OOH Cover

RE: OOH Cover

Silvia Maldonado — Sat, 21 May 2022 19:41:55 GMT

OOH providers are also answering the calls and giving phone advise. I guess that's why clinics have to pay a fee to their OOH providers.

RE: OOH Cover

Clive Ansell — Sat, 21 May 2022 08:36:11 GMT

[quote userid="13609" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237222#237222"]maybe a way forward would be to subscribe to an OOH provider, re-direct all your unregistered (and possibly difficult) clients there but still see your regular clients OOH?[/quote]

But why should anyone have to subscribe and may a fee to provide an OOH service to non clients, and other practices clients, when they could and should be redirected anyway?

Come to think of it, why should a practice pay a subscription fee to an OOH provider at all. Surely the end user of the service, the client, should be resonsible for pay all the fees without it being subsidised by a daytime user practice.

RE: OOH Cover

Clive Ansell — Sat, 21 May 2022 08:29:17 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237219#237219"]BUT how many animals suffer for longer than necessary because the owners cannot afford the OOH fee. The way the cost of living is going this is going to become much more of an issue[/quote]

Some for sure, it would be wrong to assume otherwise.

Also; how many animals suffer, to a greater or lesser degree, because

1) They cannot , or cannot easily, afford daytime fees (Where I am = £53 consultation), so put things off as long as possible? Those on the appropriate benefits are luckier, and are eligible for RSPCA or PDSA assistance, (if they can get a timely appointment).

2) Owners cannot get to the surgery, busy, working etc

3) Lack of available appointments. We currently have 4 or 5 of 11 branches open, and 3 of those are 2 vets down to 1. There is a wait of 2 to 3 weeks for routine appointments. I saw a dog last night with 3 nails growing into punctures and infected pads, that had waited 2 weeks for an appointment. It was booked a straightforward nail clip, hence the wait.

4) Those that decline investigation or treatment because of costs. I'm seeing many of these at the moment.

RE: OOH Cover

Joyce Whitehead — Fri, 20 May 2022 08:21:11 GMT

I think for us the messing around calls reduced a lot when we started using an answering service.(we use Phoneta, used to be Kernow). It is answered as surgery name emergency service, and they will pass on all calls that need to be passed on, but lots of people at that stage will decide it’s not something they need to speak to us immediately about. Our clients are pretty respectful, but we are rural and I think therefore it isn’t as much of an issue. Also most neighbouring practices do their own ooh, as most are mixed in some respect.

Before we changed to the answering service one particular horse owner often phoned at 9pm as she thought it was a good time for my husband to be about. I started to always answer the phone and say he was on a call.

RE: OOH Cover

Michael Woodhouse — Thu, 19 May 2022 22:44:38 GMT

[quote userid="12375" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237221#237221"]it wasn’t that long ago that you were extolling the virtues of OOH work as a business opportunity[/quote]

It wouldn't be much of a business opportunity if we didn't charge for the work, would it?!

[quote userid="12375" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237221#237221"]Presumably your OOH fee is entirely fair[/quote]

I believe so

[quote userid="12375" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237221#237221"]but others are ripping people off. [/quote]

I never said that. What I do note is that the quoted £180 is 50% more than we would charge, and I suspect if they had a caeser/pyo etc at the OOH centre the bill would be many multiples of what we would charge. A 4 figure sum for a bitch caeser etc.

Personally I don't mind OOH work and most of our clients (and holidaymakers) seem pretty respectful in the way it's used. One thing that I would say has more than halved the calls (and fished out a LOT of rubbish) is a message saying surgery close, emergency only and giving opening times. It then puts the call through to the duty vet.

RE: OOH Cover

cairncross — Thu, 19 May 2022 19:46:23 GMT

Re pyo dog some get returned to the breeder/money lender some never return with consent ?

Rest i largely agree with, its not sustainible the fee are good value at what ever level .

Its the city i guess Birmingham or Belfast below me has sifficient footfall or catchment who can afford the ooh anal glands etc to sustain an ooh centre and rota of vets for this. Rural we dont , at £180 call outs would be zero so no income to pay the vets on call and clients would be going to any of the other rurals still offering ooh at a rate that gets clients to pay for it. I guess we its this transition period from everyone contributing to ooh most can afford to few contributing to an ooh that only the wealthy few can afford, its dragging out in tge rural and poorer areas.

2 nights ago was woke 3 times by client wishing to discuss his bitch coming to be spayed that am , on 3rd call i cancelled spay as explained lack of sleep had reduced my capacity next day . Genuine situation obviously got a rant threatining to sue as him and wife had booked week off work too look after dog post op etc wife akready traumatised by idea of spay now distraught. Back too sleep 20min and next call describes the usual lake of blood panic cant get useful hx was it bloody diarrh wound ?? arives at clinic zero blood losx pic on phone of tiny speck of blood on other dogs bed , husbamd and wife then fall out over my offer to admit incase some obvious blood loss recurrs

RE: OOH Cover

Andreas Ege — Thu, 19 May 2022 13:40:20 GMT

[quote userid="9035" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237223#237223"]Not sure what the OOH provider would think about that thought.[/quote]

Well, for one they wouldn't necessarily need to know, would they? :-)

When I locumed for a VetsNow couple years back, they had one of my previous permanent practices on their registered practices list. Did surprise me, as to my knowledge they were still doing there own out-of-hours. A quick check online confirmed. The nurses at VetsNow couldn't remember having ever seen one of their clients. They were reasonably big (6 -7 full time vets, if remembering right) with 4, later 3 sites and only 1 vet on call after they gave up the large animal work, so I assume they were using VetsNow as a back-up.

No idea how much something like that would cost, though.

RE: OOH Cover

Glenn Hodgson — Thu, 19 May 2022 12:45:55 GMT

"maybe a way forward would be to subscribe to an OOH provider, re-direct all your unregistered (and possibly difficult) clients there but still see your regular clients OOH?"

That's an interesting thought... Not sure what the OOH provider would think about that thought.

RE: OOH Cover

Andreas Ege — Thu, 19 May 2022 08:05:18 GMT

Hello,

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237208#237208"]2) Ditch OOH work altogether, and subscribe to an OOH provider, so you don't have to do it.[/quote][quote userid="19228" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237215#237215"]I think the ditch ooh altogether is a very different senario in different parts of the country . [/quote]

maybe a way forward would be to subscribe to an OOH provider, re-direct all your unregistered (and possibly difficult) clients there but still see your regular clients OOH?

RE: OOH Cover

Alastair Welch — Wed, 18 May 2022 23:02:31 GMT

Michael,

I am most surprised that you choose to levy an OOH fee at all. If the animal needs to be seen why are you penalising the unfortunate owner. Why are you trying to ‘deter’ clients at all (it wasn’t that long ago that you were extolling the virtues of OOH work as a business opportunity). Surely you should be encouraging them through your door? and differential pricing is just going to put people off. Presumably your OOH fee is entirely fair and reasonable but others are ripping people off. Take the plank out of your eye.

RE: OOH Cover

Michael Woodhouse — Wed, 18 May 2022 21:48:24 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237218#237218"]It is amazing how some cases dramatically improve once the OOH fee is given. The dog that can't stand, and the cat breathing badly that initially had to be seen immediately, will suddenly now improve and wait until the morning. Better than any medicine! [/quote]

I don't know what I think, because I do use the OOH fee as a deterrent BUT how many animals suffer for longer than necessary because the owners cannot afford the OOH fee. The way the cost of living is going this is going to become much more of an issue

RE: OOH Cover

Clive Ansell — Wed, 18 May 2022 21:39:51 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237217#237217"]OK There is a touch of Devils Advocate here[/quote]

Yes there is!

You know as well as I do, that with a few pertinent questions the relevant information could be teased out and a decision reached as to whether a patient needs to be seen OOH or not. Of course, if a patient can't walk, is staggering, or breathing heavily they should be seen asap.

All of the above are real life cases, only this week. All could have waited until the next day. The rabbit had no maggots, the lame dog was not lame and NAD, the diarrhoea dog was NAD and sent away with prokolin paste, the AG dog was EAG and no other treatment required. These were convenience rather than emergency appointments.

Both where I am currently working, and nationally, OOH care provision is on the brink of crisis; unable to staff clinics and unmanageable workloads - there needs to be a way of triaging or filtering out the garbage.

It is amazing how some cases dramatically improve once the OOH fee is given. The dog that can't stand, and the cat breathing badly that initially had to be seen immediately, will suddenly now improve and wait until the morning. Better than any medicine!

RE: OOH Cover

Neil Wheadon — Wed, 18 May 2022 21:13:01 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237216#237216"]Also, don't forget, more than 90% of the cases seen OOH could have easily waited until the next day[/quote]

I once made the mistake of telling a client 'This isn't an emergency' He looked me squarely in the eye and politely replied 'I didn't know that, you're the vet'

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237216#237216"]clip and clean a rabbits arse [/quote]

How does the vet know there are no flies?

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237216#237216"]dog been lame for 2 weeks[/quote]

How lame? My dog can't stand

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237216#237216"]dietary diarrhoea[/quote]

He's got the runs, he staggered into the house, I think he's really sick

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237216#237216"]sore anal glands[/quote]

She's very very bothered, seems in pain, she's breathing more heavily

OK There is a touch of Devils Advocate here, but we know because we're vets, owners don't

Neil

RE: OOH Cover

Clive Ansell — Wed, 18 May 2022 20:56:39 GMT

[quote userid="19228" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237215#237215"]Re the pyo dog its not the payment thays the problem its that it doesnt happen as the owner cant and wont consent [/quote]

So, what happens too it?

[quote userid="19228" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237215#237215"]If only 5 or 10 % of your client base can afford an ooh provider and they have 5 or 6 other options locally providing ( struggling) their own actually affordable ooh . Ditching ooh is impossible . Several locsls will swallow the client base. Locally here outside the city even the corporates who own the ooh centre still have their practises just 20 30 min away from the centre do their own ooh itvwould be buisines suicide to exclude 90% of your client base for 2/3 of the time. [/quote]

Together with the workloads you've described in the past, it is just not sustainable in the long term.

There will have to come a point in time, where either OOH care isn't available, or folk will have to put their hands in their pockets and cough up for it.

I'm working in the poorer and more deprived areas of Birmingham at the moment. To be seen OOH is about £180, which is not unreasonable given a daytime consultation is £53. It would cost roughly double that to call a plumber OOH. I still think in most situations it is case of not wanting to pay, rather than being unable too.

Also, don't forget, more than 90% of the cases seen OOH could have easily waited until the next day. So far this week we've had clinical notes from the OOH provider for; clip and clean a rabbits arse (No flystrike) at 3 o'clock in the morning, dog been lame for 2 weeks, dietary diarrhoea, and sore anal glands.

RE: OOH Cover

cairncross — Wed, 18 May 2022 16:48:12 GMT

I think the ditch ooh altogether is a very different senario in different parts of the country . If only 5 or 10 % of your client base can afford an ooh provider and they have 5 or 6 other options locally providing ( struggling) their own actually affordable ooh . Ditching ooh is impossible . Several locsls will swallow the client base. Locally here outside the city even the corporates who own the ooh centre still have their practises just 20 30 min away from the centre do their own ooh itvwould be buisines suicide to exclude 90% of your client base for 2/3 of the time.

Re the pyo dog its not the payment thays the problem its that it doesnt happen as the owner cant and wont consent

RE: OOH Cover

Clive Ansell — Wed, 18 May 2022 08:29:27 GMT

[quote userid="19228" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237200#237200"]We have had numerous cases where owners can't agree to have spay for pyo or large vaginally prolapse as they still owe breeder and they are demanding litter of pups.[/quote]

In these cases who gives and signs for consent to anaesthesia and surgery?

Presumable the one giving consent is responsible for payment?

I have never thought of it before, but is the registeree of a microchip necessarily to legal owner?

[quote userid="19228" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237200#237200"]It is not my responsibility to fix this system that duty of care to animals and the profession is thankfully someone else's liability. But this does not stop its problems landing at my door 24 7 365 in every increasi numbers. [/quote]

I suppose the only solutions would be

1) Clear cut guidance from the college that you can restrict OOH care to your own clients only, and others can be told to go away

2) Ditch OOH work altogether, and subscribe to an OOH provider, so you don't have to do it.

At the end of the day, and when the chips are down, these clients have no loyalty to you and do not care about your welfare, sanity or well being, which should always come first.

RE: OOH Cover

cairncross — Tue, 17 May 2022 15:00:57 GMT

Spoke to our microchip and database rep this am. He is inundated with enquiries and disputes from breeders who sold puppies on tik , 100 a month over 2 years etc etc . Purchaser stops paying some months in and angry breeder contacting him trying to use his database as proof of ownership sometimes police involvement. Completely illegal unregulated system and not his responsibility but he is struggling to cope with volume of enquiries ad complaints that he won't take responsibility etc But the puppies in their thousand were bought on tik or , from some sort of windfall , whiplash claim , benefit scam wwhatever or on the agreement a litter of puppies will be produced to pay . We have had numerous cases where owners can't agree to have spay for pyo or large vaginally prolapse as they still owe breeder and they are demanding litter of pups.

Then there are the responsible middle ground who when they bought the pup f could afford the going rate for insurance or ooh care but during its lifespan our ooh fees have risen 500 % and now there disposible income has fallen 10%

It is not my responsibility to fix this system that duty of care to animals and the profession is thankfully someone else's liability. But this does not stop its problems landing at my door 24 7 365 in every increasi numbers.

RE: OOH Cover

cairncross — Mon, 16 May 2022 19:31:15 GMT

I understand your aim here but I run into difficulty.

With 1 I have previously explained all the routes round this people take., I don't have a vet , they get s family member or friend who is a client to call abd claim its their new dog, they wait outside the clinic to ambush vet coming in to see someone ,Some still are nieve enough to say we are client of elsewhere snd that I'd where I direct them bug often we are the third or fourth practise they have tried so they Spon know what to say.

On point 5 that would probably take 45 min each morning to enter that so do I go I early and make my 14h day nearly 15 ? do I spend 10 min after each call making notes that's probably 1 to 1.5 h each night on call , I am on call 3 nights out of 4 do I make my 14h day 15 or 16

RE: OOH Cover

Silvia Maldonado — Sun, 15 May 2022 14:04:43 GMT

I find this tips quite useful too:

“Are you a client of the practice?” The answer (frequently): “No, but my vet is closed,” or “No, but they want me to contact another practice, so I thought I’d ring you instead.” These clients should be firmly told to call their own vet and go to their emergency service, even if it is 30 miles away in a different town. Don’t even think of seeing everybody else’s OOH cases.
[...]
“Consultations out of hours are much more expensive. If it will wait until morning, it will be much cheaper.” This is designed to persuade people who want Rover’s anal glands expressed on a Sunday teatime to come in tomorrow morning. “I don’t care about the cost, he needs a vet now” will often change to: “That’s okay love, I’m sure he’ll last until morning.” If they use the “I don’t care about the cost” argument, Dr Clinical-Director’s second OOH catchphrase is: “Fine, because it will be £250 before my backside leaves the car seat, plus everything else on top, and it’s payable at the time. Plus VAT
It is essential to give a proper estimate of consultation costs before seeing emergencies or you will be breaking the RCVS Code of Conduct, and when they come to pay the bill, the client will be very happy to shout at the boss that you did not warn her about emergency service charges. If you’re accused of only being interested in money, tell them that.
Always end calls from clients whose pets are not seen by telling them to call back if the pet becomes more poorly and they are in any way concerned. This is your defence against the accusation that you refused to see a sick patient. You offered, they declined and were told to get back in touch if they felt they needed you. They did not do so. Say the same thing every single time and you will be able to respond to any complaint with your standard formula for OOH patients who elect not to be seen by a vet. And when you go into the surgery next morning, before you do anything else, enter into the patient record the details of the OOH call and your advice.

Source: cpd.vettimes.co.uk/.../how-to-train-your-deldragondel-new-grad-part-six--solving-struggles-and-ooh

RE: OOH Cover

Glenn Hodgson — Sat, 14 May 2022 07:07:19 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237163#237163"]

Remember this:

ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care

(as soon as you become aware of a genuinely ill animals that's in your care IMO)

[/quote]

There's a balance that needs to be insisted upon, IMO. I'll have all the patients of the practice under my care OOH. To ensure the health and welfare of the animals that are clearly committed to our care (by registering) I think we must no stretch ourselves too thin looking after other animals., eg dogs registered at the next door corporate practice with more distant OOH provider. Geographically closed wildlife and holidaymakers,. I think we should all see these.animals.

RE: OOH Cover

Clive Ansell — Fri, 13 May 2022 20:29:45 GMT

[quote userid="19228" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237173#237173"]Probably at least once per night minimum we get the we can't afford to go to where we are being directed it is not an option . This will be the truth in most cases now they can't go they haven't the funds. Wither they should or shouldn't have they don't they may as well be directed to the moon. [/quote]

But, it doesn't have to be your problem.

They can be redirected to their own practices OOH provider, as per the RCVS code. In the event of a true emergency (rare) or welfare concern the clinic is professionally obliged to see them even if the client has no money. May just be offered euthanasia though.

I still don't get how the impoverished masses will find several £1000's to buy a puppy, yet don't have the money or insurance to attend an OOH clinic. I have little time or sympathy for the idiots.

When I worked in OOH clinics, it was almost a nightly event listening to folk pleading poverty etc. Once it was pointed out that no money = no treatment - end off (Company policy) and we could PTS for £75, the money they haven't got was almost always found PDQ.

RE: OOH Cover

Clive Ansell — Fri, 13 May 2022 20:14:48 GMT

[quote userid="2100" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237170#237170"]Reading through it, I don't see any mention of being able to redirect clients other than back to their own vet. Which makes sense, really. I mean otherwise you'd have everyone passing the buck.[/quote]

Yes, you're right. Over simplification on my part

We can redirect clients back to their own vet or that vets OOH provider - clear cut

what is vague, and where the RCVS code needs updating, is OOH care for unregistered clients. To me it seems unreasonable that a practice covering its own OOH for its own clients, where likely or not staff will be on call in addition to working full days, should have to see any non clients when there is a dedicated OOH facilty within a reasonable distance, where they could be directed too.

RE: OOH Cover

cairncross — Fri, 13 May 2022 15:35:35 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237117#237117"]

30 - 40 minutes away OOH is not that unreasonable in todays climate, certainly in Scotland where distances travelled tend to be greater anyway. Many clients in the West Midlands where I live have longer travelling times than that. Over the Mayday holiday weekend, the OOH clinic that covers where I am working could not get night staff with clients being redirected to another OOH clinic. Some had to travel well in excess of an hour.

These non-clients calling you could just be redirected to their own practice or OOH provider. If they are not happy they need to discuss it with their own practice, and change practices if they want too

[/quote]

Probably at least once per night minimum we get the we can't afford to go to where we are being directed it is not an option . This will be the truth in most cases now they can't go they haven't the funds. Wither they should or shouldn't have they don't they may as well be directed to the moon.

RE: OOH Cover

cairncross — Fri, 13 May 2022 15:32:53 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237116#237116"]

I agree - treat this as an opportunity. Neighbours selling out to corporate and far away OOH has been great for my business. On the whole people pleased you help them out when they need you and a good, bonded client.

Glenn Hodgson said:
For example, I can not be doing another practices OOH GDV surgery, as the sole vet on call for our practice, and then be unavailable for my own patients c-section/seizure.

I hear this, but has it actually happened? Could you not have had 2 calls at the same time from long-established clients, in the same way?

[/quote]

I get most of your understanding this is how I built my practise up, but the numbers don't stack up now . You can' be awake 18 or 18 h per day and survive but when numbers double again you can't work 36h days. If the 2 at once happen every few days you can triage snd make them fit in but when 2 more and w more keep coming in the same period ?,

RE: OOH Cover

cairncross — Fri, 13 May 2022 15:30:10 GMT

[quote userid="8858" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30288/ooh-cover/237115#237115"]

Gosh I feel for you. It's what James has been experiencing in Ireland for a considerable time. 30-40 travel time isn't actually too bad, but it can be a might difficult job persuading them.

I think if I were you I might seriously consider making lemonade from the lemons, raise your fees and set up an OOH arm of your practice.

[/quote]

I have been more than snowed under so not looked in recently. I fear my situation is about to escalate . A corporate has I think( just bought up some of the remaining independents doing ooh North and West of us. Up until now it was just the population to the south that was directed to an ooh centre earth miles away on the map and light years away in affordability. The population to the north isnd west s less well off as a whole.