Out of Hours - Are we running into trouble?

RE: Out of Hours - Are we running into trouble?

vs0u — Tue, 05 Dec 2017 11:42:50 GMT

[quote user="Vicki Mason"]

[quote user="vs0u "]I don't think it will go back though for 2 reasons - firstly because many vets have only experienced working in the very busy long hours daytime only practice and for them the idea of adding on call to that is awful - they don't know that practices where you do OOH are differently run[/quote]

In what way are they differently run? In my 10 year experience of working OOH in conventional practices, you did a long day, then a night on call, and then worked briefly the next morning as well! The nights on-call were feared. The 48 hr weekends on call were even worse. And "time off" was spent recovering, not living your life.

[/quote]

Maybe I've been unusual with my experience! Generally find that practices doing OOH (or that have recently done it) are less busy in the daytime and allow for lunch breaks (generally with vets going home for an hour or 2). Also they usually finish by 6 if you aren't on call. Whereas practices that have never done their own OOH seem to be non-stop 8 am till 7 pm and never any chance of finishing earlier or leaving the building during the day.

RE: Out of Hours - Are we running into trouble?

Vicki Mason — Mon, 04 Dec 2017 18:49:35 GMT

RE: Out of Hours - Are we running into trouble?

Rob Loxley — Sat, 25 Nov 2017 13:28:10 GMT

[quote user="Arlo Guthrie"]I have a question. In any given day, how many consultations could actually be done by a veterinary nurse? For example, the time I turned up with an itching dog, to be given some advocate. [/quote]

I'd rather have hoped that whoever booked the appointment checked the patient was up to date on flea control at the outset. If it was, and still itching, then it needs diagnosis as to the cause of its itch, which is what vets do. To suggest all the vet did was sell you some flea treatment seems harsh, I hope they took a history, examined the dog, considered differential diagnoses and formulated a treatment plan etc.?

RE: Out of Hours - Are we running into trouble?

Anthony Todd — Fri, 24 Nov 2017 16:48:38 GMT

BTW if people noted the time, energy and exasperation we, certainly, had with all the problems associated with "wet" xay processing they'd mortgage their relatives, and ditch wet filming.

I think you can use your old Xray generator which is the major cost??

RE: Out of Hours - Are we running into trouble?

Evelyn Barbour-Hill — Fri, 24 Nov 2017 16:35:08 GMT

[quote user="Arlo Guthrie"]

[quote user="Evelyn Barbour-Hill"]Quite... but when I suggested a couple of years ago that RVNs might be leaving the profession when they realised they were being used as cheap substitutes for veterinary surgeons, I got a severe telling-off.[/quote]

I don't agree, but can't think why you'd get a telling off!

[/quote]

It may be my memory fading, but I believe it came from you.

[quote user="Arlo Guthrie"]

[quote user="Evelyn Barbour-Hill"]Why on earth nurses should wish to do bits of surgery "not entering into a body cavity" is beyond me[/quote]

I am amazed it is beyond you. Of course, not all nurses want to do it. But for those that do, I imagine it's for the very same reasons that vets thirst to develop their skills. For personal development. Because it is more interesting, challenging or rewarding than wielding a mop. Because there is satisfaction in being an income generator.

[/quote]

Well, we all have to wield mops sometimes, although no doubt the occasional senior partner thinks it's beneath them. And everybody employed in the practice is an income generator! Even if maybe you feel that too fanciful applied to practice managers and the man who sweeps the steps and changes the lightbulbs, certainly all nurses and receptionists are income generators just by virtue of doing their nursing and receiving.

Sorry, but as with equine dental technicians, chiropractors, rodentologists, all in their different ways: if nurses wish to do veterinary surgery they should consider entering a veterinary school and becoming veterinary surgeons. As some do.

While the nurse is doing a skin lump excision, clearly he or she is not available to be nursing; so who's doing the nursing in that time? Unless no-one is (which I guess is quite possible) then another nurse must be. So an extra nurse is being employed to do surgery. A cheap substitute for a veterinary surgeon.

I have huge respect for the qualifications and expertise of a RVN in nursing and all that goes with it; it's great to have, just as an example, someone who can arrange and supervise the exact type of hospital care for a spinal patient post-op compared to a GDV patient post-op. If that sort of expertise is not being put fully to use, the veterinary surgeon employer is wasting the nurses. But if nurses want to excise skin tumours and they are not being asked to do so, their complaint should be against the training system that taught them to do it.

Was that a proper consultation? (It doesn't sound like it, the way you put it). If it was a proper consultation then it would be a veterinary surgeon's responsibility.

Other people's clients may be different, but I think for most of mine if they come to "see the vet" then they expect to "see the vet" i.e. a veterinary surgeon. This is not remotely denigrating of or demeaning to nurses.

RE: Out of Hours - Are we running into trouble?

Arlo Guthrie — Fri, 24 Nov 2017 16:07:17 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Arlo Guthrie"]I expect howls of 'we don't want minivet nurses'. [/quote]

You got 'em. [/quote]

And I just won the bet I had with myself as to where they would come from!

I don't agree, but can't think why you'd get a telling off!

[quote user="Evelyn Barbour-Hill"]Why on earth nurses should wish to do bits of surgery "not entering into a body cavity" is beyond me[/quote]

I have a question. In any given day, how many consultations could actually be done by a veterinary nurse? For example, the time I turned up with an itching dog, to be given some advocate.

RE: Out of Hours - Are we running into trouble?

Evelyn Barbour-Hill — Fri, 24 Nov 2017 15:22:35 GMT

[quote user="Arlo Guthrie"]I expect howls of 'we don't want minivet nurses'. [/quote]

You got 'em.

[quote user="Arlo Guthrie"]They're much cheaper.[/quote]

Quite... but when I suggested a couple of years ago that RVNs might be leaving the profession when they realised they were being used as cheap substitutes for veterinary surgeons, I got a severe telling-off.

Nurses should be doing nursing and Mr. Cooper and Mr. Hyde have quite correctly indicated their importance. Why on earth nurses should wish to do bits of surgery "not entering into a body cavity" is beyond me, though it's pretty obvious why certain employers would wish to have them do so.

RE: Out of Hours - Are we running into trouble?

George Cooper — Fri, 24 Nov 2017 14:21:11 GMT

[quote user="Phil Hyde"]

With OOH work, VN’s are extremely important, generate a very significant income and, IMHO, are the key personnel. To elaborate; if we took on a vet surgeon of questionable experience, the VN would cover for their inexperience and teach our techniques. If we had a VN of that same standard, all would fall appart. Why? Because the nurses take the phone calls, the nurses triage, the nurses support (train) the vets, the nurses care for the inpatients, the nurses prepare for surgery, the nurses are the main spokesperson for the practice. Never underestimate the importance of your nurses.

[/quote]

and this goes, in my solid opinion, for ANY practice worth it’s salt.

VNs are THE backbone of a well run and profitable practice. I feel that the lack of delegation to a VN comes from mainly the younger VSs who, as ever, have the fear of the RCVS, PIC, DC ingrained - and see that if they pass on anything to a VN, they could be seen as not ‘in charge’ of the case and therefore weak. I also have questions about younger VSs from a different cultural background where there is perhaps a more hierarchical ethic. This latter has been gleaned from comments by nurses who were grumbling about vets trained abroad, whose attitude to the nurse was that of a lackey.

if vets could help themselves to help nurses by allowing more to be done it would hopefully reduce the stress levels for many of them - both VN and VS.

RE: Out of Hours - Are we running into trouble?

Phil Hyde — Fri, 24 Nov 2017 14:19:22 GMT

RE: Out of Hours - Are we running into trouble?

Robin Grimmer — Fri, 24 Nov 2017 12:59:52 GMT

[quote user="Neil Wheadon"]

[quote user="Robin Grimmer"]Vets do tend to generate a lot more fees than nurses.[/quote]

But do they? Question is what generation are you talking about? If a nurse spots a dental needs doing.....

An awful lot of practices offer free nurse consults for all sorts of things, why does the profession do that? What kind of message does that send to the client as to the professionalism of a nursing qualification?

Neil

[/quote]

They do. One of my practices has a really good team of nurses and they do a lot of nurse consults. The only ones they charge for are BP measurements, behaviour, nail clip, ags etc. Post op checks, weight clinics all no charge. 2nd vaccs have already paid for the full course. I can't see what else nurses could charge for. Of course they often sell products like flea and worm treatments, diets etc.

RE: Out of Hours - Are we running into trouble?

Arlo Guthrie — Fri, 24 Nov 2017 12:54:29 GMT

[quote user="Wren"]But are nurses cheaper?[/quote]

Well, I am not sure whether i am interpreting the figures right, but just looking at the latest CM Research survey, which has nurses pegged at around £20K and, by the same measure, vets at more than double (though of course that is simplistic as doesn't factor role, location etc.)

[quote user="Neil Wheadon"]An awful lot of practices offer free nurse consults for all sorts of things, why does the profession do that? What kind of message does that send to the client as to the professionalism of a nursing qualification?[/quote]

Yes, it's bonkers. And as importantly, what sort of message does it send to the employee? Must be so much more rewarding for an employee to think they are contributing financially to the success of the business.

RE: Out of Hours - Are we running into trouble?

Neil Wheadon — Fri, 24 Nov 2017 12:23:07 GMT

[quote user="Robin Grimmer"]Vets do tend to generate a lot more fees than nurses.[/quote]

But do they? Question is what generation are you talking about? If a nurse spots a dental needs doing.....

Neil

RE: Out of Hours - Are we running into trouble?

Robin Grimmer — Fri, 24 Nov 2017 12:13:55 GMT

Vets do tend to generate a lot more fees than nurses.

RE: Out of Hours - Are we running into trouble?

Michael Woodhouse — Fri, 24 Nov 2017 11:57:38 GMT

[quote user="Neil Wheadon"]But... If they were paid better and were allowed to do more things then would more stay in the profession. After all where's the career path?[/quote]

Same points as for the vets then!!!

The majority of work is in first opinion practice for vets and nurses. Each practice only needs 1 head nurse. Few vets and nurses seem to want the financial commitment of buying into practice. What sort of career ladder to you envisage? I'm not trying to be a pain but we need nurses to take bloods, monitor anaesthetics and do some cleaning. We need vets to consult, operate and interpret results. There is no lack of specialists in the vet sphere if you want them, I'm not convinced we need lots more.

It's an absolute shame having qualified nurses and not letting them do the things they are trained to do. That I don't understand.

RE: Out of Hours - Are we running into trouble?

Neil Wheadon — Fri, 24 Nov 2017 11:36:50 GMT

[quote user="Michael Woodhouse"]There is also a massive shortage of qualified nurses......[/quote]

But... If they were paid better and were allowed to do more things then would more stay in the profession. After all where's the career path?

The NHS use this extensively and look at Canada in this thread, where auxiliary staff do a lot. We have a GP friend who's day has got better because he does the difficult cases, whilst nurses do the common colds

Neil

RE: Out of Hours - Are we running into trouble?

Michael Woodhouse — Fri, 24 Nov 2017 09:15:38 GMT

There is also a massive shortage of qualified nurses......

I do think under the current regulations nurses could be utilised much better and do a lot more than they do in a lot of practices. I'm not sure they are particularly cheaper. If you take an OOH scenario where you have nurse assisting the vet if you get the nurse to do more you then need an auxiliary nurse to help the nurse, but then there's no one to help the vet so you need another nurse and suddenly the workload is lessened but you've doubled your staff OOH and increased costs.....

RE: Out of Hours - Are we running into trouble?

Wren — Fri, 24 Nov 2017 09:04:55 GMT

But are nurses cheaper? Certainly in my first job the head nurse was (probably rightly! ) paid more than me. Give them more responsibility, and possibly further qualifications, to do basic consults and you surely have to pay them more - probably on a par with new grad wages.

RE: Out of Hours - Are we running into trouble?

Arlo Guthrie — Fri, 24 Nov 2017 08:58:37 GMT

[quote user="Neil Wheadon"]Immaginative thinking required I feel, maybe even a return to everyone having to take a turn in the OOH centre or a complete cutting of the obligation.[/quote]

Coming back to the OP, and here's a train of thought (which may just go into a siding, but I'll try it anyway).

a) Profession increasingly divided between specialist treatment being referred and GP stuff.

b) As a consequence, a) GPVs doing less interesting / rewarding stuff and b) increasingly less cost-effective??? (presumably performing surgery is more profitable than a flea consultation).

meanwhile ...

c) Nurses seem (to me anyway), often overqualified for what they are asked to do. So many times I hear them talking about not being able to use half the skills they've been taught.

I just wonder if there is some creative thinking to be done about the best use of the workforce. Whether in fact there should be a radical rethink about the role of the nurse, and to try and shift much more of the run-of-the-mill stuff over to them, thereby allowing GPVs to concentrate on the more complex stuff.

Maybe that requires quite a big rethink of Schedule 3 / training.

How that could affect OOH, I don't know. Only got as far as thinking perhaps there is a better use of everyone's time, and maybe that could make OOH less burdensome.

I expect howls of 'we don't want minivet nurses'. But apart from being instinctively protective of your role, why on earth not? They're much cheaper. You get to focus on the more interesting stuff, and possibly work less hard. Probably good for the consumer, as it might lead to GPVs regaining experience/confidence in stuff that is now being referred, and therefore reduction in cost to consumer.

As an aside ...

[quote user="David Mills"]Surveys are a very weak form of research.[/quote]

... as I am sure everyone will be reminding me on Monday, when we publish the results of the Behaviour in Practice survey

RE: Out of Hours - Are we running into trouble?

Robin Grimmer — Wed, 22 Nov 2017 21:11:37 GMT

Blood testing in healthy animals is fundamentally flawed as you will get a significant amount of 'abnormal' results that aren't actually abnormal. Bit like if you go testing for cushings in dogs that don't fit the clinical picture - sensitivity and specificity go out the window and you have results that are impossible to interpret.

RE: Out of Hours - Are we running into trouble?

David Mills — Wed, 22 Nov 2017 20:35:47 GMT

[quote user="Clive Ansell"]

[quote user="David Mills"] but just because the prevailing culture is "health screens", how comfortable are you with taking bloods from a healthy animal? What, bluntly, is the point?[/quote]

My brother who lives in the US where his healthcare is private, has annual blood tests, ecg, monitored session on a treadmill or exercise bike and a lifestyle assessment. Presumably his insurers, with a primary remit of making money, would not do this if it were 1) not cost effective 2) didn't improve health by foreseeing or preventing certain illnesses ?

Incidentally, his private healthcare insurance costs roughly two-thirds of what the NHS costs per person in the UK, and also includes all of his dentistry and eye care. Also includes gym membership.

Maybe there should be more emphasis on preventative healthcare in the UK, in human and veterinary medicine?

[/quote]

I've no idea what the relevance of this is. We are not treating humans are we? Health economics and risk profiling of human disease is not extrapolatable to veterinary medicine.

Would you be happy taking bloods off a healthy dog every year because an insurance company told you to? Or the client expected you to?

RE: Out of Hours - Are we running into trouble?

Clive Ansell — Wed, 22 Nov 2017 19:35:34 GMT

[quote user="David Mills"] but just because the prevailing culture is "health screens", how comfortable are you with taking bloods from a healthy animal? What, bluntly, is the point?[/quote]

Incidentally, his private healthcare insurance costs roughly two-thirds of what the NHS costs per person in the UK, and also includes all of his dentistry and eye care. Also includes gym membership.

Maybe there should be more emphasis on preventative healthcare in the UK, in human and veterinary medicine?

RE: Out of Hours - Are we running into trouble?

Wren — Wed, 22 Nov 2017 18:59:21 GMT

[quote user="David Mills"]The DR systems I've seen still used plates, just directly linked to the machine, they may have changed since then. The plates were even more expensive than the CR ones, so even more precarious.[/quote]

I have a portable DR machine that I use at clients' premises for horses. Using the plate around horses' feet scares the hell out of me - they are frighteningly expensive - but 4 years on and no major incidents. Yet *touches wood frantically*. Ours is attached to the machine via a cable, but the more modern ones use Bluetooth and are wireless. Technology has moved so quickly in just 4 years!

RE: Out of Hours - Are we running into trouble?

Martin Hamilton — Wed, 22 Nov 2017 18:06:17 GMT

[quote user="Julie Innes"]

[quote user="MartinH1"]Speed would be the main reason - no need to try position a plate precariously under a 60kg Newfoundland for ages, only to find that the plate isn't large enough or you have to lift the dog up again and move the slide slightly. With a DR sit it on the table, collimate and shoot.[/quote]

I have CR and a floating table, which means you can easily move the dog (without moving the plate) or change the plate without moving the dog. I love it!

[/quote]

Ooooh, sounds great!!

RE: Out of Hours - Are we running into trouble?

Julie Innes — Wed, 22 Nov 2017 18:01:48 GMT

I have CR and a floating table, which means you can easily move the dog (without moving the plate) or change the plate without moving the dog. I love it!

RE: Out of Hours - Are we running into trouble?

David Mills — Wed, 22 Nov 2017 17:57:53 GMT

[quote user="MartinH1"]up to 20% of vets in practice, according to the SPVS survey[/quote]

Surveys are a very weak form of research.

[quote user="MartinH1"]I agree that fluoroscopy isn't necessarily needed[/quote]

I would say hardly ever, unless you're routinely doing interventional radiography.

[quote user="MartinH1"]just pointing out that it's a feature of these machines. Speed would be the main reason - no need to try position a plate precariously under a 60kg Newfoundland for ages, only to find that the plate isn't large enough or you have to lift the dog up again and move the slide slightly. With a DR sit it on the table, collimate and shoot[/quote]

You can always use a tray

The DR systems I've seen still used plates, just directly linked to the machine, they may have changed since then. The plates were even more expensive than the CR ones, so even more precarious.

Other than that, the reasons you give are, well, a little like marketing talk

[quote user="MartinH1"] It's just what is standard - I'm sure that many vets years ago said the same thing about the transition from old film to CR.[/quote]

Not really. Digital image radiography was a bit of a game changer in terms of image quality, and the ability to post-exposure adjust the image, measure, rotate, send for 2nd opinion. It wasn't quite revolutionary, but close to it in terms of ease and speed. DR is a mere tweak of the system, and feels like being sold something that you don't really need (but because it's the "best" it does feed somewhat into a vet's or practice's ego).