Episode 41 – Purpose Over Profit Rethinking Veterinary Care Through a Welfare Lens

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In this week’s episode:

• Pragmatism ≠ low value – Alison Thomas highlights that while pragmatic care may be lower cost, its value to the animal and owner can be huge. Evidence-based guidelines help vets feel confident offering simpler, welfare-focused solutions rather than defaulting to “do everything.”
• Understanding true service costs – Paul Manktelow explains how Blue Cross analyses the real cost of delivering services, then adjusts efficiency and capacity to balance standards with affordability. This business mindset is often missing in private practice and could transform pricing transparency.
• Euthanasia is not a failure – Both Paul and Alison stress that euthanasia is a valid treatment option when welfare is compromised. Normalising this perspective—and supporting both clients and teams through earlier conversations—protects animals and reduces moral distress.
• Transparency builds trust – The panel argue that veterinary teams (and the public) often don’t understand why services cost what they do. Publishing prices, educating teams, and being open about margins can restore confidence and strengthen client relationships.

This episode explores how Blue Cross leaders Dr. Paul Manktelow and Dr. Alison Thomas are redefining veterinary care through pragmatism, transparency, and welfare-first decision-making – offering powerful lessons the whole profession can learn from.

Additional Guest Spotlights

• Recommend Resource: This week, Richard White’s pick: Google Workspace (Gmail, Docs, Sheets, Meet) as an integrated, reliable stack for practice operations and team collaboration.
  
• Next Episode Sneak Peak: Coming up next, we’re joined by Jamie Crittall and Charlie Barton, co-founders of Boop Pet Records. We’ll explore compliance, data security, and how to meet Gen Z & Millennial pet owners where they are – digitally – without weakening the vet-client bond.
  

Show Notes

• Out every other week on your favourite podcast platform.
• Presented by Jack Peploe: Veterinary IT Expert, Certified Ethical Hacker, CEO of Veterinary IT Services and dog Dad to the adorable Puffin.

Transcription

Jack Peploe:

Coming up on Modern Veterinary Practice Podcast,

Alison Thomas:

There tends to be a belief that pragmatism might equate with low value. I think it may be low cost, but I think the value to the animal and its owner can be huge despite the lack of financial input. If you focus on the quality of life and the welfare implications, then you can achieve an awful lot.

Jack Peploe:

Welcome to the Modern Veterinary Practice Podcast. I’m your host and Veterinary IT expert, Jack Peploe. In this episode, I’ll be welcoming Dr. Paul Manktelow, chief Vet at Blue Cross and Dr. Allison Thomas, head of veterinary standards at Blue Cross, the podcast together. Will it be exploring what veterinary care looks like when it’s built around purpose and accessibility rather than profit from pragmatic approaches to treatment, to the realities of delivering high standards with limited resources and the lessons the wider profession can take from the charity sector,

Paul Manolo:

Hi, I’m Dr. Paul Manktelow, and I’m the Chief Vet at Blue Cross.

Alison Thomas:

Hi, I am Dr. Allison Thomas and I’m the head of veterinary standards at Blue Cross.

Jack Peploe:

Paul and Allison, welcome to the Modern Veterinary Practice Podcast. It’s an absolute honor to have you on. How are you both doing today? Yeah, good. It’s a good day. Very

Alison Thomas:

Good, thank you. Yeah, yeah,

Jack Peploe:

We’re blessed with the sunshine. I was just saying, Alison, that unfortunately we’re stuck inside. We’ll have to change that for the future. Now, look guys, you’ve both had sort of such a rich and very career in clinical practice, media leadership and beyond, and yet you found, well, you both found yourselves deeply rooted in the charity sector shaping what veterinary care can look like when it’s built around impact rather than income. So today I’d love to explore something that doesn’t get talked about enough. What happens when you design veterinary care around purpose, pragmatism, and accessibility rather than perfection and profitability? We’ll look at what this means in real life from policy to clinical practice if we get time and how we might bring some of these lessons into the wider profession. Does that sound okay?

Alison Thomas:

Sounds good. Yeah,

Jack Peploe:

Sounds great.

Alison Thomas:

Awesome. Lot a conversation.

Jack Peploe:

I try. You both work in the model that prioritises pet welfare over profitability. Do you think the wider profession could adopt some of the principles of charity medicine and what would need to change for that to happen?

Alison Thomas:

Yeah, I think there’s definitely scope for the whole profession to look more closely at this, particularly with the current financial situation, which doesn’t look like it. It’s going to be getting any better for anybody at the moment. But also from a welfare perspective, there is a tendency to feel that more is better when it comes to treatment and investigations that actually, exactly the reverse can be true. We put a lot of animals through diagnostics and treatments that don’t really make a difference to their welfare.

Jack Peploe:

Paul, is there anything you’d like to add on that?

Paul Manktelow:

Yeah, I think it’s a really interesting place that we are in right now in terms of society affordability, and I think there’s a lot of lessons that can be learned both ways really. I think we as charity services are fairly experts at managing costs. That’s where our real sort of strength lies. But we do that without compromising the standards and quality of treatment. And I think in order to achieve that, we’ve had to develop quite a lot of clinical guidelines, pragmatic protocols, and ensure that the service is again focused on welfare with the interventions that we make actually, do they, do they change treatment course? Do they actually alter the outcome? So I do think there’s a lot to be learned. I think the profession’s lost its way a little bit. I would say in my 20 odd years of working in it, there has to be a focus on doing everything, and I think we do need to move away with that. And it’s good to see the profession’s having those sort of conversations now.

Jack Peploe:

A hundred percent. I’m actually going to pick on something there where you mentioned pragmatism and Alison, you’ve been a strong advocate for sort of pragmatic care meeting pets and owners where they are. What are the clinical or ethical tensions that arise from this approach and how do we ensure that pragmatism still protects patient welfare?

Alison Thomas:

I think there’s a lot of challenges. I think some of the challenges arise in vets themselves. There tends to be a belief that pragmatism might equate with low value. I think it may be low cost, but I think the value to the animal and its owner can be huge despite the lack of financial input. If you focus on the quality of life and the welfare implications, then you can achieve an awful lot. I think also owners will sometimes feel that if they spend more money and if they do more, they’re being a better owner. So I think there’s a conversation that you have to have with the owner, and I think you have to have real confidence that what you are doing is right. It’s very easy as a vet to recommend everything, recommend the most expensive advanced treatments or investigations. It’s a comfortable place to sit. If you start recommending a different approach, I think you perhaps worry that somebody else wouldn’t agree with that approach. So that’s why we have our clinical guidelines which lay out what we recommend doing and why. So importantly, we look at the evidence behind our recommendations and we have good reasons for what we do. So those clinical guidelines will give vets the confidence to deliver that pragmatic level of care

Jack Peploe:

And delivering excellent care with limited resources ultimately has to be quite a challenge. Paul, how do you navigate the emotional and operational strain of balancing high demand with fin capacity? And again, what lessons can the other practice leaders learn from that?

Paul Manktelow :

I think our starting point is that the cost pressures that we’re facing of charities are exactly the same as what our colleagues in private practice are seeing. So I think over the last few years we’ve seen a huge rise in costs, and I think that the latest hit that we’ve just been bashed with is the national contributions for employers change that the government made, which for us as a charity is going to add on a million pounds next year. So our cost base is a challenge, but I think for me, it’s coming back to that purpose. What are we here to do? And the way that I try and position this, and I recently did a talk at spiffs on exactly this, is looking at your cost as a focus for how you price your service. Because I think out there in the sector, there’s been a sort of approach where certain things are positioned as a loss leader, and that’s preventive services nurturing, for example, as a means to get clients in the practice.

That’s fine. But it’s that understanding of, well, how much does that service actually cost you? And in order for you to make a profit, where does that margin then have to go? And I think we’ve got ourselves into a place in the sector where we’re disproportionately placing margin on some of the services that are now critical for animal welfare, like the treatment of sick and injured pets, surgeries and things like that. So where we’ve got to is we have looked at our cost base, we’ve looked at our available resource, and we’ve really established, well, what is the actual cost of running this service? And once you can establish that, you’ve then got levers you can pull. So for example, if you see more pets, the average cost per pet goes down. And that is exactly the same principle in private practice as well. If you are more efficient, then you can either increase your profits or you can reduce your prices with the same profit margin.

And it was a really interesting talk that I gave because there was almost some sort of oh, light bulbs going on with people and say, oh, that’s where that’s a really, you got it. Fundamentals for me of business is work out how much it costs to produce something, decide what margin you want to put on it, and then go ahead. And our margins are just reverse. So we might be making an 80% loss versus a 20% profit, but it’s exactly the same principles. But I think even our teams struggle a little bit with it because what we do is we compare ourselves to everybody else in the locality or the sector and say, we know how much, for example, a ER procedure costs, but even doing that at cost or doing that at a loss, we’re not competitive with private practises, which means that there must be a huge loss on those sort of procedures. And I can say that I can probably hand on heart say that we’re probably more efficient than a lot of practises that surround just because of the nature of we set up and how we’ve evolved our service. So there just isn’t that understanding from clients about how much things cost. And I think that’s a real challenge when we’re starting to look at the current context of pricing in VE services, which we know is now under investigation. So for all these reasons,

Jack Peploe:

And we probably don’t help ourselves as well, I mean, it’s interesting how a number of these health plans are sort launching where they’re offering these unlimited consultations, which kind of from an outsider’s perspective really sort of devalues what you guys do as professionals. What’s your take on that, Alison? I’ll let you go first. I’ve got some views on this.

Alison Thomas:

I guess this is a way of getting people through the door, getting clients bonded to the practice. And the money presumably is, I’m not a business woman, but the money is made on drugs and surgeries, and I think it’s probably pretty nice for clients actually to be able to stroll into their practice and consult with their vet for no cost or for the cost of a subscription every month. And I myself worked for private practices, a locum that employed that. They’d just opened a new branch in Primrose Hill actually, and I was in that branch. And it was that type of service where actually consultations were completely free. There was no subscription. They just wanted people to start coming into the practice. And yeah, I mean, it’s nice to be able to do that, but I think the other side of it you’ve already touched on is that it might devalue our time and our time is one of the most expensive commodities that we have. Over to you, Paul.

Paul Manktelow :

Yeah, I completely agree. I mean, staffing is our biggest cost as it is is for most veterinary practices. But I think that the principle of providing sort of health plans, I’m not against it at all, but I think it comes down to that principle of banding, which is effectively what it is. It’s banding everything in and charging one price for everything. And within that, there are winners and losers. And the NHS prescription charge is a really good example of that. So within that, everybody’s paying, it’s about nine pounds something, isn’t it? Now, within that, there are medicines in there that cost pence, and there are medicines in there that cost tens of pounds. So some people are underpaying, some people are overpaying. Now, I think some clients like that, they just want the assurance that they know how much and they’re happy to pay that.

But it’s trying to balance that simplicity with fairness. And I think that’s where we struggle a little bit as a profession. And it’s going from one extreme where you charge for every individual thing separately and end up with inability to estimate wide variations in costs between vets in the same practice versus, well, let’s just charge one price. And I think there’s a middle ground, but again, it comes down to what the clients want. And if you run a practice that has a health scheme and there’s good buy and the clients are really happy with it, I would say go for it. It makes things really clean and simple for everybody involved. And the ability to quote prices, I think is something that’s really missing from the profession right now. The fact that you can actually articulate how much something’s going to cost so people can prepare, plan and budget for it, I think is one of the most important things. So if you can get that through a health plan, absolutely do it.

Jack Peploe:

Yeah. Well, I suppose the complete transparency and also fixed cost procedures as well. I mean, I recently had my Labrador, Woohoo, unfortunately had to have both hips replaced. And actually having that fixed cost, even though I was sort of covered by insurance, which is great, it was still knowing that there was that sort of cap, it’s something that you could allow for. So I think it completely makes sense. I want to sort of flip things a little bit and talk about euthanasia now. It’s often one of the most emotionally complex parts of the job, some of which I am not looking forward to when my day, not my day, but when I’m in that position, and I’ve been younger, I’ve always grown up with animals. So I have been there and done that, but obviously got a very special bond with my dogs now. But from your perspective, how can we better support teams in making those decisions, particularly when resource limitations make it harder to sort of offer alternatives either of you on that one?

Alison Thomas:

Well, I mean I think the biggest thing is accepting that euthanasia is not failure. I think people, vets in particular, nurses feel like they failed an animal if they’re having to recommend euthanasia, it’s absolutely not failure. It is a very viable treatment option for an animal that’s struggling. And that might be an animal that has completely untreatable condition, or it might be a treatable condition, but not in the circumstances that that animal is in. And it’s a tool that can really help with a welfare dilemma like that. So I think overcoming that is a big part of it, but also knowing how to communicate with the owner. And that is a real skill. We have the pet loss support service at the Blue Cross, which not only councils owners who have lost pets to euthanasia or for other reasons, but we’ll also talk to owners when they’re trying to make those decisions. So it’s really helpful to have a conversation that is approaching that from an earlier stage in a pet’s illness rather than just on the day. It absolutely has to happen.

Paul Manktelow :

It’s an interesting sort of emergence in the profession about the reluctance around euthanasia and a veterinary surgeon and the wider practice team, their aversion to that. And as Alison says, seeing it as a failure rather than a viable treatment option. And I think in the charity sector, we’re kind of at the sharp end of this whereby we see the consequences from a welfare perspective when euthanasia hasn’t been considered. And I know there’s some really sort of controversial areas like behavioural euthanasia in young healthy dogs, and we’re seeing post pandemic a huge emergence of behaviour problems. And obviously with veterinary costs and rising owners that were unable to afford treatment. But when that conversation isn’t had properly or that treatment course considered, owners often have nowhere to go and they end up in either not treating their pets or putting their pets or themselves at risk, or they end up in falling into the charity sector for us to try and improve the situation. And ultimately, a pet that’s had their welfare compromised often for quite a long period of time. So I think we have to think wider as a profession about some of the impacts of not considering euthanasia. We’re definitely having problems with it.

Jack Peploe:

Yeah, no, a hundred percent. So I’m going to move shift across to something else now and then sort of talk about involving the CMA, but obviously you’ve both got a sort of immediate presence. How do we communicate the complexity of veterinary care and its cost to the public without fueling, mistrust or diminishing the value of what we do?

Alison Thomas:

I’ll let you go, Paul.

Paul Manktelow :

I think this is a challenging one. I think the challenge that we’ve got is that there isn’t really a good public understanding of why things cost the amount they cost. And in the profession you often hear, well, the NHS is to blame for that because people don’t necessarily pay for healthcare in this country. I would sign kind of counter challenge that the NHS has always been there and people have in the most always paid for veterinary services. So I don’t necessarily think it’s that. I think that part of the problem we’ve currently got is that even within a veterinary practice, the teams do not understand why I think has cost the amount they do. So I think that’s the starting point. And if your team is trying to explain a treatment cost to an owner and they have got no idea, or fundamentally they don’t agree that things should cost that much, and we know chronic undercharging in the profession has always been a problem, I think that’s part of that trust and confidence.

There’s a missing gap there. But I think it’s a challenging one. But you touched on transparency earlier, but I think when the CMA started their investigation, there was over 80% of practices that didn’t publish any prices on their websites. I mean, you just have to look at dentists, which I often look at as a comparable profession, and you don’t really find a dental practice that doesn’t publish their standard prices on the website. So I think that’s a starting point. I think there’s also this misconception that all prior practices have to charge the same and offer the same value, but we know just in terms of value propositions, there are different supermarkets. There’s Aldi versus a Waitrose. The different airlines wants to be a Ryan or a British Airways. I feel that we fundamentally can charge whatever we want as veterinary practices and business, but having transparency and honesty about where those charges come from, I think is the key.

And I don’t think consumers, clients necessarily misunderstand that. I think that people accept that there are different prices for different types of service that you might want to access, but there just isn’t that understanding. And I guess the CMAs other point they’re looking at is within a local area, is there that choice? Is their choice between going to ULD or your Waitrose in that area? And often that’s not the thing that’s very clear for clients, but I think we have to also acknowledge that we are very highly trained, experienced professionals and we should be able to charge for our time. And the profession’s really shied away from that. We’ve put margins on drugs and consumables rather than consults, and we’ve undercut ourselves on certain procedures. So I think hopefully the CMA is going to shine a light on this and do a bit of an overhaul.

Jack Peploe:

A hundred percent. And I suppose there’s an aspect comes down to the educational system as well in prepping you guys for these types of things. It’s not just about the clinical side. There are other elements. So there’s possibly an element there. I didn’t

Paul Manktelow :

Do any financial training as part of my veterinary degree. I dunno if you did Alison, but there was absolutely nothing. I did not,

Alison Thomas:

Nothing.

Paul Manktelow :

It’s just what I’ve learned as I’ve learned things. Yeah, and it is crazy, isn’t it? I mean, it is a business at the end of the day. Yes, you are focused on providing a service, but that service comes at a charge. There’s a financial element to it. And even if it doesn’t come at a charge, it comes at a cost. So we should be more financially aware. And even in our sector, in the charity sector, our teams do not understand the cost of things. And when you do show them, they’re often shocked and then they can’t believe that things cost that much. And so I do think as a profession, we need to educate ourselves first. And as soon as we can do that, I think we’re in a better position to start educating the general public.

Jack Peploe:

No, amazing. Well, guys, I can’t believe it, but I always say this, the 20 minutes has flown by, but thank you so much for obviously a really deep and thought provoking conversation. You’ve definitely highlighted how values, value led veterinary care isn’t just possible. It’s sort of essential. Now for listeners who want to follow your work, learn more about the Blue Cross or explore some of the topics we discussed today, where’s the best place that they can connect with you both?

Alison Thomas:

For me, it’s email. So that would be Alison.Thomas@bluecross.org uk.

Paul Manktelow :

And for me, you can see the wider activities of Blue Cross on our Blue Cross website, blue cross.org uk. But if anybody wants to connect with me, LinkedIn is probably the best place to go. And that’s just Paul Manktelow

Jack Peploe:

Perfect. And these all be in the show notes. But guys, it’s been an absolute privilege to have you on the show. Thank you for the work that you are doing and for helping to shape a future where veterinary care is more compassionate, more sustainable, and more accessible to all. But again, thanks so much for being here. Thank you. Thank you.

Jack Peploe:

Every week we ask professionals and experts to suggest a best business resource for our listeners. This week’s recommendation is from Richard White.

Richard White:

I would say I’m a big fan of Google and Google Suites and email and stuff like that. I think it’s really nice. I mean, to be fair, I haven’t used Microsoft that much. I’m sure it’s got all the same stuff, but I’m a big fan of that.

Jack Peploe:

Coming on next, we welcome Jamie Crittall and Charlie Barton veterinary entrepreneurs and co-founders of Boop and Pet Records. Jamie and Charlie share their journey from creating virtual recall to building new platforms designed to transform how pet owners is engaged with their pets health. We explore the challenges of healthcare compliance, the impact of shifting client demographics and how technology can empower pet owners while strengthening the vet client relationship. They also discuss responsible tech adoption, the importance of data security and lessons revenue businesses can learn from consumer tech. Tune into here how Jamie and Charlie are reshaping the future of veterinary care by combining clinical expertise with a consumer first mindset.

Next Episode Sneak Peak:

By 2030, every single Gen Z person on the planet will legally be allowed to have a pet. They will have reached 18 years of age. Their spending double what my age as a Gen X. They love their pets. They’re probably putting off a human family longer and applying that love and sort of devotion to pets, but there’s a whole pool in which they’re swimming in. Whereas for the veterinary profession, and Charlie and I are part of that very proudly and as still, I own Beach House vets, we’re swimming in one lane. So how do we get that message out to them in a relevant way? And millennials and Gen Zs, the digitally native want to have sustainable solutions and they want to receive health education

Jack Peploe:

Digitally. That’s it for this episode. All links and recommendations we talked about are in the show notes. Don’t forget to subscribe and share the podcast if you found it useful. In the meantime, thanks for listening and see you next time.