Is this pro bono scheme the solution or a symptom of the problem?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Judith Joyce — Mon, 20 May 2024 08:15:07 GMT

I agree with both of you, but why pick on this scheme when I am relatively sure it isn't common practice to disclose all our incentives with our clients. I may be mistaken or the guidance maybe out of touch with the times. . Whilst as members of a liberal profession we could once proudly boast (whether true or not) that all our decisions were based on clinical grounds, many supply chain decisions are now taken out of our hands by procurement departments of corporate owners , where cost may be the deciding factor (ie financial incentive). The provision of CPD free to practices may also be linked to buying decisions. Not saying any of those are wrong or suggesting not following the guidance, but is there a mismatch between reality and the guidance as currently worded?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Michael Woodhouse — Sun, 19 May 2024 23:05:52 GMT

[quote userid="3513" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244632#244632"]The standard Fitzpatrick TPLO price being quoted on this forum, if correct, is certainly at the high end of the spectrum of referral TPLO prices.[/quote]

https://www.fitzpatrickreferrals.co.uk/veterinary-professionals/price-guide/

You would expect so.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Andy Moores — Sun, 19 May 2024 17:12:46 GMT

[quote userid="25265" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244622#244622"]

I would still like to know people’s opinion on whether the existence of this sort of incentive needs to be disclosed to all clients you refer to the practice. The relevant supporting guidance states:

”23.10 Veterinary surgeons should not allow any interest in a particular product or service to affect the way they prescribe or make recommendations. This is the case whether the interest is held by the veterinary surgeon themselves, their employer, or any other organisation they are associated with. Veterinary surgeons should inform clients of any real or perceived conflict of interest.”

[/quote]

As a profession we are very good at ignoring this RCVS guidance. It equally applies to referrals to peripatetic clinicians (where there is a conflict of interest because the host practice is keeping a chunk of the referral fee in-house) versus external referral. In this particular scenario there clearly is a conflict of interest if you are specifically referring cases to get access to the pro bono case, but I suspect that is rarely going to be the case. Another consideration is whether the 15 clients you refer who are paying full fees are being disadvantaged because you want to get access to the pro bono case. The standard Fitzpatrick TPLO price being quoted on this forum, if correct, is certainly at the high end of the spectrum of referral TPLO prices.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Ben Walker — Sun, 19 May 2024 10:08:17 GMT

Sorry - an addendum. This stems in part because the terms are so clear. “You send us 15 cases and we will do one with no charge to your client to a maximum of £y.”

I think this is an enforceable contract between the referral provider and referring practice, hence IFRS 15 applying.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Ben Walker — Sun, 19 May 2024 09:58:25 GMT

[quote userid="13891" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244624#244624"]can you have a philanthropic bung?[/quote]

This is why I think it would be well tolerated. I don’t think practices are doing anything immoral.

But yes. The philanthropy is that you are doing work pro bono. The bung (I prefer “incentive”) is that it’s conditional on x number of referrals.

To be clear, I didn’t say there was a tax liability. Liability accounts appear on your balance sheet and reflect money that needs to be paid at a later date. Each set of x referrals creates a liability (though your accountant may advise it’s allocated proportionately per referral). IFRS 15 is the relevant accounting standard (required since 2018). This relates to what is reported to Companies House (if you’re incorporated), not to HMRC.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Judith Joyce — Sun, 19 May 2024 08:13:11 GMT

Depends on your definitions of ‘direct’ and ‘bung’ I guess - can you have a philanthropic bung? Goodwill and feel good are difficult to quantify and measure but does that matter? The financial transactional winner is the petowner.We discussed the 23.10 point - starts with negotiated discounts and “free” CPD with pharmaceutical companies perhaps and grows from there maybe?

Our accountants took a different view on Tax liability from yours.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Michael Woodhouse — Sat, 18 May 2024 23:26:05 GMT

[quote userid="25265" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244622#244622"]I would still like to know people’s opinion on whether the existence of this sort of incentive needs to be disclosed to all clients you refer to the practice.[/quote]

It's an interesting thought process. What if the really deserving client was actually referral 12 - do we squeeze a couple of extra ones through to get to the magic number? Do we send a couple of people somewhere further away or more expensive to help out our very deserving client?

Realistically do we think many practices send more than 15 people to a single referral centre in a year? Am I just out of touch?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Ben Walker — Sat, 18 May 2024 18:42:32 GMT

[quote userid="13891" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244620#244620"]There is no direct bung to the practice.[/quote]

I disagree, but I think it’s a bung many members of the public would be comfortable with.

This incentive gives referring practices a substantial amount of discretionary spending power for every 15 referrals. Accountants wouldn’t need to accommodate for it in your liability accounts if a financial liability weren’t being created.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Judith Joyce — Sat, 18 May 2024 09:06:48 GMT

I don't see what's wrong with the scheme itself, although allowing practical problems and still think the problem might be the presentation of it.

The pro bono scheme for referral practices uses the same principle as Alasdair has described. . Ours followed discussion with the stafff who wanted to offer services to deserving causes and, as our customer stakeholders as a referral practice are the referring practice as well as the pet owners it seemed right. As cases for referral are, of necessity, 'screened' by the referring practice, they were better placed to decide on the criteria and their reward was that they got the feel good factor. Direct financial commission was discussed and ruled out as feeling a bit wrong and too controversial to defend without negative PR. Pet (first and foremost) , petowner and referring practice were the ultimate winners, we got some feel good too, There is no direct bung to the practice.

Vets have always offered pro bono schemes. As a mixed veterinary and non-veterinary Board we felt the conflict between veterinary human motivators, corporate body motivators (Friedman vs stakeholder theories and the rest,) and the need to create profit. Our attempt at organising it a bit tried to address a few issues.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Judith Joyce — Fri, 17 May 2024 09:21:31 GMT

This scheme is only new to Fitzpatrick referrals, it isn't innovative, so could I suggest that the only reason it is generating so much interest is because of the personalities involved?

Our scheme launched a number of years ago, which was remarkably similar, was instigated to give something back to/bond (or whatever your perception) referring practices. The referring practices liked it and practice staff could select one of their own 'special causes' as long as they had referred sufficient cases. Marketing ploy or philanthropic action - both? The accountants hated it as it needed to be provided for in accounts and it was a nebulous figure

RE: Is this pro bono scheme the solution or a symptom of the problem?

Anthony Dennison — Thu, 16 May 2024 13:44:07 GMT

[quote userid="8663" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244597#244597"](I like the IVC one, £1000 I think once a year per clinician. [/quote]

It's gone up to £1250 now, and vets can club together if it's a larger bill. We use it quite regularly throughout the year.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Alasdair Hotston Moore — Wed, 15 May 2024 08:08:07 GMT

I’m very cynical. Some of these schemes have some value I think (I like the IVC one, £1000 I think once a year per clinician. But this feels wrong

RE: Is this pro bono scheme the solution or a symptom of the problem?

Elizabeth — Sat, 11 May 2024 18:48:41 GMT

Although I also want to say -good for him for offering it, Could be great if it’s done discretely and we can save the freebies for the most deserving/in need

RE: Is this pro bono scheme the solution or a symptom of the problem?

Elizabeth — Sat, 11 May 2024 18:44:36 GMT

Could be a nightmare - do you end up slotting in your favourite clients at the 15 spot each time - and what happens if the 14th/16 th people complain? Or save up your freebies for the non-insured?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Ben Walker — Sat, 11 May 2024 18:44:33 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244553#244553"]If it has the desired effect and also brings in more customers or clients, then the company makes more[/quote]

If it truly influences referral decisions (which it seems reasonable to assume it might) do referring vets need to disclose the existence of this incentive to their clients?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Arlo Guthrie — Sat, 11 May 2024 16:12:46 GMT

[quote userid="5012" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244574#244574"]I'm not suggesting it is wrong in any way, just trying to differentiate between clever marketing and true philanthropy. [/quote]

Does it matter what the motive, if the end result is support for a worthy cause?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Clive Ansell — Sat, 11 May 2024 07:49:53 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244553#244553"]

Clive Ansell said:
Isn't that the same as marketing?

Seems very similar! But I dont read anything negative into marketing, whereas gimmick is pejorative.

[/quote]

Just a use of language I suppose.

I've always viewed Richard Branson's Virgin brand as gimmicky. but is it, or is it clever marketing, I don't really know but it amounts to the same thing. He's no doubt a very successful and clever business man.

[quote userid="2100" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244553#244553"]

Clive Ansell said:
but if so why advertise it or shout it from the rooftops?

It's not unusual to do that. Cause-related marketing is everywhere.

Any why not? If it has the desired effect and also brings in more customers or clients, then the company makes more and can afford to give more.

[/quote]

I know less than the negative square root of FA about marketing, and I've never heard of cause-related marketing.

I'm not suggesting it is wrong in any way, just trying to differentiate between clever marketing and true philanthropy.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Clive Ansell — Sat, 11 May 2024 07:43:23 GMT

[quote userid="3169" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244572#244572"]£5200 for a TPLO in a 25kg dog. Pro rata the price only drops to £4875. I suspect +/- £320 won't make the difference for hardly anyone. The 1 in 15 free could make one hell of the difference to the occasional deserving client.[/quote]

Yes, fair point.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Michael Woodhouse — Sat, 11 May 2024 00:30:31 GMT

[quote userid="5012" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244544#244544"]Why can't they just reduce fees overall if there is spare money in the pot[/quote]

£5200 for a TPLO in a 25kg dog. Pro rata the price only drops to £4875. I suspect +/- £320 won't make the difference for hardly anyone. The 1 in 15 free could make one hell of the difference to the occasional deserving client.

(not that a TPLO is 10X as good as other techniques at 1/10th of the cost......)

RE: Is this pro bono scheme the solution or a symptom of the problem?

Beats — Fri, 10 May 2024 22:05:42 GMT

Nobody is going to publicise on an internet forum that they are guilty of providing discounted or free care on occasions to those who can't afford it as that is to suggest that they are running a robin hood outfit and those funding it might object.

Ask a retired vet though and you might get a different story.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Arlo Guthrie — Fri, 10 May 2024 14:33:38 GMT

[quote userid="5012" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244552#244552"]Dictionary definition of gimmick is a means or mechanism to attract attention for benefit.[/quote]

So it is! Didn't know that. Thank you! I've always thought it to mean, I dunno, something attention-grabbing but without any substance.

[quote userid="5012" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244552#244552"]Isn't that the same as marketing?[/quote]

Seems very similar! But I dont read anything negative into marketing, whereas gimmick is pejorative.

[quote userid="5012" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244552#244552"]but if so why advertise it or shout it from the rooftops?[/quote]

It's not unusual to do that. Cause-related marketing is everywhere.

Any why not? If it has the desired effect and also brings in more customers or clients, then the company makes more and can afford to give more.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Clive Ansell — Fri, 10 May 2024 14:20:18 GMT

Dictionary definition of gimmick is a means or mechanism to attract attention for benefit. Isn't that the same as marketing?

It may be a kind and genuine act of altruism or philanthropy of course, but if so why advertise it or shout it from the rooftops?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Arlo Guthrie — Fri, 10 May 2024 12:43:11 GMT

[quote userid="4181" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244546#244546"]

Arlo Guthrie said:
Probably nobody would notice reduced fees

except maybe all those people complaining to the cma? Or the insurance companies who are mostly paying the fees?

[/quote]

I was assuming that whatever money this initiative is costing would not be enough to reduce the cost of veterinary care across the profession if Fitzpatrick were to give it out to every other practice.

Or indeed to drop just its own prices by any significant degree (not that that would make any difference, because I doubt very much that it's fitzpatrick clients who are complaining to the CMA!)

[quote userid="2131" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244547#244547"]So, it's a gimmick.[/quote]

I'm not sure why you would call cause related marketing a 'gimmick'. What on earth causes you to think that?

RE: Is this pro bono scheme the solution or a symptom of the problem?

Evelyn Barbour-Hill — Fri, 10 May 2024 11:29:43 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244545#244545"]

Publicity stunt? Well, it has generated some publicity, but I think it would be more accurate to call it cause-related marketing, and there is nothing inherently wrong in that. Cause-related marketing can do a lot of good.

Clive Ansell said:
Why can't they just reduce fees overall if there is spare money in the pot

I think this is better marketing than just reducing fees. Probably nobody would notice reduced fees. This way generates publicity and a nice warm feeling (one imagines) for the referring vet.

Clive Ansell said:
or direct it to folk who cannot afford or cannot access basic level veterinary care?

Which presumably they would have to outsource (ie give the money in some way to first opinion practices that provide the basic level of care), which would be an inefficient way of using the resources they have.

[/quote]

So, it's a gimmick.

RE: Is this pro bono scheme the solution or a symptom of the problem?

Rob Loxley — Fri, 10 May 2024 10:08:01 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30949/is-this-pro-bono-scheme-the-solution-or-a-symptom-of-the-problem/244545#244545"]Probably nobody would notice reduced fees[/quote]

except maybe all those people complaining to the cma? Or the insurance companies who are mostly paying the fees?