out of hours

Re: out of hours

scarlet — Sat, 16 Jun 2012 17:11:30 GMT

plantagenet, i do sympathise - we have a similar issue being pretty well the only practice in town that does the oohrs ourselves so we get everyone elses calls - we redirect all who arent ours (unless new to area etc) , give pet taxi nos etc so that theres no excuse.

if they insist on being seen then we quote them a non client surcharge fee in addition to the call out. which works out in total more than the other oohrs providers. most of that surcharge is given as a (taxable ) bonus ,to the oncall vet. that often does the trick. and also some recompense to the individual vet.

it doesnt however stop all the phone calls. so you still get less sleep now than before the on call services lot started.........

Re: out of hours

patrick murphy — Fri, 15 Jun 2012 14:17:36 GMT

I just use an answering service who filter for registered cclients only, and redirects all others to the local emergency hospital

Re: out of hours

Rajat — Fri, 15 Jun 2012 13:11:08 GMT

We too, often get stung by people registered at other practices bringing their pets to us.

I will often speak to these owners myself, on the phone where there is a suspicion along these lines (after the nurse has spoken to them). I usually try to prise it out by asking last date of vaccination, and casually ask when their pet last visited the vet.

Obviously there are some cases where the owner is on on holiday or has genuinely just moved to the area. Others let it out during the conversation that they are registered elsewhere but cant be bothered to drive the extra 2-3 miles or prefer to come to us because of other reasons. IF the pet is critically ill I will see it (or if genuine -new clients). All others I redirect to their emergency /OOH provider, doesn't always go down well, but I don't see why I should be inconvenienced for their convenience, so as to speak. Often people are unaware of the OOH provision that their clinic has arranged and are annoyed at having to go much further than they anticipated, which is understandable.

We do get the odd moaning (non) client , more often though, we find people moving to us because we do our own OOH w/hospital facilities.

Re: out of hours

Clive Ansell — Fri, 15 Jun 2012 12:28:31 GMT

[quote user="Alet Engelbrecht"]

[quote user="Clive Ansell"]Should you not be directing their clients back to them? I thought it was unethical to see other practices clients' OOH?? if they can get to you, they can get to Vets-Now as it is unlikely to be light years away, and there are such things as taxis and animal ambulances??. When I used to work in OOH clinics, non user practice clients were quickly directed to their own practice or OOH provider, unless a life and death emergency (rare). [/quote]

I locumed for a joint venture with long opening hours over weekends. Saw a rat with mild circling one Saturday afternoon - it also had a skin problem. When I commented on the skin, the newly registered client told me that her vet had treated the rat the day before for mites. By now, the other clinic was closed for the weekend and using an OOH provider, so no way to get a history. I examined the rat and explained to her that it could be the medication that was administered could possibly be the cause of the clinical signs and as the rat was in no great distress, still eating and lively, only mild circling, I would suggest to monitor it over the weekend, contact a vet if it gets worse and see her own vet on the Monday morning. On the Monday, my boss called me in for a bollocking - the client lodged a complaint against me as I apparently refused to treat the rat!

Damned if you do, damned if you don't...

[/quote]

The case should have been declined. the first question when the client phoned should have been "is he/she registered or receiving treatment elsewhere?", if yes then the response should have been "sorry, you need to see you own VS or their OOH provider" If the client wanted to change practices, it should only have been done once their original practice was open so that a clinical history could be obtained prior to the consultation.

I had a similar problem while working for a corporate 18 months ago; they were open Saturday and Sunday and would readily accept ongoing cases, some complicated ones, that were registered with local practices who closed at 1200 on Saturdays. some of these cases that needed hospital care would then just bounce back to their original one at 1600 on the Sunday - result = a very p***** off local practice. The problem was that most of these cases should have been identified, declined and redirected to their own VS at the original telephone call. I would send away those that were not emergencies (most) but some had to be dealt with.

Re: out of hours

Clive Ansell — Fri, 15 Jun 2012 12:11:59 GMT

[quote user="Becky Filby"]

That works well in principle but a lot of people get wise to this and tell the nurse on call that they are either not registered anywhere or that they are registered with us.

It's only when you've started the consult that they let something slip about another vets / you notice the neatly shaved venipuncture sites / see the note on their file saying their history was faxed to another vet several years ago and they have been going elsewhere ever since!! By this stage it's usually too late to redirect them for the animal's sake or you have already started treating before the lie has become apparent. They get the conversation about using their own vet's OOH service in future but it doesn't really seem to work.

[/quote]

I know, one can only ask the question and yes some of them will lie - what can you do? .

If it is obvious when they are seen they have lied to get an appointment, and they are clearly registered elsewhere the consultation should be declined and the client redirected to their usual practice or OOH provider (except basic triage and immediate and necessary emergency care of course prior to bouncing back) The RCVS GtoPC is quite clear on supersession; the patients usual VS should be contacted and a clinical history obtained prior to taking the case.

From GtoPC:

3.12 If an owner of an animal, who is not a client of the practice, requests an emergency out-of-hours consultation, the veterinary surgeon may reasonably direct the owner to his or her usual veterinary surgeon and decline to carry out the consultation. Immediate first aid and pain relief should be provided to the animal if, for whatever reason, the owner cannot contact his or her usual veterinary surgeon

Re: out of hours

Alet Engelbrecht — Fri, 15 Jun 2012 11:49:52 GMT

Damned if you do, damned if you don't...

Re: out of hours

Hannah Wynne Richards — Fri, 15 Jun 2012 10:12:35 GMT

Wouldn't life be bliss if all owners did as they were told

Wynne

Re: out of hours

Becky Filby — Thu, 14 Jun 2012 22:00:17 GMT

That works well in principle but a lot of people get wise to this and tell the nurse on call that they are either not registered anywhere or that they are registered with us. It's only when you've started the consult that they let something slip about another vets / you notice the neatly shaved venipuncture sites / see the note on their file saying their history was faxed to another vet several years ago and they have been going elsewhere ever since!! By this stage it's usually too late to redirect them for the animal's sake or you have already started treating before the lie has become apparent. They get the conversation about using their own vet's OOH service in future but it doesn't really seem to work.

We had one dog present on a sunday evening with numerous problems including breathing difficulty. The owner claimed they had just moved to the area and were not registered anywhere. Part way into a work-up the duty vet received an angry phone call from Vets Now wanting to know if we were dealing with this client and if so why we had not rung them as a courtesy and asked for it's history. Turns out the dog had been seen by them that morning and had been made an emergency appointment with a neuro specialist that it had never arrived for! The owner did apologise when confronted but they had wanted a second opinion and had thought that if they were honest about it we might not have agreed to see them.

Re: out of hours

Neil Wheadon — Thu, 14 Jun 2012 20:46:31 GMT

[quote user="Clive Ansell"]

I suppose the ideal solution would be a move towards larger multi-staffed practices that operate a full 24 hour service with vets and VN's working 24/7, but with separate day and night teams so that staff are getting proper rest time and working sensible and civilised hours and not being on call at night in addition to working all day.

[/quote]

Vets Now referrals then, OK slightly biaised

or as the BBC says 'Other service providers are available'

Re: out of hours

Clive Ansell — Thu, 14 Jun 2012 19:58:11 GMT

[quote user="Helen Wallace"]

Everyone else in the area is using Vets Now, we get all their clients insisting that they can't get to them.

[/quote]

Should you not be directing their clients back to them? I thought it was unethical to see other practices clients' OOH?? if they can get to you, they can get to Vets-Now as it is unlikely to be light years away, and there are such things as taxis and animal ambulances??. When I used to work in OOH clinics, non user practice clients were quickly directed to their own practice or OOH provider, unless a life and death emergency (rare).

[quote user="Helen Wallace"]

Then we get clients registering with us during the week just so they can use our OOH. I can remember one delightful client who, as I discharged his bitch post 3am C-section, informed me that he wouldn't be coming back for his post op checks as he would use his own vets for that. I didn't know what to say but I know what I though of saying would have had me up in front of the DC.

[/quote]

If I were their "own vet" and they attended OOH with you I would bounce them back PDQ for all post operative care with whoever did the surgery - the minute they went to you they become your client. maybe you should all get your heads together and charge a high admin fee for changing practices?? It should be made clear that they register with practice X or practice Y, and cannot keep changing between the 2.

[quote user="Helen Wallace"]

There really isn't a right answer to OOH.

[/quote]

Re: out of hours

Helen Wallace — Thu, 14 Jun 2012 14:28:54 GMT

Well I'm a bit late to this threat but thought I'd add my 2 pence worth anyway

Job no 1- mixed practice 1 in 4 rota with 2nd on call. I was a young, keen new grad. I can remember offering to go with the partners to calls on my nights off to gain extra experience. Theoretically plenty of back up. In reality often little or none. I did learn a lot doing OOH but, unfortunately, often from my mistakes. Nights on call became more and more stressful. Day shifts were 8.30-6.30, I rarely left before 7.30pm. I was constantly exhausted.

Job no 2- SA practice 1 in 7 rota. When I started we did our own OOH. The number of call outs was civilised and I has a very approachable boss on the end of the phone if I needed. I was more competent so this wasn't often but it was reassuring to know he was there. Didn't sleep well when I was on call but coped okay. Fast forward 3 years later... the practice is busier, much busier. Everyone else in the area is using Vets Now, we get all their clients insisting that they can't get to them. We discuss this with the RCVS. They agree we can charge an OOH registration fee. We set this high and it works for a month or two. Then we get clients registering with us during the week just so they can use our OOH. I can remember one delightful client who, as I discharged his bitch post 3am C-section, informed me that he wouldn't be coming back for his post op checks as he would use his own vets for that. I didn't know what to say but I know what I though of saying would have had me up in front of the DC.

We were left with no choice but to start using Vets Now. We couldn't cope with 20 hour working days, and that's what it was becomming. I have to say it made such a difference knwing that once the phones went through I might not be leaving any time soon but that at least there was nothing more coming in.

Job no 3- SA hosp practice. We do our own OOH 1 in 5 but our night nurses take the phone and can do the basic advice calls. other practices in the area also do their own OOH. Its ok. I've had a couple of bad nights and other very quiet ones. I sleep better than I used to, mainly because it will be someone I know ringing not some stranger wanting to give me abuse at 2am. But do I want to be doing it in 10 years...? I could go out to social events but I don't because I know I will just sit there fretting that the phone will ring.

There really isn't a right answer to OOH. Some people cope brilliantly with it and some don't. Its not just the rota, its how many hours you've worked that week, what your neighbouring practces do, what your family comitments are.

I can't say I wasn't warned about the antisocial side of being a vet but at 15 I just didn't get it.

Re: out of hours

karen jones — Tue, 12 Jun 2012 20:07:01 GMT

[quote user="Gillian Mostyn"]

[quote user="karen jones"]Our rota is around one in 4 weekends and one in 6 Saturday morning till 10.30 and one night a week. We usually are finished by 5.30 if not on call and have a half day every week.[/quote]

So, to be fair, you are only working approx 36 hours per week plus 1:6 Saturdays and 1:4 on-call, which I think is low compared to most full-time vets! I'm not surprised you find time for all your activities!

Having just looked back at some of the replies, the mixed practice vets (presumably rural areas) on here do see to have an easier life than the smallies - finishing between 5-6pm, working less weekend clinics and possibly having less total OOH calls? Not really surprising but also not comparable to a very busy urban small animal practice.

[/quote]

I do small animal all day and everything at night (no horses if at all possible!!). We are a hospital standard (tier 3) practice and are very busy during the day. OOH consists of mainly large animal emergencies with a smattering of cats and dogs. The difference between the two is the physicality of large animal work and the mental intensity and expectations of small animal clients . I enjoy the diversity of a trip out to visit farms on call with a nice chat and a drive around without the intensity of 10 minute appointments and continued questions, though would no longer like to spend hours tb testing. We employ some part timers to do weekend clinics, they are all local girls with their own following which again decreases the pressure on the rest of us. I think that we all work very hard during the day and the nights on call ( though didn't have call last night) but life balance is important. Maybe us rural people pander to our clients less, surely most people can see vet by 6.30 in week and attend one of 3 surgeries at weekend

Re: out of hours

Neil Wheadon — Tue, 12 Jun 2012 17:32:25 GMT

I'm not so sure about that.

I worked with 2 former partners who were VI's for AHVLA. Both had left the practice in their early 50's and both said it was the OOH commitment (both were in mixed practice) that was the deciding factor. Both came from medium sized practices.

On a more interesting note, working for Vets Now, I meet plenty of vets who work on the 'edge' of veterinary practice. They do OOH work on a part time basis and that's all they do. It allows them to stay within the profession whilst dealing with a period of life that's challenging, childcare for example. If this opportunity wasn't there many would be lost to the profession, so there is a benefit to everyone here.

Neil

Re: out of hours

plantagenet — Tue, 12 Jun 2012 17:18:40 GMT

I have, sadly, known more than a handful of vets who have committed suicide. None were new or recent graduates with lack of support. The majority were established partners whose ooh commitment was less than in their younger days. I accept that we do have an excessive suicide rate but am still not sure that ooh is responsible. If it is we should hope to see a drop in the rate. I find ooh a pain sometimes, but a minute stress compared with red tape, bad debt, employment issues and lack of time off in the day.

Re: out of hours

Julian Earl — Tue, 12 Jun 2012 16:52:18 GMT

[quote user="Utlendigur"]

...One of my last ever nights I did on call wasn't unusual - I worked the day from 9am to 11.30pm (2 eve emergencies including a stick injury), got home, had something to eat, walked the dogs, went to bed - got woken up 90min later (caesarian) - got back home 7am, another call 7.15am so back to work - finished 8pm that evening. It simply isn't possible to do that regularly and be able to work safely - or drive safely. Most practices are about 4 vets - big enough to have busy OOH but too small to allow adequate rest after a night on call. OOH providers are here to stay, and maybe will help reduce the levels of stress, suicide and vets leaving the profession...

[/quote]

Two words to throw a slight spanner in to that ideal situation:

Farm. Practice.

Re: out of hours

Evelyn Barbour-Hill — Tue, 12 Jun 2012 14:34:41 GMT

[quote user="Utlendigur"]Also I think, given the proliferation of 24hr helplines, that people have got into the habit of simply picking up the phone as soon as they come across a slight difficulty, and expecting to have that difficulty immediately resolved by someone else, so the number of "silly" calls has gone up.[/quote]

Yes. Together with the proliferation of mobile phones: something pops into the head, the mobile's all ready in the hand. But a good telephone-answerer can deal with that sort.

Re: out of hours

Mark Holmes — Tue, 12 Jun 2012 14:03:16 GMT

I think its about more than safety, its also about having patience to speak to and deliver service the following day. After missing a nights sleep be it on call or children. I am fully aware that my ability to communicate and work with clients is severely compromised.

I wonder how many complaints against vets are directly or indirectly down to this. As an example I was on call over the weekend and ran into a difficult phone call with a client. Long and irrelevant story but the has phoned wanting to know if their house was warm enough for puppies. When I wouldn't give a yes or no answer she became aggressive and I became irritable.... it didn't go well.

Re: out of hours

Malcolm Ness — Tue, 12 Jun 2012 13:42:47 GMT

[quote user="Utlendigur"] It simply isn't possible to do that regularly and be able to work safely - or drive safely[/quote]

Agree with that (and most of the rest of your post)

The real villains here are the bosses that set fees too low, the assistants that don't charge properly and the charities that encourage people to believe that pet-keeping can happen without money.

Re: out of hours

Utlendigur — Tue, 12 Jun 2012 13:14:00 GMT

Having only just got round to skimming through the thread...just some random thoughts.

I've done OOH for most of my career - it's only in the last couple of years that we've used an OOH provider. To go back to the original post, even when we and all our neighbours did our own OOH, it wasn't unusual to get other practices' clients turning up at our weekend surgeries because we were open at different times (and vice versa) - it was cheaper than calling out their own vet.

I think OOH has changed in the last 10yrs or so. When I first started there weren't 24hr supermarkets, pubs, clubs, restaurants, shops didn't have such extended hours, etc - but now more people are up and about very late or very early, working shifts, and therefore more calls. Practices are bigger - fewer single man/woman practices - so on-call there is a bigger pool of clients who may need seeing by whoever is on call. Also I think, given the proliferation of 24hr helplines, that people have got into the habit of simply picking up the phone as soon as they come across a slight difficulty, and expecting to have that difficulty immediately resolved by someone else, so the number of "silly" calls has gone up. Client's expectations have increased, thanks to all the vet programmes, that they expect in-patients to be monitored through the night - and animals that previously would have been pts because of lack of diagnostics or treatment options are now able to be diagnosed and treated, but also require much higher levels of care. All that adds up to significantly busier OOH. I started on a 1 in 3 rota and apart from the odd bad night, it was rare to get more than one call or have many/any in-patients - so working the days either side was not a problem. By the time we started using an OOH provider it was 1 in 5 but it was normal to have 2 or 3 calls throughout the night, several in-patients and only a couple of hours sleep. One of my last ever nights I did on call wasn't unusual - I worked the day from 9am to 11.30pm (2 eve emergencies including a stick injury), got home, had something to eat, walked the dogs, went to bed - got woken up 90min later (caesarian) - got back home 7am, another call 7.15am so back to work - finished 8pm that evening. It simply isn't possible to do that regularly and be able to work safely - or drive safely. Most practices are about 4 vets - big enough to have busy OOH but too small to allow adequate rest after a night on call. OOH providers are here to stay, and maybe will help reduce the levels of stress, suicide and vets leaving the profession. I also think clients are more aware of the difficulties in OOH provision than they are given credit for given media coverage of issues such as tired junior doctors, medical mistakes, RTAs caused by tired lorry drivers, working time regulations etc. Some clients will always complain at the cost (usually those with too many/unsuitable pets with no money who make no provision for ANY vets bills) but equally we have had many clients very happy with things like being able to phone for advice at any hour without worrying about waking someone up, and having pets monitored 24/7.

Re: out of hours

Gillian Mostyn — Tue, 12 Jun 2012 12:09:49 GMT

Re: out of hours

Gillian Mostyn — Tue, 12 Jun 2012 12:05:36 GMT

[quote user="Michael Woodhouse"]It's amazing what you can do and if I am in the practice area I just crack on as normal. [/quote]

Depends what 'normal' is for you - no? Some activities just aren't compatible with being on-call!

Re: out of hours

Gillian Mostyn — Tue, 12 Jun 2012 12:03:17 GMT

Obviously all practices are different and OOH may not be so onerous for some. My question was aimed at very small practices and solo practices.

I have done OOH for most of my career, including a 1:6, 1:4 and sole charge. I know how it used to affect my life, and that I did come to resent it, so was wondering how others find it.

Re: out of hours

Evelyn Barbour-Hill — Mon, 11 Jun 2012 23:12:01 GMT

[quote user="Gillian Mostyn"]So I ask those people who do their own OOH on their own - does it not affect your choice of hobbies/activities outside of work[/quote]

No............ sometimes had to miss a movie, and memorably once had to come out in the middle of HMS Pinafore and miss the best bits; but we have no cinema or theatre in Bangor now.Sometimes have to stop shooting early.

P.S. Italian: try Rosetta Stone

Re: out of hours

Busybee — Mon, 11 Jun 2012 22:10:39 GMT

[quote user="Michael Woodhouse"]No bad debtors with you![/quote]

Kind of why I took it up! Young recent grad female vet working alone OOH - need to be able to kick some butt!

Re: out of hours

Michael Woodhouse — Mon, 11 Jun 2012 22:01:42 GMT

[quote user="Busybee"] Krav Maga[/quote]

I had to google that:

Krav Maga is a noncompetitive eclectic self-defense system developed in Israel that involves striking techniques, wrestling and grappling. Krav Maga is known for its focus on real-world situations and extremely efficient, brutal counter-attacks.

No bad debtors with you! If you are any good I'd expect you could make a colleague swap the other two nights to learn Italian!

We are 1 in 4 nights on call but my wife is on the same rota so 1 in 2 nights one of us stuck in.

It's amazing what you can do and if I am in the practice area I just crack on as normal. Went to all the Jubilee celebrations whilst on duty. Wouldn't aim to go out to a restaurant but meals with friends are fine. People understand you are on call.

There was one night when I got my car stuck in a field at 1am shooting rabbits whilst on duty. Took me an hour and a half to rescue myself. If a call had come in I would have had to have woken up the missus!

There are very few cases that you need to drop everything and run. You can usually finish up what you are doing and then go on the call (I have never left the house half way through a meal!). As I have said already, we provide an emergency service. I am more than happy to tell people that it's not an emergency and we will see you in the morning. Semi-sick things I will make wait to see if any other jobs come in.