Having worked in practice for years I know how expensive it can be if one of our dogs gets hit by a car. We don't run a clinical practice, we don't have the X-ray, surgical and hospitalisation facilities to deal with a RTA, even if we know what must be done. So we insure our own dogs.

If road traffic accidents and other traumatic events befall your pet you don't have that much choice over where to take your animal, you just need to get the problem seen to, ideally at a 'trauma-centre' close-by. When something requires specialist treatment and it's not an emergency things are a bit different. You've got time to look for information, and choose.

Last weekend's Sunday Times Business section carried an article entitled "Sick of costly health insurance? Avoid London". It opened by saying that BUPA has lost 5% of its customers over the last year, QUOTE:"142,000 people who have decided to drop their medical insurance".

The article speculates that it's the recession doing this, but BUPA apparently believes the explanation is that private medical treatment has become too expensive with the rise in cost oustripping inflation and failing to reflect improvements in technology that should make operations cheaper [extrapolating from that statement I'm guessing that this is causing BUPA to bump premiums up]. In April the Office of Fair Trading referred the private healthcare industry to the Competition Commission. But BUPA isn't going to wait for that; whatever the reason for the 5% drop is it will be an 'economic' reason and BUPA is reportedly going to respond by offering policies with an "avoid London" clause from next year.

In companion animal veterinary care we would be naive to think that economic factors affecting something as important as the health of our families would not also at some point come to have an influence on what we do about our pets. In veterinary care we clearly do not have a single large organisation like the NHS having a dysproportionate effect on the market...effectively having a dominant position . We do however have the Royal College of Veterinary Surgeons looking at specialisation and trying to introduce the concept of an "Advanced Practitioner" although such a thing does not yet exist on the RCVS findavet service.

It is perhaps too early to tell what the effect of this "Advanced Practitioner" status will be on the veterinary market. RCVS already offers an "advanced" diploma for nurses, and there's an ongoing debate about qualified nurses and monitoring anaesthetics, but the Veterinary Nurse title itself is not yet protected. Will the general public understand what's on offer? In fact, will members of the RCVS seeking someone to refer to understand what this actually means? And if you were choosing a surgeon, whether for your own healthcare needs or those of your pet, what would you be most interested in: Would you care most about the qualification or would you be more interested in the outcomes reported by that centre, along with the costs perhaps if you weren't insured.

If you run a veterinary practice that might benefit from cases being referred to you then here are a few things to bear in mind, especially in a recession.

1. If asked, do you have the results of a series of cases of procedure to demonstrate that you should be considered as a potential treatment centre for your chosen surgical "specialism".
2. Are potential customers, including both referring vets, interested pet owners and possibly insurance companies likely to understand your charges?
3. Will all of these potential 'customers' easily be able to find you and your information on the internet and will they understand how you describe the procedure?
4. And will proposals for "Advanced Practitioner" status enable you to advertise what you need to advertise on the internet?