Hi there. My name's Doctor Gwen Rees. I am lecturer in veterinary Science at Aberystwyth University.

And today, I'm going to talk a little bit about a pet passion of mine, which is the farm medicine cupboard and whether this is an untapped opportunity for us as farm vets. So I thought I'd give a little bit of background about myself first, you know, who's talking to you. I graduated in 2009 from the University of Liverpool.

I worked in farm animal and equine practise, both in Wales and New Zealand for several years before moving to the University of Bristol, where I taught population medicine. I then did a PhD, which I'm going to talk a little bit about, because the research that I did in my PhD has really led to this talk. I did a postdoc looking at diagnostic innovation in agriculture and livestock.

I was a senior research associate for Arwy Vet Cymry, which is an antimicrobial stewardship project here in Wales, and I'm now a lecturer in veterinary Science at Aberystwyth University. So the learning objectives for this webinar today, I will read them out to you, hopefully, after watching this webinar, you will understand the way that farmers store their medicines and how this can be useful in understanding the health and welfare of their animals. We will look at how to conduct a medicine covered health check as part of the routine herd or flock health plan.

Looking at identifying possible issues with medicine use and storage based on that medicine cover health check. And how we can use that to discuss best practise medicine use with farmers. So focusing on things like the choice of treatment, the door size, course length, and the impact of residues or withdrawal periods, and how to create a farm, a practical farm action plan for responsible medicine use that you can then incorporate into your routine health planning.

So, first, I wanted to talk a little bit about the research that led to this being my pet passion. My PhD was titled Understanding Medicine Use on UK Dairy Farms. And Basically, it was because of the knowledge gap that we knew was there.

So vets, we prescribe medicines to farms that are under our care. The farmers then store these medicines, and they usually are using them when we're not actually physically present on the farms. They're using these medicines, kind of at their own discretion.

And there, there really was very little understanding understanding of what was happening from that point onwards. So what was happening with those medicines after they'd left our car or left our practise and ended up in the medicine cupboard. So for my PhD, I recruited 27 dairy farms across the Southwest, of England and South Wales.

These were quite a heterogeneous mix of farms, but the total sort of herd size and number of cows and milk was broadly reflective of what is happening across the UK. We had some small family farms, a lot of sort of average sized commercial farms, and some very big units as well. So we wanted to be able to reflect what was going on in the UK.

And this is approximately where those farms were based, so quite heavy dairy areas of the UK. And one of the studies that was part of this thesis was looking at determining On farm prescription veterinary medicine storage. So, what exactly was on these farms?

What prescription veterinary medicines did these farms have in stock? How were they storing them, and what was, what was going on, really? So, this was a cross-sectional study across these 27 dairy farms, and I hunted down and recorded all prescription veterinary medicines present on these farms, during one initial visit.

And with the medicine storage, I mean, I had a, a broad mix of different types of farm on the project, and I think it's fair to say that there was a broad mix of different types of medicine storage to be found as well. So, quite, you know, a lot of farms had very good medicine storage. They had really nice, well organised cupboards like this, which made my life very easy.

And then we had other farms where, and I'm sure this is something that's familiar to all of you going out to farms. You have other farms where perhaps They don't place quite as much value in keeping a very tidy medicine cupboard and finding where these medicines were and sorting through them took a little bit more time. So there's quite a variety out there of different ways of storing medicines, I think, on farms.

We published the results of this study, which I will just briefly touch on in the vet record a few years ago. And Broadly, what we found was that most medicines were found in a lockable medicine cupboard, which was great. But farmers aren't storing all medicines in the cupboard.

I mean, I think the results that are in this paper aren't gonna be a shock to anyone who is a farm vet, because we know that not all medicines are found in the cupboard. We know that some are found in the dairy, some are found in the calf shed, some are found in the box on the quad bike, for example, But it was important to try and sort of quantify this. That's what we saw.

We looked at antibiotics that were being stored on these farms, and what we tried to do was to Work out how much antibiotic was being stored on the farm and correcting that for the number of cows. So we did it in M for PCU. This graph, all it's showing really is that there's quite a range of amount of antibiotic being stored, even when you correct for the number of cows.

So some farms are storing 10 times as much antibiotic per cow as other farms are. And I wanted to try and understand why that might be. We also thought, well, maybe that's because of production.

So the really productive farms that are pushing their cows really hard. Perhaps they're having to store a lot more antibiotics just in case. But, again, when corrected for per 1000 litres of milk per year, we still saw that some farmers were storing a heck of a lot more antibiotics on their farm than others.

But you can see that that that graph means most farms are storing a kind of an average amount. Another thing that was kind of one of the more headline, results was that 3/4 of the farms did have expired medicines stored in their medicine cupboards. Again, probably not a shock to most of you, but what was a bit of a shock to me was that I did find one stash of, Medicine's 16 years out of date.

That was, I think, a few boxes of leptovac. I'm hoping that wasn't planning to be being used, but it was still on the farm, and it was not uncommon to find a lot of antimicrobials that were several years out of date, still on farm and in use, we think. Again, not a massive surprise, but the majority of farms were storing unlicensed medicines, and most of these farms were just dairy farms.

They weren't mixed enterprises. So we think that those unlicensed medicines were going into the dairy cattle. And we did have a couple of farms storing medicines that shouldn't be used at all in dairy cattle.

And we did find some imported medicines that had not been prescribed by UK vets on a couple of farms as well. So these are just things to be aware of, but as I say, probably not a huge shock to anyone. So that study led to the BVA BCVA rumour, and the University of Bristol, where I was working at the time, sort of leading a call for vets in the UK to work with their farmers to try and remove.

Expired and inappropriate veterinary medicines from farms and dispose of them appropriately. Not sure how wide-reaching that call became, but I'm still banging that drum now. So I think that this is, this is a neglected area that we could really do more to focus on and not leave it up to just the farm assurance people.

So another part of my PhD that I think, the results, which are quite important when we're thinking about the value of looking in the medicine cupboard, is I did a lot of qualitative research to trying to understand why farmers used medicines in the way that they did. And to do that, we did some semi-structured, in-depth qualitative interviews, looking at medicine storage, medicine use, medicine recording, trying to explore that decision making and understand it a little bit more. And what I also did, in combination with that was something that's, borrowed from anthropology, and that they use a lot, in the study of different cultures, which is a sort of an ethnographic study where I spent A year on 3 different farms, visiting regularly, spending lots of time on those farms, gathering lots and lots of data about, well, just observing what was happening.

So how were the farmers using the medicines? How were they going to the cupboard? What decisions were they making?

Which animals were they treating and how were they treating them? So there were some key kind of themes that came out, some things that came out from this work that were important and that influenced or had a real effect on the way that farmers stored and used their medicines. And I'll just mention them briefly here.

But one of those was the The knowledge and understanding of treatment of disease. There was the trust that the farmers had in various actors involved in the treatment process. And I'll touch a little bit more on this in a bit.

The autonomy of treatment practise, or how much control farmers have over what they can actually do. So they have to act within quite a lot of different frameworks on the farm. And this sense of having a duty of care for the wellbeing of their animals was really important to farmers, and that drove a lot of treatment decisions.

So when it comes to knowledge about medicine use, it came up as a really important part of the medicine decision-making process, perhaps unsurprisingly. But what maybe was surprising was that vets weren't really a massive source of this knowledge. So farmers mostly got their knowledge about medicines and medicine use from their own experiences, the experiences of their peers or their fathers or, other people on the farm.

And also from experimenting, so farmers will often try something to see if it works. And when it does, they'll carry on using it. So they then develop their own understanding of disease and of treatment.

So they understand how the treatment works perhaps differently to the vectors. They may we don't have the sort of pharmacokinetic knowledge that we do and understand how the medicines work. So the farmer will develop their own rational sort of explanations for how things work.

And where there's uncertainty, to where a farmer's not sure what to do, they will tend to use antibiotics, which is similar to people, I think, when we're unwell ourselves. And another thing that came out strongly from that was that farmers did want more advice from vets about medicines, how they work, and which ones they should be using when. So this is just a quote from one of the farmers we're talking about.

I think with medicine, the problem is there's no knowledge. I've seen my dad in the medicine cupboard literally picking up different bottles of antibiotic and thinking which one today. They said that you can go to agricultural college or to university, but they don't teach you a thing about medicines, and that was really interesting.

So this person had done further qualifications, for the farming qualifications and said that medicines just wasn't really taught. Trust was another really important thing, so the farmer has to develop a relationship based on trust, and the farmer has. Various sort of trust relationships with different actors.

So, by actors, I mean the vet. So the farmer trusts the vet to give good advice or not, and will listen to the vet more if they trust them more. They have to trust their staff.

So that might be relatives, it might be paid staff, but they have to trust the staff to do what they think that they, they should be doing. They also have to trust the animals, so a farmer will treat different animals differently based on how they, how well they trust that animal to get better. And I think we've all heard farmers talk about the, the sheep that just wants to die, or that kind of thing.

And that's kind of what we're talking about here. And they have to trust the medicine as well. So some farmers just don't trust certain medicines and it doesn't matter what we advise that it's going to be a really hard relationship to repair if they used it once, but the animal died anyway.

And again, Where there's a relationship, and there's a certain amount of trust that these farmers have in the data that is produced either by the vets or by themselves. So some farmers really value data. They know that that data is correct, and they're willing to base decisions on it, whereas other farmers know that the data's probably a little bit sketchy.

They're not gonna trust that data or base any decisions on it. Again, another quick quote, the farmers pretty typical. They have their favourite vet on the farm and it's always guilty until proven innocent.

I think we can all relate to that, so. But they talk about then, you know, all you have to do is turn up one morning and save a cow, and all of a sudden you're the best vet ever. And I think that probably resonates with people.

But this is what I mean about sort of how important that trust is to whether advice is listened to or not, really. Talk about a little bit about autonomy, so feelings of control or being able to control treatment decisions. I think the most important part of this is that, the physical resources that farmers have available to them are one of the most important things when it comes to deciding which medicine to use.

So, one of the most important factors, deciding which medicine a farmer's gonna use, is, does he have it, he or she have it in stock? Is it in the cupboard? And that's something that we as vets can control.

That is under our control, what that farmer has in their medicine cupboard. Is there because we prescribed it usually, and hopefully, and that means that that's one of the key things that controls what a farmer can and can't use on the farm. So that's something that is really important that came out of this.

So again, another quote that just emphasises is that, you know, what the farm has in stock is a key consideration as to what treatment they will choose for the animal that is sick in front of them. Finally, and I think most importantly, farmers have a really strong sense of a duty of care to their animals. So it's very distressing for a farmer to see a sick animal in front of them and they feel like they have to do something.

And so if they have to do something, and all they have available is an antibiotic, they're going to use that antibiotic because it makes them feel better, because they think it makes the animal better. And it's, it's sort of a, a positive action that they can do. So again, this is something that we can help to influence by giving farmers more options of that's something that they can do.

Perhaps that's providing nonsteroidals or other options of positive actions they can do when they think that an animal needs treatment. And again, this farmer's talking about how, how much they hate having sick cows. And I think that's probably true of any farmer.

But they, they have, they know that they're going to have sick cows when you farm. This is part of farming. So it's something that we need to work with the farmers to, sort of optimise, really.

So what is it that farmers actually do? There's lots of evidence out there to show that farmers, they exceed data sheet recommendations when it comes to using medicines. Farmers do use expired medicines.

They will do things such as double tube mastitis cases. So if some, if it's a favourite cow, or if it's a bad case of mastitis, farmers will quite often stick two tubes up there. They'll use medicines off licence, which obviously is related to that.

We've got things like antibiotic powders going into foot baths, that kind of stuff. And we also know that farmers do store vaccines inappropriately quite a bit, which I'll touch on again. Perhaps more importantly for us, what do they really want?

And it turns out that farmers do want standardised treatment protocols a lot of the time on their farm, because it takes away that uncertainty, and they can see, right, I know what I should be using for what disease and how much. So laminated courses for the dairy, something like that just makes it nice and easy and takes that problem of decision making away. They want practical health planning, so something with a tangible outcome.

They want time to talk with the vet, and I'm sure as vets we want time to talk with our farmers as well. They want consistency between vets. And I think that was another thing that came up quite importantly, that if they have several different vets visiting the farm, telling them several different things, that then leads to an erosion of the trust between the vet and the farmer and that advice.

So I think being consistent across your practise and what you're advising can be really important. And obviously, farmers want healthy cows and smaller bills. So when we talk about medicines, how should they be stored?

What should we be looking at? Well, we should be looking at licenced meat and milk withdrawal periods and published MRL. We should be looking at prescription-only medicines being prescribed by a vet with the animals truly under care.

And we know that the RCBS is currently, consulting on updating the undercare legislation. So if this is something that you're interested in, please do let the Royal College know. Medicines should be labelled.

They should be accompanied by accurate legible medicine records, which they aren't always. They should be kept in clean, dry, frost-free area or working refrigerator, depending on the medicine, and that should be a secure and locked store. However, on some farms, we have lots of expired medicines, lots of unlicensed medicines.

We just have lots of medicines on some farms, so storing far beyond probably what is really needed on a farm that is contacting their vet as often as they probably should be. We find medicines all over the farm, not just in the medicine cupboard. We find a lot of reusing of needles, contaminated bottles, and medicines being bought from more than one source.

So what can we as vets do about this? Well, for me, I think the answer, the simplest and most valuable answer is to do something called a medicine covered health check. So this would be once a year.

You would be physically present on the farm, standing in front of that medicine cupboard with that farmer, having an open conversation about what's in the cupboard, how it's being used, how it's being stored, and that I see as being combined with the annual herds or flock health plan wherever possible. And it can just be a really valuable tool. So we'll talk a little bit more about what a medicine covered health check looks like.

So if you're going to do a medicine covered health check on a farm, the first thing that you're probably going to look at is the cupboard. And this can come in a wide variety of, different forms. But is the cupboard secure?

Is the cupboard lockable and labelled? Is it clean? Is it organised?

So you're not farm assurance. You're not going there to tell them that their health and safety is incorrect and they should put a lock on something. That's not really the, the reason for the medicine covered health check.

What you're asking these questions for in your head is You know, how much value does this farmer place on keeping a clean and organised cupboard? Because that probably reflects a lot about that farm in general. And a lot on a lot of farms, often you can drive down the drive, and you'll know what the medicine cupboard looks like just by the, what the yard itself looks like.

But If the, if the cupboard's clean, if it's well organised, you're probably more likely to find that there's a reasonable stock of appropriate medicines gonna be in there than if the cupboard isn't. But that's not always the case. Again, the same as with the cupboard, you want to have a look at the fridge.

The fridge is a really important and again neglected part of medicine storage. So do, does the farm have a separate fridge for medicines or are they using the fridge in the house? Is the fridge working?

A lot of farms will have a fridge, but it doesn't necessarily work. Is there a fridge thermometer? Because, even when a fridge appears to be working, there's a lot of evidence to show that it probably isn't if it's an old fridge, which often the ones on farms are.

Are the medicines that are kept in the fridge the right ones? So some medicines shouldn't get too cold, and some medicines should definitely be kept in the fridge. So just making sure that the farmer understands what should and shouldn't be in the fridge is important.

And also just talking about, you know, the medicines kept in the door, if the fridge is being used a lot, probably aren't keeping as cold as the medicines kept in the back of the fridge. So after you've had a look at the cupboards or the fridge, the next thing you're going to focus in on is the medicines themselves. So what medicines do you have?

What categories do they fall under? Do you only have loads of antibiotics and nothing else? Or do you have some antibiotics, some non-steroidals, some hormones, some vaccines?

What, what categories of medicines are available on this farm? Because that gives you a bit of an insight into the health problems on the farm, which can start some conversations about that. It also gives you a bit of an insight onto into how engaged this farmer is in using non-steroidal, anti-inflammatories, for example, or in using vaccines, and it can be the beginning of a quite a fruitful conversation about what medicines maybe they should be keeping in stock on the farm.

And then, not just what category, what range of medicines are being kept. So does the farm keep every single different antibiotic that you sell in the practise? Do they have two bottles of each, and they've got, you know, endless choice of which one to use?

Or do they just keep a couple of bottles of Pennstrep and a bottle of Alamycin? Is it A really broad range or really narrow, and you can do that for the different categories of of medicines as well. So that gives you again a bit of an insight into how this farmer is approaching disease on their farm.

After that, you can start thinking about what volume. So what quantities of these medicines are being kept. Are there 20 bottles of pen and strap being kept, or just one half open and one an open bottle?

Are they opening several bottles at a time, or are they being quite, systematic in finishing an open bottle before opening another one, for example? Again, looking at those medicines, there are other questions that we want to ask. So, this is a really good time to be going through a cupboard and checking for expired medicines, because that's something that perhaps a farmer will do before their farm assurance visit.

But, a lot of the farms on my projects admitted that what they would do was just hide those in the house until the farm assurance was over, and then they go back in the cupboard, because they don't know how to, dispose of these medicines a lot of the time. So are there expired medicines there? Are there contaminated bottles there?

So are there bottles that look like they've been open for, you know, at least a year, or they have the needles still in the hub of the bottle? Are these bottles labelled? Are they legal?

So should they be there in the first place? And, quite importantly, were they prescribed by your practise? So actually going and looking in the medicine cupboards are really Easy way of finding out whether you have problems with other practises prescribing to your farm.

Have a look at the equipment. So, do they have a nice fresh supply of needles, or do they have 3 needles that have been being reused for 3 years? And if so, perhaps that's a conversation to have about, making sure that, you know, needles are kept as clean and sharp as possible.

Are needles being left in bottles like in this picture? Because that is not an appropriate way to store medicine, and that is going to be quite a contaminated bottle of medicine. Do they have a range of syringe sizes available so that they can appropriately treat calves and adult cows, or are they, do they just have 130 mil syringe that they use for everything?

Again, have a quick look at the records. So, like I say, you're not there to be the farm assurance. You're not there to make sure that everything's being done perfectly or to go through cross-referencing these records.

But this might give you an insight on some farms into how much they value the data, how are they keeping records and what data they have available to them to make decisions on. And it's a nice way to start having a conversation about the value of good quality data. And it's a nice way to ask, you know, could we, as a practise, help you with this data?

Would you be interested in starting benchmarking or any other kind of initiatives that you as a practise, would like to run with your farmers? So, just a few issues to look out for, when you are doing the medicine covered health checks. So, as I've already mentioned, not all medicines are going to be in the medicine cupboard.

I think with these medicine covered health checks, it's going to be very important to make sure that the farmer knows you're not going there as the farm assurance inspector and that. You are not going to be penalising anything that's wrong. You don't want them to tidy up specifically for you to arrive.

You want to see exactly what's happening so you can have an open, honest conversation about where improvements can be made. So just ask, you know, do you have medicines out with the cars? Do you have medicines in the car?

Can I just have a quick, can we just chat about what, what those medicines are as well? Otherwise, you, you are quite likely to miss quite a lot of the medicines on that farm. But with refrigerated medicine, there was a really nice paper published, by Paul and Gustavo a few years ago where they looked at the farm fridges and the way that farm fridges were being used to store vaccines on farms.

And they found that almost all farm fridges do not work appropriately, which means that the vaccines in those fridges are not being kept at the proper sort of cold chain temperature. And that means that those vaccines, if they're being kept in those fridges for any length of time, are quite likely not to work as well as they should. And that has huge knock-on effects for farm animal health and welfare, but also for, you know, it's a waste of money to buy vaccines that don't work.

And this may be sometimes when you have farmers saying, Oh, we tried using a vaccine, but it didn't, it didn't help with the disease problem. Perhaps it's as simple as not being stored properly. So again, it's A fridge thermometer is quite a cheap way of making sure that when you're spending hundreds and hundreds of pounds on vaccines, you're not wasting that money and you are storing these effectively.

Again, non-prescription medicines, even though they're not really within the vet's remit and they're not under our control, I think if the farm is under your care, you want to know what non-prescription medicines are on that farm and being used. It's a good time to have a chat about wormers, chat about different trenches, perhaps that the farmers are using in their animals. And also chat about these complementary alternative medicines which are.

Found a lot more commonly on farms than I think vets realised. So, on a lot of the farms in my PhD study, there were the odd bottle of homoeopathic remedy, and they said, No, my vet doesn't know I've got this. A rep came around and I bought it, and sometimes I try it.

So, again, it's, it just gives us a better picture of what's happening on our farms. Talked a little bit about expired and contaminated medicines. So what's the consequence of this?

Well, there isn't really much evidence that using expired medicines is a problem, because that expiration date is often arbitrary and has been chosen just because that's the point at which the drug company tested it to still work. It doesn't mean that it doesn't still work after that point. But it's not legal to be using it after that point in food producing animals, so we do still need to be doing something about it, even if that medicine potentially still is effective.

What is more risky is contaminated medicine, so medicines that are still well within their expiry date but were perhaps broached over a month ago. So that a needle first went in it, we know that farmers don't throw every bottle of antibiotic after a month if they haven't finished it. But if there's bacteria contaminating those medicines, then the efficacy of those medicines is likely to be reduced, even though it's not, you know, technically, you can't really prove when something was open.

So it's kind of OK to be using these bottles longer than, or farmers think it is to be using them longer than is stated on the data sheet. But it's probably more risky from a low efficacy, increasing problems with antimicrobial resistance, etc. So this slide is just trying to show that the medicine coverI Health Check might be a good way of kind of combating this issue that I think does happen on farms where as vets, we assume that farmers know things and we don't want to patronise them, perhaps because We think they should, they know how to use pen and strep, for example, they've used it for 20 years.

So you don't bring it up and you don't have that conversation. And the farmer thinks, I mean, no one's ever really explained to me how to use pen and strep. I should probably know.

So they don't want to ask the vet. And the vet doesn't volunteer that information, and then you end up with this, these disparate understandings of how to use even quite straightforward common medicines. And as a medicine cover health check, it can just be A kind of low key way to start having these slightly awkward conversations, because as vets, this is our responsibility.

We are responsible ultimately for the farmers using these medicines correctly, so we should be having these conversations. So we need to make sure that the farmer knows which medicine to use and when. We need to be careful about how we raise this, and we don't want to be offending farmers, and a lot of farmers know a lot already, of course, but we can broach this, this topic, I think, without too much fear.

So maybe pick up one of the medicines in the cupboard and just say, oh, you know, when would you normally use this? Because a farmer's knowledge might be out of date. The last time they were told about it, it might have been a long time ago and our thinking has changed, or their source of knowledge was not a vet, as I said, a lot of the time it isn't really, but farmers want that advice, so this is the perfect opportunity for us to get in there and give that advice, but it's not always easy for vets, I know that.

Sometimes developing treatment protocols might be a useful way of sort of helping to control that knowledge and what farmer does with the medicine. It's a good time as well to discuss residues and withdrawal periods because I think Quite commonly, farmers are not aware that what is on licence use and what is off licence use, and when something is off licence, they're not aware of the increased statutory withdrawal periods. So it's a good time to just remind them on that.

Talk a little bit about dose and course. So, what doses they normally using? Where would they normally get this information?

Would it be helpful for them if you produced as a practise, a crib sheet of the dose for an adult cow or the dose for a calf for different medicines? So just have a little bit of a conversation, because again, there's lots of evidence and research showing that farmers tend to increase both the size of the dos and the length of the course in their animals because they are very risk averse people. And another thing to ask about and to discuss, I think, is the disposal of medicines.

A lot of farmers don't really think about this or know how to dispose of medicines properly, which is why we end up with loads and loads of expired medicines on farms. So offer to dispose of them. If you find them, say, right, you know, we can dispose of this for you and come up with a plan for an ongoing plan for disposal of expired or contaminated medicines.

Perhaps that's doing an annual Ced medicine cupboard health check, and then disposing of things that need disposing at that time. And then that's a decision for you and your practise. Do you want to charge for the disposal of medicines?

And some practises decide they don't want to because it can drive sales in replacement and expired medicines. Some practises do. And then you can come up with an action plan, which can be a short part of the herd or flock health review, where you just make some recommendations.

So is there anything to recommend with storage on that farm? So you can make something that's really bespoke to the farm that you've been on, which farmers, we know, appreciate a lot more than just a cut and paste applies to every farm kind of list of recommendations. So, recommendations on the medicines, should the farmer perhaps stock more non-steroidals or stock fewer Different types of antimicrobial and just keep some key, key antibiotics to hand.

Are there any recommendations for equipment, any recommendations when it comes to records, and is there a disposal plan in place? So it's quite a simple little list of recommendations, but it's really tailored to the farm that you have been on and had a good discussion. About and that is really valued by farmers.

So on the farm, again, with these practical actions, you might come up with an expired medicine disposal plan, you might develop some farm-specific treatment protocols. You can identify training needs, perhaps. So it may be that the farmer that you're speaking to is very knowledgeable, but they say that the new stockman doesn't really know what he's doing, so perhaps that's a training need you've identified.

And you might want to draw up a list of recommendations for stocking levels as well, so farmers know what's the reasonable amount to have in stock. And something that you can think of doing in the practise is just developing some handy resources that you can then give out to farmers. So maybe a little crib sheet on pen and strap or a crib sheet on alamycin that's, you know, just the important things that farmers need to know about it, not the entire data sheet that we would normally perhaps give out.

And is that gonna be useful to just give when you're doing these medicine covered health checks? And think about developing practise by prescribing protocols as well. Like I said at the start, farmers really appreciate all the vets, giving them the same advice and not getting conflicting advice.

Perhaps having practise wide prescribing guidelines, can be helpful in that. With the medicine covered health checks, I see that they fit really well within kind of auditing and quality improvement in practises, and this is something that our CVS Knowledge and Others have said, you know, veterinary practises really should be engaging in quality improvement and in auditing and. These medicine covered health checks really integrate into a practise quality improvement cycle very well.

So if you want to know more about quality improvement stuff, RCDS Knowledge have a huge range of resources available, so have a look online. So when it comes to doing a medicine covered health check, the first one is going to be the worst. It's gonna be the longest because you are gonna have years and years perhaps of medicines to wade through and conversations to have that haven't been had before.

For subsequent years, it should be quite a short and sweet thing that you can integrate into your flock or herd health plan. And I think flock or herd health plans are always better than on the farm anyway. And this is a good excuse to get on the farm and have a look in those cupboards.

And it just really facilitates face to face discussion, and I think that's the most important part of it is it's just having those conversations. I do genuinely believe we should charge for doing this. But it does bring a lot of benefits to the practise as well.

So again, that's, that's a decision for your practise, because there are lots of benefits to you from doing the medicine cupboard health checks. So you improve your relationship with your farmer and you improve communication. You develop opportunities to discuss the use of vaccines, so.

We want to, you know, from an antimicrobial stewardship point of view, improve the, and increase the use of vaccines and reduce reliance on using antibiotics in the face of disease. So we want to prevent disease and preventive, health is key. So it's an opportunity to discuss, you know, what vaccines do you have in stock, what do you vaccinate against, what diseases are a problem on your farm that we could vaccinate against.

And the same with non-steroidals. If you discuss the benefits of having non-steroidals, if you recommend having nonsteroidals in the cupboard, then you're increasing that farm's likelihood of using them. And that brings benefit both to the farm and to your practise.

And so, for obvious reasons, the benefits of doing this are, Very strong when it comes to antimicrobial stewardship. If you want to make sure that your farmer is using, you know, the right antibiotic at the right dose and the right time, and as little as possible, as often as necessary, then you need to know what's on that farm. You need to know what antibiotics the farmer has access to.

Whether the farmer is involving you in those decisions when they are choosing to use antibiotics, or whether they are just going into the cupboard, like the quote that I mentioned at the beginning and saying, Hmmm, which one of these should I use today? So, do we Want to be antibiotic stewards. I think we do as vets.

I think as a profession, we've got a responsibility to improve the use of antibiotics in the agricultural sector and on our farms. And I think this is a really practical, nice way of doing it. And again, an opportunity to open up those conversations about antibiotic use on the farm, about how you can improve it, how you can move more towards preventative health measures, that kind of thing.

It's an opportunity to replace expired or contaminated medicines. So again, that's driving sales, perhaps if you're finding that half of the bottles that a farmer has in stock are expired or contaminated and advising them that they should dispose of them, that is an opportunity to replace those sales, and that's a missed opportunity if you don't do a medicine cupboard health check. It's also a good opportunity to spot external sources of medicines.

So like I said, the odd farm will have medicines that they're sourcing from more than one practise. We know that this is a problem, in Northern Ireland. It's been in the vet record quite a bit recently that this is a problem.

We know it's a problem in Wales as well. So if you are getting out on the farm, and if you're managing to sort of have these conversations with your farmer in a nice, honest and open way, and framing the point of doing this exercise properly, then it's an opportunity to also discuss with the farmer, look, are you Getting your medicines from another practise as well? Or do you get medicines from the farm next door if you don't have something in stock, that kind of thing.

And it just helps us as vets who, as I said before, are ultimately responsible for the medicines going into those animals, which then go into the food chain, it helps us to show that we have some control over that, and that we know what's going on. And I think we, we need to know what's going on more than we do at the moment. As a practise, it gives you the opportunity to dispose of waste medicines, and that might be something you charge for, it might not, but that's still a benefit to your practise to not have those waste medicines just sat on farms.

And it's also something that can add, I think, some practical value to flock and her health planning. We know how difficult it can be sometimes to convince farmers that. Flock or herd health planning is anything more than a tick box exercise.

Even when we put a lot of effort into it, it can be difficult sometimes to get people to see the practical value or the practical outputs other than the tick box element of these health plans. And this can be a way. Of showing that, because you do need to be on the farm.

You need to be spending time standing in front of that cupboard and going through it and talking about what's in there. That's kind of a tangible thing that the farmers can see that you are doing. And you come out with a list of practical recommendations that are tailored to that exact context of that farm, which we know farmers love.

Then that really helps to add value. And if we're trying to sell flock or her health planning, we're trying to sell ourselves more as, you know, consultants of preventative health, rather than just people who sell drugs and treat sick animals as and when they're ill, then I think this is a good way of, increasing the buy-in to that from farmers. So, in conclusion, really, We know there is a lot of evidence, not just the research that I've been doing, that farmers do often store inappropriate medicines inappropriately.

That's not to say that farmers do it on purpose or are incompetent or any of those things. It's just a fact. And I don't think it's a shock to anyone listening that that's the case.

So there are often medicines on farm that perhaps either shouldn't be there or could be replaced by something more appropriate. So A lot of farms will still have fluorocrinelos, that kind of thing on farms, as a hangover from when we were prescribing those more freely, for example. So again, it's a good way of getting in and making sure that those aren't being used, .

So we know that that's happening. We also know that vets could improve advice on medicine use. So the farmers are saying they're telling us in the research.

That they don't feel that they get enough advice on medicine use. They don't have enough knowledge on this, and they want that. They don't want that advice to come from just doing a, you know, a one day course and taking that box on their farm assurance.

That helps, but what they want is proper open conversations with the vet who understands their farm. About specific issues and problems on their farm related to their cows, and that's what they find valuable, and that takes time, but it is really important. I think medicine cupboards are a neglected space at the moment.

I don't think they're being looked at enough. I know I was quite shocked. The more I looked in, the more I realised I didn't know when I was practising that, and I just assumed that things were, a certain way, and they may be aren't, and looking in the medicine cupboards is a really good start.

So, I hope at the end of this webinar, I have convinced you that medicine covered health checks are really quite simple and really valuable to you in your practise, thing that you could be doing as a farm vet, to improve the health and welfare of the animals on the farm, to improve your relationship with that farmer, to improve practise business viability and sales and the use of preventative medicine. And, yeah, hopefully, it's something that you also find enjoyable because it means that you get to go out on farm and have conversations with the farmer, that are both interesting and, you know, give you a real insight into how that farm, how that farm runs. Thank you very much.