Who's responsible for OOH care?

RE: Who's responsible for OOH care?

karen jones — Wed, 05 Aug 2015 22:26:29 GMT

The vets4pets and companion care practices near our branch surgery use a out of hours at least a 40 minute drive away traffic depending especially during the holiday season. We now charge a registration fee to see these clients as its for their convenience for us to see them. If they register with us and use us for routine things we refund it. We have gained quite a few clients this way. I'm always surprised that people think we will forget them. Our chief receptionist has a memory like an elephant for people who fleece us! This week we have been offered a pound a month to pay off bill of £500 even though they have the necessity of a £80 per month sky package , 40 on mobile phones cigarettes, socialising etc we have declined !

RE: Who's responsible for OOH care?

Anthony Dennison — Wed, 05 Aug 2015 09:25:56 GMT

[quote user="Wren"]a surprising number then go on to register with us for their day to day work.[/quote]

That happens with us too - think clients are sometimes surprised to see a smiling, professional face at midnight!

RE: Who's responsible for OOH care?

Wren — Wed, 05 Aug 2015 08:38:27 GMT

[quote user="Anthony Dennison"]

We often get clients of other practices coming to our OOH centre, as the nearest VetsNow is in Bury, at least a 30 minute drive away.

We also get a lot of people that just don't want to go to their own vets OOH.

[/quote]

Slightly different as I'm in equine practice, but quite a few people in his area use a practice over an hour away (assuming the vet on call is at home/the practice and not at one of their clients another hour in the opposite direction). Consequently we see a lot of their clients OOH who feel that the other practice are just too far away to be of use. It annoys the hell out of me, but I smile sweetly, do my best to arrive there in 10 minutes (to emphasise our proximity), do the best job I can, pocket the money, and a surprising number then go on to register with us for their day to day work.

It did irk me a little when I saw them advertising for a new vet using the phrase 'very quiet on-call work' though. Yes, because I'm blooming doing it for you!

RE: Who's responsible for OOH care?

Hannah Wynne Richards — Tue, 04 Aug 2015 14:00:18 GMT

Only if they've neglected an animal to such an extent that a successful criminal prosecution can ban the culprit from owning an animal. Unfortunately, the law can't ban them from co-habiting with an animalowner so "ownership" is merely transfered to another family member. Sickeningly ineffective.

Wynne

RE: Who's responsible for OOH care?

Nhombokisheni — Tue, 04 Aug 2015 12:58:58 GMT

[quote user="Clive Ansell"]

The initial question still remains though; should a practice keep such a client where a 24/7 continuity of care as per the GtoPC cannot be provided through no fault of the practice?

[/quote] The answer is NO and NO. If you are not in a position to provide continuity of care then you can be liable for knowingly exposing the animal to suffering when adequate care is not provided. Its only professional to remove "procedurally" all such clients from your books immediately before a situation arises such as the one you mentioned. The last thing you want is them turning up and preying on your compassion and professional obligations. Maybe such clients should be flagged to the RSPCA so animals can be "rescued" at the first sign of suffering. Is there a law banning such people from owning pets?

RE: Who's responsible for OOH care?

Braden Collins — Tue, 04 Aug 2015 11:36:01 GMT

We have similar laws but good relationships with most clinics in the area so we generally know when to insist "we need to contact your last vet for a history", or at least get them to prepay. My experience of bad debtors is asking them to prepay will almost always make them remember they don't have any money/intention of paying and they can be moved on.

Any clients which have been bad debtrs in the past who want to come back to us have to pay their previous debt then prepay for the estimated work. I;m always amazed how many people think we will forget about them bad debting before, and don't realise our computer records are going to flag theem up every time.

RE: Who's responsible for OOH care?

Hannah Wynne Richards — Tue, 04 Aug 2015 08:35:49 GMT

The problem in this country is data protection laws mean we can't be told about debts

Wynne

RE: Who's responsible for OOH care?

Braden Collins — Tue, 04 Aug 2015 01:33:56 GMT

As a general rule, if we become aware of a client owing another clinic money, we will refuse to continue treatment without them first squaring their account with the other clinic. If it's after hours and the animal can't be sent to another clinic, we would insist on them pre-paying for the estimated work. I think this is basic professional courtesy, and we would expect the same of other clinics.

RE: Who's responsible for OOH care?

Catriona MacIntyre — Mon, 03 Aug 2015 19:08:01 GMT

No Clive, personally, I don't think they should.

I would be writing to them... something along the lines of "A satisfactory professional relationship between a client and his/her veterinary surgeon must be founded on the basis of mutual trust and confidence. It is clear that there is no longer such a basis to our relationship."

RE: Who's responsible for OOH care?

Clive Ansell — Mon, 03 Aug 2015 18:45:28 GMT

Update to my OP of June 2012 in this thread.

This client eventually ran up large debts and was never seen again, so probably should have been dismissed long ago. I took the view that if they were bad debtors elsewhere, they would likely repeat themselves. Leopards, spots etc.

The initial question still remains though; should a practice keep such a client where a 24/7 continuity of care as per the GtoPC cannot be provided through no fault of the practice?

RE: Who's responsible for OOH care?

Hannah Wynne Richards — Mon, 03 Aug 2015 16:24:30 GMT

Not everybody, but a depressing number

Wynne

RE: Who's responsible for OOH care?

Rob Davis — Mon, 03 Aug 2015 15:55:44 GMT

[quote user="Neil Wheadon"]I always ask this and am amazed just how many people ...well to be frank...lie.[/quote]

House MD, "Everybody lies"....

RE: Who's responsible for OOH care?

Neil Wheadon — Mon, 03 Aug 2015 13:40:33 GMT

[quote user="Clive Ansell"]First aid and pain relief should, however, be provided to the animal if, for whatever reason, the owner cannot contact his or her usual veterinary surgeon or practice[/quote]

Unless the phone re-direction isn't working there is no reason why a client cannot contact their usual practice. In this case I would have have contacted their usual vet for them and 99 times out of 100 I get a reply, so this excludes the 'It's too far excuse'

[quote user="Clive Ansell"]or the circumstances are exceptional and the condition of the animal is such that it should be seen immediately.[/quote]

Entirely reasonable, however how many OOH calls are 'true emergencies' To be brutal if a cat has survived an RTA and the car journey, I can't think of many cases at all when another 10 minutes will make any difference especially considering that clients OOH are going to a strange address

.[quote user="Clive Ansell"]When an animal is initially presented, a veterinary surgeon should ask whether the animal is already receiving veterinary attention or treatment and, if so, when it was last seen; then, contact the original veterinary surgeon for a case history. It should be made clear to the client that this is necessary in the interests of the patient. If the client refuses to provide information, the case should be declined.[/quote]

I always ask this and am amazed just how many people ...well to be frank...lie. half way through an ear case, you're putting the drops down the ears and they'll say 'Those are the ones I've used before'

Neil

RE: Who's responsible for OOH care?

Clive Ansell — Mon, 03 Aug 2015 13:09:46 GMT

From the RCVS CofPC

Non-clients – clients of another veterinary surgeon / practice

3.45 A client of another veterinary surgeon or practice who requests an emergency consultation may be redirected to that veterinary surgeon or practice (or the emergency service provider for that veterinary surgeon or practice). The on-duty veterinary surgeon to whom the initial request has been made may decline to carry out the consultation. First aid and pain relief should, however, be provided to the animal if, for whatever reason, the owner cannot contact his or her usual veterinary surgeon or practice or the circumstances are exceptional and the condition of the animal is such that it should be seen immediately.

Non-clients – owners have no veterinary surgeon / practice

3.46 First aid and pain relief should be provided to an animal if, for whatever reason, the owner does not have a usual veterinary surgeon or practice. Holidaymakers, new owners and other categories of animal owner may not have a usual veterinary surgeon or practice in the locality.

Taking over a colleague’s case

5.5 Although both veterinary surgeon and client have freedom of choice, in the interests of the welfare of the animals involved, a veterinary surgeon should not knowingly take over a colleague's case without informing the colleague in question and obtaining a clinical history.

5.6 When an animal is initially presented, a veterinary surgeon should ask whether the animal is already receiving veterinary attention or treatment and, if so, when it was last seen; then, contact the original veterinary surgeon for a case history. It should be made clear to the client that this is necessary in the interests of the patient. If the client refuses to provide information, the case should be declined.

5.7 In an emergency, it is acceptable to make an initial assessment and administer any essential treatment before contacting the original veterinary surgeon.

RE: Who's responsible for OOH care?

Neil Wheadon — Mon, 03 Aug 2015 12:00:54 GMT

[quote user="Clive Ansell"]

Doesn't seem to be any hard and fast rules, and a lack of clear guidance.

When I used to work in OOH clinics I would always redirect such cases to their own vet or their own vets OOH provider, unless of course it was an absolute emergency or there were exceptional circumstances such as distance to travel. If in doubt I would see the case and sort out the BS and politics later. The most important thing is that the animal gets seen.

2 of the 4 OOH clinics I have worked in had unofficial and unwritten policies of seeing anyone that rings, and 1 of the 4 had a written policy of not seeing clients registered with non user practices, unless an emergency of course.

One OOH clinic used to charge a higher OOH consult fee for clients of non registered practices or clients with no vet. They argued that fees paid by user practices should be in part passed on to those practices' clients.

[/quote]

There are no rules for clients are there?

Yes we are bounded to request a history from a practice if a case is seen, but this is almost impossible in an OOH setting.

Clients are increasingly using veterinary services like they would for other things in life. Vaccinate here, neuter there, lumpectomy there, often preceded by estimates and phone calls.

What's holding things mostly together is the integrity of a practice, but in an increasingly competitive environment how much longer will this hold.

Day practices can fight back by offering a terrific service so retaining business and this extends to OOH cover. However in the case of OOH providers that's a touch tricky. Consider if your car broke down. One mechanic offers a repair on a Sunday for normal rates, but your usual garage recommends another at maybe 5 times the price just to be seen, where would you go?

Neil

RE: Who's responsible for OOH care?

Clive Ansell — Mon, 03 Aug 2015 11:35:19 GMT

Doesn't seem to be any hard and fast rules, and a lack of clear guidance.

RE: Who's responsible for OOH care?

Anthony Dennison — Mon, 03 Aug 2015 10:24:14 GMT

We often get clients of other practices coming to our OOH centre, as the nearest VetsNow is in Bury, at least a 30 minute drive away.

We also get a lot of people that just don't want to go to their own vets OOH.

RE: Who's responsible for OOH care?

Bob Russell — Mon, 03 Aug 2015 09:22:17 GMT

[quote user="Hannah Wynne Richards"]

Nothing at all wrong with the Guide A great deal wrong that some people are getting away with flounting it

Wynne

[/quote]

Nothing wrong with the guide IMO. It is easy to justify that it is in the interests of the patient to be moved to an OOH provider where constant supervision is in place.

Not sure what flouting is taking place.

RE: Who's responsible for OOH care?

Hannah Wynne Richards — Mon, 03 Aug 2015 08:40:43 GMT

This subject came up in an RCVS regional meeting in 2003. A partner in a Brecon practice was very annoyed because a practice some 20 miles away referred OOH work to Cardiff (a further 20 miles again) People who lived btween the 2 practices were phoning him in the middle of the night because it was a 10 mile journey as opposed to a 30 mile one. The then President of RCVS told him that if it was an emergency, he had to attend.

Wynne

RE: Who's responsible for OOH care?

Dagmar Steele — Mon, 03 Aug 2015 06:53:36 GMT

[quote user="Silvia Maldonado"]

In regards to the same subject, and working on night shifts, we had a phone call last night that made me wonder. A pet's owner called us, can't remember what was the issue (not an emergency, in any case), but his vet practice was not one of our member practices. On the one hand, we would not have denied any appointment if needed. On the other hand, and being in the day vet's shoes, I would have some concerns, if not annoyed, if a different OOH vet that the one I had arranged for my clients would attend and treat my client's pets. So my question is, to what extend any client can choose the OOH practice to visit, if it is not their vet's OOH provider? To what extend should an OOH practice allow clients to choose where to be seen? Previously it's being discussed the case of a cat's owner who wouldn't want to go back to the OOH practice due to a debt. In my case, it was a matter of distance, and recalling similar cases, we've had clients who live at 45 minutes drive and were concerned of why shouldn't they request an OOH appointment to other practices much closer to their home?

I would like to have your opinions and arguments ;)

[/quote]

I think every pet owner should have the right to take his pet everywhere he wants to. If he for whatever reason doesn't trust the OOH Provider of his normal vet why on earth can't he take the pet somewhere else? Provided that somewhere else is prepared to care for the pet I see nothing wrong with it. I wouldn't want to be forced to take me, my kids or my pets to any doctor I don't like/trust/can't get to. And as it's no social service system or something like the NHS but people are paying the bills with their own money IMHO there's nobody who can tell them where to go and where not to go.

RE: Who's responsible for OOH care?

Silvia Maldonado — Mon, 03 Aug 2015 03:28:09 GMT

I would like to have your opinions and arguments ;)

Re: Who's responsible for OOH care?

Rajat — Fri, 29 Jun 2012 20:42:32 GMT

Hi Lorna

My post followed Clive's reply, which quoted several other users' posts and the RCVS code, all of which use the term 'critically ill animals'. Says 2 things to me, which is that they need close 24 hour care and attention, and that there will be a phase when they are no longer 'critically ill' but will still need hospitalisation to be monitored. Hence my reply. I am not commenting on animals that need monitoring/meds/fluids for a few more hours and then sending home.

[quote user="Lorna McHardy"]With a lot of the ones I send back to their usual practices via the owners, it's mostly about the usual practice being able to see and assess their patients for themselves and sort out whatever follow up treatment they consider appropriate. I see no reason whatsoever why owners can't transport animals like this. [/quote]

I totally agree and do the same

Re: Who's responsible for OOH care?

CatherineThomas — Fri, 29 Jun 2012 20:30:11 GMT

The practice where vetsnow work from is owned by the same corporate as us, so I guess if we couldn't transport an animal safely we would have to ask them to take on the patient until it was stable enough to be transported by the owners. But we can't be the only practice without suitable transport/staff for this situation. In the 2 years I have been working here I think it has only happened twice I think.

Regarding the seizuring cat I think it had been seizuring when admitted the previous evening but had been stabilised through the night and the reason they thought it needed us to transport it was because it was still a bit dopey from the meds given (it was a while ago so I can't remember the details).

Re: Who's responsible for OOH care?

Lorna McHardy — Fri, 29 Jun 2012 20:28:25 GMT

[quote user="Rajat"]

Hmm..I don't think these critically ill animals should be transferred back to the practice in the day - they should stay put and be treated where they first showed till stable. The practice needs to arrange provisions with the OOH centre/day practice for this prior to these siutations arising to ensure smooth communication and best care for the patients. I agree with the RCVS code in this circumstance. If it was one of our relatives in hospital, critically ill, we wouldnt be happy with this kind of back and forth. Additionally,. some patients are critically ill for 2-3 days- do they then get transported back and forth every 12 hours?

[/quote]

I don't think anyone's talking about moving animals not fit to be moved (i.e., critically ill ones). As far as I can see, it's about moving animals that are stable, but require some further treatment as in-patients before being sent home, such as another 12 hours or so on fluids, or further doses of parenteral medication. With a lot of the ones I send back to their usual practices via the owners, it's mostly about the usual practice being able to see and assess their patients for themselves and sort out whatever follow up treatment they consider appropriate. I see no reason whatsoever why owners can't transport animals like this.

Re: Who's responsible for OOH care?

Lorna McHardy — Fri, 29 Jun 2012 20:21:27 GMT

[quote user="An On MRCVS"]

"Unenforceable: veterinary code for 'i'm not going to do it and you can't make me'"

[/quote]

Why is it necessary for this comment to be anonymous?