RCVS Call for Evidence on 24/7 provision II

Re: RCVS Call for Evidence on 24/7 provision II

Jo Dyer — Fri, 17 Jan 2014 08:45:35 GMT

[quote user="Gillian Mostyn"]and although we did our own on-call for years, including with small children, life is soooooooo much better for the whole family since we stopped![/quote]

Ah, I see….

So,

a) you would not have been on the list of 'reasonably competent veterinary surgeons providing an out of hours service' whose views would have been sought by the DC had they chosen to follow their own legal assessor's advice and

b) you have an enormous amount to lose if OOH providers find their businesses unsustainable due to conscientious vets deciding not to work for them for fear of being put in an impossible situation…..

Be careful what you wish for

Re: RCVS Call for Evidence on 24/7 provision II

Alet Engelbrecht — Fri, 17 Jan 2014 05:07:31 GMT

[quote user="Chris Barker"]While they were not part of the decision-making process, the observers made an annual report [/quote]

Sounds a bit like the scifi series Fringe:

Observers are evolved humans from the future. In an attempt to study their evolution, they utilize the technology of their time period (which allows them to travel through time and space). Quite literally, they exist "outside" of time. They are from one possible future. In this future, the world is damaged beyond repair and unsustainable. Their endgame was to rise to a position of totalitarian power, which they assumed in 2015.

Re: RCVS Call for Evidence on 24/7 provision II

Chris Barker — Thu, 16 Jan 2014 18:56:44 GMT

[quote user="Bob Russell"]

It hadn't really occurred to me that anyone at the RCVS might actually give a toss about those working in the profession.

[/quote]

There are... Perhaps just not enough of us....!

Chris B

Re: RCVS Call for Evidence on 24/7 provision II

Chris Barker — Thu, 16 Jan 2014 18:54:32 GMT

[quote user="Bob Russell"]

I have to admit I have serious concerns regarding Clare TapsfielWrights comments that 'Over the last two years, lay people working with the RCVS have raised questions about the ability to provide 24/7 to the extent required by the RCVS Code of Professional Conduct.

Also consider there is a disconnect between the public's expectations and the professions capacity to meet these expectations.

Who the heck is advising them? Is it some of the vets on the committee stirring the melting pot?

[/quote]

Prior to the recent reorganisation of DC and PIC, the Preliminary Investigation Committee had lay observers who cast their eye over all the complaints that PIC members had to assess, both those that were progressed and those that were rejected. While they were not part of the decision-making process, the observers made an annual report to RCVS Council regarding what they had seen/read/experienced. It was their final report to Council from which Clare has quoted.

PIC members are strictly limited in what they can say about any complaints made to the RCVS, and are therefore very cautious in those few comments that they do make, even to fellow Council members. But the former lay observers offer the Standards Committee an opportunity to talk with well-informed and relatively recent participants in the disciplinary process free from such constraint, and for this reason they will be amongst those invited to talk with us as part of the consultation on 24/7 provision

Chris B

Re: RCVS Call for Evidence on 24/7 provision II

Bob Russell — Thu, 16 Jan 2014 15:10:25 GMT

[quote user="Jo Dyer"]

[quote user="Bob Russell"] 'Over the last two years, lay people working with the RCVS have raised questions about the ability to provide 24/7 to the extent required by the RCVS Code of Professional Conduct'.[/quote]

Funnily enough, I read that bit of the Call for Evidence as meaning that lay people can see that we are expecting too much of ourselves and we should lighten up, get over ourselves and be a bit more like the medics…...

It's all a question of interpretation I suppose. Perhaps someone could ask said 'lay people' for more detail on what they are actually saying.

[/quote]

Perhaps I am getting too cynical in my old age. I suspect the committee will read/interpret in the way it suits their individual beliefs. Of course we expect too much of ourselves, always have, perhaps one of the reasons it is such a stressful job.

It hadn't really occurred to me that anyone at the RCVS might actually give a toss about those working in the profession. More interested in how the general public view the profession and its regulators!

I wonder which it is!

Re: RCVS Call for Evidence on 24/7 provision II

Jo Dyer — Thu, 16 Jan 2014 14:33:54 GMT

It's all a question of interpretation I suppose. Perhaps someone could ask said 'lay people' for more detail on what they are actually saying.

Re: RCVS Call for Evidence on 24/7 provision II

Anthony Dennison — Thu, 16 Jan 2014 14:32:47 GMT

[quote user="Clive Ansell"]Vet doesn't drive, has been banned from driving, or doesn't own a car.[/quote]

I know of a farm vet who was banned from driving for 12 months. His dad had to move in with him and drive him around to all his calls.

Re: RCVS Call for Evidence on 24/7 provision II

Anthony Todd — Thu, 16 Jan 2014 13:08:54 GMT

[quote user="Bob Russell"]

Also consider there is a disconnect between the public's expectations and the professions capacity to meet these expectations.

Who the heck is advising them? Is it some of the vets on the committee stirring the melting pot?

[/quote]

+1 and with cases like Chikosi and the inability of the RC to look at forums like this, but demand we make submissions which, we all know, can be filed under "IGNORE" the disconnect will get wider.

By the way, it was standard practice in the last 10 years or so to take a cab on visits as there is never any parking and the car would be ticketed if left for 30 seconds.

Seemed to work OK, but most owners were persuaded to bring the animal in and most of our vets avoided visits if at all possible......

Re: RCVS Call for Evidence on 24/7 provision II

KMurphy — Thu, 16 Jan 2014 12:30:52 GMT

[quote user="Clive Ansell"]But would it not be easier in most cases for the client to get a taxi and bring the patient straight to be surgery? very few cases cannot be moved, and unless it is a pts the sooner at the surgery the better.[/quote]

Well, we all know this but in those rare exceptions where a house visit is necessary...

I just meant that people, especially locums, who are worried about their obligation to visit when transport for the vet might be an issue could have this as an option. They are fulfilling their obligations but the onus is still on the client to arrange transport. If the animal has analgesia and any haemorrhage controlled the owner then has time to arrange a friend/neighbour/taxi to transport the animal. There is no obligation on the vet's part to organise this.

Re: RCVS Call for Evidence on 24/7 provision II

Bob Russell — Thu, 16 Jan 2014 11:43:01 GMT

Also consider there is a disconnect between the public's expectations and the professions capacity to meet these expectations.

Who the heck is advising them? Is it some of the vets on the committee stirring the melting pot?

I am a vet and a pet owning member of the public and consider the profession does a really good job almost all the time. Better than A+E seems to be at the moment.

I suspect this is all bulls*it created by the ill informed or unqualified. The general public would love a free service, vets on tap to visit but this is not what they expect!

Re: RCVS Call for Evidence on 24/7 provision II

Gillian Mostyn — Thu, 16 Jan 2014 11:41:20 GMT

[quote user="Michael Woodhouse"]The problem is both Wynne and myself do our own on-call![/quote]

And neither of you have children. Do you think that your opinion on OOH duties may change when/if you have little 'uns! Afterall, like Ian and I, you are both vets..... and although we did our own on-call for years, including with small children, life is soooooooo much better for the whole family since we stopped!

I still look after in-patients if at all possible - I spent my weekend back and forth to the practice looking after a very sick bunny - but at least you can manage your own time and not be in that 'what if the phone rings' frame of mind.

Re: RCVS Call for Evidence on 24/7 provision II

Clive Ansell — Thu, 16 Jan 2014 11:24:15 GMT

[quote user="KMurphy"]

If there is a reason why you can't drive or don't have access to a vehicle then you could get a taxi to the house, provide the necessary analgesia/euthanasia and then the client can arrange transport of the animal to the surgery if required after.

I'm not suggesting this as an ideal but it would do in an emergency, no?

[/quote]

Yes, perfectly feasible. I have never had to do it though.

But would it not be easier in most cases for the client to get a taxi and bring the patient straight to be surgery? very few cases cannot be moved, and unless it is a pts the sooner at the surgery the better.

Also, need to be aware than many taxi drivers, particularly Asians, will not transport animals.

I do think that more practices should have a protocol in place for this, even a list of local taxis at reception or an arrangement with a local taxi firm perhaps, so that all permanent and locum staff can easily comply with the C of C.

Re: RCVS Call for Evidence on 24/7 provision II

KMurphy — Thu, 16 Jan 2014 11:02:00 GMT

I'm not suggesting this as an ideal but it would do in an emergency, no?

Re: RCVS Call for Evidence on 24/7 provision II

Thomas Johnson — Thu, 16 Jan 2014 10:40:33 GMT

[quote user="Clive Ansell"]

[quote user="Thomas Johnson"]

The Royal College would probably take the view that as the code says that you may on rare occasions have to perform visits, then it is your responsibility to make sure you are able to perform visits.

[/quote]

That is the view I tend to take, but I feel there should be some responsibility placed on practices and practice owners to provide the means to do it, and have protocols in place, as most don't.

[/quote]

I agree, but again we have the problem that the Royal College regulates individuals not practices. All of your scenarios do provide real problems for the vet on the ground. I have worked in jobs where I was contractually obliged to either have a practice car, or be paid a car allowance and be able to use my own car to go on visits.

Re: RCVS Call for Evidence on 24/7 provision II

Clive Ansell — Thu, 16 Jan 2014 09:13:47 GMT

[quote user="Thomas Johnson"]

[quote user="Matt Hilary"]

[quote user="Clive Ansell"]

Only 2 have a practice vehicle, one of which is a home visiting service. A third had a vehicle, but is was only insured for the 2 partners to drive, who were both on holiday!

[/quote]

Something that's occurred to me in the past. Are we obliged to perform home visits if not insured on available vehicles?

[/quote]

The Royal College would probably take the view that as the code says that you may on rare occasions have to perform visits, then it is your responsibility to make sure you are able to perform visits.

[/quote]

That is the view I tend to take, but I feel there should be some responsibility placed on practices and practice owners to provide the means to do it, and have protocols in place, as most don't. There are cases where immediate home visits are just not possible or practical. I can and often do them where they are pre arranged and non urgent.

Consider the following scenarios, what would you do?:

No available vehicle. When working locally to home I often commute by cycle, and in the case of one practice by train. If I know there is a booked visit I will take my car, but if an emergency immediate visit is needed, I may not have it with me. It may be off the road for service, partner may have borrowed it again.

Vet doesn't drive, has been banned from driving, or doesn't own a car.

Insufficient level of insurance for either a practice or your own vehicle.

Insufficient staff, meaning closing the clinic and cancelling booked appointments and ops. Could see that going down really well with most bosses/owners. One practice I occasionally work have a policy that the door cannot be open to the public until and unless there are 2 staff members in the building. A home visit from that practice requires 4 staff members to keep the clinic open too.

Difficulty finding animal ambulance or taxi willing to attend or to transport animals at very short notice.

Re: RCVS Call for Evidence on 24/7 provision II

Thomas Johnson — Thu, 16 Jan 2014 08:51:46 GMT

[quote user="Matt Hilary"]

[quote user="Clive Ansell"]

Only 2 have a practice vehicle, one of which is a home visiting service. A third had a vehicle, but is was only insured for the 2 partners to drive, who were both on holiday!

[/quote]

Something that's occurred to me in the past. Are we obliged to perform home visits if not insured on available vehicles?

[/quote]

The Royal College would probably take the view that as the code says that you may on rare occasions have to perform visits, then it is your responsibility to make sure you are able to perform visits.

Re: RCVS Call for Evidence on 24/7 provision II

Mark Holmes — Wed, 15 Jan 2014 20:50:11 GMT

On reflection I think that removing the requirement to offer a home visit would actually improve animal welfare rather than reduce it. Inevitably practices would still cover true emergencies such as entrapments... But if they are made to be explicit about their visits policy, truly open and explicit, clients can then vote with their feet. More importantly a practice cannot then "fudge" the issue. Either do them and be properly resourced for them (easier with greater numbers if visit demanding clients under the same practice) or be clear you do not do them and don't do them without the resources to cover them properly). You would also need to make sure your out of hours cover was similarly resourced) In the wisdom of Yoda "Do. Or do not. There is no try"

Re: RCVS Call for Evidence on 24/7 provision II

Francisco Gomez — Wed, 15 Jan 2014 20:24:36 GMT

Well, this would b an attempt to put my post up there so more people look at my letter. Looking to send it next couple of days. So far there will b a couple of changes: the proposals would be referred as one possible solution, but not necessarily the right one. Most importantly the issues raised seemed to be correct and shared by most people.

Re: RCVS Call for Evidence on 24/7 provision II

Francisco Gomez — Mon, 13 Jan 2014 13:07:37 GMT

[quote user="Matt Hilary"]

Something that's occurred to me in the past. Are we obliged to perform home visits if not insured on available vehicles?

[/quote]

Whatever you go in an insured vehicle or in Marvel's agent flying car, it does not matter. If an animal is suffering and the movement of the animal is detrimental/causes unnecessary suffering, you (or another vet in whom you have delegated responsibility on) have to find the way to get there so the animal receives veterinary attention.

Re: RCVS Call for Evidence on 24/7 provision II

Matt Hilary — Mon, 13 Jan 2014 13:02:54 GMT

[quote user="Clive Ansell"]

Only 2 have a practice vehicle, one of which is a home visiting service. A third had a vehicle, but is was only insured for the 2 partners to drive, who were both on holiday!

[/quote]

Something that's occurred to me in the past. Are we obliged to perform home visits if not insured on available vehicles?

Re: RCVS Call for Evidence on 24/7 provision II

Clive Ansell — Mon, 13 Jan 2014 12:26:20 GMT

[quote user="Linda Filshie"]

I'm curious about how many requests for OOH visits (whether reasonable or unreasonable) people are actually getting and whether it has increased in recent years - and whether it varies whether you are doing your own on call or are a dedicated OOH provider.

[/quote]

It seems to vary greatly from practice to practice. last week we had 11 requests during daytime hours. 8 were carried out; 6 for PTS's with known registered clients, 1 was an elderly house bound lady with cat with fad, 1 was terrier belonging to an elderly man for eag. In 2 cases the patients were ill and they were successfully advised to bring them in for treatment, which they happily did. I was refused; non client, no money with a non emergency PTS request which was directed to the PDSA.

Many practices I work in (daytime, not OOH.) can go weeks without a request for one. Many practices still have an unwritten policy of "we don't do them", but if challenged they sidestep the issues with comments like "it's up to the individual vet" or it "depends upon the case"

Of 11 practices I worked for in 2013:

Only 2 have a practice vehicle, one of which is a home visiting service. A third had a vehicle, but is was only insured for the 2 partners to drive, who were both on holiday!

10 have a list of numbers for animal ambulance or taxis willing to transport animals at reception.

2 practices have an unwritten, unofficial policy of no visits.

1 practice actually had an official policy of no visits at one of its branches, documented in the practice manual, the reason given being safety as it is a bad area with know drug gang violence where paramedics only go with a police escort. The practice has been in contact with local police and they advise not to go there.

1 practice has a home visiting service within the group, so requests are handed over to them.

1 practice is a visiting only service, no surgery based consults.

3 practices are sole charge with always 3 or more staff present so visits can be arranged depending upon work load during the day

5 practices are sole charge and some or all of the time have only 1 additional staff member, where an immediate home visit if carried out could require locking up, kicking out any clients and cancelling appointments.

Re: RCVS Call for Evidence on 24/7 provision II

Yantha Smyth — Sun, 12 Jan 2014 18:06:40 GMT

In New Zealand the city I worked in, Wellington, had a roughly centrally located OOH clinic that was set up by about 5 of the larger practices in the region. The clinic was not a day practice at all- closed at 8am, and opened again at 7pm during the week then was open 24/7 on weekends on a 3 shift per 24hr basis. All 25 practices in the city ( at that time ) were 'members', so did not do their own on-call. There was a tendency for practices to be open more generous hours on weekends, eg 9-5 sat and 10-4 sun, since there was no ooh, and this also reduced the need for ooh attendance when clients knew they could always attend their normal surgery the next day no matter what day it was. The ooh clinic was mainly staffed by some dedicated ooh employees, but some locums etc. and the odd shift spread across all the member practices to fill in the gaps. There was always a back-up vet available, but who did not attend the clinic unless called in. This back-up vet was not paid anything to be back up unless they got called in, and the back up rota was scheduled by spreading the duty across all member practices. For me in a four vet practice this worked out to working one shift every 3-4 months ( paid ), and being a back up once every 3-4 months. There was also a guy who would collect patients from the ooh and return them to the member practice in the morning if needed. It all seemed to work pretty well. Clinics took care of their own inpatients though- these were not transferred to the ooh as far as I can recall. I am sure with the many member practices the vetsNOW and others have, that if back-up duties were spread across the practices, and vets within those, there could easily be an inexpensive back-up system implemented that was not onerous on any one individual.

Re: RCVS Call for Evidence on 24/7 provision II

Anthony Todd — Sun, 12 Jan 2014 13:37:41 GMT

How did i get 5 stars in 1 minute??? and it wasn't me!!!

Re: RCVS Call for Evidence on 24/7 provision II

Anthony Todd — Sun, 12 Jan 2014 13:32:50 GMT

[quote user="Alet Engelbrecht"]So why not then help to make this better?[/quote]

Exactly, and it's not that hard, the various threads have identified most of the OOH faults and most of the OOH fixes.

1. Owners need to be told/forced/reminded that they have a responsibility to ensure first aid for their pet, and that involves transport, and this must be reinforced by the RC and not bounced back firmly to the vet who happens to pick up the phone.

[the blanket use, again, can be advocated, demonstrated and supported etc.]

2. Opting out of [OOO] OOH must be combined with adequate advice of policy, cost and contact details. "This practice is now closed until 9am tomorrow [or Monday!] would, and should become a DC matter.

3. Current likely OOH cases must have the notes transferred to the OOH provider or access to them made easily available.

4. OOH home visits made not mandatory, supported by the RC, but transport should be. Seems to work OK for humans....

5. The quoting of exorbitant fees, particularly as a means of refusing attendance, brings the profession into disrepute.

for a start.

Re: RCVS Call for Evidence on 24/7 provision II

Alet Engelbrecht — Sun, 12 Jan 2014 06:00:47 GMT

[quote user="Michael Woodhouse"]I'm not supportive of the concept of OOH providers covering for lots of practices, but I guess they are here to stay.[/quote]

So why not then help to make this better?

[quote user="Michael Woodhouse"]I've worked in various 4, 5 & 6 vet practices and the OOH isn't that onerous.[/quote]

I agree. I found OOH quite exciting. Some people don't. I had a second on call and/or a nurse in most cases. My bosses unfortunately weren't as nice as yours, as I was expected to do the full complement the next day, unless I had a planned half day.

[quote user="Michael Woodhouse"]Maybe get small groups of practices to share OOH, rather than big centres mopping up the whole area?[/quote]

Been there, done that. Many logistical problems, like in-patients at every practice, etc. Eventually many of these evolve into an EC environment anyway. You also get the occasional night with no sleep, but now you are definitely not going to get any slack the next day as you are in a small day practice.

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.
Charles Darwin