Competition and Markets Authority identifies multiple concerns in vets market

• CMA provisionally decides it should launch a formal Market Investigation.

• Initial review prompts over 56,000 responses from public and vet industry.

 

***

​

As the CMA report highlighted, corporate groups retain the name of the original practice post-sale, which is very misleading. Almost as if they have something to hide.

​

I am the Managing Partner of my own practice – independent – and have been calling out for an investigation for years. Sadly I think the damage is largely done and the CMA will probably struggle to make the changes that really need to be made, with the potential knock-on that good independent practices will become mired with added bureaucracy which will counterproductively simply push up costs.

 

I have been fending-off would-be purchasers for years and have built our ownership team now to 10 vets. There has been far too much focus on vet practices as opportunities for financial investment, instead of lifelong career businesses. I maintain a guiding compass that every practice has three values:

 

Financially – obviously, we are businesses and have to balance our books which means we have loans, balance sheets, P&Ls etc. just like any other business.

Clients – without the clients’ loyalty we don’t have a practice.

Staff – it is a team approach to get it right. If we balance the needs of the business, our clients and our staff then we will deliver the most appropriate care to the animal – and do it in a way that is to the best of our abilities. Whilst what we do is work with animals, how we do it is by working with people.

​

***

​

A vet practice as a business is valued as the sum of its tangible assets (buildings, equipment etc) and intangible assets (goodwill). The goodwill is the ability of someone buying into the practice to generate an income from the client base that has been established – a partner selling shares has put the work in to build the practice so receives compensation for this through the value of goodwill. Goodwill is calculated by establishing an average recent level of “profit” (earnings before interest, tax, depreciation and amortisation – EBITDA) and multiplying it by a factor. The multiplication factor is a reflection of the value that a selling partner places on the time he has invested in building the business and the value that a purchaser is willing to make.

 

Traditionally vet practices had multiplication factors in the region of 3-4x EBITDA for a good practice – in other words, a buyer could reasonably expect work to continue for another 3-4 years simply by piggy-backing on what the previous partner had achieved. As a fragmented market of veterinary business owners this system worked well.

 

Unfortunately, corporate groups decided that the veterinary sector could be plundered for investment of Private Equity capital and a land-grab began, with the big corporates buying up practices for 10-15x EBITDA! Partners of practices saw the £££ and jumped at the opportunity to take the cash and retire early. The corporate groups then underwent a process of corporate arbitrage – selling on to bigger Private Equity houses and increasing the EBITDA multiple each time. IVC reckons its EBITDA multiple is now 25x – for practices that used to value themselves at <3x. The big problem is that these high levels of Private Equity debt need servicing and this sucks huge amounts of money from the practices – money that then essentially leaves the ecosystem of the veterinary profession because it is lost to the City instead of being invested back in the business.

 

Unfortunately this is far too complicated for headline-grabbing UK media, so never really gets reported.

 

I am reminded of the confrontation between Tom Cruise and Jack Nicholson in A Few Good Men:

Cruise – “I want answers.”

Nicholson – “I’ll give you answers.”

Cruise – “I want the truth.”

Nicholson – “You can’t handle the truth.”

​

***

 

THE WELFARE OF ANIMALS. David Thomson MRCVS

It is with a heavy heart and a lot of depressive soul searching that I am writing this.

I am David Thomson, a graduate from London 1976. I have seen changes in my once beloved profession that are really upsetting me. 

I held my hand up in 1976 with pride. I then stated,

"I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care."

In no way did I agree to the current statement from the standards guidelines by the Royal College of Veterinary Surgeons to the veterinary profession.

You may also wish to review information from Chapter 9 of the RCVS Supporting Guidance which comments on this issue. This states,
 
“9.16. Where a client cannot afford to pay the fee for veterinary treatment, the veterinary surgeon may wish to discuss the availability of charitable services or assistance with the client.
9.17. All charities have a duty to apply their funds to make the best possible use of their resources. Clients should contact the charity to confirm their eligibility for assistance. The veterinary surgeon should ensure that the animal's condition is stabilised so that the animal is fit to travel to the charity, and provide details of the animal's condition, and any treatment already given, to the charity.
9.18. Where the client is not eligible for the charitable assistance and no other form of financial assistance can be found, euthanasia may have to be considered on economic grounds."
 
I work in Stoke on Trent and have done since November 1976.

I feel the problems with our profession goes some way back.

 
When I started I was only allowed to put a small plaque up. Then came advertising being allowed so that that loudest advert attracted the most clients and so on.

In the 1980s insurance started with Pet Plan, and as an idea I thought that it was excellent but with the caveat that I thought some practices might put their prices up using insurance.

 
Specialisation was started in '80s which meant that apart from ringing the colleges for advice previously, and doing all the surgery procedures ourselves, in some cases we could send the more intractable cases to these specialists.

 
Then came corporation of veterinary practices, and practices then being able to be run by NON VETS, apparently due to EU regulations on competition; then the corporates started to takeover until now they control 60% of all Veterinary practices.

This was all the logical evolution from the guidance from the RCVS which ultimately eroded the very fabric and core of the profession by way of handing over welfare of animals eventually for corporate profit.

I am so unhappy that the veterinary  profession, once  beloved by the masses is now considered a profession of greed avarice and uncaring.

The first question in any consultation now seems to be,  “Are you insured?“ and not,  “How can I help you?”

It says in 9.16 that the charities should help.

 

But how?
 

They are all strapped for cash. The PDSA in our area has virtually closed its lists, there is no Blue Cross, and at present most independent veterinary practices are taking on no more new clients; the end result is the the RSPCA is more interested in prosecuting those people who fail to provide veterinary attention for their animals even though they cannot get into a practice. 

A further result is a massive distrust of vets - their pricing and their interest in money rather welfare.

A client is now asked for their credit card number before treatment begins. This is illogical as how does the client know how much is going to be charged? This brings us back to the whole point of welfare for the animal and the client.

There is an dark undercurrent now and a massive rejection of veterinary services; a disturbing new underworld of treatment and purchasing of drugs on the black market has inevitably started. I am told by a person who is not a vet that you can get any drug whether it be tablet, injections or vaccinations now.

Why is it that we as vets cannot purchase some drugs at the same price or near to those of the prescription companies? For example, Meticam costs me £45 plus but you can buy it online for £22 including postage.

How do we compete ?.
 

Once prescriptions were given without charge, a compulsory mandatory edict from the VMD, but now they have to be paid for and can be charged at whatever price the individual vet practice decides.

My son is a farrier. He tells me stories from his clients, the most recent being of a dog with a small 1/2 inch cut which had been taken to the vet. The vet suggested it needed a full anaesthetic in order to be stitched. The owner refused and so the vet agreed to sedate the dog and put in two stitches at a cost of £540. I ask you, is this reasonable? We would not even sedate a human being to put in two stitches. Wouldn’t just cleaning the wound and putting in two quick staples have done the job as efficiently and at a fraction of the cost?

A local vet practice boarded a dog overnight at a cost that equated to my and I staying at the Savoy hotel for two nights. This begs the question, Where is the Royal College of Surgeons advising its veterinary surgeons on a mandate for providing welfare because how can a little old lady with her Yorkie be a bad owner because she can’t afford a £1000 bill?
 

We have forgotten all of our standards of welfare to the animal and client?

We seem to have forgotten who we are?

Years ago, I said to then President of the Royal College, "WE ARE NOT BRAIN SURGEONS, WE TREAT ANIMALS." I think that has been forgotten these days; some of the prices charged are just incredulous.

We have forgotten that we used to sort things out most times without the need for a specialist, but admittedly they were useful to talk to and were there to help in those intractable cases.

We have forgotten the Art of Veterinary Medicine and Surgery and it seems now just to be Veterinary Science.

This brings me to the point of specialisation and the problem it can create for some veterinary surgeons, because now graduates in many cases have not been enabled to routinely handle flesh and gain experience with routine non-elective surgical procedures.

This level of specialisation is what the corporates are investing heavily into, providing veterinary first -opinion practices and state-of-the-art second-opinion specialist clinics with CT and MRI scanners, laboratory facilities and all the add-on mod cons looking to control the day-to-day running of the style of veterinary practices. Eventually there will be no independent veterinary practices or those independents able to afford to employ young vets to give them experience to do any non-elective routine surgery as all cases will have been referred to specialists at an extra cost of course.

What is the Royal College doing about this?

What has the Royal College been doing for the last 30 years in not seeing what was happening?

The new edict in September 2023 requiring all animals to be examined by a vet before being prescribed or a prescription given for items such as POM wormers and flea medication has only fuelled an increasingly annoyed and disenfranchised general public.

Clients are coming into practices and venting their anger on being charged £52 for a worming tablet on the poor veterinary staff who have no control over pricing, and in a lot of cases on the veterinary surgeons too, which is creating such stress in a profession known for its lack of retention of staff and high suicidal rate.

I’ve been working for over 45 years and am now doing restricted work with local charities and stray dogs homes shelters.

In the past I have run a practice with 7 Vets 30 staff. I tried deliberately to keep prices down in our area.

The people of Stoke-on-Trent (and many other areas) are getting into an increasingly desperate state to the point that they virtually can’t afford to have animals treated., and when they can’t afford the treatment they are then offered, under the RVC guidelines, the ”final solution” to have their pet euthanised. However euthanasia itself is now getting so expensive for the client that they are having to start literally taking matters into their own hands.

I have always gone by the mantra that in all surgery....

“YOU SHOULD FIRST DO NO HARM.“

It appears no that some surgery is being done in some cases solely so that the profit can be made  with no net benefit to the animal.
 

This is not an exaggeration.
 

I have been sent the x-rays of a dog involved in a road traffic accident. It had had fractured its pelvis. The dog was walking and eating but in some discomfort . X-rays were taken and they showed a small pelvic fracture that the veterinary practice said would cost £9000 to repair.

I advised  the client to rest the dog and give it Meticam. This dog is now fine. When I showed the x-rays to a human orthopaedic consultant he questioned why was it even necessary to consider surgery!

How can this state of affairs be stopped?

Where is the leadership from the Royal College about the standards of welfare for animals and clients?

At one time veterinary graduates used to come from parents in veterinary practices, equine establishments, farming, game, conservation and medical practitioners, people in country outdoor pursuits and such like. These individuals had the sort of attitude that enabled them to overcome issues that faced them; they were very self-reliant.

New graduates are facing increasingly challenging pressures, this can put them at odds especially when making clinical decisions when they feel they are, and are, being led by practice protocols and especially corporate practice protocols.

The art of veterinary medicine and Surgery used to be

LOOK - Observe the animal and client.
TALK and, BUT more importantly, LISTEN.
SMELL - anything out of the ordinary.
TOUCH and FEEL.
 

To Vet something was to examine it thoroughly!

With the use of these arts at our fingertips we would endeavour to make a diagnosis to help both the animal and the client.

In many cases we would start with a fairly simple treatment without doing anything expensive to see how things progressed; later we would perhaps do some relevant tests to confirm our diagnosis.

X -Rays were done to confirm our diagnosis and NOT to find one.

There seems, in some cases, EXTRA UNNECESSARY TESTS being performed under these corporate protocols that these overworked young vet staff are faced with rather than being given the chance to use their vast knowledge as newly qualified vets (though tinged with inexperience). They are forced to run with the protocols they have been told to use to increase prices of treatment to clients.

Veterinary medicine has become more expensive through many things - increasing drug costs, staffing costs , building investments, , laboratory tests, rents and sheer running costs, but the huge increase in veterinary fees must be justified to an increasingly unbelieving and sceptical client who sees just money being the main motivation for corporate veterinary practices.

The overuse of MRI and CT scans as stated at the London Symposium is very worrisome as why does everything seem to need scanning just to “find” an answer?

Is it just because the practice has invested in this technology so it HAS to be used to cover the cost of investment, rather than a benefit to the animal and client?

It seems that this “GOLD STANDARD” seems to be the way the Royal College wants the profession to move to.

But do we want all practices to be the equivalent of Harley Street clinics, forgetting that general practices should be looking at ways of simplifying and moderating some of the treatments given to animals to achieve the benefit required then, and only if necessary, ramping up tests and treatments as each individual cases should require; this the client could understand and accept.

The use of specialists in the event of it being required should be just that, but it seems the norm now is to refer these cases immediately to specialists who unfortunately have their own pricing structure.

We need to get back to the time when the ANIMAL is what is important, not finance.

I have so much more I could say. I could talk and explain so much more. I’ve been trying to say this for ten years and especially in the last five. I’ve written to newspapers, I’ve written to the Royal College but one individual is only one small voice and nobody is listening. Soon we will not have a vet profession; it will all go underground.

How can you expect people to pay these ever-increasing exorbitant fees; how are these fees sustainable in the long run?

I am 73 years old now I’ve seen it all and I am so depressed. However I will not retire while I can still help those people who cannot afford these so-called veterinary fees as my conscience will not allow me to stop working as an independent vet.
 

When I raised my hand, I said I would do all I can to relieve the suffering and improve the welfare of animals . I believe in my whole being I really care, do you?

 

Use an independent veterinary practice.