Right, hello, everyone. We're getting fairly close to 9 o'clock now, so I thought I would just welcome you all to the webinar. Thanks very much for coming.

We're still getting people coming in. We're very fortunate today to have Alan Robinson once again with us. I know he's very busy at the moment.

He's . Starting his platinum group on Friday, so, that's right, that's right, so very soon take the screen back now, Antony. You can have the screen back, OK, so welcome to the webinar, everyone.

I'll just pass the screen back to Alan and then we'll do a little introduction and should be able to, to get started. Mm. Right.

So, yes, Alan has done already two of these talks about practising for profit, but also, you know, to make sure that we don't feel guilty about it, and at the same time, hopefully practising very good medicine, which, you know, will give us fulfilment that we're not chasing our tail and not getting a lot accomplished. I'm sure you all know Alan is . a practise management consultant, it's heavily involved with the whatever we want to call them now, the 4 Dodge indices, I know the names are probably going to change, but, it's heavily involved with producing those which are a very useful resource for the.

Veterinary profession and I'm really looking forward to the talk without any more ado, I'll pass over to you, Alan. I will mute myself, but I'll be keeping an eye if anybody's unhappy about anything, can't hear, can't see the slides. If you let me know, I'll try and sort that and if I need to come back on, I'll unmute myself and, and shout at you, Alan, if that's OK.

That's fine. All right, thanks, Alan, and I will I'll, I'll pass over to you now. Thanks once again.

Thanks, Antony. Welcome everybody to this webinar. Thanks for taking the time out to come to this.

As Antony said, this is the 3rd or 4th in a series of practise management webinars that we've done, and it's sort of been developing a theme around how we charge, how we invoice, how we practise our medicine as veterinary surgeons in an attempt to just improve the profitability of practises, improve the ability for the practise to function, particularly in these recessionary times when things are under pressure. As Anthony suggested, the, the Fort Dodge index is giving us some indications that some practises out there are, are doing less well than before than last year. But interestingly, some practises are doing much, much better than before, some having record months, of production.

And of course, it's interesting to know what the difference between those sorts of practises are. So this is stage 3. If you haven't seen the previous webinars, hopefully this will be a standalone and make some sense in its own right.

If you have seen the others, I will be referring to some of the information we looked at there, but of course, those webinars are available on Anthony's website, free of charge still, I think at the moment. So worth a review of those. Really what we're moving on to, and part of the theme we were looking at, with this was the fact that the money we collect as vets, the money that comes over the counter, if we take out the VAT, which is of course 17.5% of that or as from January 20% of that will disappear straight away, that money is made up of fixed costs, costs of buildings, equipment, gas, electric, all the rents and rates, etc.

Just to have the building on the ground. A good percentage of that, usually over 40%, goes out as wages to vets, nurses, receptionists, etc. A good 25, 30%, that can disappear purely as the cost of drugs we use within the consulting room.

And often that leaves a thin slither on top called profit, which is the money we actually keep as a practise owner, which we have to reinvest back into the practise. To spend on new equipment, to spend on new staff, etc. And of course, if we don't control the costs, that profit remains about the same.

If that profit is eroded, which is very easy, of course, we've got less money to spread out to these things we need to put back into a business. So a difficult business in these difficult times, of high fixed costs, a large percentage of, of, of costs going out thin. Margins on top and of course squeeze from every angle regards competition, regards legislation, regards, the economy, clients, panorama, whoever you care to mention, is putting pressure on these businesses.

And so it's very, very easy to erode that percentage. And of course any money we don't collect any money we don't charge any money that we don't get paid comes straight off that top line, . 10 pounds that we have left, of course, can erode further into there.

Now, I spend my, my weeks going through practises, these exact same figures and finding that that percentage is 2%, 3%, or even minus 2 or 3% in some cases. And practises are struggling with those figures. Now, in the previous seminars, we have talked about.

Find out what your base costs should be for your practise to earn the money you need to be, not being greedy, but just being, sufficiently business minded to make an excess 10% profit to reinvest back into the practise. We've calculated that. We've also looked at how vets can increase the amount of work they're doing through repeat consult rates by proactive work, etc.

What I want to focus on today is, two things. One is very much so the compliance issues of how we should be. Managing our work to produce, that income, because one of my key tenets here is that we tend to give away an awful lot of veterinary time and money.

We do know that client-patient numbers are declining overall through more competition, through the current economy, but also from the long historical decline in client and patient numbers through demographics and changes in social, pet owning, etc. Is, is part of a longer trend. But of course, that's become quite more acute in the current economy.

We talk about the compliance and some of the, the key things in here apply to two parts of the business. One, the preventative side, only about 40% of our clients have their animals actively vaccinated every year, of course these are our bonded clients that bring in the bulk of our, Our work and our income. Even those clients that do vaccinate, only a small percentage of those actually worm or flea control on a regular basis.

We're down to sort of 25, 30% for flea control. We're down to less than 40% for worming. So in reality, there's a, just a retail business that we're not optimising.

And of course, it's not for the money we're talking about. It's because if we truly believe we're looking after our patients. In our practise, and you believe that every animal should be vaccinated or looked at, at least a health check once a year, should be wormed on a regular basis, should have regular flea control, should be eating a good diet, and should have some sort of health assessment on a regular basis.

These things are things we should be insisting upon, but the figures we're getting coming back saying we're doing a pretty poor job of that compliance. Now, we could blame the clients for not wanting to do it. But I would suggest we need to look internally and say, well, who's meant to be educating these people in the first place?

So I want to look specifically at some of the preventative healthcare measures, but all I want to, and I don't want to drone on about we should do more, but I just want to give you some ways of measuring that, that may be slightly different from what you're currently doing. And of course, we have talked about the solution to this in regards of, Pet health clubs or health schemes to help clients buy into the, the packaged product. The second part of it is the compliance for even the long term, clinical drugs we use.

So even the clinical medicine we do, is particularly poor compliance in terms of what we should be. One example being that the average compliance for a long-term non-steroidal anti-inflammatory, which an animal should be on for life once it's been diagnosed with a long-term arthritic condition. The average compliance is only about 3 months, and that's a combination of compliance issues around cost, around internet, around the way we Provided around the necessity to see the animals and regulate, very complex situation.

But I think these are the new approaches we need to be addressing in this, new age of internet, etc. The world has changed sufficiently and, and I heard a, An expression today that this recession is probably long overdue because it's probably the enema that the economy needs to actually philtre out some of the old standards of, of work we're doing and actually give us a new look at some new stuff. Of course, combine that with the competition out there, corporate, non-corporate, offline, online, and just veterinary, .

Competition all around, in quality and quantity, and of course the external competition, looking at us. And of course the thing not to forget, it's not the competition, it's also the accountability that we're under. For example, the panorama type programmes, the, the, the media is interested in veterinary medicine these days we're a hot topic, and we're not quite as protected as we were.

So the accountability is probably as important. So just quickly, just to focus directly on Those two issues. These are some figures from last year's Fort Dodge Index, December '09.

Obviously we're now getting up to September this year. We're just having the new figures come in, and that'll be interesting to see. What we're seeing is there was growth last year, about 2.5%, not particularly great.

Professional fees and drugs both grew. But if we split that down, what we actually see is that If we split it to veterinary driven turnovers in clinical income, that actually grew by about 5 or 6%. Where we had most losses is what we call leverage turnover, the over the counter, the additional sales we make what I'd call discretionary sales, that the clients may or may not buy.

So typically diets, worms, flea control vaccines, etc. Have all decreased in the same time, giving us that average of 2.5%.

Now if we look further at that leverage sales, it's particularly dog and more particularly cat wormers that have decreased 7, 8% in in in some quarters, a dramatic drop off. Now if you think that Leverage sales constitute about 40% of our income, and 8% just in wormers is quite considerable, and that's relayed across other things as well. Flea products, similar sort of things, 89, 10% drop off in sales of those.

Now, if the clients are buying them elsewhere, they might be buying them internet, they might be buying, say, Bob Martins, which of course is a, a disaster in its own right. We're still not getting the sales. We're still not getting compliant clients.

And more importantly, those clients are not coming into the practise. And we need to look at some of these things diets is another example, dogs and cats again, particularly drops off in, in those. So, and of course the nature of these products is their discretionary right.

They don't have to buy them from us, but the educated client, the, the, the bonded client will do so. If allowed to. Now, if we look at clients with and without vaccinated animals, here's the really telling piece.

It is those clients with vaccinated animals, the light blue graph here, that have actually maintain their loyalty, maintain their compliance, maintain their sales with us. And it's those clients that don't have vaccinated animals who come in purely for the emergency when the animal's ill, as and when they need us. They're the ones that are dropping off the equation and not Coming in and doing the work.

So again, just reiterating that fact that clients with vaccinate is your primary definition of your better client, of your loyal client. And this is not about how rich they are, how much money they've got. This is purely about their attitude to pet owning.

So from a marketing perspective, we need to have a philtre and look for the best clients we can get. And the best clients are the ones who tend to engage in preventative healthcare as a definition up front. So, Just looking at the, the booster jab, the sort of the, the, the, the situation whereby we send out the reminders once a month, hopefully some people come in.

What is it? Is it the booster jab, basically they get a vaccination, they perhaps get 10 minutes of our veterinary time. They may get a health examination of vaccine.

Now, in terms of transactional terms, that may or may not be of value to the clients. So if these are important clients, we need to add something to this. What I see, and I've done it myself, the vaccination can often become, thank God for the vaccination, I can catch up on a busy consulting period and get back to the interesting stuff in a minute.

So just be aware of how we deal with this. Now, if you want to measure veterinary performance around this, and of course, what I'm suggesting at the end of this is this is vet and nurse performance, because nurses should be providing the bulk of this preventative healthcare provision. Typically, if an animal goes home with this sort of invoice, the puppy health check and first vaccination, I'd have to ask everybody listening, is what's missing from this invoice?

And if you can't give me at least 5 things, you're probably, missing a trick yourselves. There's huge opportunities in every vaccinations, every worming, and I'm kind of preaching to the converted, I'm sure. But if we're not sort of optimising all this potential through education, through example, through giving people the opportunity, making it quality product, making it convenient, making it easy by bundling up some of these things, we're gonna miss out on an awful lot of the opportunity in those delivery salesmen, but the clients do not have to buy this stuff.

They choose to, and they'll choose that from an educated point of view. Now, a couple of things I would suggest you look at measuring in terms of the current economy, your current practise, Function is looking at the trend data, and I would suggest you look at trend data over at least 2 years because in any 112 month period you have 4 seasons. Typically a a busy summer, spring summer season and a quieter autumn winter season and.

Depending on when you start your measuring, you can always get an uplift or a downlift, which is a bit misleading. What you need to be looking at is what are the trends from season to season. So what happened in April, May, June, July in 2009 compared to April, May, June, and July in 2010.

And we can see from this, overall, we seem to be doing less primary vaccines, less kitten vaccines, and less puppy vaccines in this particular example. If we looked at this graph, from December '09, we might be fooled into thinking that the actual, practise was increasing in vaccines rather than the other way around. So just a tip here, always measure trends over a longer period of time, typically two years.

So you capture two seasons of each piece. Now I have a theory that actually, the vaccination, particularly the primary vaccination, is one of the front doors to an income generation. It's the, the, the front door to your whole preventative healthcare provision.

So your primary vaccine, your booster vaccination, is they need to engage in that process first before they will take on the rest of the, healthcare package, wormers, flea control, diets, microchips, even nutrients, etc. So consider a practise has got two front doors. One is called the vaccination, which is for your healthy animals, and the other is called the consultation for your sick animals.

Looking at your primary vaccine, primary vaccine, by definition, is where you get your new puppies and new kittens coming through the practise. So this is your lifeblood for the next 10 to 15 years if you look after them. So if we sell a primary vaccination, what should we expect to happen as a result?

OK, we earn 40 quid from the vaccine, or whatever the price is these days. However, there's some other things that should automatically happen as a result of that. After every primary vaccine, you should sell a microchip, almost guaranteed.

Where is that linked in? You should at least neuter most of the, the cats and a vast proportion of the dogs and bitches as well should be neutered. So that should be an add on to that.

If you think about it, if you sell one worm at primary vaccine and you're worming 4 times a year, and the animal is for 15 years, that's at least 60 more worming opportunities is directly linked to that primary vaccination. Equally, if you're selling flea control once a month for the next 12 years, that's another 144 flea control opportunities, or divide that by 6 or 3, you see how many of, Units of flea control should be sold per primary vaccination. So everything we do actually generates a ratio.

And of course the important thing that that drives that then each primary vaccination has inherently linked to it 12 or 15 booster vaccinations. So we can actually start to generate some ratios here to see how well the practise maintains compliance within this. So.

Instead of just measuring microchips sold, I would suggest you look at something like microchips generated per primary vaccine. Another way of doing this, depending on your protocol, of course, if you give microchips primarily at neutering, it would therefore be microchips per neuter would be the useful criteria. So here we're seeing a practises running around about 60, 65% microchips per primary, which in my benchmarking figures is probably pretty good.

Obviously, some may microchipped before you see them. But I would suggest that an optimum figure here would be close to 80 or 90%. If you had a good compelling protocol that clients could engage in, or you package microchips up into the whole bundle, and help clients buy that.

So measure that on a on a monthly basis, it will vary depending on how many. Primaries you're actually doing, but as a ratio, you should get a fairly consistent figure. Now, we'll have to think about why that varies from month to month, and that can be down to individual vets, individual branches, individual promotions.

If you do a microchip month, that figure soars, but it only soars for that one month. So why isn't every month a microchip month? It's a question you've got to ask yourself.

So what we're looking for is if you want to set some targets by focusing on this, and you just say microchip, put in a protocol, put in a procedure, put in some sort of offer, some sort of incentive for the client, you should drive your microchips per primary ratio from 60% to 70 to 80, even 90%. Could be a target. And of course, that adds up per unit to quite a bit of money over time.

Plus you've got a much, more protected patient base because they've all got microchip, they all, because you're not selling a microchip, you're actually selling security. That's the thing that's for sale, not the microchip. Neutering obviously you can measure the number of bitch spaces and castrates, and of course this can be complicated whether you're doing charity work or not.

If I'm looking at these figures, I would normally exclude charity work because they're not naturally your bonded clients. Now obviously, you might pick up some of those in the, in the, in the short or long term, but I'm looking at your primary, clients. So numbers are interesting, but what we need to be looking at, is your neutering rates, for Tom's and Queens.

But more importantly, per primary vaccination, how good is your neuter rate? And of course, we get some. Odd figures here.

If you're neutering a lot of animals that you're not vaccinating, that could be higher. And of course, that if you're including charities, etc. Or if you've got a particularly competitive, neutering rate, compared to other practises, you could be drawing in work from other practises, which one certainly brings in some income, but don't forget it's a subsidised procedure anyway.

Don't make any profit from it, but it does give you the opportunity to sell your services, sell your practise, sell your health schemes, and maybe come back. But of course, you've got to think about the psychology here. What brought them in in the first place, low price.

What's going to keep them there, a low price, probably. So you've got to really think about some of this in terms, but it's a very good indicator of the sort of work you're generating. Now, obviously, there is a bit of a differential cause you Muter occur probably 3 months after your primary, so you've got to factor that in a little bit.

So again, longer term trends are worth looking at in this figure. So that sort of takes through primary vaccine. Think about those opportunities per primary.

Next thing is, of course, they get them to the next, 12 months, which is the annual vaccination. Again, looking at an invoice, very good. We've got a booster, DHLPPIL, and we've got a kennel cough, we got 3 animals in here.

But of course, again, I've just asked the question, what's missing from this, these invoices? What hasn't happened? And, and the question I'd ask, just looking at a, a, a bare faced invoice saying, What's your protocol here?

How is this managed? How are people, what's your, what's your script within your, Your your your vaccination process, what's the offer, what's the, the marketing, etc. The usual things.

So again, similar question you ask, what are the opportunities? What is inherently linked to every booster? Well, number one, the next booster, do they get the is that the next thing that should happen.

So this becomes a chain of events. It's a production line, basically. Every booster should generate 4 worm sales if your protocol is 4 times a year.

Now, if your average dog weighs 20 kg and you're using, say, a product like Drontle, well, that's 8 drontles per booster. If you're using Milbmax, it's 4 milbmax per booster. It's kind of averages out.

You can start to look at these figures. Flea control, if you're selling 6 packs, that's 26 packs for the next 12 months. That's the instant ratio, you're generating here.

And of course, as the animal gets older, depending on its age, anything over 6 or 7 should probably produce a dental scale and polish of some sort, at least a prophylactic or a dental diet or a dental chew or some or toothpaste or something of that nature. So, a ratio develops with everything you do and what you should be measuring is looking at those ratios. So again, looking at booster vaccinations, yes, here's our trend.

Overall, we're selling more of these, particularly dog boosters, cats in this particular instance, a bit static. And they've gone over a short period of time, over 12 months, it's a bit hard to tell. We really need to be looking at this over a longer period of time.

Are we doing more this year than we do? Last year and even go back further than the year before. The world has changed dramatically in that time span, OK?

And it probably won't be the same when it restructures itself as we go on. So, my, one of my primary, ratios I look at here is the booster rate per primary vaccination. If you think about it, if for every primary vaccine you did, that dog or cat came back every year for a booster, you should generate a ratio of 12 to 15 boosters per primary vaccine, and that's an indication of their, bondedness, their compliance, their lifetime value, if you want to put it.

So looking at that ratio of how many boosters we did we do this month compared to primaries, over time a ratio would develop. So we take an average of that, so the, the graph on the right hand side here shows us on average for dogs and cats and overall, . We have 4 boosters per primary.

So on average, clients that get a primary vaccination hang around this practise for on average 4 years. Obviously some do stay for 10 or 15, but an awful lot must only disappear after 12 to 24 months to get it down to a 4. So one of the targets here is how do we get that figure up to 5, cause even if going from 4 times the 4 ratio of 4 to 5 is a 25% increase, and that must be worth a certain amount of money.

Very useful ratio. Now, As I've talked about in some previous, in a previous webinar, one of my ideas is that you should be bundling this up, offering preventative healthcare packages, and that is one thing that immediately starts to increase that. It takes 2 to 3 to 4 years sometimes to see it.

But because you're bundling, you're offering people better value, you're offering, more in it, that does naturally start to drive up that, that rate. And I've said, you don't need much of an improvement to get a, a definite change. Now, you might say, well, that practise must be doing something terribly wrong.

At a ratio of 4, according to my figures, and I I've looked at a fair number of these. It might be just the ones I'm looking at, of course. The average for the country is about 2.8, OK, which is a fair old indictment on the way we, manage our booster vaccinations, over time.

So in this practise running at 4, probably a congratulations are in order. In fact, this practise is running a health scheme, to achieve some of that. So again, useful ratio to look at.

On the back of that, as I said, every booster should sell wormers and flea control. And again, it depends on the product, it depends on your protocol within that. But you can start to look at ratios here.

Sorry, I've jumped the gun here a little bit. This is boosters per primary in, another practise that is running a health scheme. This is now running up to 5 times.

So this is a far better compliance. But of course optimum would be maybe 7 or 8 if we're really hanging on to it. Not forgetting once animals are over the age of 7 or 8, the percentage is down to 40%.

Moving on back to wormers now. We're looking at wormers per dog, wormers per cat, and if we're saying average protocol is for worming opportunities per year with a product in a tablet or a spot on for cats, perhaps, we should be seeing for, a cat, a ratio of 4 to 1. So on this graph, 400% would be the average if every cat that was got a, a booster vaccination was getting worms 4 times a year.

Here we're seeing a ratio of 1.1, which is just about average for the country in terms of worming compliance of vaccinated animals. Dogs are still a bit higher, about 1.25.

But don't forget the ratio here perhaps should be a little bit higher. It should be, probably two tablets if it's a draw to, etc. So you'd have to look at the product.

Flea products per vaccination, same, we should have a ratio of two flea product packs, a six-pack or 4, perhaps if you're selling 3 packs, depending on the product again. So ratio should be something like 200% and what we're seeing here, again, typical of the country, averages of 40 to 50%, about a 25% compliance for these things. Useful, interesting as well, you can see step changes, in the sales of these things.

So here between October and November 2008, we saw a drop off of this. And when tracked back in this particular practise, it was definitely a change of vet. One vet left, another one joined, and there was a shift in the way things happened in this practise.

So again, just interesting to find the historical stuff within this. And again, here's just the, the same thing, showing us averages here over time, higher flea control, and, and wormness. Of course you can do this with all sorts of other factors within that.

The way we work that out is what's the percentage, what's the potential percentage are here for Worm's got 140%, it should be 400%. So we're getting a 35% compliance, flea control, 20% compliance. I hope that makes sense to people, but it is just a little bit of simple maths more than anything else.

It's just understanding your own protocols, your own products, how many products per year per booster, and pull it off the computer. It's a relatively straightforward thing to do. Now this is something we do as standard when analysing practise performance, particularly preventative healthcare.

It is relatively easy to do with most of the computer platforms we work with. This data is all in there, it's just having a system of getting it out and recording it. Of course this is something we do with a lot of our practises.

OK, just the last one, dentals, well, again, I would just say make the differential here between your dental types. There's two types of dentistry, there's prophylactic dental, which is your scale and polishes, which is your, Routine maintenance, typically of your 567 year old dog onwards that just needs a scale and polish, probably don't need antibiotics, probably don't need pain relief, need an anaesthetic, obviously. But it should be a low-cost routine hygienist type of thing, particularly something capable that nurses are capable of doing, it should be priced accordingly to be part of your preventative healthcare.

If a tip here is on your computer systems, separate those dentals, prophylactic dentals from your dental surgery. And I would actually name your dental surgery, dental surgery, so it actually has more importance to your client because it should be a hell of a lot more expensive to those clients as well, because of the nature, it's a veterinary input, it's a veterinary skill that Be charged for accordingly. So separate those two things.

What we're looking for here is your prophylactic dentals per booster, cause that's where they're generated from, mostly. If a dog's got rotten teeth and infections, etc. It will probably come in for a consultation, one would hope.

But unfortunately, too many of those are picked up at booster as well. . So what we're looking at here, or the average for this practise, it's running for dogs and cats around about 8%, so 8 out of every 100 vaccinations is generating a.

Dental scale and polish. Now again, that's fairly typical for the UK practise, small animal practise, but if you think about it, the potential here of the numbers of dogs you see, probably 40 to 50% are over the age of 6 or 7. Nearly all of those need a routine scale and polish, so our potential here should be 50%.

We're getting 8%. So we're less than 20% of our compliance, in the fact. If you do the sums, add one extra dental, per vet per week in this practise with the sort of average cost of 60 to 80 pounds for a routine dental, there's an extra 36,000 pounds in potential dental income generated by nurses, which is actually far better all around.

OK. So, I said, I won't go on too much from that, but of course my belief is you should bundle this stuff up, you should make it a, a health scheme, that is helps clients to comply with this, make it easy for them, make it beneficial for them, for the patient as well as the client. And again, go back to the webinar on preventative healthcare to go through that if if that's an issue for you.

Simple systems, there's plenty of, of ways of doing that. But it should be a key focus. And for my mind, this isn't a money generating process.

This is a client compliance, marketing activity. Hence, you need to market it well with good literature, good branding, good promotion, and primarily let your nurses and receptionists drive this. They'll do a far better job overall.

OK, let's move on. As I said, there's the other front door to your practise to practise income is the consultation. That is the primary reactive piece that is generated by the client, not by the vet.

If the client feels the need that the animal is ill, they will ring up, hopefully, they'll speak to reception, they'll be booked in for a consultation, hopefully. OK? Now, consultation's fine, we can generate those.

We've already talked about the repeat consultation rate in the previous webinar. So again, if you missed that, go back to the previous webinar. It's on the website and have a look at that.

So there's some proactive things every vet can do within the realms of professionalism and ethics, etc. To practise better medicine. So the opportunities for consultation is one, the repeat consultation.

We've covered that. The other things that are only generated if a consultation happens first are things like diagnostics, that's the X-ray, ultrasounds, lab work, etc. And a consultation should be the precursor to anaesthetics, hospitalisation, fluid therapy, surgery.

So everything clinically we produce is actually an outcome of a primary consultation. So there again, we should be able to look at some consistent ratios over time. And, OK, it varies from month to month, but as a ratio per consultation, we should have a consistency developing in our practise.

Once we know the baseline, we can then do something about whether it's possible to improve it or not. Now, I'm not saying we create these things unnecessarily, obviously, but what I would find is there's some things usually blocking the ability to produce the work that can be done for the benefit of the patient, benefit of the practise, benefit of the client, etc. They come to you for your clinical expertise, it's remiss of us not to exercise that at the client's behest.

So let's look at some of those ratios as well. So what I want to do with this now is look at how do we measure these things in terms of veterinary performance. The stuff we just talked about is preventative performance.

So that's down to the practise nurses and receptionists. This is down now primarily to vets. They are the ones that do or don't do this.

They proactively or reactively, create this sort of work. And like I said, for me, this is a direct quantifiable measure of their. Medicine, the practising of their medicine, OK, so what happens once the once the client's initiate a concentration, what are we doing?

And of course we're looking retrospectively what he is doing, and then looking at the opportunities. Third thing I want to do with this is back to the, the issue about charging for our professional time. Do all the things we do post consultation.

Get charged with our professional time involved. Whatever our 10 or 15 minutes of professional time is worth, have we built that into the equation? But here is one of the major, major leakages of practising income.

We've done the work, we've got the result, we've paid the drugs, we've paid the staff, we've had the buildings, we've had the equipment. We don't charge for our professional times, those things go. With no income generated for them.

OK, let's let's just have a look at those things. Foot dodgy index again gives us some parameters here so we can look at these overall, but like I said, that's interesting, but what we really want to look at is what's happening in your practise. So we can measure things like lab fees.

We can measure internal external lab results. We, if we have something like a lab, or a blood sample fee or a sort of an instigating fee within that, we can measure that or we can just look at the amount of actual lab work we're doing. So here's this practise.

We know how many consults they've generated. We know how much blood work or lab work they've generated internal or external, and we see a ratio developing here. So here's a practise on average doing about 19%, lab work.

So 19 consults out of every 100 produce some sort of laboratory intervention. Now, whether that's good or bad, obviously I've seen practises up to 30 or 40%, but they're highly invested in internal medicine. I've seen other practises down as low as 4 or 5% who obviously don't have an internal lab, don't send anything off, and I would suspect practise pretty poor medicine overall.

So somewhere in there, your practise will have a mean. And of course, the question you could ask yourself, if you're around about this percentage, is there any more opportunities for doing better clinical medicine by doing more lab work? That's the question you've got to ask.

It's not a question of how do we create more work, Unprofessionally, it's about, have we missed an opportunity here to give the client what they want and help the animal at this end of the day. So again, what we're seeing here is a positive trend over time, bit seasonal as well. But of course, if we're at 20%, and this time.

Next year we're 22%, that can only be a good thing. It probably means we're practising better medicine, looking for the opportunities within the clinical load we currently have. We're not looking for more clients, we're just looking to practise better medicine with the ones we've got.

We can move that practise forward. Now, question here, and this is just a suggestion, and many of you are probably doing this in some shape or form. All I want to dictate here is, What does a lab fee consist of?

Where is the professional time and then the consumables built into this? OK. From my mind, in my practise, what we did is to take a blood sample, that was a, a, an added procedure we did.

It took a vet, it took a nurse, it took a, a syringe and needle, a vacutainer, it took a, package posting submission form, time to fill in the reports, etc. So, Have you got a fee built into it somewhere with macrodian or separate fee, or to take the actual blood sample? Because like I said, the main cost of that is your vet and nurse time.

Now, it might be 5 minutes, it might be 7 minutes, it might be whatever. But make some estimate as to the time. Of course, you know your rate per hour now.

So, so for 5 minutes at 120 pounds an hour, you know what to. For your time. Add on the cost of the consumables, add on the cost of the package postings, etc.

To go with that. OK? There's one fee.

Second fee is obviously what you're going to be charged by the external lab or the cost to run that, that test within your own internal lab. So that's externally, there's a set fee. Now, do we mark that up or do we not?

Well, again, don't forget. In the current days we need to be more transparent. What we did, we charged that very, we just passed that lab fee on, OK, we, because that's all it was, it was just a consumable fee.

With that, because we're only charged the time to take it. Internal lab fees, obviously, you've got the cost of the equipment, you've got the cost of consumables, you've got the cost of the nurse or the vet running the test. So that's how you would charge for that.

And that would depend on the equipment you have and the level of, of expertise you have within there. But you would need to calculate an internal lab fee. Don't forget, not just on your consumables, because you've got to Include the cost of staff to run that test and maintenance, etc.

And the third part of that fee is, you get the results you need to interpret, diagnose, prognose, and feed that information back to the client. That takes veterinary skill, expertise, and, more importantly, time. So again, that can be estimated, depending on the test, but overall, We have the client back, and we spend some time with them because the value is in it for the client, .

All right. For the client is that we, you're giving them, a prognosis of what needs to happen next. Now, here's a tip for this.

What we did in our practise was at the time of taking the blood sample, we rebooked a follow-up consultation within the time period we knew that result would be back. So most results came back within 3 days. If it's internal, we could have it the next day.

Some of the, endocrine tests maybe took longer, so that might be a week or so. But we had this scale of timings. So when we took the sample, we actually made an appointment.

We'd like to see you again on Thursday, and at that time, we'll have the results and we'll go through it. What this did, it made us think, well, we're giving the client a valuable time. It may just charge for that consultation, which is our interpretation fee, basically.

Equally, it gave more importance to the client to the result, . And it saved an awful lot of time because the main problem was getting on the phone and chasing clients, and they weren't there, and you had to ring them back and it was never convenient for them. It was never convenient for you.

And you ended up spending your life 8 o'clock at night trying to catch clients. And of course, if that fell through the loop, then you had a disgruntled client ringing you in a week saying, Where's my blood result? I paid you all that money.

And it was just not worth the hassle. So our, our Experience was booked them in. Now, obviously it's just a screening test and everything's OK, yes, we'd hand to the nurse and say no, everything's fine, we'll see you again in 3 or 6 months, whatever it was.

But for a clinical case that needed further diagnosis or prognosis, that would be the procedure. That's. Worked very well, and it created that.

So within that, now whether you bundle those three fees up, whether you charge them separately, it really doesn't matter. Transparency is the important thing, and each one of those you're going to add value to the whole process. So there's just a, a few tips on that.

OK. Other diagnostics. X-rays is obviously something we're doing more of.

Interesting, had a practise the other day, just invested in digital X-rays. They're doing far better diagnostic X-rays. They're, they're not doing more per case because, well, they're doing less per case because actually the quality of the X-rays is coming out so much better.

But their vets are much more willing to engage in taking X-rays. I think it's the novelty of having a digital X-ray as part of that, playing with toys. But it is improving their income from that and paying for the extra cost of the digital X-rays.

So that'd be an interesting thing to discuss. So X-rays, what are we doing per month? Again, the criteria I'd look at here is what's your X-rays per consult, because your console is your primary driving, .

Creator of, of these things. So again, we can over time create a percentage. Here's a practise running about 15, 16% of their consultation cases.

Now if you're an orthopaedic driven practise, you'll do a lot more of these. If you've got someone in in with a certificate in imaging, you'll do a lot more of these. And of course, the same theory applies to ultrasound as well.

Ultrasound or X-rays, any imaging should be measured as a ratio, depending on. Per consult is a, is a useful thing to do. And again, I would say here's an average practise 15 to 20% is what I'm finding is a, is a fair old average, If you start to interesting, then this is on a per practise basis.

Interesting if you do these on a per vet basis, huge variations in, in the way people are doing. And obviously, you've got to make sure your vets are doing similar sorts of work, and, and similar amounts of work. But of course, on a per consult basis, it doesn't matter whether, whether working one day a week or 5 days a week, the ratio should be the same, or at least equivalent in that.

Again, just pricing here, just remember, I'll come back to this again. You have to charge for your time to do the procedure. So if you're involving nurses, do it, which is fine, charge for your nurse time, charge for your X-ray costs, your leasing, obviously, if you're using wet radiography, you use time for your plates, etc.

Less consumed. But of course you've got your maintenance and your costs and your. Leasing cost to go into that.

That's the consumable cost and there's your time cost on top of that. The second part of your cost here is then exactly the same. How do you get the information you've gleaned, your diagnostic and prognostic information from the X-ray procedure back to the client.

And again, What we tended to do was book the client in, have them in a room with a viewer, put the X-rays on the screen, because the beauty of digital now they're all dry straight away. And there was a consultation for our interpretation fee, and we could add a lot more value on a face to face consultation. So think about how you charge for that.

If you look at your current charging, I would almost guarantee in many cases you've not covered the time involved in both those procedures looking at that. The big one I find is hospitalisation fees. Most people, obviously hospitalised animals, and we have big cages, we have little cages, we have cats, we have birds, and there seems to be variation in the way we charge for those sorts of things.

Again, if you think about a hospitalisation fee, the cost incurred has very little to do with the size of the animal. The cost incurred is the condition of the animal in how much nursing and veterinary time it takes up to have that animal hospitalised. Now, if it wasn't particularly ill, it probably Wouldn't need to be hospitalised in the first place.

So there's always a set criteria of how much time and effort a hospitalised animal, even if it's in just for observation. Someone still needs to get the animal out. They need to take it for a wee, they need to clean out the cage, they need to replace the vet bed, they need to put food and water in.

So there is a kennel time with it, so a basic boarding fee in that. And then if it's ill, it needs Triage, it needs treatment. It needs consultations by vets.

It needs treatments. It needs drips, etc. So all that builds up.

So again, just look at your hospitalisation utility rate is how many hospitalizations you're doing of any sort, how, how, and because this can be looked at in terms of cages available, etc. But again, your primary driver for hospitalisation, you will. I've had to sit here at first.

So hospitalizations per consult for me is a good, criteria for comparing performance between vets, between practises, between branches, etc. Of course, if the branch doesn't hospitalise, you're not going to get the figure. But of course, we see some big variations in graphs like this, and you start to wonder what happens after September '08, etc.

And what goes on. Overall trend data looks like it's improving, getting more over time, and that might be the case load, it might be all sorts of things there. But what we're looking for is what's your baseline, where you're starting off from?

Is there an opportunity to improve that? If there's not, are you're doing the best you can. And that's the only question you really should be asking about that.

Now, Just think about your hospitalisation charging. Every animal that comes in needs to be admitted by a nurse. It needs to be taken through.

It needs to be processed. It needs to, be hospitalised, fed, watered, weed, checked over, etc. So even animals coming in for a day.

Treatment incur a cost. OK? Is there a fee to cover that cost?

Is that built in somewhere? And like I said, it doesn't matter whether it's a, a kitten or a, or a Great Dane, particularly, the cost is kind of the same because it's incurred by the people you employ. That's the biggest cost with it.

So, for, and, and again, in our practise, what something we had was a, a day fee basically. Anything under 12 hours was charged the basic fee, and I mean that needs to be worked out on your own basis on those costs. Don't forget there's consumables incurred as well.

So make sure any drip sets, any food that's used, any catheters, any extra pieces, any pills, not just the drugs they're getting, but the consumables really need to be looked at for a hospital, particularly something staying in over a period. The use of an infusion pump incurs a cost. You've had to buy the thing, you have to maintain the thing, you have to replace the thing.

A cost is incurred with every usage, drips, etc. Go in with that. So just think about what the possibilities are with these things as time goes on.

Obviously, now, the cost can be twofold for nurse for, hospitalisation. There's primary, the primary cost is nursing time, cause they're the ones primarily charged with inpatient care, and it is probably the primary job of nurses. That's why they got into nursing.

That's what they should be doing, and that's what they should be valued for. So anything that is looked after, I'm not suggesting these are particularly good prices, but is there a nursing or hospitalisation fee, whether that's incurred in your day fee or your Your, overall feet, just be aware of that. So the question I'm asking is should our charges then be.

Small dog, medium dog, large dog based on a space or size of the animal, which is actually seems a bit ridiculous compared to the, how the cost is incurred. Or should we actually look at the time? So here's, here's something, this is actually some work, it's people may have seen it before.

Tom Catanzano from America, now based in Australia, has came up with this formula, and I think it works particularly well. And because what you have to do with this is adding your own cost basis to it. Primary hospitalisation one is basically a boarding fee.

It's in for observation. It's fed waters, weed, cleaned out, and given up for a newspaper and vet bed once a day. So maybe comparable to a, a, a boarding fee of kennels, maybe a bit more, but it still incurs a bit of nursing time, not in or if you've just got kennel people looking after it, etc.

So there's your basic feed on a 12 or 24 hour basis. How do you decide which, if it's in there, After 7 o'clock in the morning or after 7 o'clock at night, it goes to a 24 hour fee. If it falls between 7 and 7, it's a 12-hour fee is how we work that one out.

Very simple heuristic to work on that one. Second one is, so this is level 2 hospitalisation, a boarding fee plus fairly non-invasive nurse care. So they will get it out.

They might, Move it around. I'll just check it's OK, temperature, pulse, respiration, basically, and just routine, clinical observation is what goes on here. And of course, what you're selling out here is probably 2030 minutes of nurse time.

If you're not sure what you charge for your nurses, our formula there was we charge, we charge half the rate we charge for our nurses. So 10 minutes of nurse time is half the cost of the 10-minute vet consultation. Level 3 is boarding.

It's then getting treatment. So treatment would be getting the animal out of the cage onto a consulting or a treatment table. It would have temperature, pulse respiration.

It would be examined by a veterinary surgeon, full body system checkover. It would have a full consultation, which is looked at. Minutes treatment, a diagnosis reiterated or made, and a prognosis produced and a treatment plan altered and measured, and that would probably happen in the morning round and an afternoon round.

So yeah, your cost here is your boarding fee plus two consultations is kind of the basic hospitalisation for a clinically ill animal. Level 4 is then boarding, and now we're talking about the additional here is IV treatment. So anything that goes into a cat.

And of course, I've used Roman numerals to make it easy to remember. Level 4 is the IV treatment and monitoring. And now we all know the, the expense and cost and time it takes to, look after a dog with a drip.

They run around in circles, they chew the catheters out, they chew the bandage off. You've got a nurse that full time running and that looking out for these things. That's a fairly hefty cost to you.

In the practise to maintain that plus it needs monitoring, it needs veterinary input to it. So we're now talking about a fairly major intensive time input to a hospitalisation treatment. And of course, level 5 would be a full intensive care or an overnight care, having a nurse or a vet, fairly full-time attending to this animal.

So we could be talking 120, 150 pounds a night for these types of interventions, which is exactly the care the animal needs, for this sort of thing. So again, I'm not suggesting you, this is exactly what you should do, but think about the time input to these things. OK, I hope this is making sense, and Anthony, if anyone's got any queries and they're they're putting any questions through, just, just catch me, but I'll I'll push on with this for now.

Anaesthetics, again, measure anaesthetics because this is your primary indicator of how much surgical activity you're doing. You need to anaesthetize something to operate on it, hopefully. So anaesthetics is a good indication of your surgical load.

Total anaesthetics again would vary from practise to practise. Anaesthetics per consult is a far better ratio to work with. And of course, what we see here, the graph suddenly changes in a different way.

We, we get an increase in, in anaesthetics per consult. So in this practise, we're generating more, back-end clinical surgical work or certainly diagnostic work as a result of the consultation process. Your vets are being more efficient in picking up cases, more proactive in treating them, and hopefully getting a better result, out of that.

And over time, they're doing that better and better. So as in terms of veterinary performance as being veterinary surgeons, practising clinical veterinary medicine, I would suggest this is an indicator, and you've obviously got to monitor that, that this is good work being done. OK.

Another indicator here just on the other side is obviously pre-anesthetic profiles is something that some practises do depending on what level. And again, if it's something as a protocol that you do, a high proportion of animals would be getting those. So you can measure your protocol implementation here if you have a protocol that every animal has a pre-anesthetic blood test of some sort, and there's, of course, some discussion around that, what that should be, you should be hitting 80 to 100%.

Of course, in some months you seem to Test more animals than you anaesthetize, so that's a good thing in some ways, . So looking at that, of course, if your protocol, we only do them for older animals, you might have a lower percentage, 40, 50% if you're starting to just, again, it depends on your protocol, but think about your protocol in terms of what's best for the animal, what's the best, test to include in that pre-anesthetic? Does it give us value?

Does it give the client value? If so, let's do it, and then you can measure whether that's happening or not. The other thing that's of interest that comes down to again a clinical veterinary protocol that you'd seriously think about is what's your fluid usage.

Now, obviously, fluids are used in two instances. When you have sick animals that need fluid intervention, dehydrated, sick, vomiting, diarrhoea, gastric torsions, etc. All need, probably should be having fluids as an indicator of how well you're treating animals.

And I would hope we take that as standard now. But of course, if you're short of nurses, it's short of time, if you're short of skill, you hate, you know, you can't hit a vein, well, you probably do far less of those. So fluids for consult might be an indicator of the, the proactivity of using fluids in the cases.

Probably the other one you'd look at is fluids per anaesthetic. And again, this comes down to a primary protocol here, is, do you believe that every animal under Under an anaesthetic should have at least an IV line or fluids as routine. Of course, that's up to you to decide.

In my practise, it was every animal that was anaesthetized had an IV line, neuter, and I'm excluding neutters here because there are subsidised costs and for some reason we, we practise slightly different medicine for those but we charge a lot less. But for clinical cases, for an anaesthetic, because the anesthetic's included in the space, so we don't need that anyway. The anaesthetic, we said every animal has an IV line and fluids as standard, and of course, we charge for that.

And so, in our practise, our fluids for anaesthetic was near 100%. In this practise, they're running at about 30%. So there was a discretionary do we or don't we in terms of anaesthetic protocol, that.

Now I'm not suggesting you do what I did, but it's certainly something you need to discuss with your vets. What's best medicine? What should we be doing?

How can we measure it? They're the three questions you should be asking with this. So think about your fluids, how do we charge for that?

Does it include fluids, does it not? One way to put that in is giving sexs catheter fluid therapy. So again, fee to set up fluids, time expertise, the cost of the bag, the actual consumable, and of course nurse maintenance, strip set, catheter, infusion pump, etc.

Is another cost you want to put into that. So think how you charge up fluid usage in a clinical case. OK, I'm nearly done, and I just want to finish off with the, the last piece here.

Obviously, this all comes with a surgical piece. Think about two things here. Surgery is an unknown to most of our clients.

They don't know what they're getting, they don't know what's involved. It's a worry for them. It's an emotional time.

They're worried about the anaesthetic, they're worrying about the animal dying, they're worried about the cost. So how we do things, so. A couple of things.

Getting animals in appropriate for surgery, charging appropriate for that, and of course what I see is people take shortcuts, because most of us as vets, we find surgery pretty easy and therefore we tend to undercharge for that. The top consultation is probably worth twice as much as it actually is if we look at what we actually did within the, the surgical fees. So just think about again, your time, your, your usage, and, and the consumables within that.

Again, if a client gets an invoice like that, very little value in its, in its, appearance, with that 1000 pancakes looks like it's a made up figure. So just make sure when you're adding value, clients are, and of course this helps receptionists. If you can give them a detailed invoice to work through, they can actually add a lot of value, to the client in paying the bill.

That's a lot of money for a client to pay, so they need to have some value built around that. So just thinking about it, I won't go into too much detail, but just remember with your pricing surgery, make sure you have macros and protocols that involves all the things that go into a surgical consultation. What I see in a lot of surgical invoices, big pieces missed out because it looks too expensive, unofficial discounting, forgot to put it on there, or it was too easy.

I really didn't do much, and I can't add value to it. One of the key things in here is, is the free post-op checks included in that fee because an orthopaedic could have 5 or 610 or 15 minute consultations post-operatively, has that been covered? There's another big leakage of free veterinary time.

Getting through this, so I just want to reiterate a couple of things we've said over this series that are probably important to consider in terms of the quality of medicine and your financial state. Beware of unofficial discounting, the no charge, the free consult, the low cost consult, the 3rd consult, that is just depreciating your veterinary time. Find a way to add value to those of the clients who can charge an appropriate rate.

Make sure all your products and services consumables, are charged out correctly, which is down to the practise managers to make sure your pricing is right. One way to make sure you do this properly is computer systems, itemised worksheets in, in hospital size sheets, detailed estimates, etc. Helps you capture these things.

Big losses in disposables, theatre times, drips, fluids, hospitalisation, hospitalisation, treatments. Again, this is a great topic for your vet meetings. Sit down, pick a topic, hospitalisation.

OK, what's involved with that? Where's our veterinary time? What are the disposables?

What should we? How do we construct a fee for this? OK, fluids, take each one of these topics and discuss it with your vets and find, let them find the value that they're putting into it.

I said my criteria here is if you just charge for the work you currently did, you'd probably double your profits overnight, OK? And of course, this is that then getting agreed and consistent clinical protocols with your vets, which will only happen if you sit down and talk to them, OK, and give them the opportunity to discover the work we're doing with that. So, overall, think about your pricing, clinical, very different from preventative, it's very different from drug pricing, they get 3 strategic price points, clinical to earn the income, preventative to gain clients, drugs to cover the cost and make a profit.

Invoice your consultations correctly, improve your consultation to your consultation 1 rate per proactive practising proactive medicine. Preventative healthcare packages and bundles is, is the simplest way of of dealing that. That's not work for vets, that's work for nurses and receptionists.

Look at your diagnostics, look at your hospitalisation, fluids and surgery, and just continually add value to your own time. Find your own worth in what you're doing as a veter. Highly skilled, highly necessary people.

We underrate ourselves and give far too much weight in direct contrast to what Panorama might say. So I think if I had my chance, it'd be a different story. On that note, Antony, I'd like to say thank you very much for listening, and if anyone's got any questions, I'd more than be happy to take them.

That's great, Alan. Thanks very much. That's been a fantastic sort of pulling together of everything, and, you know, I've really appreciated the four talks, obviously sat through them, have looked at some of them again, I passed them on to you, members of my staff, and, you know, certainly having put some of those ideas into action, we've certainly seen some results, so thanks very much for that.

It's a pleasure. I think you were suggesting that these will go up onto your membership site in the very near future as well, is that correct? Yeah, that's right, and I just wonder, you know, with people on at the moment, if people would see a value of us turning those into a CD or whether they may like them to be turned into an MP3 and whether people would see a value in that, and you know, whether they'd want to.

You know, pay, you know, a small fee to get those downloaded, or are we CD people or are we MP3 people? I've got a couple of polls that I've put together just from what you were talking about. Would you like me to run those and see what sort of results we get?

Be very interesting. That'd be interesting. OK, so let's have a look and see how, how they go on, .

The English isn't very good on the first one, but I'll I'll still launch it. Sorry for my bad English. It means, do you have a practise healthcare scheme?

I've missed the have out, apologies. I was trying to do 3 things at once, and it never works. There should be a possibility of you just voting either on yes or no.

And if we get a decent enough number, we can come back and see what the percentages are on those. I'll just let that run for a couple of more seconds. Nearly got everybody voting, just the last couple, which is interesting, so I think I will close that one.

Most people have voted. We've got 29% have a practise healthcare scheme. 71% don't.

71% don't, so I would I would urge everyone to look at that as a primary marketing tool for the future. It's going to make the difference in the coming couple of years, I'm sure. For those of you who haven't, we did one of the talks was particularly on practise healthcare schemes, so I would encourage you to look at that, and I know, Alan, we actually run a scheme at our practise, we use the same company that Alan recommends.

So, you know, do look at that webinar and I'm sure, Alan, you'd be happy to have a chat with people if they wanted to take something forward. Certainly the numbers on the screen there, if people want to just give me a call or email, more than happy to discuss. OK, just interested in the next one, are you a part of the Fort Dodge indices?

So, which of you, you know, obviously some of you will be vets, some will be nurses, some will be assistants. If you know if your practise does it or not, would be an interesting, just a, a feel for, whether they, they kind of throw all the data in and get these beautiful, beautiful reports off Alan. I think we're nearly there, Alan, to get it after about 4 or 5 years.

Easy vets have have finally got their act together. And I know Wendy's working on this, aren't you, Wendy? Good.

Right, OK, well Wendy. We will close on that. 24%, yes, 76% no.

Excellent. I, I would get, I guess that Ford Dodge is kind of changing a bit with Pfizer taking over, but at the moment still going forward. Yes, very much so, and of course Pfizer will open it up to a whole new raft of of people.

So if you are a Pfizer, if you're a Pfizer vaccine practise, it might be worth chasing them up about that. Right, 3rd question, do you measure booster uptake? Is that an OK question, Alan?

Yes, that's fine, that's something we do in the Fort Dodge index. We look at repeat, booster rates, for the practise, and of course it's something you can do fairly easily in most of your computer systems. I think many of them have that as a built in report some .

And what we're seeing over time is that it is dropping unfortunately in the current environment, so it's something you need to focus on, rethink about your reminder systems, of course, with the new technology, you can use email, SMS texting. The phone is still a beautiful way of actually communicating with people. We found we pushed ours up, we worked on it, we chatted to the staff.

We have a a pet health scheme and I'm. I haven't looked at it just in the last month or two, but it was about 50%, which is not great, but it was it was better than it was. Yes, so it's above average anyway, so that's good.

54%, yes, 46% no, so that's, getting closer. So we'll close that one, and then finally, because I know this is one of your big things, obviously the Fort Dodge practises may be doing it. Do you measure key performance indices in the practise?

So, obviously all of these things like, you know, how many anaesthetics do you do? Per month or per consult, per 100 consults, just to get an idea of what people are measuring, obviously turnover, cash flow. The interesting thing here is that most practises sort of look at the hard figures of turnover transactions, average transaction value, which is useful in what are we achieving, but the key performance indicators should be telling you how you're achieving it.

What is it you're actually doing that creates the value that's an important thing to know about. 47% yes, 53% no. That's excellent, that's really good.

Now, I don't know if I'm speaking out of turn here, Alan, and if you want to tell me off, you can tell me off. I know Alan does his his course, which is really a pre-course for those who may want to join his platinum group. He's not really talked a lot about his platinum group, but I know you're running one of these weekends this weekend.

I know it's very short notice, but . If anybody is particularly excited and wants to know more, they can give you a ring, presumably, Alan, tomorrow, a bit late in the day, I know, but, you know, I know your other one in November, which you advertised last time is fully booked up now, so there won't be any more opportunities until potentially spring time. Yeah.

OK. Now just 2 days, we cover a lot of these topics. We look at the marketing, preventative healthcare, web strategies, .

Offline and online marketing and then we look at all the financial factors we've discussed in these webinars, so it's really just a face to face refresher for those practises who really want to, Do something slightly different, with their practises and take on board some of these ideas. So it's, it's a free seminar, free two-day seminar. You need to just pay for your accommodation because it's over the two days.

It's down in Wiltshire, so if you're, need to travel, there's hotel accommodation, etc. For that. But yes, it starts tomorrow morning at 10 o'clock tomorrow morning they really will have to rush down.

But your other one in November to get organised. So maybe that won't work, but I mean if any of you were really desperate to go, I, I just thought I would. But if people are interested, they can ring us and put their names on a waiting list for one cancellations, which we hope we don't have, or 2 next year we'll certainly be doing the same thing again.

Yeah, that's great. And it's about, is it about 150 pounds for the accommodation. We stay at Alexandra House Hotel, which is very nice.

It's full bed and breakfast, accommodation. It's got leisure facilities. It's also, that's the room rate for the two days, lunch is included, all your refreshments.

So 147 is purely just to cover costs, but the, the content and the, the seminar are are free from me. What we will do is . See if we've got any questions here and then.

I've, I've got . I've got a little something about the webinars, which I'll say at the end. So if people want to get off, you can do, but let's go over this and see what we've got.

Basically, just, just while we're looking at those, we've got . Quite a lot going on with the webinar Vet now, it's quite exciting times, lots of webinars happening, so if you are interested, we'll perhaps have 10 minutes of questions, and then if there's anybody left, I know there's people on that probably have heard me talk about it a few times, so you may get bored, so let's do that at the end. Let, let's have the first question, which, I can't see who this is from actually, Peter.

Peter, when you talk about the cost for consumables, are you adding a markup and how much? If you estimate the cost for external lab, you just pass the cost on or have you a markup? That's one for you, Alan.

Thanks, Peter, for good, good question, Peter, . What I see in a lot of practises is they, they, the way they come up with the lab fee is take the lab fee from the laboratory and add a 50 or 100% markup, but of course that skews the cost and it doesn't necessarily represent the cost you've incurred in the scheme I described there. I charge for taking the sample, which is my time.

I passed the direct cost from the lab fee on. Now, I might add 5 or 10% to that just as a cushion for lossages and loss and leakage through that, etc. But generally I'm being fairly transparent.

So that's just a cost to me. I pass that on. Where I make my money is from selling my professional time.

And other such things. It's, it's, it could put a costing, but I wouldn't suggest it's a huge markup, for that, because I don't think that's fair on the client, particularly. It's not particularly transparent.

My, my income is generated from me taking the blood sample, interpreting the blood sample, and feeding. That back to the client. That's my, my fee if I price that right, the cost of the lab fee is immaterial.

And then of course you have the consultation, your first primary or secondary consultation on the in the first place because that's a different process. No, but in your blood test you've got the taking of it, the cost from the lab, but you've also got the consult at the end where you get them back in to say. This is what the bloods have shown.

Yes, now it may be that whole cost comes to exactly the same as a 100% 50% markup, but it's much more transparent and it's much more logical way. The importance of of these pricing strategies is to convince your vets to do it, and assistant vets in particularly, if they can see logic and reason, they're more likely to do it, otherwise they just see it's a price that someone's made up. Yeah.

Just before we go on to the next question, thank you so much for doing those polls, because I think they're fascinating. We, you know, I enjoy them, and I think, Alan, it's interesting for you to see what's going on. I've also done a little survey at the end.

When you come off the webinar at the end, there's about 3 or 4 questions. If you could be good enough to answer those, it helps me to see what I can put forward for the future, and I know Alan has talked about doing. Some other webinars, maybe even getting other, practise management experts involved.

So, you know, if you let us know the sort of topics you'd like us to cover, I can obviously feed that back to Alan and, and he can look at that for the future. Right, next question. Routine health check vaccination.

Do we charge additional fees for empty anal glands, clip nails, etc. Oh, you tell me, do you? I, in my, again, I'll just in my practise, a, a consultation was a set piece of work.

A vaccination was a set piece of work. It's a full health check, of the animal, it's the vaccines given, and any work generated beyond that was usually a chargeable item. So in, in my practise, yes, anal glands, clipped nails, anything extra would be passed on.

Two things we would do with that is, one, I'll probably There would be a reduced cost. It was part of another consultation. 2, there would be a veterinary cost.

If someone came in purely for anal glands, it would be, and they, and they wanted a vet to do it, I would charge my 10 or 15 minute consultation. If they wanted a lower price, I would pass it on to a nurse to do that as well. But if the answer to the question, yes, it is a separate piece of work that is chargeable.

And it's not the time you take necessarily or what you do, it's the value to the client that you're actually charging for, OK, and most charges will happily give you a fiver to squeeze anal glands rather than them do it themselves, to put it slightly cynically. I think, would be an interesting poll question, Antony. Yeah, now could I do one quickly, I don't know quickly.

Don't. Don't make me triple task, it will all end up horribly wrong. Peter just said, in addition to that question, we just asked, what about consumables, how do you mark them up?

Or how do you suggest we look at that? Again, got to be a little bit careful. Consumables in my mind, they're either prescription drugs or over the counter drugs, or food, anything are consumable in my definition is anything you buy and resell, and therefore probably should be marked up to a degree.

Unfortunately, what happens in veterinary practise is. We rely on the markup on consumables to make up most of our profit, and we don't charge still sufficiently for our veterinary time. And if you look at the breakdown I showed this in, I think the last seminar or the one before, when you look at the breakdown of your fee income, your veterinary fee income versus your drug income, you make 90 to 150% of your profit from.

Drug income because we compensate, our income with drug income. The markups are huge. They're actually extortion in some cases.

But we need those in the current thing because we just don't charge enough for our vet time. If we just charge for our vet time, we can almost give the drugs away at cost, it wouldn't matter, but I'm not saying you do that because obviously they're gonna get paid for them. You'll do it.

Consumables need to be, Marked up according to their category. And again, I would say work if you're talking about something like an X-ray and ultrasound, look at the cost of using the X-ray machine on an average basis and there would be a 5, 10, or 15 pounds per usage fee that would cover. Your least cost and your maintenance, etc.

It's kind of a practise management job to work some of this out. Of course, you can go back to your figures and look at these things if you've got good records. But yeah, markup is a sensible way to run a retail business, and that's all consumables are.

You buy stuff in mark up and sell it off. But like I said, unfortunately, we use that to excess in veterinary practise to compensate for not charging for our veterinary time. I hope that answers your question.

Yeah, no, that's good. Let me just get the the next question up. Sorry, I've been messing with screens there, so I do apologise if that's been.

Upsetting people. Is it possible to access the previous webinars? Yes, it is.

We're not going to keep them open for very much longer because I have left them up there, but if I go to the website, and I will just check that they are where I think they should be, we've also got audios which we are looking to sort out, but . Not everybody can see those if you're not a member of the website. The membership is a monthly fee and it gives you access to the website, and you also get free access to all the live webinars.

So let me just look at the webinars coming up. Sorry, these webinars here, and I hope that these are on veterinary practise management. Let me just see if they come up.

I have a feeling, Alan, that I have put those . Actually into the membership site now. If there are people who particularly want to see them who are on the, the webinar, perhaps if you send me an email and we can sort something out.

To let you have a little look at those, if there's a particular one you want to see. I think we've got pricing for profit without feeling guilty about it, part one, then what's your professional time worth part two. We've done the part 3 just today, and then Alan also did one on practise health schemes why every profitable practise needs one.

And I actually got an internet guy to help me 5 simple tricks to improve your website, which was very interesting seeing as most websites are pretty poor by his reckoning anyway. . So that they're all the er various webinars we've got, so my particular interest is dermatology.

If we go into that, you can see, . There's one on AIP, there's one on food allergy, pruritus, and there's also one on pyderma. And then at the moment, ones that may interest people because they are free at the moment, are the, let me just see them coming up, if this is helpful for people.

There's a couple on Cushing's disease, one on dentistry. Topical therapy and veterinary dermatology and the ATP talk is also on the free one. So if people want to have a look at those, and you like what you see, there may be some, benefits in, in you joining the membership which Till, it's, it's 47 a month for a .

For a single member, it gets cheaper if it's a practise membership, proportionally, but we are doing a, a, a little offer until the . Until about Tuesday, I think it's the 1st or the 2nd of November, instead of 47, the first month is . 27.

So if that is helpful, if if people have kind of liked what they've seen, you can have a look at it for a month then, and what you need to do is press on the gold membership 47 pounds button, and then when you get to the shopping cart, there's a discount box. Put the word Cushing's as in Cushing's disease, hyperadrenal corticism. In the box, and that will bring the price down by 20 pounds.

I if you, what will then happen is in a month you would get charged £47. So if you don't like it, if you think, oh well, I, I'm not getting value out of this. Obviously, if you if you cancel, if you let us know, then you would only be charged 27, but if you don't let us know, you will get, you will get charged.

Webinars coming up, . Let me look on the products page, if this is helping people who are still in. I'm doing a talk on dermatophytosis or ringworm next week.

We've got John Innes talking about hip dysplasia the week after. Filippo de Bellis, who is a dermatologist like myself, talking about otitis the week after that and . We've not got it on here, but Alison Lambert is doing a practise management one on secret shopping and the effect your reception, your reception team can have on turnover.

So there's some of the things going on. Do you agree, Alan, that the reception can have a big effect on the practise? I I would imagine that'll be an excellent, webinar.

Alison does a very good interactive process. And just to back up what you're doing there, Anthony, this still must be the cheapest CPD in the country for vets. Well, you know, I, hopefully people just get value out of it, enjoy it and I'm getting free CPD so everybody's happy.

Good. Do you advise charging extra to see someone out of? H Cons hours, but during the day, I presume normal consulting hours but during the day.

Not necessarily, but what I would say is the, the two places you earn income in your, in your building are in the consulting rooms and the operating theatre. If they're empty for any length of time, you're not earning money. So the question is, when are your consulting hours?

And again, I would just go back to what we practised was they were open from 8 o'clock in the morning till 8 o'clock at night, basically. So no, there was no differential for that. One thing you can think about, if you have dead time in your week, you can actually, charge a differential price to get maybe pensioners, some, for different people into practise to differentially, get them to pay a different price, but I wouldn't drop that below your, your marked, market price.

But they might be charged at maybe a cons too when they normally get a charge points one, but that's a marketing tool just to ease your, client flow. But not necessarily. I mean, if it's truly inconvenient that they come in, during the day, but out of, your normal consulting time, they'd either have to wait or you'd be perfectly reasonable to, to charge them a fee, but I wouldn't, we didn't naturally do that.

We're more than keen to have them come in in the first place, so we wanted to encourage them. Great, I think we'll let everybody go. Just before we go, a lot of people always ask about certificates.

What I will do with this particular webinar, I think, is we will put the webinar on the free site, so if any of you want to go over it, we'll keep it on the free site for a week so that you can go over it, and what we'll do is we'll put the certificate next to the webinar. If you go to the webinar vet.com and then you move to the .

To the webinar section. So let me just find that for you because it's, it's, it can get a bit complicated. If you go to the, the free webinar section there, and you click on one of the webinars, which we will quickly do, the ATP talk, and we'll put, we'll put Alan's in here so that you've got a chance to, to look over it again.

You'll see that, or at least I hope. There should be a certificate around, not on that one. Let me have a look.

I know there is for the Cushing's ones. Oops. Just got something in the way I need to move out the way here.

Just give me one second. Yeah. Yeah, if you go to free webinars, apologies for this, but we, we will put the certificate next door to the .

To the talk, so if you go to hyperadrenal corticism. You can see that underneath we have an attendance certificate. So they were two very interesting talks for those who didn't make them.

Professor Mike Kurtti from Cambridge University, and it's just a case of you printing that up and, putting your name in. That's I think all I need to show there, . And .

I think all, all, all else really to say is, again, Alan, thank you so much for, you know, for giving of your time. I know it's probably not the best day, the day before you're doing your weekend presentation, but I really appreciate you making some time. I've thoroughly enjoyed it.

Unfortunately with webinars, we can't have too much clapping. There isn't always the the atmosphere we would like, but I'm sure everybody has enjoyed it, and we can see from the questions, it's certainly given us a lot of food for thought, so thanks again, and I look forward to speaking to you soon and I will get that webinar on probably by Monday, Tuesday, so if any of you have any issues, problems. If any of you are not sure about this 27 pounds offer and you want to email or phone us up, all the information is on the webinar vet sites.

Have a look at that and either speak to Wendy or myself or send us an email. We'll see if we can get that sorted for you. Thanks again, Alan, and hope to speak to you soon.

Pleasure, thank you. Good night. Thanks, Alan, good night, bye bye.