Sheep medicine has traditionally been a low priority for cattle-dominated practice, as it is commonly thought that there is minimal financial opportunities in this sector. The perception has been that the vet’s role regarding sheep is that of an emergency care provider and that farmers would be reluctant to pay for training and preventive advice. As such, this has inhibited investment in sheep services within farm animal practices that predominantly focus on dairy cattle, as these services are deemed less lucrative revenue streams for the business (Bellet and others 2015). In this article, we explore the challenges associated with delivering sheep preventive medicine within private veterinary practice, and look at how, by harnessing positive relationships with commercial flock owners, farm animal practices can develop this service.
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Emily Gascoigne qualified from the University of Cambridge in 2012. She is currently an assistant at Synergy Farm Health in Dorset.
Fiona Lovatt qualified from Bristol university in 1995. She runs a sheep veterinary consultancy business and is a clinical associate professor at the University of Nottingham.
Andrew Davies qualified from the Royal Veterinary College, London in 1986. He is the managing director of Synergy Farm Health.
Jonathan Reader qualified from the University of Bristol in 1997. He is a founder director of Synergy Farm Health.
The challenges facing commercial sheep flocks are multiplying, with increasing diagnoses of anthelmintic and flukicide resistance (Gordon and others 2012, Glover and others 2017, Hamer and others 2018), recent diagnosis of resistance in Psoroptes ovis to macrocyclic lactones (Doherty and others 2018), diagnoses of antibiotic resistance in common conditions in sheep flocks (Lacasta and others 2008, Gascoigne and Millar 2015), the emergence and spread of novel diseases (Harris and others 2014), endemic diseases (Ritchie and Hosie 2014) and ongoing economic challenge. In addition to the necessity to demonstrate due diligence with regards to antibiotic prescription (RUMA 2017) (Box 1), there is an increasing requirement for engagement between vets and sheep farmers.
Like all other areas of the veterinary profession, the industry is being required to justify and reduce its use of antibiotics. While the estimated use of antibiotics is low for the sheep sector compared to other sectors (Davies and others 2017), the Responsible Use of Medicines in Agriculture Alliance (RUMA) has identified three key areas where usage can be reduced.
Infectious lameness management,
Routine use of antibiotics in the management of infectious abortion,
Use of prophylactic antibiotics in neonatal lambs.
The key targets set by RUMA (2017) are:
Reduce total antibiotic use by 10 per cent by 2020,
Monitor and reduce use of high-priority critically important antibiotics by 50 per cent by 2020,
Coordinate national data on usage,
Reduce national lameness level. Increase the number of foot rot vaccine sales by 5 per cent between 2017 and 2021,
Reduce abortion in ewes. Increase the chlamydial abortion vaccine sales by 5 per cent between 2017 and 2021,
Reduce use of oral antibiotics in neonatal lambs by 10 per cent between 2017 and 2021,
Increase knowledge transfer of best practice among veterinary professionals.
Although it has set these targets, RUMA does acknowledge that there are challenges that the sheep industry faces, including low veterinary involvement in the sector with many Prescription-only Medicine – Veterinarian, Pharmacist, Suitably Qualified Person (POM-VPS) prescriptions and dispensing occurring via merchants, and sheep enterprises using multiple veterinary practices. However, there is an opportunity for practices to review standard operating procedures with regards to their prescribing and dispensing for sheep flocks. A guide to prescribing is available from the RCVS at www.rcvs.org.uk.
Historically, sheep work has been a low priority for vets working in farm animal practices that predominantly focus on dairy cattle, and has accounted for a small percentage of turnover despite the high proportion of holdings within practice portfolios (Reader 2014). Furthermore, farmer perception of sheep vets has sometimes been quite negative, with farmers citing vets’ lack of knowledge of sheep, a lack of consistency of care, high turnover of vets and time constraints of vets as factors that undermine a positive, proactive interaction (Kaler and Green 2013).
How to develop engagement with flock owners?
When designing a service for sheep clients it is important to understand the drivers and motivators for commercial sheep flocks, as well as the reasons for previous resistance to engagement with farm animal vets. A commercially sensitive service delivered by practitioners with a special interest in sheep medicine is required, but it must be one that is mutually beneficial for both farmer and the practice so that is economically viable to permit ongoing resourcing and reinvestment.
A fundamental criterion for a successful sheep vet is an interest in sheep health and production. While an encyclopedic knowledge of sheep systems is unrealistic, especially for new graduates, an interest in sheep medicine and a willingness to learn is necessary.
The perceived high economic costs of vets with regards to sheep flocks may dissuade farmers from engaging with their veterinary surgeon, but this is one challenge that vets should not be afraid to tackle. Fundamentally, the difference between cost and value should be understood and communicated. Poor advice, that is not based on evidence or is given without ongoing follow up, is costly for the farmer, potentially costly for animal welfare and highly damaging to the relationship between farmer and vet. A high standard of advice is fundamental to this working relationship. Vets wishing to work with commercial flocks need to understand the cost of production of lamb, the cost of key diseases and be prepared to communicate their own knowledge to clients in these economic terms for flocks.
Ultimately, vets wishing to work with sheep flocks must understand the difference between ‘investment’ and ‘cost’ and the value that the positive impact of investment can have on flock health and welfare. Areas that farmers could invest in veterinary involvement include:
Flock health planning strategy visits,
Ram checks in advance of mating,
Abortion management strategies that are put in place in advance of mating,
Robust quarantine procedures that aim to preserve performance, in turn creating a robust flock in advance of anticipated health challenges.
‘Positive’ veterinary spend also includes laboratory work to inform flock management, such as worm egg counting throughout the grazing season, Coccidia speciation before treatment, Fasciola hepatica screening protocols and sheep scab serology at purchase. Veterinary input is of high value if it is of a high quality and based on evidence from the farm. ‘Negative’ vet spend is ‘damage limitation spend’ – cost of disease already incurred plus additional investigation cost. Positive vet spend is in a preventive capacity before the cost of disease can be lost. For example, managing an abortion outbreak at lambing will incur costs of intervention, diagnosis and management that will far outstrip any costs that would have occurred in a preventive capacity (Table 1).
Different models for providing services
For descriptions of types of flock health packages, readers are referred to Richards and Knight (2005), Ganter (2008) and Gascoigne (2016). Notably in the UK, Flock Health Clubs (Anon 2016a, b) can help spread the cost of preventive health care (ie, flock planning meetings) by monthly payments or by sharing costs between groups of similar flocks using group knowledge transfer. There has been a high level of national uptake for these clubs by private practitioners and commercial sheep flocks.
Appropriate communication is constantly evolving and once practices have developed novel services it is crucial to send out marketing around these. In addition to the traditional paper-based farming press and radio, social media platforms, such as Twitter, Instagram, Facebook and SellMyLivestock (www.sellmylivestock.co.uk), are growing in uptake. The RCVS issues guidelines for veterinary surgeons and practices engaging with social media, either professionally or personally, which can be found on their website: www.rcvs.org.uk. How we are engaging with our clients is evolving and novel services should take advantage of this.
In our experience, a focused approach to engaging with flocks is crucial. For example, providing targeted advice by flock type (ie, flock size, organic versus conventional flock types, store lamb versus breeding flocks) has had a positive impact on service uptake. This could extend to targeted newsletters, meetings and discussion groups.
Ideally, any package structure that is developed should include sufficient visits to the flock to generate flock-specific data and to hold discussions with the farming team to pass on flock-specific advice.
Appraising your sheep business
‘Big data’ generated in practice is used to inform clinic protocols, facilitate disease surveillance and to facilitate business development and appraisal (Santamaria and Zimmerman 2011). There are few published examples of how big data or informatics can be used to appraise business performance in farm animal veterinary practice (Smith-Akin and others 2007) but it can be a useful approach when developing an aspect of your business.
In a study by Gascoigne and others (2017), a sheep veterinary business was appraised by extracting data from the practice management system. This coded data was used to assess how sheep farms were using the practice (ie, visit types [flock, individual], purpose of the visit [preventive, investigation or intervention] and themes of visits).
Table 2 summarises the key performance indicators that practices could use to appraise the sheep sector of their practice. These include:
Number of active ovine farm clients and sheep within the practice,
Change in number of flock health planning visits over time,
Number of training places filled on sheep-specific training courses run by the practice,
How many clients are flock health club members,
Change in turnover of the sheep business over time,
Gross margin of a sheep vet within the practice.
A day in the life of a ‘sheep vet’
Practitioners should remember that while there is increasing emphasis on flock health work, ‘intervention’ visits (ie, incidental and emergency work) still have huge importance for both smallholders and commercial flocks. Gascoigne and others (2017) found that intervention visits accounted for 68 per cent of all veterinary visits to sheep farms, with preventive work accounting for just 19 per cent. In this study, the main reasons for veterinary visits to sheep farms were sick animals (30 per cent), obstetrics (20 per cent), lameness (13 per cent) and flock health planning (11 per cent) (Fig 1).
We can see from Fig 1 that parasitic gastroenteritis appears underrepresented given its significance to small ruminant production. This is likely to reflect its inclusion in flock health planning and consultancy in a preventive capacity, performance in an investigatory capacity (ie, where poor performance is being explored), or may also be a reflection of the diverse range of animal health advisers through which worm management is provided. This highlights the importance of establishing a common ‘language’ when using informatics for practice analysis.
When examining the reasons for ‘sick’ animal visits in more detail (Fig 2), we can see that where cause of visit is described skin (18 per cent) and euthanasia (14 per cent) were the most common reasons. Visits were unspecified when there was insufficient detail on the practice management system to assign a topic to the visit. Gascoigne and others (2017) found that ‘sheep scab’ was the most common reason for skin visits within the study practice, which is highly relevant given the recent diagnosis of macrocyclic lactone resistance in Psoroptes ovis (Doherty and others 2018). It should be noted that the study practice in Gascoigne and others (2017) is based in England and therefore sheep scab is not notifiable, although it does come under the Sheep Scab Order 1997. As a consequence, practitioners and farmers are not required to inform the APHA of any suspicion or confirmation of sheep scab. But, nevertheless, one can see how good practice informatics potentially have a role in supporting surveillance.
Developing your practice ‘sheep specialist’
There is an opportunity for individual practitioners within a practice who have a particular interest in sheep work to develop this interest further; for example, they may wish to pursue further study in this area (Box 2). In the study by Gascoigne and others (2017), a vet ‘with a specialist interest’ had a markedly different caseload within the practice, spending 44 per cent of their time on preventive work, 29 per cent of their time on investigative work and just 27 per cent of their time on interventions and emergency work.
Routes to specialising in sheep medicine and production
For practitioners wishing to pursue further specialism in sheep medicine and production there are several options depending on the requirements of the practitioner, the practice and the time available.
For those wishing to increase their knowledge to expand their understanding of production, further training is available from:
The Sheep Veterinary Society (www.sheepvetsoc.org.uk )
Commercial providers - such as BVA, London Vet Show, Flock Health Ltd.
For those wishing to pursue formal further training, the RCVS introduced the Certificate of Advanced Veterinary Practice (CertAVP) (Sheep) in 2007. Practitioners are able to access the CertAVP(Sheep) through:
The University of Liverpool
The University of Edinburgh
Practitioners are able to add extra modules to the certificate and three ovine-specific modules are available:
Diseases of adult sheep
Reproduction, pregnancy and parturition of sheep
Diseases of lambs and parasitic disease
To achieve a designated sheep certificate, completion of all three ovine modules is required.
Unless a practitioner already holds an RCVS diploma, to achieve recognised Specialist status in the UK, veterinary surgeons need to achieve a diploma of small ruminant health management awarded by the European College of Small Ruminant Health Management (ECSRHM) as part of the European Board of Veterinary Specialisation. This can be achieved either through:
A university residency (typical programme length three years) under the supervision of a diplomate of the ECSRHM or,
In practice (ie, the alternative route).
The alternative route is not in a designated training centre and not under the direct supervision of a diplomate. It is anticipated that this route will take longer than the university residency but both should be completed within seven years. It is recommended that residents have caseloads where over 60 per cent is small ruminants. Residents are required to conduct and publish original research work and case studies in addition to maintaining a case log. Further information is available at www.ecsrhm.eu
There are great opportunities for veterinary surgeons to engage more with sheep flocks, providing they are willing to engage in evidence-based medicine, spend time understanding the economics of both endemic disease and cost of management of those diseases, and use their imagination to deliver innovative solutions to flocks.
A fundamental requirement for developing a sheep service is a veterinary surgeon or team of vets who are genuinely enthused by sheep. It may be unrealistic to expect every member of a mixed or farm animal practice to fit this role, but it provides an opportunity for internal referral within a practice to those who are interested in sheep, and an opportunity to create a specialist role within the team who can take the lead on non-emergency work.
With vision, a supportive and enabling management team, imagination and an interest in sheep, generating income from proactive flock work for farm animal and mixed practices should be achievable for both the benefit of the sheep flocks and the practice. Innovative farmers and vets will recognise one another’s role in the success of each of their ventures.
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