Changes in the farming industry including an over-all increase in farm size, consumer demand for high health status of products and lower profit margins have impacted sheep farming and caused the need for changes in flock management (Lowe, 2009). The Department for Environment, Food & Rural Affairs (Defra) of the UK government issued a report stating the importance of farm animal veterinary surgeons providing preventative advice about disease rather than focusing solely on treating individual animals (Lowe, 2009). Disease prevention can be aided by monitoring the nutrition, husbandry and genetic selection of farm animals, as well as health, but it requires the establishment of a relationship between veterinary surgeons and farmers. While this approach has been widely taken up in the dairy cattle and pig sectors, studies indicated there was limited evidence of regular preventative advice being given to sheep farmers by veterinary surgeons and instead the majority of sheep farmers still considered the veterinary surgeon only as an emergency contact (Kaler and Green, 2013).
Research conducted at the University of Nottingham investigated farmers' and veterinary surgeons' views around preventative advice on sheep farms (Kaler and Green, 2013; Bellet et al, 2015; Ruston et al, 2016). According to this research, famers and veterinary surgeons both agreed that the preventative advice on farms is provided on an ad-hoc basis. Sheep farmers considered inconsistent service, high turnover and lack of sheep farming expertise among veterinary surgeons as their key barriers to forming good relationships. Farmers considered themselves as experts and were unable to see where veterinary surgeons could add value. Veterinary surgeons felt that they were not promoting the preventative ethos enough and they lacked marketing skills, but also felt that farmers did not need or value their services. Veterinary surgeons reported being unable to lever sufficient organisational or business skills to support the provision of an acceptable advisory service and felt the pressure of competition from outside the profession. These studies highlighted the need for more proactive and regular contact between sheep farmers and veterinary surgeons, identified key barriers to delivering preventative advice on flock health on farms and suggested that veterinary surgeons not only needed to improve expertise on sheep-related topics and develop confidence in delivering them, but also needed to find business models to offer these services to farmers and effectively market these services in order to improve the productivity and health of the national flock (Kaler and Green, 2013).
As a direct result of these research findings, and following consultation with the Sheep Veterinary Society, the National Sheep Association and the National Farmers' Union, the concept of Flock Health Clubs was developed by Fiona Lovatt of Flock Health Ltd. The basic principle is that members pay a monthly subscription to their veterinary practice to take part in regular discussion groups with other farmers. A Flock Health Club is a business group of sheep farmers brought together by their veterinary surgeon who facilitates discussions and arranges farm visits alongside practical training sessions. The aim of the Flock Health Club is to promote farmer interaction with a sheep focused veterinary surgeon resulting in increased sheep expertise for both parties and to encourage better relationships between farmers and their local veterinary surgeons. Under the Flock Health Club banner, veterinary surgeons are also provided with continued professional development (CPD) to enhance their expertise, knowledge and confidence in sheep-related issues.
The Flock Health Club concept was trialled through the formation of two pilot clubs in the north west and north east of England in 2015. These ran for 12 months. Following positive feed-back from participating veterinary surgeons and farmers, a wider launch was initiated with provision of a number of veterinary surgeon CPD training and information sessions held throughout June and July 2016.
To assess the impact of Flock Health Clubs for veterinary surgeons and farmers, two studies were conducted: an interview study asking veterinary surgeons who run a Flock Health Club for their opinions (funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 679302); and an online survey of sheep farmers in the UK and Ireland (funded by University of Nottingham) to identify the difference in their sheep lameness levels and management practices before and after joining the Flock Health Club.
Methods
Veterinary surgeon interviews
Study sample
Flock Health Ltd. provided a master list of 35 veterinary surgeon contacts who had previously agreed, in a Flock Health Club survey, to participate in future research. Of these 35 veterinary surgeons, 28 were still working at the same practice and running a Flock Health Club. Each veterinary surgeon was initially contacted by email informing them of the opportunity to take part in this case study and stating that they would be contacted over the next few weeks. Some of the veterinary surgeons replied to this email directly, and a convenient time for a short telephone interview to take place was arranged. If no return contact was received, the veterinary surgeons were contacted at their surgery and the details of the study discussed, after which they were invited to take part in a short telephone interview. There were 22 veterinary surgeons interviewed. Following the interview a written consent form for participation was sent to the veterinary surgeon for signature. Fifteen consents were returned, and it is the data from these practices that have been used in the analysis.
Questionnaire design
An interview guide, designed by the National Sheep Association (NSA), the Organic Research Centre (ORC), Flock Health Ltd and Nottingham University, was used for all telephone interviews. Interviews were conducted by the same researcher at the NSA (NN). Veterinary surgeons were telephoned at an agreed interview time and after reiterating the reason for data collection, verbal consent to record the interview was requested, ensuring accurate transcription. The questions within the interview were grouped into five categories:
- Information about the practice
- Information about the client flocks
- Information about the characteristics of Flock Health Club members
- Information on relationships between the practice and local farmers
- Information about the Flock Health Club and its activities.
Survey
Study sample
The survey was distributed electronically by asking the veterinary surgeons that had previously been identified as either running a Flock Health Club or being interested in setting one up (n=355) to share a link with their farmers either at a Flock Health Club meeting or electronically. The link to the survey was also shared at the Sheep Breeders Round Table conference and using additional social media to reach as many farmers as possible. The survey was open for 4 months and responses were received between 4th November 2019 and 14th February 2020.
Survey design
The survey was divided into four sections. The first section contained questions about the flock type, size and whether the farmer was a member of the Flock Health Club or not. The second section addressed Flock Health Club members and asked details about their Flock Health Club. The third contained questions about lameness in their flock before and after joining the Flock Health Club and the fourth section investigated the farmer's use of medicine for lame sheep before and after joining the Flock Health Club. At the end of the questionnaire there was a statement of consent for the use of the information for the purposes of this research study in accordance with the General Data Protection Regulation (EU) 2016/679 (GDPR). The survey included a mixture of multiple-choice questions and open questions, such as the percentage of lameness in the flock, and the satisfaction of the farmers with their ability to deal with lameness in their flock, expressed on a scale of 0 to 100.
Data analysis
The data were analysed anonymously. The data analysis was conducted using STATA 14 (Statacorp, USA). Descriptive statistics in the form of frequencies, means and medians were conducted on all the variables depending on the type of variable in question. The categorical outcomes derived from the multiple-choice questions were analysed using McNemar's test to compare before and after joining the Flock Health Club while for the continuous variables the Wilcoxon matched pairs signed rank test was used.
Results
Veterinary surgeon interviews
Characteristics of the veterinary practices
Of the 15 practices surveyed, six focused solely on farm animals while the remaining nine were mixed practices. Of the mixed practices, some had completely separate farm animal and small animal divisions and others had designated veterinary surgeons that moved between farm animals and small animals. The numbers of farm veterinary surgeons employed per practice ranged from three to 11. Thirteen practices reported that they were independent, with four of these also being members of a national veterinary group. Two practices were part of a corporate veterinary group.
When questioned as to whether the veterinary surgeons in the practice had specific areas of expertise, a few had veterinary surgeons who only attended a specific species, while in the majority of practices, veterinary surgeons had preferences or biases, as evidenced by the following comment: ‘If possible, we will hand clients on to the veterinary surgeon with that particular interest’. A f ew veterinary surgeons expressed a clear preference for sheep and attended as many of these cases as possible. All practices had a range of clients, the numbers of each reflecting the size of the practice. Sheep were not the core source of income in any of the practices interviewed, dairy and beef cattle being the mainstay for farm only practices.
Broad descriptions of the flocks in the practice
The types and sizes of flock were influenced by locality. The majority of practices included lowland breeds and a few had hill flocks. Pedigree sheep were recorded in half of the practices with flock sizes ranging from 20–50 sheep. Flock sizes within practices varied depending on the flock type: hill flocks were larger, with two practices recording flocks of 2000 plus ewes. The majority of practices treated flocks of 200–400 animals; all declared a range of flock sizes from a few animals (small holders and pedigrees) to a few larger flocks of over 800. Sheep were usually kept with a beef enterprise or in a few cases sheep were kept in conjunction with an off-farm job. In arable areas, practices were treating sheep integrated with the arable enterprise. When asked which breeds were most common, over half of the practices specifically identified mules as the most common breed. Dorsets were kept in a number of practices, Easycare, Lleyn, Swaledale flocks were mentioned and the pedigree flocks identified were either Texel or Suffolk.
Characteristics of Flock Health Club members
When questioned about the age of Flock Health Club members the only agreement between practices was that members were generally under 65 and those that attended were keen to learn, engaged and enthusiastic. It was observed that a balance of older experienced farmers and younger newer farmers was ideal, and one practice deliberately aimed to maintain this balance. Flock Health Club members were regarded as forward thinking and in-novative, commercial and generally in the top 5–10% of farmers in the area, as expressed by the following quotes: ‘They're normally the better farms already, and generally the better farms and farmers drive themselves to get better’ and ‘they are really trying to improve on their flocks, and get the best out of them. They're quite motivated farmers compared to a lot of them’.
Relationships between the practice and local farmers
Several practices expressed difficulty in engaging with sheep farmers in general because a core of sheep clients only ever contacted them in emergencies and the veterinary surgeon was called in for ‘disasters’. In addition, some of the veterinary surgeons stated that most sheep farmers are not very receptive to advice as explained in this quote: ‘I find sheep farmers quite difficult to get to change. So, dairy farmers are used to changing but sheep farmers are much more like, well this is the way my dad did it and my grandad did it. I've been doing this for 40 years and I don't think you've got anything to teach me’. Every practice felt that contact with Flock Health Club members was better than with the average sheep farming client. Flock Health Club members rang the veterinary surgeon more, they actively sought advice, and they were engaged and keen to improve. Flock Health Club members tended to seek preventative measures, rather than react to disease or a health problem once it presented itself. Flock Health Club members spent more time talking and were more aware of topics covered in Flock Health Club meetings and the impact on their farms.
The Flock Health Clubs
Flock Health Clubs in the practices interviewed had been running on average for 2 years and up to a maximum of 3 years. Membership ranged from 8 to 29 farmers. Only one out of 15 practices expressed disappointment with turn out at meetings, achieving around 25% of members of the Flock Health Clubs (at the practice); this club was the only one that had been running for less than 2 years. The majority of clubs had a meeting attendance rate of over 75% of members of the particular Flock Health Clubs, with several achieving 100%. Most clubs were careful when they held meetings, timing them to fit the sheep farming calendar, and one noted that if there was an external speaker (Figure 1) or a practical demonstration (Figure 2), attendance was higher.
Every Flock Health Club veterinary surgeon interviewed agreed that if membership increased beyond a number that they felt optimised interaction (varying between 15 and 25) they would split the group. All agreed that smaller numbers encouraged interaction and farmers got to know each other better. Several groups recognised that the farmers that attended were of high calibre and they tried to discourage individuals who were opinionated, knew it all or did not interact well with a group. Several practices actively selected participants so that the meetings would be congenial and effective. Potential members were also identified if the veterinary surgeon felt that they had a particular issue on their farm that could be addressed through Flock Health Club membership, and could act as a good demonstration tool for the group. The most popular format for meetings was to hold four per year (one practice held 5–6 per year). Farmers were noted as choosing informal discussion meetings with practical aspects held on farm in preference to meetings that involved more formal slide presentations (Figures 2 and 3).
A wide range of topics are discussed at Flock Health Club meetings, but every group runs lambing sessions. The topics covered can be broadly divided into lambing, growing lambs, lamb grading and slaughter, ewe management (Figure 2), tup selection and MOTs, parasites, antibiotic reduction and health issues, nutrition and pasture (Figure 1), handling and other topics of specific interest to the members. The majority of practices consulted the farmers as to which topics they would be interested in, and one actively chose topics of relevance, for example if a number of farmers were affected by an issue. Most Flock Health Club veterinary surgeons claimed that they struggled with engaging the group in consistent benchmarking or data collection activities.
Is the Flock Health Club effective?
When veterinary surgeons were asked if they had seen changes in their members' flocks since joining the Flock Health Club, all agreed that they had and gave a variety of examples. The most common changes were in parasite management, lameness and reduced lamb losses. Other changes included more use of testing (for example measuring colostrum quality, regular faecal egg counts or investigating anthelmintic resistance), changes in worming practices observed, uptake of FAMACHA scoring following Haemonchus contortus outbreaks, better targeted antibiotic use as well as increases in vaccination rates, and post-mortem examinations. In general it was found that most veterinary surgeons considered the Flock Health Clubs a success from the point of view of both the practice and the farmers, as exemplified in this quote: ‘From a personal point of view […] I know quite detailed information about each and every one of my flock health club members and their flock, and feel like if they ring me up with an issue I already am well in touch with their flock and we can get to the bottom of any problems fairly promptly because of it,[…] job satisfaction and enjoyment and just knowledge growth and all of those things, yes very successful. From a farmer point of view […] they all try and come to the meetings and they are very full of discussion and questions with each other and myself, so I think that's quite a good sign that they are getting some enjoyment out of it’. The Flock Health Clubs were also praised as a way for veterinary surgeons to gain more knowledge about sheep as explained in the following comment: ‘I do a lot more sheep work now than I did 3 years ago and I think the club has probably got quite a lot to do with that’. However, a few veterinary surgeons commented that the members of their Flock Health Club were in the top end of farmers in their area and thus they had not necessarily seen much in the way of management changes as their management was already of high standard.
From the farmer point of view, the Flock Health Club farmers reported how much they appreciated having a veterinary surgeon who was interested in their flock and that they valued the opportunity to discuss sheep matters with both their veterinary surgeons and like-minded peers.
Challenges of Flock Health Clubs
When questioned as to the challenges of running a Flock Health Club the majority of responders were concerned about the time taken up by Flock Health Club, especially regarding the preparation and facilitation of meetings. Maintaining appropriate size of Flock Health Club was highlighted as being important to ensure efficiency. By keeping meetings small and congenial, the frustrations caused by time wasters and difficult clients were reduced. Veterinary surgeons also pointed out that they were trying to attend other sheep courses and professional groups to keep their knowledge up to date. Another concern was that running a Flock Health Club was used to draw clients to them, but now many practices were developing them, often because ‘they feel they have to and feel dragged into it’. This was explained in this comment: ‘I think all vet practices now, it almost feels that everyone is doing one. They're sort of missing a trick if they're not. I think it should still be something that is individual to each practice’. A number of veterinary surgeons expressed a feeling of running out of topics and being out of their comfort zone if exploring novel topics. It was acknowledged that information could be shared but ‘what works in one practice doesn't necessarily work in another’.
Survey
The survey was completed by 132 farmers, out of which 126 respondents were from the UK and six from Ireland.
When asked to describe their type of enterprise with the ability to tick more than one option, 85 of the respondents classified theirs as a commercial flock, 35 as a pedigree flock and 4 as a hobby flock; 46 respondents defined their enterprise as progressively run, 22 as traditionally run and 12 as a small-holding. Additionally, 79 farmers defined their enterprise as lowland, 39 as upland and 21 as hill. The size of the flock varied: 33 farms had up to 200 ewes, 45 had between 201 and 500 ewes, 34 had between 501 and 1000 and 20 had over 1000 ewes.
Out of the 132 total respondents, 61 stated that they were members of a Flock Health Club. Of these 8 had joined in 2019, 10 in 2018, 23 in 2017 and 17 in 2016 or earlier. 55 farmers stated that their Flock Health Club had held a specific session on lameness. When asked about their attitudes before and after joining the Flock Health Club, it was clear that there was a significant change in many aspects: there was a significant increase in people considering the use of the Five Point Plan, a significant increase in the use of the footrot vaccine and a significant reduction in routine foot trimming (Table 1).
Table 1. Proportion of respondents, Non - Flock Health Club (FHC) members, members of a FHC, that replied yes or no to questions about their management practices related to lameness before and after joining the FHC (n=61)
| Question | Non-FHC members (n=73) who answered yes | FHC members (n=61) | Comparing before and after joining the FHC | |||
|---|---|---|---|---|---|---|
| Before joining FHC | After joining FHC | P value | ||||
| No | Yes | No | Yes | |||
| Have you considered the Five Point Plan for lameness control? | 77% | 49% | 51% | 13% | 87% | <0.001 |
| Do you undertake routine foot trimming in your flock? | 15% | 61% | 39% | 84% | 16% | <0.001 |
| Do you use foot trimming to treat lame ewes? | 11% | 62% | 38% | 92% | 8% | <0.001 |
| Do you use foot bathing as a routine treatment for lameness in your ewe flock? | 56% | 44% | 56% | 39% | 61% | 0.453 |
| Do you use the footrot vaccine? | 41% | 66% | 34% | 46% | 54% | <0.001 |
There was also a significant increase in the farmer's confidence in their ability to deal with the lameness in their flock, which went from an average of 61% to 77% (Z= -4.883, p<0.001) and an overall decrease in average lameness in the flocks since joining the Flock Health Club, from a flock average of 8.7% to 4.5% (Z=5.641, p<0.001, n=61). The 71 farmers who were not members of Flock Health Club reported low levels of lameness (median = 4% IQR (1–5 %).
In terms of antibiotic use, 30% of respondents claimed that they ‘didn't use very much’ before joining the Flock Health Club and 33% said the same thing after joining the Flock Health Club. The proportion of respondents who stated that they used ‘an appropriate amount’ of antibiotics was 39% before joining the Flock Health Club and 57% after joining and the ones who used ‘more than [they] would like’ decreased from 31% to 10% after joining the Flock Health Club (Z= 2.173, p=0.031, n=61).
Discussion
This is the first study to analyse the impact of Flock Health Clubs on veterinary surgeon–farmer relationships and on the management practices of farmers who take part in the initiative, with a particular focus on specifically measuring changes in flock health parameters such as levels of lameness. The Flock Health Club concept was developed as a directly research-led intervention. This study highlights the impact of the Flock Health Club concept, and demonstrates it as a successful strategy for the sheep industry. Extrapolation of these results suggest that the implementation of Flock Health Clubs more widely in the sheep industry has potential to improve interaction between sheep farmers and veterinary surgeons and ultimately improve sheep health and welfare.
The combination of qualitative and quantitative research on this topic has allowed the analysis of multiple aspects of the impact of Flock Health Clubs: the interviews highlighted the perceived improved relationship between veterinary surgeons and farmers, and the survey demonstrated improved management practices and better health outcomes.
The veterinary surgeons interviewed were positive overall about the success of the Flock Health Club and reported that they had improved relationships with its members, recognising that it was a good forum for these more forward thinking farmers to benefit from increased veterinary contact, to learn from each other and to feel supported enough to make positive changes to their flock management. This reflects wider evidence of peer to peer learning as a tool for implementing best practice (Wenger, 1998; Jansen et al, 2010).
The veterinary surgeons interviewed identified that running a Flock Health Club had improved their understanding of sheep farmers and their knowledge of sheep-related issues. Previous research identified lack of sheep expertise as one of the barriers for a successful veterinary surgeon–farmer relationship (Kaler and Green, 2013; Bellet et al, 2015). Gaining this expertise has improved veterinary surgeon confidence in communicating with other sheep farmers. Veterinary surgeons reported that running a Flock Health Club demonstrated more widely that the practice was interested in both serving the needs of sheep farmer clients and championing the implementation of preventative measures in sheep flocks, thus delivering the needs identified by the Lowe report (2009), Kaler and Green (2013), Bellet et al (2015), Lovatt (2015) and Gascoigne (2016).
The consistently high farmer attendance at Flock Health Club meetings, and their willingness to pay a subscription, suggested that the farmers perceived there were benefits from being part of a club. Certainly, for the cohort of sheep farmers prepared to buy into the Flock Health Club, when given access to information in a cost-effective and engaging way, alongside the motivation provided by club membership, sheep farmers are inclined to follow advice and change their practices with a positive result on flock health. These results are a clear indication of a transition to more preventative care for sheep flocks, which aligns with the government aspirations in the Lowe report (2009) as well as in the Responsible Use of Medicine in Agriculture (RUMA) antibiotic targets (Anon, 2019).
These findings were further supported by the results of the farmer survey, which showed changes in management practices after joining the Flock Health Club, indicating that the information shared at the meetings impacted subsequent farmer behaviour. The survey provided specific evidence that, since joining the Flock Health Club, farmers reported an increase in their confidence in their ability to deal with lameness and measurable evidence that they had made key changes to evidence-based preventative measures in their management of lameness (such as increasing uptake of the industry recognised Five Point Plan, in-creasing use of footrot vaccination and reducing their use of foot trimming). These behaviour changes also resulted in improvements in flock health and welfare as measured by reductions in actual levels of flock lameness. A large-scale intervention study has demonstrated the effectiveness of a group led by a facilitator in the reduction of lameness in sheep in the UK (Grant et al, 2018). The current study adds to the evidence that farmer opinions and beliefs can be changed as a result of being part of a Flock Health Club. Interestingly the respondents in the study who were not members of a Flock Health Club already had low lameness levels and not significantly different to the lameness levels achieved by respondents after joining the Flock Health Club. This suggests that these non-Flock Health Club farmers were already undertaking lameness best practice. This could be explained by the recruitment method for the online survey — Flock Health Club members pre-dominantly via their Flock Health Club veterinary surgeons and the non-Flock Health Club members via social media and a pro-gressive sheep farmer conference.
A limitation of this study is that the data have the potential for response bias, reflecting the opinions of those respondents who actively decided to take part. Despite this, data triangulation with both Flock Health Club veterinary surgeon interviews and Flock Health Club farmer survey responses suggest the results are ro-bust. It would be useful to further compare the management of Flock Health Club members vs representative non Flock Health Club farmers to investigate the impact of attending the Flock Health Club. As a further limitation, our data on the impact of joining the Flock Health Club on lameness is derived from farmer estimations. Previous research suggested farmers can estimate lameness correctly (Kaler and Green, 2008). However, ideally it would be preferable for the impact of Flock Health Clubs to be assessed on the basis of independent measurements of flock health, though this clearly would depend on reliable flock data.
A major barrier to the success of the Flock Health Club was identified in the difficulty of collecting data for active benchmarking of the flocks between each other and from one year to the next. This was previously identified as a key barrier to sheep veterinary surgeons (Kaler and Green, 2013; Lima et al, 2018) and it is interesting that it is still an issue even with the more highly motivated farmers who are prepared to pay to join a Flock Health Club. There is a pressing need for simple to use and reliable methods of data collection and collation, which may be addressed by means of recent advances in precision technology (Lima et al, 2018; Vittis et al, 2020), though the authors consider that the consolidation of different currently available data collection tools is essential.
Conclusions
This study demonstrates the impact of a research-informed initiative and has shown that setting up a Flock Health Club within a practice has significant and measurable flock health benefits which we believe result from its ability to transform the relationships between the sheep farmers and veterinary surgeons involved and improve mutual confidence and motivation. Although there are barriers that need addressing, such as difficulties in collation of flock data, there appears to be much potential for the wider establishment of Flock Health Clubs to further benefit both the sheep industry and the agricultural veterinary profession.
KEY POINTS
- There has been widespread uptake of the Flock Health Club concept by veterinary practices nationally but there remains scope for further developments.
- Both farmers and veterinary surgeons were positive about the contribution Flock Health Clubs had made towards improved farmer–veterinary surgeon relationships and communications with respect to sheep health and practices.
- Positive changes in management practices, particularly in reducing flock lameness and increased farmer confidence in their ability to deal with lameness, suggest that Flock Health Clubs are constructive environments for both peer to peer learning and veterinary-based knowledge exchange.
- The awareness of current recommended lameness control practices by all respondents to the online survey indicates that key messages about changing practices are being taken up by the industry.
- Data collection for benchmarking purposes is highlighted as an ongoing sheep industry challenge, even among Flock Health Club farmers.