Using the National Audit for Small Animal Neutering in practice

RCVS Knowledge
Welcome to this special RCVS Knowledge podcast episode about the National Audit for Small Animal Neutering, or the NASAN for short. We invited Harry Connock, a vet from Shepton Vets, and James Poff, Head Veterinary Surgeon from Cedar Vets, to talk about their experiences of using the NASAN. This episode was recorded shortly after we released the 2025 NASAN Annual Benchmark Report. We hope you enjoy the episode.

Jen Marsan-Stott

Hello and welcome to this RCVS Knowledge podcast. I’m Jen, I’m an RVN and I’m the Senior Project Officer at RCVS Knowledge. Today I’m joined by some great inspiring colleagues, Harry Connock from Shepton Vets and James Poff from Cedar Vets, they’re primary care practices and part of  XLVets.

Their teams have been auditing post-op complication rates and contributing to the NASAN, the registry held by RCVS Knowledge. In this podcast, we hope to highlight the importance of auditing for patients and their post-op complications and the insights and many opportunities you can find to improve from that. So great. Thank you very much for joining us guys. If you could start by introducing yourselves and telling us a little bit more about how you first got involved with the NASAN.

Harry Connock

I’m Harry Connock, small animal vet at Shepton Vets in Somerset. Originally I did a little bit of mixed and therefore got involved auditing on the farm side, so I had a little bit of sort of experience with that. So then when the NASAN started, I reckon we must have started in 2024, one of the directors was keen for us to join it. So he knew that I did a bit of auditing before.

So yeah, he approached me and asked me to get involved. I think especially it’s beneficial around the Practice Standard Scheme. So yeah, that’s how I was first introduced from one of my directors.

Jen

Fantastic. That’s great. Thank you very much for sharing that. And James?

James Poff

Hello, my name is James Poff and I’m the Head Vet at Cedars in Alton, Hampshire. So we’ve been submitting data, think since probably since Harry 2023, 2024. So Rachel Clay, who’s now XL Vets, she was she was working here at the time. And she was a big force with the quality improvement. I think that was getting our teeth into that something we’ve not done much of is reviewing our … You know, it’s a massive area and it was a kind of a nice way to start just to get the ball rolling.

So through that yeah, we started doing our own initially just in-house. So actually to be fair, we probably did it in a few years in-house and just reviewing it. And then we then started submitting it to RCVS Knowledge in 2024. And yeah, we’ve had a bit of a glitch due to the staffing. The vet who was submitting it then went to move into industry.

So we’re just getting, Judy’s gonna get back up and running again. So, but it’s been, we can talk about more about what we’ve found that yeah, it’s been fairly user friendly and yeah.

Jen

That’s great. That’s great to hear because it was designed to be a free to access, easy to access sort of gateway audit, if you like. It’s one that people can kind of pick up if they haven’t got much auditing experience. It’s one that’s quite easy to pick up and run with and kind of get your teeth into it if you’re starting on the auditing and QI journey. So that’s great to hear.

So what were your early insights of it or experiences with it? Was it harder or easier than you thought it would be when you first started? And did you have to overcome any barriers to be able to implement it in your practices?

Harry

I think it was, when I first started, it was very simple in the sense of data required to fill in the spreadsheet and therefore it did make it quite a simple, appealing auditing process because all you really needed to do was have an animal ID, have a procedure and have an outcome and that was nothing more than that. So it gave you some useful data, pretty useful answers with little information.

James

Yes, to us, submitting into RCVS Knowledge was the easy bit. The bit we struggled with was getting off our practice management system. And so there’s just a lot of clicking and looking into the history. Once you’ve done that bit, submitting it is pretty straightforward. So yeah, that’s the only sort of main friction point, is the PMS.

Jen

Yeah. Each system is different as well, isn’t it? So it’s, it’s finding a way to work around your practice management system that will give you the data. Did you manage to find a solution for that or is it just a process that you’ve put in place that works for you guys?

Harry

Yeah, process and just being more used to the PMS and just yeah, just efficiency. I think it’s like anything the more you do it, the easier it is. And also, I think it’s also quite daunting because you leave it for a month or two months and then you’ve got loads to go through whereas just a little bit at a time. Yeah. But that like you said, you don’t have to submit that much detail, which is good.

Jen

No, that’s great point actually that you know, you can submit….There are drop down menus within the spreadsheet to try and help with data entry. So you can populate that form quite easily. And like you say, depending on how busy and how big your practice is, the frequency that you do it, sort of, you can decide that what works for you in your own practice. We don’t prescribe that it has to be every month or every six months or anything like that. It is a, you know, what works for you guys out in practice. So that’s great. Thank you very much. That’s a good tip.

And how did you go about making any changes for improvement? And what do you think was the biggest impact that you’ve seen in your practices?

Harry

I think for us, we never noticed any significant complication rates comparing to the national benchmark. The main thing we were noticing is our follow-ups and understandably a lot of follow-up, like lost to follow-up animals are maybe a lot of cat castrates or cat spays that we do a lot of charity work. So maybe they are seeing lots of animal neuterings. So they are more comfortable checking post-op complications themselves.

But we were seeing quite a lot of owned bitch spays, dog castrations which weren’t having follow-ups, which we were surprised about. And therefore one of the big things was about our process of booking in post-op checks with our nurses is how we ensure that all of them are getting their routine post-op checks booked in far more frequently than was initially happening. So that has helped definitely.

Jen

That’s great. So did you add a step into the process to make sure that that was booked at the time that the patient was still in practice with you or follow up phone calls?

Harry

Yeah, so we have follow up phone calls of every operation and procedure the day after, and part of the process is ensuring that all follow-up phone calls have a post-op check booked. A lot of them will be booked already, but just making sure they do have them booked by the end of that phone call, rather than allowing someone to say, I’ll call back and book it in, or I’ll have a look at the diary, just so the process is there to stop any lost follow-ups or reduce lost follow-ups.

Jen

That’s great because actually sometimes they’re quite easily life takes over, isn’t it? You have every intention of phoning back in to make an appointment, but things get busy and you never do. So that’s great. What about you James? What kind of things did you have to implement or change?

James

Yeah, again, that was similar to us. That was one of the big things we noticed. It was quite a surprise and the loss to follow up. I think cat castrates was top, which is understandable.

I guess with us, did quite a bit of post op checks on Petsapp. So the nurses are looking at lot of photos and then everything’s okay, but they’re just not submitting it on the notes. So we’ve added a new sort of post op consults, like telecoms post op, So just making sure that’s added.

But it’s just reminding the team, it’s very easy to go through Petsapp and say, oh, reply and not then transfer it to the notes. So it’s just again, it’s reminding the team about that. I think because some of the lap spays, unless the owners are concerned, they’re quite like just taking photos and, and send them in to, so that that’s been a big thing.

I think a couple of years back, we found… we didn’t really notice, but actually we were getting more post-op complications with lap spays and bitch conventional spay, which is a bit disappointing because it’s, you know, it’s more, clients are paying more for it, and we were noticing we were getting more, not major ones, but we’re getting, most common, a seroma developing in the caudal ports. And we’re quite lucky our conventional bitch spays, the complications were pretty low. So to get higher percentage with the lap spays was disappointing.

So I think we just went back to surgical technique, made sure we’re closing the dead space. That was just going through and the teaching the teams really, and that was the, I think that’s been a lot better. And we glue, we glue all this, all the wounds now. I think that’s helped as well. yeah.

So that was, it’s interesting to like everything until you start investigating, digging into it. You think everything’s okay, because just looking at small select cases that you know of. And then dog castrates, you get a you get a run, had a few run where the dogs would get into them.

And I think it mostly came down to just communication with the client. I don’t think the surgical procedure was, was any different. Just had a spell of dogs ….and I think it just came out. Yeah. The post-op communication.

But no, touch wood… it’s nice to compare to national average and to see we’re not doing too bad a job.

Jen

Yeah, that’s great. I think that is one of the good things about having something like the NASAN in place. Like you say, you and your colleagues may spot one or two issues, like complications coming back and think, it’s just a one-off. But then when you start looking at the bigger picture, you realize that there’s a little trend for whatever reason at that moment, and you can delve a bit deeper and find out why, and then simple things in place to prevent that complication from continuing to happen for further patients.

I mean, it’s a great thing. Then as you said, the advance of technology, like with PetsApp and things, enabling that post-op follow-up much easier for clients rather than having to come back into the practice all the time, and you can keep check on your patients and make sure that everything’s going in the right direction. So it’s fabulous, great stuff.

Wonderful. Okay. So you’ve both mentioned that you’ve introduced new processes and you’re having to speak to your teams about things. So how did you engage your teams? Did you find that they were super engaged with it and super excited about things once you explained the situation?

Harry

How did we engage? I think on the vets side of things, we have a quarterly clinical meeting, which once we had some, I had collected some data, it was quite sort of novel, interesting for everyone to sit down look at our data and compare it straight away to some benchmarks, see where we compare, where we can improve. So yeah, I think the vets, that was kind of the way I introduced it and so the rest of the team, the nurses, VCA’s and reception, I think I sent out a bit of a summary email at some point, keeping them all in the loop. I wouldn’t necessarily say it’s any… so it’s quite sort of driven by me. I do quite a lot of the data collecting, data processing.

So actually, yes, providing them with some statistics of us compared to the rest of the country. It’s useful and interesting, but I don’t think they are hugely involved in the whole process, if that makes sense, which is something that I’ll probably discuss later about how I can improve our auditing in our practice.

Jen

I mean, things are never perfect though. That’s the thing, isn’t it? It’s a continuous process. And how about you, James? How did you sort of get your teams involved? Were they quite enthusiastic?

James

Yeah, it’s again, like, certain individuals. I get a similar as well. we have a, try and have a vet meeting at least every two months. And then not every time, but then the audit, neutering audit is brought up and then anything discussed. Then from then we might just have a little discussion about why that might be the case. And then, yeah, and then it’s passed down to the teams, so like there’ll be some nurses at that meeting and then it’s most, there’ll lot of vets at that meeting.

So then the nurses will take that way to their specific meeting. yeah, I think that’s the same with a lot of changes or communications, it’s passing it through the teams, we’re big, quite big groups that we find it the hardest to make sure that everyone’s heard it. You can, you can email everyone, but if you ask them a week later, you know, a lot of them say they haven’t, they didn’t know about it. That’s the hardest bit is getting it around, just got to be persistent and try different ways, avenues of communicating.

Jen

Yeah, like you say, it’s not everyone’s going to read an email and absorb it or even have an opportunity to see it, you know, with busy life, busy practice life. Finding ways that work for the individuals and the teams to spread that news around, especially when you’re spread out over a big area like that. Yeah, that’s important. Okay. That’s great. Thank you.

And have you got any advice for anybody who’s starting out on auditing in general or with the NASAN more specifically?

Harry

I’d definitely be cautious about how much you try and start to do. think initially I was very keen on doing every single neuter that we did, which on your own took quite a bit of time. And to be at that time I did have the time to do it, but now it’s a lot, we’ve grown, so we’re doing more neuters. I think I’m bit busier, trying to record every single one is pushing it.

So if you’re going to do that, maybe sort of start off with your bitch spays or your, your dog castrates or whatnot initially and do, do them for a month or, I know I’ve spoken to Rachel Clay at XL Vets before about maybe just doing your first 10 of every month of every sort of category just to make it nice and manageable to start with. And then maybe once you engage more of your team, you get someone else to help you or you make it a bit more efficient with your PMS, then you can start doing more.

Start off with a manageable amount, which you can get some good information from to start with probably would be quite sensible.

Jen

Yeah, I think that’s good advice that you start with what you can manage to do because any start, you know, is good. You’ve taken that ffirst step so anything that you can do to get started, it’ll be really great.

And you can start getting that information back, even if it’s just a snapshot and you can grow it from there. Like I say, as you get as more people come on board and help you out with that. That’s great. And James, what about you?

James

Yeah, I’ll just be reiterating what you both said. Just like anything, you just start it. Don’t make it too daunting. I think pick something you think will be useful. Like you said there, Harry, probably cats would tend to get less complications, maybe pick dog castrates because they can be a bit sometimes…so pick them and see how you can be interested and just see how you compare to the, to the, to the average submission. And it’s quite a good benchmark then. So just start, just start and yeah, don’t make it, don’t make it difficult.

Jen

No, that’s, I mean, that’s great advice. Pick something that’s relevant. And something you see often enough in practice that you can actually gather that data over a short period of time, because then you see the results quickly and it becomes less daunting that way. So that’s great advice. Thank you.

And you both mentioned the benchmark for the neutering complications. Obviously we publish the report every year and hot off the press yesterday on the 23rd of June, we published a 2025 report. I know it’s only overnight and you may not have had a chance to really absorb all the information yet, but how important is it to have these reports, and to be able to measure against that benchmark and see where you fall. How beneficial is that for you?

Harry

I find it fascinating. I’ve got a bit of a sort of math-statistics, not obsession, but interest. I think, I don’t know exactly the size of James’s practice Cedar, but we are, we’re sort of a medium-sized independent practice. And actually it’s, you assume you’re pretty good, you’re maybe you’re average, you’re better than average, but actually, because we’re kind of…I know we’re part of XL Vets, but until we started doing this, you don’t really know what everyone else is seeing. You don’t know what their complications are or how often they see them.

If it’s common to get a bit of suture poking out through a castrate wound or, I don’t know, something more serious like scrotal hematomas. And so you don’t really know what normal is until you start comparing. Obviously this is just like numbers on a page, but it’s something to compare our own little practice to everyone else. And we were pretty, we’re pretty good. We were always just a little bit better than average. So we were always very, very happy, but I’m sure there are some people, there has to be people below average so yeah for them to see their statistics compared to the average would be quite insightful definitely.

Jen

Yeah I think yeah I agree what you’re saying about the numbers. Once you start delving into it it can be quite, can get quite obsessive about it and actually sort of delving into what everything means and why might that be and what’s this mean and where do I fall compared to that. Yeah it’s a fascinating and insightful process. James how did you find it?

James

Yeah it’s just exactly similar. It’s nice to know I think. You can look at it two ways; one you can think yeah we are doing a good job compared to the average NASAN and you can also look at it actually we’re not so great with doing some, let’s delve into it and improve. Um, I guess it also is quite good to as a statistic to use if you did get complications, so you can use looking at speaking to clients.

So if you did, I don’t know, there was a complaint, you could say, well, statistically across the country… I just with a quick look now, 75%. It’s quite interesting. It’s quite high, in 25% there is some form of abnormality, which is, I think, little high, but when you dig into it, they’re probably quite minor things. So that’s quite useful as well.

Because I know in the human field, they’ve got tons and tons of statistics and knowledge, whereas we don’t. So this is quite, you know, stepping stone to having something like that.

Jen

Yeah, so that’s a good point. So would you say that the benchmark reports that we, for the NASAN are useful tools then for discussing cases and competition rates with your pet owners, with your clients?

James

Yeah. Yeah. I think it’s something that was not really thought about long time ago, you know, we thought about it more recently to talk to the vets and nurses, you know, this is the numbers across the country. So, yeah, I think it’s, it probably fits. It’s just, so dogs get more complications than in cats and that that’s what we find as well. They’re just more notorious for getting to their wounds. think that’s the main, big part of it. yeah.

Jen

So it can be quite reassuring as well when you see that you are where you fall in that benchmark, as well as sort of highlighting where you might be able to improve. It’s quite reassuring if you find, well, actually I’m sitting quite where I need to be and I’m quite happy with that. So it’s, yeah, it shouldn’t be a big scary thing to kind of have a look and measure your outcomes and measure yourself against the national benchmark.

That’s great. Thank you.

Well, thank you very much for joining us. This has been great. So just for all our listeners out there, we have just published the 2025 report and it’s the 20th anniversary. So NASAN has been running for 20 years this year in 2025. So in this report, we wanted to particularly highlight the data that we’ve got so far that provide meaningful benchmarks for spays and castrates in each species. So the report is laid out slightly differently this year. It’s had a bit of a refresh.

Hopefully this will help people when it comes to auditing those procedures specifically and when having conversations with their teams and with their owners, which you guys have already highlighted today. So thanks for that. We have also broken procedures down by surgery type as we started collecting that a few years ago. So there’s still early days for that data, but it’s something that’s going to, I think, prove to be very interesting as as time goes on and we get more data on that. We’d still love to have more data on rabbits and guinea pigs and we can continue to grow the NASAN. That’s great.

We highly recommend everybody have a look and we will put the link to the NASAN report in our notes with the podcast today and we’ll also have a link to any other resources. So if you guys want any help with starting out on quality improvement, or the NASAN in particular, please feel free to reach out to us and have a look at our website.

There’s lots and lots of free resources and CPD available at www.rcvsknowledge.org.

Well, thank you very much, Harry and James. It’s been brilliant and I really appreciate you joining us today. So thank you.

RCVS Knowledge

Thank you for listening to this podcast by RCVS Knowledge. If you’ve been inspired by what you’ve just heard, learn how you can contribute to the NASA by heading to rcvsnowledge.org/NASAN-submit.