shocking amount of calories. I think it equates to around About 360 cheeseburgers, you know, for, sorry, yeah, 360 cheeseburgers per pet per year on top of their normal food. So, you know, we want to just carry on addressing that.

So after lockdown, crikey, you know, who knows what they've been having. And there's some good reasons to keep persisting. This is a DEXA scan from the Liverpool Liverpool University weight clinic, and you can see here the, you know, the decrease in lung space.

This is all fat gathered around here, reducing the area in the lungs, all of the organs of viscera, are also surround. By fat. So this is just an unhealthy animal that the owner doesn't really see what's going on inside.

And, you know, our jobs are really for the health of the pets. So any given time, 90% of our patients are well, so preventative care is really, really important. And anyone who's attended any of our weight management, trainings and, and, the all of the, all the clubs and clinics that we've been, focusing on over the last few years as a company.

You'll, you'll know that this is really important and you'll know that the health of the pet is the paramount, part of it. So I'm not going to talk to you about the, the, the, the way the fat cells behave or any of the science behind obesity because you probably are already aware of that. But we're just going to talk about how to keep these things going now.

I would say it's very disheartening to have to start again. So if people are lapsing during this time, it's, you know, then the weight creeps back on again and maybe they've already been doing so well for 6 months, you know, it's really difficult to get the motivation to start going again. And it's just as difficult if it's, if it's your pet as if it's yourself, you know, because you think, oh, back to the drawing board, it's just, you know, it crushing, really.

If you keep up with people and, you know, you maintain that bond and you show that it does still matter. And I'm really well aware that lots of practises have got furloughed staff, that practises very busy, that there's a lot of time being spent seeing emergencies and seeing, seeing some silly appointments, but in a very different, different way. The way that we've been doing in the past.

And that's quite difficult, but I think it's really important to keep people bonded to practise because they, they want, they want to be cared for by you. That's, you know, people want to have the relationship with their vet practise, and it's a very easy way to do it is, is with that good relationship they have with their veterinary nurse. So there's a few different options you can use and I I chat about some of them this morning, but I thought I just sort of specify them properly.

Obviously, video calling and, and this enables you to do a few things. Firstly, it gives you that visual on how the animal's doing and enables you to body condition school the animal over, over the video. And You know, without getting your hands on, it's not completely accurate, but you can direct the owner as well.

You can also make sure that they have copy of the body condition score so that they can, you can, you know, they can do the feeling. They can have a look and you can assess and see where you both are in the same way as you would in, in a face to face. It keeps It really personal when you can see them and you can see the animal.

And also, and most importantly, you can find out what happens at dinner time. So you can time your consultation so that you can see exactly, you know, we walk me through it, what you do, you know, when you measure the food. I've had conversations with people running we clinics where We've gone around the houses for 20 minutes and I've said, do you, do you measure out the food every day, and I've not specified on digital scales, and 20 minutes in, I found out that they've been using a cup, and I could have averted all that problem if I had seen what they were doing.

So this is a really great way to see whether they actually do it or whether they've marked their cup, whether they are using scales, whether they're using accurate scales, all that sort of stuff. You know, what's the routine? I think that would be really useful.

And then you can intersperse up with phone calls, keep them motivated, keep them really keen on, on, continuing with it. And I've got some other ideas on how to keep them motivated here with the texting. And I took this from, this idea about motivational texts from a friend of mine who was giving up smoking via, I think it was nicotine.

And they, they set up they have a text service where they, they text you every day and say, now your lungs are this much clearer. Now you should, you know, now you should find it easier to go up the stairs. Now, this has started to clear and there's no physical addiction anymore.

So there's lots of things like this that are that I said and I thought, well, a great thing to do just to tell people, well done. So not to nag them, not to remind them of appointments or remind them of phone calls, but just to tell them they're doing really great and it's hard and that you appreciate how hard it is. So, you know, motivate them inspers with other communications.

And you could have a socially distanced visit. Yeah, they could come to you and you could be in a car park or they, you know, chatting to them depending on your, your outside space, or you could visit them and you could go into their garden and, you know, bear in mind your personal safety, bearing in mind, you know, don't go somewhere that you don't know with somebody you don't know on your own. But you know, you could combine this with a phone consultation and, and you can, you know, make a decision as a practise as to whether you want to do this.

But really, there are lots of ways that you can keep in touch and none of these involves standing in a consulting room with them. Finally, emailing so you can give them all the information that they need, body condition score charts, confession sheets, food diaries, all of those sorts of things that will be really beneficial in maintaining their commitment and their motivation throughout this, this programme. So just some ideas, you know, you can read as well as I can.

I thought, you know, just 6% weight loss dramatically improves quality of life, mentioning their coat and their skin, mentioning that their breathing will be easier, you're showing them pictures of DEXA scans and showing them the difference between this treat and that treat calorie wise, you're making suggestions for, for, For, for good ways to, to give them healthy foods. I was absolutely stunned recently to find that my greedy little dog really likes cooked broccoli. And, he, he really begs for it, which is a really strange thing.

And it's never occurred to me in 5 years to offer it to him. And now I keep, you know, keep some leftover broccoli aside. I cook extra so that he's got some really healthy, healthy foods to, to snack on.

And rather than wanting to beg for other things, you know, it's a really Really surprising. So I think you can be surprised sometimes at what animals will, will like. I've been reliably informed that cats really like courgette chopped up into very tiny little cubes and, and cooked in the microwave and that they really like it.

And a whole courgette's only got 20 calories. So I, you know, I've I've yet to see it. I've seen a video of a cat joining a courgette, but it's worth it's worth a shot.

Courgette's season's just about upon us at the moment. So lots of things that you can say, just I'm sure you can think of lots that are very much geared to your practise, you know, losing life, losing weight, sorry, increases life expectancy by up to 2.5 years.

And that was a study that we carried out, over, over the last 13 years, we've been gathering data. So body condition scoring, when you're going to be doing that, you need to only do it once a week because obviously changes in the body don't happen as quickly as weight changes. But you need to make sure that you've started off with the correct one and also using the, the correct body morphology.

So I've popped the cat one up here. You, if you're a royal. Practise, you'll know that we'll have, we've got, I think, 7 different body morphologies, but there's also WSAVA have got a body condition score and other pet food companies will produce them, but just make sure you're using the 9 point score because that's the one that's mostly most recommended by the WSAVA.

So they can put it on their fridge, you know, they, you can email it across to them and they can print it off themselves so they can have it on their phone as a good, a good record for them to, to keep. And then taking a photo record, that should be once a week as well, and the animal should be in the same position and and ideally against the plain contrasting background. And I'm going to show you a sort of poor picture in a second because it, it really does make a difference, even though you can see, the, the weight loss in this dog on the.

The bottom right, it's really not that impactful when it's against the pattern the carpet or some or some leaves there. But these ones on the left, you can clearly see the, the differences when you take when you've taken the photos and, and, and kept them in the same sort of position. We often talk about this dog here.

I think his name is Rocco, and the whole Huge change in his demeanour. So you're not just saying to the owner, look at, look, look at his lovely figure now. Look at everything about him, his confidence, his enjoyment of life has, has shot up just, just by losing weight.

So, so these are a really good record for people and they should be doing this once a week and seeing that progression as it happens. Ideally from the side and from above, but definitely in the same position, and very difficult to see the benefits of, of weight loss on a black cat on a brown sofa, you know, it's really hard to see the defining edges. So obviously, they can send you cute face shots, of course, you know, they want to send nice photos of their animals.

That's always a good thing to encourage. But for, for your, for your records, it needs to be like this. And if you haven't got scales, and, and obviously your owners aren't going to have scales that are big enough for a, for Labrador, as I said, it would be really useful to use these, these, these body measurements and you would set the measurements that you want to, to set, you know, this cat is measured from behind his neck as well because it often carry some extra weight around the back of their neck, but the neck measurement, the chest measurement, the waist measurement.

Anyway you see fit and then you can put it all together to have one overall measurement, and then you can see how many centimetres they've lost in total. And you can also have those individually as well because the areas that you really, you know, importantly want to lose it around the chest and around the waist because that's where the fat will be surrounding the organs. And that's really quite nice to be able to put that onto a graph and see the improvements.

. As with normal life and, and normal face to face life, anything that you live with, whether it's a human or an animal, it's very hard to see differences day to day because you're so complacent really with who you who you have with you, and you're so familiar with the people and the animals that you live with. It's, it's really important to have some specific record, even yourself, you may not remember, you know, how, how much, you know, how much more you weighed before you went on a diet until you get your old genes out and find that they're much larger than they were. It's very difficult to see it on anything that you see all the time.

So please do keep these records. I got a couple of videos here because encouraging exercise is important. And I just, sorry about the noise there.

I just wanted to get a couple of my colleagues to give their, their, their animals something to do and just feeding from a cold. This is a lovely slim Labrador from My colleague Susanna, but you can see that a dog that's eating from aong isn't just gonna lay down and eat it. They do move around.

So even if you've got a big, big overweight animal that struggles to exercise, just the fact of putting in more effort to eat is, is, is worthwhile. And I'm just gonna, I'm gonna pause that because it's quite a long video. And then we've also got, another colleague sent her, I don't like to say it, her Toby cats, who was reluctant to move around at first, but did actually make an effort to do some exercise, albeit from a sitting position.

And I had to cut the video a bit too. Is he gone? I cut the video bit to to fit it into download, but the cat does move and, and what happens later in this video is the cat starts jumping around a little bit more.

And anything that you can get any animal to do to move where it wouldn't have moved before is a huge benefit. I would say that one of the issues with, with cat owners is that they think that cats don't want to play once they become an adult. And it's really because They're not, they're not encouraged to play.

So activity, activity games are really useful. You could get pet fitness trackers. So there's a couple of brands there that I just happened to look on Amazon to see what was available and there's absolutely tonnes of them.

So you can, you know, get them to count their steps with you, you, you know, any, anything you can do to get them moving around more at home, you can at least see what they've been doing. It's quite a nice modern way of doing things. You can build assault courses in your house, particularly for your feed your cats up high, you can get things in your garden for your animals to jump over and climb around, put trails down of their kibble for them to search for it.

You can make puzzle feeders out of piles of loo rolls or or egg boxes that you've, you've hidden kibble in and, and, you know, and allow making them find their way into the boxes to for the food or you can. Scrunch up newspaper and put that into a box and put the kibble all in that so that it kind of gets mucked up within the paper. You know, just things that will make their life a bit more interesting and, and make them put some effort into getting their food, even just scattering dry kibble.

My dog's got a, a routine where he has to eat his food. I have to keep some of the biscuits aside, so he has an activity feeder. And then afterwards, he likes me to throw the cable so that he can look around the kitchen for it and, and do that.

And this has become a routine. And obviously, I bowed down to the, the dog that runs the household. But this is a really good way because I see him moving around and he's definitely a, a dog that's prone to weight gain.

You could learn some click clicker training. It's quite fun, keeps them mentally active, particularly if they're not going outside. So you can just very easily teach people to click a train.

There's lots of resources online, and you can look at the Karen Pryor Academy to, to find out a bit more about that. And, you know, teach them to do stuff that's going to keep them active, like finding things on your phone. It's obviously quite handy.

Keys also very handy. You know, just get people thinking, animals are animals are clever and they, and they're generally interested in, in the, the world around them and they can become bored in the same way as we can. So I think if you just get your, your people to, to do things like this and retrieving games and all sorts, your animals will be more active and you're going to be encouraging exercise in the normal way.

A quick note with fishing toys for cats, I never leave them hanging off door handles because, particularly for younger cats, they can get themselves hung on them. So you should always put them away. And another tip with cats and, and toys is to always put the toys away when you finish playing with them, because adult cats, can't be distracted, that they're being sold sort of hunters.

They can't be distracted by every little thing. So if you buy that mouse and it's lovely and they play with it for a couple of days and then they never touch it again. That's because they would be, you know, they would die of hunger if they were distracted by silly things like that.

So you put it away and you get a different one out and they'll, if you keep rotating toys every 2 or 3 days, your cat will always maintain an interest in them. OK. Oops, sorry, just accidentally playing that video again.

Sorry. So that's, that's for existing patients and I'd say for new weight patients, you need to think about who to target. So there's a few people, those that you've seen, you know, they've come in for surgery or or consultation and you know that they, they could do is come to the clinic.

Obviously, this animal needs a surgery, but, he, he's gonna probably need some sort of a Weight maintenance and potentially some joint maintenance after this, after this surgery. So anything that's had a historical surgery where you know, it reduces their mobility to some some degree that they're gonna have a predisposition to weight gain. Maybe people that you've noticed that you haven't ever approached for whatever reason, maybe you can use this as a new way to get them interested in what you're doing and anything on any sort of joint medication because we know the two, you know, conditions, the joint disease and obesity go hand in hand.

And it's a very much a chicken and an egg thing, isn't it? If they get overweight because they've got bad joints or do they get bad joints because they're overweight. I think it's a, it's a perpetual cycle of, of problems.

And you could also just target specific breeds because we know for sure, some, some breeds are, are, are much more likely to, to have a problem. Labradors. Genetically have more fat cells and that's because they come from the cold, you know, cold area of up in north of Canada and they're used to swimming in water that's cold, and they've got that genetic predisposition to being, to being fat to start with.

So what you could do is you could have a group video meeting, so the group Zoom call, maybe a bit like this where you invite everyone along. I suspect that most people who are attending today have attended virtual pub quizzes or virtual family quizzes or CPD or, or, or things where they've been able to, to use this technology. And it, and it's really important that you can perhaps put something together and explain weight management, explain the importance of weight management, you can explain the, the life cycle of a fat cell.

Certainly, anyone from Royal Canon will be more than happy to help you put something together to, to talk to people, but I'm sure that most, most of you have a huge amount of, of information that you would be very competent at sharing. And it's a really efficient use of time because the owners of these people, if you, of these animals, if they come to a group meeting, you're only doing it once, you haven't got that scary standing up in front of a group of people, hoping people are going to turn up at the practise and worrying about whether they will or not. And, and, you know, all the things that face to face meetings entail.

And you can just do it and, you know, give it a go. It doesn't mean that you, have to stand up in front of groups of people in the future. It also gives the client the ability to be anonymous, and that's really important because nobody wants to be, you know, fat shamed or you know, their animals to be fat shamed, but they, they, you can make it into just about an education evening with the ability to offer follow up private appointments, whether it's a follow up Zoom or a socially distance visit or whatever you decide you want to do, for those who think that it would be really useful to look at, look at a weight management programme.

And I, I would really say that the best people to bring to weight clinics are the ones that, the ones that are whose pets are not that overweight, but just a little bit because it's so much easier to reduce a little bit of weight than it is to wait till they're double what they should be and then have to have their whole life, yo yo dieting. So don't be afraid to target that, you know, 5 kg cat that should weigh 4 kg because you can keep them healthy and it's a tiny amount of weight that makes a big difference to their quality of life. So we can have obviously socially distance visits or private video calls if you are just wanting to do them 1 to 1 and, you know, combine them with a visit to a phone consultation as well.

I'm sure this is something that you've been doing. But, you know, you can switch a video off if you don't want anyone to see you and, and nobody has to see, nobody has to see anybody else at all. In fact, you can just, you can, I think there's the ability to stop anyone being seen if you're the owner of the meeting.

And I just really wanted to say, you know, I said this this morning, this is the, this, this photo I took out of the, the Daily Mirror, the, the first day that we had some freedom on the 5th of July. The streets were packed. There was not any socially distancing in sight.

And I think You know, prepare for the future because this is not going to happen, and that's not going to go away. It's gonna happen again, and whether or not it's COVID-19, it will be maybe COVID-21 and whatever, whatever comes along again. And so I think we have to get used to this way of working and, and let's do it, let's do it now, where we can really learn and hone our skills so that it becomes much more normal for us and we're not caught on the hop in the future.

And that's, that's the end of my section there. Hopefully I've brought us back to time. Sophie.

Hi, thank you very much, Claire. We have got a few questions, which we've got time for, so, we're far away, one of which was how do you, I guess breach that initial. Invite to, to welcome them to await information, Zoom or virtual meeting, especially in the current times of COVID, and especially if they may have had someone close to them or themselves that have been affected by it.

I think, I think you just have to be sensitive to the fact that there's always a possibility that somebody would be affected. And so I think it's the wording of your invitations, acknowledging that they, that, that you hope everyone is safe and well and you, you know, you apologise. For contacting them if this is not the case.

But we, as a practise, want to look after your pets as well. And we want to offer this service and continue to offer what we think is best for the pets. I just think it's being sensitive to, to, to the possibility of there being a problem.

But we, we, we have to acknowledge that animals won't be healthier at the end of it. If they, you know, if they, if they gain even more weight from being stuck inside. So yeah, just a bit of sensitivity.

Yeah, OK. And, I mean, in your experience, I touched a bit on Steph's previous webinar, do you Feel in terms of charging for weight clinics. In your experience, what, what are your thoughts on that?

Is that? Yeah, I, well, I think you should charge for weight clinics. I think everyone is very switched on with paying for Weight Watchers for, you know, Slimming World for all of those ones for people.

They're also the new modern version of, of NM. It's a, it's a very good one. It's, it's pretty expensive, really, but actually, it's to, to, to keep the motivation going.

And I, I guess it's the way you ask for payment, isn't it? If you, if you're apologetic when you're asking for payment as if you don't deserve it, then people are going to find it strange. But for me, I think with weight clinics especially, they take up a lot of time, and they, and they, they're a huge benefit to the, to the, to the, to the animal.

And in the long run, they mean that your veterinary fees will be lower. So I'm a complete advocate for charging, sometimes charging in a pack, you know, a group so we're gonna, I'm going to give you 6 months' worth of as many appointments as you need, and it's going to be this price and you can factor in the cost of the food as well at that time. It also generates them back again, I suppose as well if they pay that fee upfront, you know.

And commit to the, the whole journey, whether it be 6 weeks, 6 months, like it'll, it'll continue. Exactly. Exactly.

And that's what you really want because if you don't pay for something, it doesn't, it just makes it seem that it's not, not important or of value, in which case, if you're not bothered about taking some money for your expertise and you're, and you're not that bothered about whether they come or not, you know, and that's not true. We really want them all to be a nice, healthy weight. Yeah.

And it's, I mean, obviously a lot easier said. Than done to say to have confidence as a nurse that you should have confidence in your value, your worth, and, and your time. Do you have any tips for nurses with how to portray that to clients and, and how, you know, to prove that obviously your, your time is valuable and it is worth what they're paying you?

I, I'm, I'm always an advocate for educating people on the, on the brilliance of vet nurses. They, you know, they don't, I don't think, I think stopping calling, calling vet nurses, the, the guys and girls out the back and, you know, I'll just grab somebody to, to do this, all of those things really the ones that, the things that devalue us, but to start educating people on what nurses have to Cover, you know, and I've seen some great displays in practises where there's information about how long it's taken them to study, the fact that a lot of the time these days, it's a degree as well, you know, and all the subjects and all the things that they are covered by nurses. It's just about educating people as to how great they are.

I'm a very much a flag waving nurse advocate. I love us That's straight. People always ask me why did you, why did you never go into nursing, and frankly, I said, I can't do it.

I can't do what they do. They're incredible and no one ever realises it because you're just out the back, as everyone always says, kind of going a bit back to Brian and a bit of what Steph has discussed, with the. Making sure you get the, the buy-in and the, the money for, for your nurse clinics.

I worked in a clinic where the nurse consult room was at the front of the building and right by the front door. So clients had a habit of, as soon as that nurse consult was over, nipping straight out that front door, which was hard to see from the reception desk to encourage them to come back to you to settle their bill if they've got one for the nurse clinic. So, That Bermuda Triangle situation that Brian was talking about, is really important.

Do you actively encourage obviously nurses to, to lead their, their clients to the reception desk after they've, they've absolutely. I, I, I think it's, it can, it can just be seen as a courtesy to take them to the desk, even if it is just a case of tapping the tapping the book and making sure that they pay their bill, . I, and I think most people know if they know there's a charge, they, they know that they shouldn't sneak out really.

It's just a bit of a traditional thing and it's playing on the emotions, isn't it, of, of, you know, the, the, the love that the vets and nurses have for their animals, so they, they just think they're not going to pursue it, but we do have to, if we're going to continue to provide a good service, we do have to charge for it because it's, you know, none of us can live on air. So I think that's really important. To take, yeah, to, to encourage them to pay at the time.

Definitely. And it's a whole team effort as well with it. Oh yeah, completely, yeah, of course it is, and everyone's got their value and everyone's got their place, and I think you, you start talking about your colleagues, as I think Steph said in her section there, it, it, you know, it values everybody regardless of whether they're a reception.

A receptionist, a nurse, a vet, an animal care assistant out the back, you know, any, everyone who, who, who contributes to that practise, should be, should be respecting each other and showing that respect to their clients as well, so that they can see that this, this no hierarchy. Yeah. Weight clinics, specifically, talking about continuity of care and clients being able to see the same nurse.

Obviously, that's gonna be buried in different clinics. Some clinics you're gonna have nurses, several nurses that can do the, the weight clinics, nutrition clinics, etc. And then some, you've only got that one set person.

Do you feel it's important for continuity that they always see the same person or? Would you be comfortable with a variety as long as you, you know, your colleagues are comfortable to do it? My personal thoughts on this, and I don't know what the others think, but my personal thoughts are that if you can be consistent seeing the same person, it's a better way to build a relationship.

So sometimes it may not be possible with holidays or sickness, but I think if you can and you know your diary, You know, 4 to 6 weeks in advance, you should always be able to book with your, you know, with yourself. You have some, it'd be interesting to hear what Christy or Samantha have to say about that because they're, they're working this every day, but I always try to see the same people and be the, be the one nurse for my patients, for sure. And what about the classic age old my dog, cat, whatever will only eat if they feed it human food.

Well, that, that, that's not, that's not really true, is it? And I, I have to say one of the things that the biggest cause for pets to refuse their pet food is poor storage of pet food, and that is leaving bags open or decanting bags of dry food into a container. So you should always, this is for all companies, not just Roy canon, you should only take out what you need and you should seal the bag and then you should put the sealed bag inside a con a container that's sealed.

That's how you keep it, because as soon as you let cs touch the air, it starts the oxidation process and so dogs and cats have got fantastic noses. They don't like the smell of something that's going off that we can't tell it's going off for months because our noses aren't very good. So that's the biggest cause if they're not liking it.

And also, of course, if you keep offering them a piece of steak instead of their food, then Eventually they learn that they get some special treatment, but they've got very few taste buds and I think part of this is educating owners as to what does it for dogs and cats and it's, it's not taste. They, they cats have only got 500 taste buds compared to our 9000 and, and also have got about 1700 compared to a 9000. So it's not bad taste at all.

It's just anthropomorphism. So all the all the questions. Yeah, I think that's everything, unless anyone else has.

I know, keep me going, you shouldn't have left all that time. Yeah, unless anyone else has a need to come through again, you can put them in the Q&A section. This is for the whole rest of the afternoon as well, and no one else sees what you ask.

It's just, just me, so, I can ask you. On your behalf, just in case that's, causing you not to input for any reason. But we'll, we'll go for a break a bit earlier.

So, we'll see you back here, in about 20, well, in a bit longer now, at 3:20, and to go on to our final, speaker of the day. So we'll see you shortly. Welcome back, everyone, and thank you for joining us again.

So our next and final speaker of the day is, Christy Paul from ICR Vetts in Edinburgh. So Christie has been a qualified RVN for 8 years. She attended Napier University in Edinburgh as soon as she left school.

She has had experience of mixed and small animal practise. The practise where Christie currently works in Edinburgh is now primarily a small animal, and she is the senior consulting and community nurse. A little extra about Christy.

She also has a tiny little baby that may or may not, distract us at some point this afternoon. Hopefully not. I've been told he's now asleep, but, just to give you all a heads up that, if you hear some baby cries, that is expected.

So I'll hand over to you now, Christy, if you're ready, to share your presentation. So, thanks for the introduction, Sophie there. So, my name's Christy Paul, and I am the consultant and community nurse, at ICR Vets, we're about 6 miles south of Edinburgh, so just on the outskirts there.

This is, soon as I'm not on camera, a photo of myself with Lola in the back there, one of our practise dogs that belongs to as one of our managers, heading out on a school visit. So, basically today we're just gonna go through some how I started consulting and things, so the contents will include where it all began for us at the practise, from going from no consults to what we have now. Implementing our consultations within our practise and how we did that.

Where we are now in the day to day running of our service. What consults that we offer. Challenges that we faced along the way because there was quite a few.

Our community nursing service, a little insight into that and how we set that up and the future and where we see ourselves in the next few years' time. A nice cute photo there, so the dog on the left, there's Arlo, he's my own, and our newbie Henry, who belongs to one of our nurses. So at the beginning, we basically had very few consults undertaken by our nursing staff in our practise.

We did the odd bandage change, the odd stitches out appointment, but the majority of our appointments were done by our veterinary surgeons. So yeah, vets at all of our nursing clinics, so all 15 minute appointments taken up by a vet's time, and then all of the post-op checks that have already been kind of paid for within ops and things where we're more than capable of capable of doing this. So we were failing to utilise our skills completely and we've all gone to college or university, and we're trained to do these appointments.

The vets should not be doing them. . We've done our OSky and the OScies include doing bandage changes, setting up for IV lines, putting IV lines in, blood smears, everything like that.

So all of the things, kind of anaesthetics and surgical wise, we also do the consultation side of things as well, and we do a lot of communication skills within uni and college, so why are we not using them? The client perceptions of a vet nurse so when I first started at the practise 7 years ago, clients just presumed that we cuddled puppies or helped reception or held on to animals for the vets while they did everything, and we'd often get asked when we were going to train as a vet, which we all know is a question that we all get, but we're, we're not. Veterinary nursing in itself as a role, we are a profession, and we should be able to, to relay that to our clients.

So we didn't really have any space to consult and I know Stephanie's gone over this a little bit, but within our practise I really really wanted the space to consult, so I'll go over what we did to, to combat that in a while. So how we implemented our consultations, basically at the beginning, we needed to find out who enjoys consulting and explain the case for change to management and to vets. So I believe that playing to people's strengths is the best way to to go forward.

So, first of all, hold a nurses meeting, come up with your pros and cons and how you can make the practise better rather than taking, taking a step backwards. So the benefits of this, your staff morale is going to be so much better because people are playing to their strengths. And, who actually enjoys speaking to clients who have those engaging nurses speaking to your clients front of house, .

It gives you better job satisfaction when you're actually utilising your skills. So what you've been trained to do, there's no point in just holding animals all day, every day when you actually can be utilising those skills and have your student nurses or your vet students holding onto those patients for you to take a blood sample, to put an IV line in, to do a bandage change because we're more than capable. So getting management on board.

The way to do this is we are going to see increased income from doing these vet nurse appointments, which I will go to go through in the next slide on how we do that. Basically start small, we started with a couple of appointments every day, and we built that up to what we are now. And start consulting.

I don't believe that any practise in the United Kingdom should not be doing some form of vet nurse appointments. There are ways around everything. Whether you have a tiny practise with one vet, one nurse, or 2 vets, and one nurse, there are ways around it.

Vets need a lunch, vets need a break, so when that break, put a couple of appointments into those slots and start off small. So I practise now 6 years on. We have consults for nurses 7 days a week, so we're open routinely on a Saturday and Sunday as well.

So per week, we roughly have 150 nursing consultations, and generally they are all full. Every single one of them gets full, and we have extras added into the extras column for discharges, admits, and things like that as well. So it's probably closer to the 170, 180 by the time you take those into account.

Now, We have a designated nurse consulting every day, so I consult on a Monday, Wednesday and Friday, and I do my community nursing on a Tuesday and Thursday. So the nurses on a Tuesday and Thursday that want to run their diabetic clinics or weight clinics of their own clients get the Tuesday and Thursday slot and it it rotates between them, but I'm primarily the consulting nurse within the practise. We do have our own room, so it's one of the benefits.

Now, space was an issue for us to begin with, but we had two very, very large consulting rooms. So I would look at your consulting rooms and see what space you have. What we did with those two rooms was we put up a wall in the middle.

And so we now have a nursing consultant room, a vet consulting room, and the other room we made into a smaller vet consulting room with an additional pharmacy. So we have a designated pharmacy now. It was fairly easy to do, the small, the smaller rooms work absolutely fine, and it gained as a vet room, it gained as a pharmacy and gained as a nursing room.

One of the most important things I've found is actually having nursing consulting room written on my door. So vets, if we were to write nursing consulting room on our door and it wasn't there, for example, the vets will use our room. If they were numbered 12345, there would be a vet in your room.

So actually having the nurses on the door does help. So we have seen a huge client perception change. That's not something that happens overnight, and that will happen over months and years, but our clients now understand that, our nurses do have a role, and it is a profession within our practise, and we can do all of these bandage changes, second vaccinations, repeat depot injections up until the point they need their rechecks and things like that.

So I mentioned before the increased revenue for the practise. Now I've worked out that our vets have a target of about 75 pounds per consultation to meet their their target. So that's in their 15 minute appointment.

If they were doing those 150 appointments that we have per week, that is taking away 11,250 pounds per week that those vets could have made. I'm not saying that we can't make money on top of that by selling toothpastes or doing a nail clip, or booking in a dental or booking them in to be neutered to get that additional revenue on top, but per year, if those vets were doing all those 150 appointments, that's a loss of 585,000 pounds per year. Which is just staggering, it's massive, so I do believe that adding those nursing consults and taking that to management will allow them to, for you to be able to do them.

So we have rules within our practise designed to suit all of our nurses. So there's some of our nurses really don't like to be client facing, so they are are surgical and . Kennel nurses that are down the back and hidden away because they don't want to speak to clients.

But we do have the nurses that do want to do a little bit of consulting and do a mixture of both, which is absolutely fine, or the nurse that's the theatre nurse that's seen a puppy and done a Robert Jones, and they want to see it back, and that's absolutely fine. They book that in for themselves within the nursing appointments and it gives me a little breather to catch up on paperwork that I need to do. So our consulting has progressed into the community as well, which I'll go on to chat chat about in a minute.

So we now go into clients' homes and do our consulting just like with the building. So some of the challenges that we faced were obviously space. Time and finding the time to do appointments can be a huge thing for practises.

So, we often think we have lots and lots we need to do, but actually if we designated roles to people and they were in charge of doing certain things throughout the day and they knew they were in charge of those things, that frees up time for a nurse to be able to go and consult. Gaining client trust is a huge thing. So if you've gone from from just seeing vets before to then having to see a nurse, you're going to gain that trust over a long period of time, and it's not something that is going to happen really quickly.

You need to use your marketing, you need to use your Facebook, you need to use your boards and the practise to let clients know what a nurse can do, and that's going to build up trust with your your clients going forward. So getting vet help when there's an issue within a consultation. If you see a patient and that has a wound, for example, that the, the wound looks infected, they have a temperature, you can't then just say you're going to give antibiotics.

You need to get those authorised by a vet. We're quite lucky in the fact. That we can nip nip down the back or nip upstairs to the vets and vet's office, and there's usually someone there to ask, or they can pop in and have a quick look at the wounds and say, Yeah, that's fine.

Give it 5 days in Oola and do a repeat check with myself in 5 days' time. But often practises won't have that luxury, so you need to find a way around that. Whether you make them wait for a break in the vet's appointments or whether you book them another appointment to come back, at some point later that day can help.

So charging for our time is a huge, huge thing. I know as a nurse at the beginning, I hated charging for my time. I just thought that I was nice by giving a client a complimentary appointment or a little half nail clip, but if that client's booked in for a nail clip with their tiny Yorkie and you've only taken the ends of those nails off.

You still charge for a full nail clip, they're expecting that, so don't be nice and do it as a half appointment because you're, you're under, you're underselling yourself, you've done your job, you've done the nail clip, so charge it fully. And confidence, you just need to have the confidence to be in front of clients and you know your job and you know what you're talking about, so just, just. Make it look like you do and have some passion for the job and Yeah.

So, this is Alfie. Alfie sat in my consulting room here. Now Alfie, believe it or not, used to be 46 kilogrammes.

He has a bandage on his back leg there a support where he snapped his Achilles tendon due to his weight. And we managed to get 12 kilogrammes off of him. So, kind of just having the confidence, to do something like that and say, actually, we can fix this, your dog doesn't need put to sleep because of its weight.

We just need some rehabilitation and, and, and crack on. And confidence as well comes from this. This is me a couple of years ago, doing some, a stitch up.

So I try and keep my hand in a little bit down the back and, Do some anaesthesia and some surgical bits and bobs now and again just to keep my skills up, or if we're short staffed, I can still go down the back and and and be a nurse down there. So services and consults that we offer, this is Alfie up here so it's nice trim waist after we got those nice 12 kilogrammes off of it. And then we have diesel, so this is a nail clip at home as part of the community nursing service.

And then we have Harvey, so Harvey, a spaniel who was getting laser therapy treatment on a weekly basis on his hips, just from for some aesthetic change that he had. So we do all of the post-op check appointments, puppy and kitten checks monthly as part of our healthy pet club or pet plan. And wound management, weight clinics, dental checks, senior health clinics, so we do these for patients over dogs and cats over the age of 7, and rabbits over the age of 4.

We have a package within this that we run, . Health bloods, and so we do full comprehensive haematology and minor urinalysis for dogs, and we also have the addition of a T4 for our cats added in there, and we have found quite a few pre-renal cases and hyperthyroid cats just from doing our senior health clinics. The way we did that was we mailshotted quite a few people and they phoned in and booked the free, well, complimentary appointments that run for half an hour and we gained clients through that.

We do diabetic clinics that one of our nurses, Jenny likes to run, routine blood sampling just in between boosters and things, we have that option for clients. Renal gland expression, laser therapy, microchipping, second vaccines, neutering advice and we advice as well. So the community nursing service I set up in 2017, as we've seen a market to put it into our area, we have quite a lot of elderly clients with cats and dogs, so, it was going to be beneficial for them instead of getting taxis and things into the practise to actually go out to the house.

Often it roughly makes the same amount of money getting a two-way taxi journey as it does, charging them for a house visit for a nurse to go out to see them. We provide appointments within their own homes, which reduces stress of patients and also reduce the stress of clients having to come in with their pets. Often pets are stressed out in their carriers, which makes the clients stressed, which in turn makes the pet stressed even more, so it's just better than their own their own environment.

We do vaccination visits to local shelters as well. And my designated days of Tuesdays and Thursdays work well for our community nursing service. We serve the local area within 20 miles, so we have a set charge for 0 to 10 miles and 10 to 20 miles, and then the procedure or whatever we're doing is charged on top of that.

So if we were doing an anal gland appointment that was 5 miles away from the practise, we would charge the visit fee plus the anal glands on top. This is one of the rescue cats at centre, so we see all of the feral cats and rescue cats at our practise for neutering, and the vets do their first vaccination. And then their second vaccines done by myself 3 weeks later at the shelter, which is beneficial for them because you're not having to put a feral cat back into a basket to then bring it back into the practise, to have its second vaccine when we can just nip out and do them within their pens.

And then this is Mabel, Mabel's a cat who was in for a scale and polish and she, she sat on her owner's bed, just letting me check her teeth and check she's OK, so she was pretty, pretty chilled out when I went to see her. So some of the barriers in community nursing comes when you can only book a few appointments per day. So you have to think about your travel time and where the location is.

So you have to take into account how long it's going to take you to get there. Obviously, being in a client's house, it's a nicer environment, so you tend to spend more than 15 minutes in a house with a little old lady chatting to them for a while, which makes it a personal service and it is good for our practise, getting our name out there as well. So as I said before, with getting vet help within the practise, this can be a hindrance as well.

So often I say to a vet before I go out that I'm going out to an appointment and would they be free if I have any issues that I can call them or video call them just to get a hand when I'm at the, at the house. And we have the financial outlay for the van. I asked for us to get a van and my practise, luckily it gave me, gave me the option of getting one and building it up myself.

But I would check with your practise as well, your insurance on your cars and things, whether you're able to transport animals in them or have a practise car that that you could utilise for this as well. But obviously you need to check with the practise that that's OK for transporting animals. And catching patients or lack of help is a huge thing.

If you have vet students or nursing students or a spare nurse, it can be really helpful, especially for cats. I've been under beds, in cupboards, in garages, trying to catch patients. And also if you're needing to do a blood sample or popping an IV.

Or anything like that, it can be helpful to have a second pair of hands with you. It'll also help with a vet or a nurse's training to be in in a different environment in front of clients, so it gets their communication skills a bit better as well, just being out with their comfort zone. So our community ambulance here Has the fitted cages in the back, and believe it or not, that big cage on the left-hand side there, we have squeezed an 80 kilogramme Great Dane in there before, and the two smaller cages are fine for your smaller dogs or they fit a decent sized cat box in there.

So we have basic drugs that we would take out with us would be flame worming treatment that's already been pre-authorized at the practise. Or if you're going to see a wound or something like that, we have been taking Metam and antibiotics along with us, but obviously those needed and phoned back to the practise, potentially a video call to look at the wound and to get a clinical history from yourself, as to whether you can dispense them or not. We have a fresh aid box, bandage materials, small scales, gauntlets, leads, and muzzles if required.

So this is Otis the cat, and now believe it or not, I'll show you this video in just a second. He has a watch, on his file at the practise, and he will bite and he will scratch because he gets so stressed out in his basket coming into the practise. But this is a nursing visit that I went to do for his post-op check.

I was slightly nervous because all over his file he has bitten multiple nurses, and this is how he behaved when I went on the visit. So as you can see from that, he seems pretty chilled out. He just hated coming into the vets and being in his basket, gets really, really stressed out in his carrier and actually at home, he was a completely different cat.

He had a mass removal from his back, which went well, and it turned out just to be a lipoma. And we did both of his post-op checks at home. We do one at 2 to 3 days post-op, and then one at 10 days for the stitches out, and he could not have been an easier cat to deal with in his own environment.

The client doesn't drive, so she would usually take a taxi in and our visit was no more expensive than what she would have paid for a two-way journey to get into the practise and have a stressed out cat at the end of the day, so it was beneficial for everyone. So the future of our service, we have already added in video consultations due to COVID, which have been working really well, and those will continue going forward. So those are booked into our consultant slots with our vets or nurses, and we have been doing post-op checks, wound checks, behaviour advice over over video consultation, so I think that's been working quite well.

Although I'm off on maternity leave just now, I have been kind of keeping an eye on everything going on. We are hoping for a new hospital premises with consultant and community unit. We're currently looking to buy land or a unit that we can build up a a new hospital, just obviously outside Edinburgh.

And I hope to have a couple of nursing consultant rooms and a little office so that I can stop sharing vets desks and getting in their way when I'm trying to sort stuff out. We'll continue education within schools and nursing homes. This is a huge part of our service, and I do believe that getting in and speaking to kids and nurseries and, schools is important early on.

And in nursing homes, it's just nice to go and see some nice old ladies and men and let them clap a retriever, really. And build on our already successful service, to be honest. In the 6 years I've been, the 7 years I've been at the practise, from going from no consults per day to building this up to 150 consults per week is a huge thing.

And I'm really proud of our, our team and our management for letting us do it, to be honest. And yeah, that's us. So, any questions at all?

And Arlo obviously looking cute in my van with my stethoscope on. Thank you so much. And he does look very cute.

Almost as cute as the cat that was so relaxed. I, I can't go over that. That's a brilliant representation of how the home clinics can really help out.

So we do have a few questions for you. First of all, did you always know you wanted to do consulting? Did you, was it part of your plan when you were training, or did it just come about as you were going along?

Yeah, I think so. I'm a very talkative person. I like dealing with my clients, and, I think that's one of my strengths is actually being nice and bubbly up the front and dealing with client complaints and getting them under control before they end up at management upstairs, and they have to deal with them.

So, I think being that type of personality, I think it was only, only fair for the practise that I built that up for them. OK. And did you have much resistance in doing it?

So, you obviously, it was, you had a very clear plan, which was brilliant, for, for the nurse consulting in general. So did you have, yeah, much resistance from management and or was management easier to persuade than maybe the vets or relatively the same? The resistance.

And you'll be surprised to hear came from our nurses. So, so actually we set up the service and because all of our nurses at that time, we didn't have designated roles. We didn't every everyone just muddled in and got through the day.

So actually when it came to the stage where I said I just want to do consulting. There was a bit of a blocker there for the other nurses in the sense that if I was consulting all day, I wasn't cleaning up or helping down the back. So I think that it took a little while for that to kind of sink in, and that I was actually doing my own job, and they were all still having to do everything down the back, but I think now, after quite a while, that's all settled down.

We all have our designated roles now, which I think worked really well, and management helped to implement them. But management were fine and getting us to do the consults and things and letting us split the rooms and get our nursing consulting room up and running, and set up the community nursing service. But yeah, I think the barrier came from a little bit of resistance from our, we have a huge team of nurses.

I think there's about 18 of us. So there was a little bit there, like she's getting to do that, and we're still stuck doing our kind of old job and it's something new. But now it's all settled down, it's absolutely fine.

Just brings a bit more structure to it I suppose. And, the, the whole community nursing side of it's really great and it's a really good asset to have as part of a practise. I don't know barely any that have, such a focused side of it like that.

Do you need any special kind of insurance for it as such? Obviously, you mentioned the van insurance and things like that, but General other insurance for your practise, or yourselves as an individual. So we have, I'm not sure about insurance and things, it's kind of all set up by management.

I know the van, you have to have the insurance for transporting animals and things. We do have a, buzzer that we take with us if I'm by myself, that if there's any issues, I just have to push this. But thing or put in a code, on my phone and it pings the practise to say that I'm having issues at the house.

So someone can come or they phone the police or whatever, just as a safety precaution, because you're obviously going into clients' houses that you've potentially never been to before. You don't know what you're walking into or what conditions it is. And by yourself, sometimes it can be a little bit daunting.

But insurance wise, I think it's just like if it's we're doing house visits. I think it's exactly the same for, for nurses, it's just a home visit that we're doing, so I don't think there's any kind of insurance wise things for going to people's houses that you need. OK, brilliant, thank you.

I think, let me just double check we haven't got any more come through, but I think that's everything. I'm not sure. I think if Steph had any questions, I think she was gonna come on, but have, have I there she is, as if by magic.

I was, I was just gonna say thank you so much, Christy. That was absolutely fabulous. Both you and Samantha, I think, have been absolutely inspiring.

I am such a huge fan of practises that really use their nurses properly, and I, I agree with you about what you said at the beginning, Christy, that, you know, this kind of feeling. Actually, nurses almost should be kind of hidden out the back doing stuff in the back of house areas. And not having that opportunity to have those face to face times with the with the with the clients.

I think it's, it's a real pity there are so many nurses out there who could be involved. And we're so used to seeing nurses in human practises, you know, if I, if I want to go to the doctors, you know, I need my blood pressure checked, it'll be the nurse who sees me and I don't understand why there is still this real resistance by some, practises to, to, you know, embracing the other, skills that nurses have and getting them in, in, in the front of house. And it's just so lovely to find that both you and Samantha in your practises both have such, you know, big, consulting type roles, because I kind of think, oh, I should showcase your practises.

That's exactly what I want to see. It makes me all excited and happy. Yeah.

So yes, fabulous. Thank you so much. No worries.

So that brings us towards the end of our day, nearly, we're gonna, I'm gonna invite all our panellists back now, all our speakers, for some general questions and answers. So if anyone has any, at all, and that they'd like to pitch to our, speakers, we can go through those in a moment. So, if, if everybody's here, there were a couple of questions that I had for Samantha, but I didn't have a chance to, to ask them at lunchtime.

So, can I, can I go ahead and ask those? So I suppose similar to Christy, I find it interesting, Samantha, because you have a certificate in ECC is emergency and critical care, isn't it? So, and yet you're a consulting nurse.

Yeah, what was it that, I mean, had you, is it a, was it a completely new idea or, or what was it that made you? I guess, yeah, I think very much when I was working in London, it was very much a busy kind of hospital that was, we had a lot of emergencies, so I kind of started going down the route of wanting to do that, and then I started working in a practise where I was pretty much the only RVN at some point. So I felt I needed a bit more kind of.

Emergency kind of experience. But as I did that, nothing ever really came of it. My love of consulting kind of got stronger, and you can only, you look back and go, actually, was that the right course for me at the time?

I. I'm glad I did it still, cause I think in reality it does help you when it comes to doing things like triage. You've got more of that experience and if you are in the front of house and something walks in the door, you can go, all right, thanks, let's, let's kind of go and get on with it.

. So I'm not kind of I certainly don't look back and say it was the wrong thing to do, but, if you gave me a choice between two different things now, say, consulting or ECC, I would very much go. So sounds maybe a little bit with you. I get the impression with Christy, from what she said, it's something that she always knew she wanted to do.

I'm sure she will jump in and say if, if, if I. Very much, it was kind of what she wanted to do, whereas with you it's been a bit of a sort of organic development type of thing, I suppose, as she started to do a bit more of it. Yeah, I think so.

I think I've always enjoyed consulting, I think, as I said, but I think certainly as time's gone on. I've grown up, and I realised quite how much I do enjoy it and it's kind of developed from there, really. And now I wouldn't wanna do anything else.

OK, OK. That's interesting. And I don't know whether or not Christy's still on or whether her little one has required her attention.

Are you still there, Christy? Oh, excellent. So just out of interest, can I ask both of you, you, I see both you and Samantha do senior sort of checked clinics, or senior, senior health checks, I suppose.

. It's, it's very interesting. We have a, one of the nurses who's going through our certificate at the moment, whose practise is just refusing to allow her to, to take, to do those. They kind of feel that there is no point.

They don't see any benefit in them. I mean, you know, obviously one, you're gonna have to answer one at a time, but how difficult was it to get those up and and running and, and, you know, I appreciate there are Concerns aren't there about them, particularly with the kind of Schedule 3 stuff, you know, what, how do you manage if during a senior clinic, you notice something, you know, what happens? Because you've then presumably got to pass it on to a vet or, you know, how, how does all those things manage?

What what is it that that that that's a barrier, or what is it, I suppose, that made it work in your practises, but, you know, is, is meaning that this student I've got going through his practise of just going, no way. You wanna go first, Christy? Yeah, it can do.

So basically, the way we actually work them is when a patient over 7 years old comes into practise for its booster. Now at that 15 minute appointment, a vet does not have the time to go over its mobility, how its eyesight is, how it's getting on at home, whether there's any issues within the last year or not. So actually, we get the majority of our referrals from our vets.

So, there was a bit of barrier to begin with in saying that if a vet wanted to run a blood sample, for example, at a booster appointment, they would do it, but we're gearing it more towards a routine and keeping an eye on how everything's going every 6 months or every year. So the vets will refer, refer them over, and we'll go through a questionnaire that I've made up, a senior health clinic questionnaire, so they fill it in while watching their animals. Over a week, and then we book them in for a senior health clinic clinic appointment, go through the questionnaire, go through whether they might need any joint supplements added in, whether they need any physio help that the owners can do at home for their mobility and things, and whether we think, actually, we could run a routine blood sample, your routine urinalysis, and see whether we pick up any kind of pre-renal hyperthyroid issues starting early on that we can treat early on.

So that works it works really, really well, and those, if there's anything comes back on those samples, any raised ALT or anything like that, they get referred back to that vet that referred on and they get a reduced follow up charge for that consultation. OK, so your kind of protocol is that the dog, cat or cattle dog comes to its routine, checkup, and then the vet arranges for you to then see it, you know, see it. Does the vet hand out your questionnaire, and they arrange them for you to come back or an appointment are all on the computer ready to be printed, and we do have a few piled up next to the computer in the.

Consultant rooms as well, so they can be handed out and also we have universal containers that are given away as well to grab a urine sample and they just bring it along to the appointment with them. Yeah, and I suppose from a Schedule 3 point of view, your protocol is very clear. So actually when the animal comes in next time, you know, taking that blood has already been delegated to you.

OK, yeah, interesting, interesting. So how do yours work, Samantha? It's pretty much the same, really.

I would probably say 70% of them are referrals from vets during, either post-op something, or, yeah, from vaccines or a health check that they've done. You know, we're not gonna be able to get as much as we want to do in those 15 minute appointments. In reality, a vaccination, all they've got time to do is do the vaccination.

So the rest of it. And yeah, it is a, it's more often not it's a referral to ourselves, from them, so they're aware there's already a possible issue. They want to make sure everything is done.

It gets referred to us. We then take the time to do things properly. We've got, we've got that little bit more time, we can schedule it better.

We can do pre, appointment things. I will sometimes phone some of them up beforehand, just to see how things are going before the appointment. But yeah, pretty much most of them are already referrals from the vet before they even get to ourselves.

OK, interesting. And if a client were to phone and just want to book a, a senior wellness or senior health check, whatever, can they just do that directly without having seen a vet first? Can they book that directly with you as nurses and the protocol is in place so you can automatically go ahead and run the bloods and, and any other tests you would normally do?

Yeah, for me, yeah, I would normally check in with one of the vets beforehand just to make sure they're happy for it. And we'll normally quote whoever it is, in the notes saying they're happy for us to go ahead with it. And they will be the person I go back to if there's any concerns on the results or if there is no concerns obviously seeing reality.

Even though the results are all fine, the vet still needs to report them in the grand scheme of things. So as long as I have someone as a backup to say they're happy for me to go ahead, then, yeah, I've had a few like that, that they've heard about it, and they want to just get it booked in, or it was mentioned a year ago. They've then come back and thought, actually, now's the time I want to do it because I'm worried now, rather than having to come in to see a vet first, they'd rather just get it done.

So yeah, as long as I've got a vet's backing, then I, I will do it. And is that the same for you, Christy? Yeah, exactly the same.

I normally go and grab a vet and say you're in charge of this case, if it comes back with them and you're reporting the blood results when, when they come back, so they don't have much option. Excellent, excellent. That sounds very good.

I like nurses who tell vets what to do. OK, excellent. Have we had any other questions, Sophie?

I mean, I've, I've got all sorts of things I can ask, but, you know, I'm aware that other people may have, may have some comments. Yeah, I was gonna say, Claire, did you want to add anything to that? Were you going back to something I think got held up in the conversation?

Yeah, I, I, I think there was something about how do you get vets that are resistant to nurse clinics to start, and that was one of the questions, and I wanted to say that. I think sometimes, because if your vets are eager in passing things over, that's brilliant, isn't it? You just want to make sure that they're passing the right things.

But I think where you've got resistance, particularly in a practise that's never had any clinics at all, that you have to just do things in bite-size pieces for, for people when you're trying to change the business in a in a really fundamental ways that you're taking work and and they're not sure. How it's gonna work. You don't say, I want to change everything, and you're just going to go with it.

I think you have to say, let's give it a go for 3 months, and this is how we're going to do it. And, and you sort of lead them and then prove yourself and then you extend and that's, that's how I've worked with quite a few people to who've had very resistant set in their ways, vets who just didn't believe that it could make a difference. And once you've shown, And you're, you know, how good you can be as a, as a nurse is consulting, it's much easier to follow that way.

But, you know, softly, softly is the my tip. I wanted to add that in really. It's hard.

And I think you're right, Clare. I mean, that's why I said in my presentation, I think with vets, you know, you often have to start small and, and work up and sort of Prove that those few consults that the nurses are doing are genuinely making a difference. They shall we say, improving the vet's life as well as, improving the the clients and the patients' lives, etc.

And you're right, but yeah, it's a bit, it's a bit irritating, this particular girl, her practise have just said, no, we will not be doing senior clinics, full stop. We don't believe in them. So, hey, I was just quite interested, but, you know, it's frustrating, and I do, I do think there are definitely.

There are issues where nurses just don't get the opportunity to do, as much as, as, as is possible. And, you know, we have a, we have a problem with, with retention of both veterinary surgeons and nurses in the profession, don't we? You know, we have veterinary surgeons wanting to leave because actually they find the job stressful and they don't feel they have enough time, and then we have veterinary nurses wanting to leave because they feel that actually they're not valued and In many ways, for those nurses who enjoy consulting, and as, as both, I think all of us have said, we've all talked about people's playing to their strengths.

No point making every nurse who doesn't like it, sit in a consulting room or stand in the consulting room. But for those nurses who enjoy it. Actually, putting nurses in the consulting room enhances their feeling of self-worth.

It, it improves their job satisfaction. Actually, it helps to keep them in the profession and actually allowing some of the vets out of those consulting rooms, getting rid of some of those consults for the vets and allowing them to maybe see those slightly more challenging, difficult cases, or do a bit more in the way of, of operating, which maybe they prefer. It, it's a win-win situation, and I do, but I do sometimes feel as I'm banging my head against a brick wall, but there you go.

It's like, Hey, I keep banging. And just ask Samantha, were your practise charging for nurse consults when you started, cos they're charging now, aren't they? Were they charging when you started or did, was that something you had to try and get them to implement?

I think they were, but probably not as much as they should be, or should have been. I think there's a lot of things that come in that it would just get done and, you know, they'd go away again. .

There's the occasional one that still be like, no, no, you know, it's, it took 2 seconds, it's fine. I think it's very much a case by case scenario a lot of the time, but most of the stuff I do charge for, we should be charging for, . There's things that we do have to do on the plans for free, so there's not really a lot we can do about those.

You know, things like nail clips, all the health checks, most of them are all free because they're all on the health plans, but, no, no, no, they're complimentary, complimentary is the right word. But anyway, you know, they are paying for them, so, you know, it, it, but it's getting across that point with clients and if they want to do other things within it, that's when they get charged. So yes, they are for a complimentary appointment, but they're being charged the extra services on top.

OK, OK. I think there's something to be said for, for having the, if you, if you're gonna not charge for the clinics to have the, the nurse consultation as is part of the fee that the vet, you know, when you pay a vet consultation fee, it automatically includes that because such great value for money, you get to see two experts rather than just one. And that's a way of pitching it as well.

That's not free or complimentary, but that's part of the service. And actually, if you do it well, you could probably increase your vet fee if you always include a nurse visit into that as well. Is that works, certainly that's how we do it.

In some of the big practises in the states where they, the fees to just seeing that are much higher, but they have half an hour and that's 10 minutes with the nurse, 10 minutes with the vet, 10 minutes with the nurse again to to round up and they, and it works really well for them. So it's just something to think of if you're bold enough to do it. Absolutely, absolutely.

While we're on the fees side of things, a question for both Brian has joined us now. Brian is here, but for both, Steph and Brian as, as vets, and more so Brian, from your work in, in clinics when you go in and you train the whole practise team, what do you see from the vet's side of things and their opinions on charging for nurse consults and, and the fees surrounding it? Well, hello again.

I've just dashed across the country since I last saw you to unknown wheels. Oh, haven't gone the most easterly point of England, to Wales. So, I hope you've had a good day and yeah.

The the the honest default answer to that is that most vets struggle to charge well enough for their own time, and therefore, the perception of taking the nurse time as well, there's a, there's a sort of a perception, there's some of them get it, but I would say the majority struggle with it. And they don't quite know how to do it, in terms of how to, they're just not creative with their time, with their charging in respect to perhaps integrating it a wee bit like you said, Claire, with more of a, a package service as opposed to necessarily every little bit has to be itemised because then people start worrying that they didn't add any value. And of course what we do in our respective expertise is we do things with a flick of a wrist that clients struggled with.

I mean, we can give a tablet in 2 seconds. Clients think we're amazing for doing it. And because they flatter us, we go, no, it's nothing, no charge, you know, because, but then of course that comes with the practise of doing it.

I'm sorry I missed the start of the conversation just a bit late getting here, but, one of the, one of the things that I find those work better is that if we can encourage The vets to prescribe nurse consultations and then charge the nurse consultations as batches and often sometimes the nurses in the beginning, if they're not confident of charging their own worth, they feel it better if the vet charges it, takes responsibility for the charge. So take for example, weight clinics is Describing 5 clinics with the nurse and charging £30 to the client at the time of the booster vaccination, which is when the weight issue has often been detected. So possibly a little bit more imaginative ways.

But the quick answer to your question, Sophie, is that there's a general sort of, oh, we've never done it before, clients will, not like it. And the other problem we have as a profession, I think is that if one person complains, it's been a disaster. We tend to react by the exception as opposed to the rule.

So therefore we worry and heaven forbid that the first person complains because then the whole, the whole thing is abandoned. So that's what I, that's what I see. I see a general reluctance.

Well, actually, and it's interesting listening to you, Samantha, in terms of some of the things that you've been saying there is that when you get there, it becomes, oh, why did we do this ages ago. Yeah. I think I took that the most from, from when Christie was saying about how you hit them with a plan.

She say, this is the plan, you she'd thought of everything, you've got it all there, you go with the plan and then all you can do is try it and obviously it works very well for them. So it's just having the confidence in the initial plan to start with. I, I think, I think as well, you know, I think, I think a lot of it depends on The attitude to their own value of the vets, you know, the question obviously is, is what the vets feel about nurses time?

And I think a bit like Ryan was saying, vets aren't very good at valuing their own time. And I, I think, you know, I now, having sold my practise, I now do locums here and there. And certainly, you know, I'm, I'm, I have been in some practises where the charge for, for what the vets are doing is tremendously low.

You know, it's way undervaluing the vet's time and everything's done very quickly and they're quick 10 minute appointments. And actually, that makes it really hard then to charge for nurses' time, if actually the vet's time is not being appropriately charged for and I think actually, as a profession, We probably need to be just very brave about thinking about how we charge in our practises at all, you know, we shouldn't really be making the bulk of our income by, you know, charging hefty markups on drugs. We should be charging for our professional time and be proud to do so.

And, and I also think it's interesting, I, I, and I had this said to me, on, on one occasion when I was doing a VM Futures presentation. I do think amongst nurses, I I was asked about vets, but I do think amongst nurses, there is a real perception of one person at the end of our session, we were talking about charging and and this nurse went, but at the end of the day, I don't want to charge because I do my job because I love animals, so I shouldn't be charging. And I have to say my initial response to that was, that I charge.

Does that mean I don't love animals? Does that mean I don't, you know, I don't enjoy my job. Does that mean I don't care about the animals that I treat?

And really frustratingly, there was an article in the Times, and not the Times, and it might have been better. Times the other day, which actually said in it, it was by a veterinary nurse. We don't charge for our nurse consultations because we have that sort of relationship with our clients, that means we don't have to.

I was like, oh, for heaven's sakes. You know, actually, we can't all be treating our clients like they're our best buddies, and therefore, we, we don't charge them. We have businesses to run.

And I, I think we actually have to be brave enough, as, as, as business owners, to share some of the basic financials with our staff, because then people get why they be charging for their time, you know, we're paying our staff. If our staff don't recognise that they've got to generate that income in order to cover their costs, in some ways, it's almost not particularly their fault either. So yeah, I think, I think it's very complicated.

I think the whole way people talk about fees in veterinary practise, it all goes back to James Harriet, doesn't it, where, you know, you do some treatment and actually get paid for it with your lunch or something instead of with, you know, a proper fee. But I, I don't know. Brian probably knows more about the psychology of pricing, psychology of encouraging clients to pay.

But I've always been very honest. You know, I had clients when I was running my practise. You know, we were a relatively high-cost practise, and clients would say, why are you so much more expensive?

And I actually would be very honest and say, well, it costs me this amount of money per hour to even keep the doors open before we even get somebody through the door. So, therefore, we have, we will charge for our professional time. You pay to see a solicitor, you pay to see.

You're paid to have your haircut, how much you're paid to have your haircut? My, my time is my time is worth this, you know. So I think it's, it's an interesting one.

The one thing I'm gonna say about the psychology of you say charging is, I never use the word expensive. Because expensive means it costs a lot of money and it's not worth it. So I will I know I know you in English, we don't have a word in English that means it costs a lot of money and it's worth it.

There is no word for that. Valuable. Potentially, but it sounds awkward in the sentence, .

I mean, so for example, let's say, vet me, if you say that's an expensive, there's the undermining of the, the product almost sounds like, yeah, it's not really worth it. So I'll say, you know, vet me is not cheap, not cheap. It's a good drug, not cheap.

And that, that neutralises this thing and it's really interesting that, you know, I'd say it's not cheap, but it's worth it. You know, so, just, just little nuances like that because we, we, it's just because of the, the word, the use of English. We don't, we don't have those words that, sometimes we want.

OK, it's a never end debate, as you say, Steph, about trying to get the vets, the business owners, even, and then of course, the nurses and even to think about what they're worth, and in relation to the charges and I think we have this double guilt complex, don't we, where this somehow seems, I, I call it the compassion paradox. We, we want to come across as caring, and we are, but somehow charging for our care sort of seems to undermine the authenticity of our care. And I think it relates a wee bit to almost what you said.

I love animals, so therefore, why would I want to charge people for doing the noble thing? So I describe myself as a compassion professional. I describe myself that as to myself.

I don't say that to anyone else. I just think you're weird. But I describe a compassion professional, and professionals are in their living by doing things the same way as a person who works in a care home, who looks after the elderly, difficult job, but incredibly, you know, needed job.

We pay them. And they are professionals, and I expect if I was putting an elderly relative into a care home, I want good care. And I'm almost, I'll tell you what, I'm almost concerned if someone says, don't worry, you don't need to pay me.

I kind of go, I'd rather pay you and do a good job. You know, as opposed to thinking somehow, I don't know. Yeah, I know.

We did, we did a really good display actually last year within our reception area that actually had the comparison between what we charged to take a blood sample in comparison to what it costs the NHS to take a blood sample and send away. So we did like comparative costs of doing an MRI scan or CT scan and did it like that, what it would be a normal charge for an animal and did it that way, and it actually got people talking in our reception area quite a lot. I was going to say I've seen it before where people have done the pie chart about what where a 100 pounds bill goes and they haven't actually displayed, which I think is really good because like you said, unless the vet's kind of honest in the concert like Steph said earlier and turns around and says, you know, this is how much it cost me to physically open this building today, so that's why it costs X amount.

They just don't know, it's just educating. Yeah, I would say that 50% of the practises certainly the traditional independent practises, especially if they're mixed animal, mixed mixed species, they charge less for a cat anaesthetic than the average woman pays to get their haircut. Absolutely, absolutely.

And I, I, I do a risk comparison, how much risk it might be very risky to have your hair cut and but when you compare the risk of an anaesthetic. You compare the price of a taxi ride compared to taking a cat to the brink of death and back again. We just don't equate for the skill or the risk that we take.

And sometimes it's just really like you said there, Christy, it's just about help giving people framing references to help them understand relative values. Another thing that I just a tactic I do and teach people a lot when they say a price, and certainly whenever I give an estimate, if I said, oh it's gonna cost £500 to remove this lump or whatever the estimate might be for and clients do this big wow. Why is it too much?

How is it that much? And I've just found the best way of neutralising that as I go, OK, I'm sorry you're surprised by that. Can I ask what you were expecting?

And it just helps them put it back on to why and then if they say, well I thought it'd be about 100 pounds, 200 pounds. And then you almost have have them in this gentle psychological process of them justifying why they think that's the right price compared to the one we've given. Without challenging or criticising them, cause I just do this, OK.

What were you expecting? I find that works really well. As a way of letting them try and justify it.

And then with no apology but with no aggression, I just sort of say, OK, I'm honestly we're we're just doing different ballparks. And then they get their heads around it, they're fine. But I think we sometimes as vets, we say 500 and then go, 0 100 and we go, OK, 250 then, done.

What? So, And It's the same with dentals, we all know dentals are expensive, but then you start talking about how much they would pay at a private dentist for a scale and polish and then. It kind of It clicks in their brain and they suddenly realise actually they're getting a very good deal for what they're getting.

Yeah. It also doesn't always occur to people that you have to knock them out to do it. It is a perception thing, definitely.

We could probably talk for the whole of the rest of the year about pricing, let alone the rest of the day, hey. Steph, do you have any more questions for, Christie and Samantha? I was just gonna ask, just, just quickly, do either of you ever have any concerns about the sort of lines of boundaries of responsibility between, you know, what vets, you know, what is a nursing, procedure, what you have to check with the vet?

Does that, do you, do you ever find that worries you, or do you feel that's pretty clear and everybody in your practise is on board with who's allowed to do what? I think myself, I, I'm quite well aware of what my limits are and what I feel I need help with. I think also when I first joined, I had kind of a meeting with, the vets to kind of discuss what I'm happy doing, what I have concerns about doing, and, and.

I gave them a chance to kind of speak to me, I've been doing it about a year or just over a year now, and they all very much understand what I can do, and I very much understand and I know what. They would rather sort of double check. So I think if I went somewhere else, it would be the same.

I would have a frank conversation, say, what are you happy me doing? And he kind of build the trust up from there. I think a lot of it is trust.

It's knowing what they want you to do and what they, I can. About, and I think once you've kind of got that trust level going on, things should become quite easy and quite smooth. So as long as you don't get anything that you thought they really need to know about, then you can just carry on.

OK. What about you, Christy? Yeah, I think it is a trust thing.

I think, At the beginning you've got, you have to go to vets all the time to OK things, I think, but as the years go on, you grow with those vets that stay at the practise as well. So there's specific vets. If I, for example, I have a wound that's, looking a bit infected, the dog's got a temperature, I know I can go to Becky, one of our, senior vets and say, I've got this dog, it's got a temperature, the wound's looking a bit yucky.

I've given it a clean. Is it all right to give it some Norala and seat back in 5 days? And she'll be like, yeah, yeah, that's absolutely fine.

Whereas if I was to go to one of our kind of newer vets who don't know me as well and know that I can look at something and say, actually, I think that's what, what's going on, they would then be like, right, I'll be there in 5 minutes. I need to come and have a look at it. I need to see it within the consult room.

So I think it is a trust thing. And building that up, and I think you know your limits as well as to when you need to go and get a vet's help and when you're OK, yourself. I mean, in our practise if the, if they've been seen for boosters and things, they fleeing worming treatment is .

RPX on the file for the next year for that patient for us to dispense it. So I think we use that quite a lot in practise that for specifically medications that if the vet RPX is it on the file and actually writes that, that takes a lot off of them and as not going and asking them all the time. Yeah, so clarity of protocols and and procedures and things just save you guys having to be in a situation where you're thinking, oh, can I do this or not?

OK. Brian, you look like you might want to add to that. No, no.

He looks pondering. Yeah, yeah, yeah, I, it's, it's, I think what Christy said was absolutely right. At the end of the day it comes down to the relationship between the vet and the nurse.

And there's just certain people that when you know and you trust totally you know their, you know they know their boundaries and You know, and we know ours, these sort of things, you end up going, yeah, I, I know, I know what you're doing, so you get a quick nod and no problem. I think it's very difficult to manage these things by protocol. Sometimes putting RPX in, people can do, I've seen, I mean, I've worked as a locum in about 250 practises and you see astonishing things really.

So I think I think, I think it comes down to much, much more to redo with the relationship and the trust and the policy, because every instance is just a little bit different. Yeah. But I do agree with you, Christy, it's .

It's, it's that When you know, when that person knows you and you know them, It's very, very smooth. But I can tell you as a locum might be in a locum in practises where the nurses are locums as well, and we don't know the clients, we don't know each other, you know what I mean? And it, it just takes, but at the end of the week we're perfectly fine, you know, you get to work with each other and you kind of perfectly fine, you go go crack on, you know more than me.

What do you think? The one thing I was gonna say that we probably haven't touched on was when you're, you're saying about implementing nursing consults and doing all of them for the nurses, I think we have to be careful and actually let your new grad vets have a shot of doing them as well. I think we have this perception that at the moment within our practise, all of those post-op check appointments, all of those wound checks do get booked in with nurses, and I think as a practise that we have 150 nurse appointments per week, that we have to be careful that we're not allowing the new grad vets to lose their skills in the first instance.

If they do a stitch up, I do believe that they should see that stitch up back if there's any too tight suits. They should be the ones that have to dig them out and they can learn from their mistakes. I thought you were being nice, so you're just it works both ways, but I think then they need to have that learning curve as well, being new grads, and I think allowing them to do that, I think at the moment we kind of take everything on board, but I think taking a step back and letting your younger vets learn as well, that's a really important thing.

I think that's a great point. That's a really good point, because, you, you don't know until you check. It's a wee bit like the recheck follow-up consultation.

I encourage many young vets to do them, so you know that stuff gets better most of the time and also you start feeling where it's not, because otherwise you just see things that don't go right. I, I, I think that's a really very, very good point. And even if it doesn't happen for whatever logistical or practical reasons, sometimes you guys, the nurses are coming back to the young younger new graduate vets and even saying so that dog's doing really well.

I'm happy. You know, it's one of the most relieving things you can give almost any bit, you know. Enables them to build up client rapport as well, because they see it through the whole journey and they develop loyalty with that client and that client has faith in them to continue.

Have you got anything else? Does anyone else want to add? Oh.

Good, cause I was gonna ask. We will leave it there then. So that brings us to the official end of the day, .

And he, yeah, don't speak too soon. We're not quite done. A special thank you to you, Christy, for that.

I mean, it's you, we know your time is valuable at the moment with the baby, so thank you so much for joining us and doing your presentation so well. It was brilliant to, to have you, . And also to Samantha, our other guest speaking today, both really brilliant insights and really, really useful to everyone listening, I, I hope, and to, Claire for being our broad kind of sponsors for today's event and being enabling it to happen, and for your brilliant talk as well.

I really appreciated, and of course, Brian and Steph. Thank you. Very good.

And you, thank you very much webinar vet for hosting. Thank you, Dan and Kyle. So everybody's all very grateful.

Been there silently helping us along the way. And for those. Oh yeah, sorry, I was to say that anyone that's missed any sections of today or, that had to pop out or anything, the recordings will be made available within 48 hours for catching up.

And you can, look at them at your own leisure in that way. I believe webinar bet will be. Sending out that information or we will be in touch to let you know how you can watch that.

So all the best everyone and take care and thank you again for joining us.