so what would you have done......?????

Re: so what would you have done......?????

Evelyn Barbour-Hill — Mon, 10 Feb 2014 19:05:51 GMT

[quote user="Toby Birch"]This takes much longer that passer-by giving dog and owner a lift and phoning you en-route [/quote]

"What? It might get blood on the seats. I don't want dogs in my car. It might have a broken back! I'm just trying to help here and I get criticised. Look, I'm just being a good samaritan, I don't see why you're so reluctant, my own vet would have rushed out......"

Re: so what would you have done......?????

Gillian Mostyn — Mon, 10 Feb 2014 10:36:48 GMT

[quote user="Toby Birch"]Even in Chikosi the son said that by the time he [Chikosi] arrived a muzzle probably was not required.[/quote]

Because it was 9/10 dead by then.

Re: so what would you have done......?????

Toby Birch — Mon, 10 Feb 2014 10:27:30 GMT

[quote user="glen mcintosh"]

All of which, I think, goes to prove my points - that working in an OOH clinic is significantly different to being on call for 1-2 small practices and that vets working in emergency clinics will ALWAYS, in my opinion, have acted reasonably and justifiably should they decide to delay a house visit to ensure the clinic is properly staffed, just as Mr Chikosi did.

[/quote]

Sorry, only just coming to this thread and it is taking a while to catch up....

We just seem to be going around in circles. Glen is talking a lot of sense and as it seems that 'necessary' visits keep being band about. In my opinion the vast (nearly all) majority of visits are clinically unnecessary and certainly with emergency or OOH visits. That does not make them unnecessary per-se but it very falls to a business decision rather than a clinical one in almost all cases. It is this fear of the RCVS that needs clarifying as potentially you can end up in front of the DC because of an over-emotional owner wishing to 'take things further' when clinically a visit was not needed.

Even in Chikosi the son said that by the time he [Chikosi] arrived a muzzle probably was not required. No mention of if this was the case why then did they [the owners] not discharge their duty under the animal welfare act and move the poor dog to the surgery? This would have resulted in more prompt treatment (euthanasia only happened because that was what the owner wanted but it is not known what injuries were actually sustained).

Back to the original post...

I am very glad the outcome was positive but... assume the dog had actually been more severely injured and was one of those cases that was more time critical. We do not turn out with flashing lights and a £100,000 ambulance where we can actually treat a patient at the roadside (the air ambulance is not there (mainly) as patient transport but to put doctors on the ground. Quite often it is to crack your chest to remove the blood clot from your pericardium and prevent you tampanading. HEMS are now carrying blood products for on-scene resuscitation as well.

Anyway. Friendly passer-by drives to the clinic to get help, you go back and cannot do more than help move dog to clinic (which in the meantime is not being prepared for arrival of said dog). This takes much longer that passer-by giving dog and owner a lift and phoning you en-route and arrives to a prepared clinic. If the dog had died would the attitude have been - I could have saved the dog if I had gone out, the dog may have survived if it had got to the clinic promptly or oh well its injuries were too severe? The answer will very much depend on the type of person you are and what level of treatment you could have provided. One of the problems is that there is no one size fits all and advances are being made all the time (especially in ECC where as a nation we are behind other parts of the world but often consider very basic treatment sufficient).

I'll await my red stars...

Re: so what would you have done......?????

Glen McIntosh — Sun, 09 Feb 2014 18:26:46 GMT

[quote user="Michael Woodhouse"]RCVS only recognise 4 Specialists in ECC:[/quote]

This is true.

But just for the sake of accuracy, there are actually 17 people working in the UK who are US boarded specialists in ECC (including those recognised by the RCVS). That is, they have DACVECC qualification (Diplomate of the American College of veterinary emergency and critical care). 15 are small animal specialists, the other 2 are large animal specialists.

Most, if not all of them, would meet the criteria for recognition by the RCVS were they to apply.

3 or 4 of them work for Vets Now.

The numbers are growing but still significantly behind other English speaking western countries.

Australia, a country with a population 1/3 the size of the UK, has around about the same number.

The US has some 300 boarded specialists in veterinary ECC.

Re: so what would you have done......?????

Anthony Todd — Sun, 09 Feb 2014 16:11:28 GMT

[quote user="Michael Woodhouse"]RCVS only recognise 4 Specialists in ECC:[/quote]

Sorry, I didn't mean "specialists" probably confusing because of my NHS analogy.

I meant someone capable of doing a GDV [or similar complexity or daunt] competently, or able to give suitable advice in a complex case over the phone.

Can't expect a recent graduate to gain anything from being plunged into a GDV on a Crufts Champion Rottie on their own, except terror panic and despair!!

Re: so what would you have done......?????

Christopher Saul — Sun, 09 Feb 2014 13:57:16 GMT

[quote user="Michael Woodhouse"]Would any of the night vets be interested in some daytime work to keep their hand-in, in general practice? [/quote]

I guess it depends upon how may experienced night vets there are at each OOH centre. If there are two of them doing 1 week on, 1 week off, I suspect not.

[quote user="Michael Woodhouse"]Closer working between daytime and night time practices has to be a positive thing.[/quote]

Agreed.

Let's suppose for a minute that our idea takes off, then I would imagine that a number of practices who do not feel comfortable outsourcing their OOH work would have a change of heart knowing that a more comprehensive service was being provided. Thus more work for the OOH centres to pay for the extra manpower etc

Re: so what would you have done......?????

Michael Woodhouse — Sun, 09 Feb 2014 13:48:19 GMT

[quote user="Christopher Saul"]so that means one week of nights every 10, and of course that means they will need the week off at their own practice in addition to their holiday allowance. For those 7 practices this means finding locum other cover for this time. How acceptable is this? Whilst this may seem harsh on these practices, there could be some benefits:-[/quote]

Would any of the night vets be interested in some daytime work to keep their hand-in, in general practice? Some routine surgery might keep their surgical skills fresh etc. Closer working between daytime and night time practices has to be a positive thing.

Re: so what would you have done......?????

Christopher Saul — Sun, 09 Feb 2014 13:40:14 GMT

[quote user="Michael Woodhouse"]In general practice that's adequate. If the genuine life threatening emergencies are piling in at such a rate you can't go out to do a visit then maybe not[/quote]

I'm with Michael on this one. I think our idea of one junior vet rotating through alongside a permanent more senior vet is a good one.

One potential hurdle to our idea is that of rotas. Let's say that we have an OOH clinic covering 20 client practices, average of 3 vets each. so there's 60 vets feeding in. How many of those will be PDP candidates? let's be generous and say 10 of them, belonging to maybe 7 of the 20 client practices.

so that means one week of nights every 10, and of course that means they will need the week off at their own practice in addition to their holiday allowance. For those 7 practices this means finding locum other cover for this time. How acceptable is this? Whilst this may seem harsh on these practices, there could be some benefits:-

-If the OOH stints could be recognised as CPD, then they would not need to provide these vets with any additional CPD allowance

-They could, as Michael suggested earlier, have a rebate on their fees

-These vets, as new graduates, are likely to be cheaper to employ in the first place

-Having some good quality first hand experience of OOH work will be of benefit to their (PDP vets) development - their surgical skills will improve faster and they will start to turn a profit during their working week sooner

I like this idea

Re: so what would you have done......?????

Michael Woodhouse — Sun, 09 Feb 2014 13:02:39 GMT

[quote user="Anthony Todd"]I do think that my idea of having a senior vet, sober and definitely available is enough; you don't need the senior to be available for the bleeding toe nail, that is how experience is gained, but you do need a senior for the GDV, or, at least on the end of a phone, at all times.[/quote]

In general practice that's adequate. If the genuine life threatening emergencies are piling in at such a rate you can't go out to do a visit then maybe not.

Either Anthony's idea is fine most of the time OR these centres have so much critical care work that you probably need two vets anyway. Both arguments don't stack up.

RCVS only recognise 4 Specialists in ECC:

Adamantos S E
Brown A J
Chan D L
L M Kellet-Gregory

1 is at Bristol Uni and looks like 2 at the RVC.

Re: so what would you have done......?????

Gareth Dowdeswell — Sun, 09 Feb 2014 12:57:19 GMT

[quote user="mariette asselbergs"]

" the rotating new grads would be in addition to the permanent, experienced OOH vets at the OOH centre."

I find this a really good and interesting idea! Will see if we can discuss it in our next vet meeting at my practice.

However, I can see one problem: VDS insurance.

Since VDS has changed from individual vet insurance to practice insurance, the position of locums is a bit delicate. I am employed in one practice and do some work for 3 other practices on an irregular basis. In the old set up I had my individual VDS and this worked wherever I worked. In the new set up, each practice's VDS covers me as a locum, BUT ONLY if I replace a normal staff member, not if I am an extra vet! In the last case I would need to have my own VDS insurance on top of the one that the practice pays.

So if you would offer/ask new graduates of member practices to join in the emergency cover work for their practices as a second (training) vet, then they would need to have additional individual VDS cover because the practice cover would not include them. An d this would be so for each person, even if they would only do a limited amount of shifts per year.

Mariette

[/quote]

Could they use the reduced rate for part timers VDS insurance? With the changes they've made this year, I've ended paying for cover to work 50 days in the next 12 months, which would cover any sort of secondment/training lasting up to 10 weeks, which has cost a little over £100, which is not a prohibitive expense. I'm sure that if some formal programme was set up then better rates could be negotiated with the insurers, especially as mistakes are less likely to happen with experienced back up.

Re: so what would you have done......?????

Michael Woodhouse — Sun, 09 Feb 2014 12:52:29 GMT

[quote user="mariette asselbergs"]The problem with that one is that it obliges you to work for VetsNow for 2 years after. I had investigated it as an idea to up my OOH skills (since I moved from mixed practice to SA practice) and obviously VetsNow OOH has a wealth of cases and experience on offer, but the obligation to work for them afterwards made it a no go since I already have a job I like .....[/quote]

I don't know. If you sign up with VN for two years and they pay you from day 1 then you are earning money whilst doing the training. You then leave at the end and have to pay them £6000. That's £600 per week or £125 per day and all your CPD for 3 years. If you break it down (assuming the training is good) it's rather good value.

To put things into context it is going to cost me nearly £4,000 by the time I have done the assessment only route for my CertAVP, add in the CPD I have done and you will easily exceed the £6000

Re: so what would you have done......?????

Anthony Todd — Sun, 09 Feb 2014 12:19:21 GMT

[quote user="Christopher Saul"]I can't comment on any of the above, I've never worked for vets now or any of the client practices so it would be pointless for me to do so. However as a general concept what Michael and I (get us two on the same hymn sheet!) are suggesting is having two vets on duty all of the time, one new or recent grad [/quote]

Whether the Vets Now experience is true or not doesn't mean the concept is wrong.

I do think that my idea of having a senior vet, sober and definitely available is enough; you don't need the senior to be available for the bleeding toe nail, that is how experience is gained, but you do need a senior for the GDV, or, at least on the end of a phone, at all times.

Re: so what would you have done......?????

mariette asselbergs — Sun, 09 Feb 2014 12:03:04 GMT

Yes I am sure VDS and practices can find an acceptable workable formula. I just posted it to keep in mind if anybody would go ahead with the idea.

One other observation of the VetsNow cutting edge program, the 10 weeks one:

The problem with that one is that it obliges you to work for VetsNow for 2 years after. I had investigated it as an idea to up my OOH skills (since I moved from mixed practice to SA practice) and obviously VetsNow OOH has a wealth of cases and experience on offer, but the obligation to work for them afterwards made it a no go since I already have a job I like .....

Mariette

Re: so what would you have done......?????

Christopher Saul — Sun, 09 Feb 2014 11:53:23 GMT

Good point well made Mariette, though I guess you could get around that problem by paying for 2 vets worth of cover all the time at each OOH centre. I suppose the situation is not that much different from that of rotating interns at a large hospital...

I'm loving that we are at last getting those on each side of the debate to talk together to talk about a solution, rather than us arguing round in circles. I wonder if these past few posts should be moved to a new thread (Arlo...?)

Re: so what would you have done......?????

mariette asselbergs — Sun, 09 Feb 2014 10:30:56 GMT

" the rotating new grads would be in addition to the permanent, experienced OOH vets at the OOH centre."

I find this a really good and interesting idea! Will see if we can discuss it in our next vet meeting at my practice.

However, I can see one problem: VDS insurance.

Mariette

Re: so what would you have done......?????

Christopher Saul — Sun, 09 Feb 2014 09:34:42 GMT

I can't comment on any of the above, I've never worked for vets now or any of the client practices so it would be pointless for me to do so. However as a general concept what Michael and I (get us two on the same hymn sheet!) are suggesting is having two vets on duty all of the time, one new or recent grad - perhaps on secondment from the client practice as part of the PDP - and one more senior vet. This would tackle the problems outlined by Katja as well as making the whole house visit problem much less of an issue

Re: so what would you have done......?????

katja wagner — Sun, 09 Feb 2014 02:13:47 GMT

I have come across several vets who had been trained by the cutting edge program and to be honest the experience was quite an eye opener. they need 6 months experience in an english speeking country before they are allowed to join the program . I have met vets who worked as a nurse to meet the entrance criteria. then they have 10 weeks training before they are let loose. vets now will pay a salary from day one of the training but you have to stay for appr. 2 years or you must pay the training fees back depending on how long you stay I think this can be around £6000. some of the vets I met while working as a locum for vets now myself had not done a single coeliotomy and were literally shitting themselves if something came in which even vaguely sounded like it might need surgery.yes they can ring for advice via phone if they are lucky enough to get hold of somebody but if you have more or less zero experience I do not consider it as fair to employ such "trained" vets in an emergency clinic as the sole clinician. some burn out very quickly and only hang in there because they are unable to pay back there debts to vets now.

this so called cutting edge program always seemed to me a way to create more vets willing to work ooh as vets now is always on the hunt for more vets because of again in my humble opinion the rubbish wages they pay their full employed vets for the work they have to do. they have a very high turn over . by kind of "breeding" their own ooh vets who are kept on an even lower salary till the master 2 years vets now is able to find new,cheap vets who keep them supplied .

altogether I consider the cutting edge program as unfair to the vets who go in there thinking they will be well prepared for emergency work and then crumble under the burden and unfair towards the client and animal who pay a lot of money expecting dedicated ooh care by an experienced vet and not somebody who starts crying when the diagnose a foreign body and know they have to open this animal up themselves.

sorry if this sounds rather negative but I had my share of cutting edge vets shifts take over were simple basic mistakes had been made which would have in day practice been picked up by a colleague,FB,pyos etc had not been operated on their shift as they wanted to wait for a second vet aso

katja

Re: so what would you have done......?????

Anthony Todd — Sun, 09 Feb 2014 00:13:41 GMT

[quote user="Neil Wheadon"]It's being done already.[/quote]

Gee, I wish that had been around when I started! I was thrown into arguably the most intensive dairy practice in the world in Taranaki NZ [49 calls was the record for a day mostly, in the season, in a paddock, in the rain] and I'd done 1, that's one, rectal on a cow when I graduated......

My boss [or Eileen the radio operator] would give me 2 hours on a calving and then call the boss, NNS, who would, fag in mouth, put one hand in, one leg, again, other leg, again, head aligned then flop it out on the cow-shed floor whilst I, exhausted, slumped in the corner.

All the while discussing the latest rugby result with the farmer, didn't even have time to finish his fag.

The only advice, at the time, was invariably "What took you so long?"....

Re: so what would you have done......?????

Neil Wheadon — Sun, 09 Feb 2014 00:03:46 GMT

See above, I edited and you read the original, sorry about that . Neil

Re: so what would you have done......?????

Christopher Saul — Sun, 09 Feb 2014 00:02:06 GMT

Aye it is, and that is good, but I was thinking more along the lines of having a junior vet and senior vet all the time at each centre.....

Re: so what would you have done......?????

Neil Wheadon — Sat, 08 Feb 2014 23:57:36 GMT

It's being done already. Cutting edge program via Vets Now. Must be a graduate with experience, 6 weeks intensive Emergency training with a recognised specialist. It's already there and has been for 2 years. Every case is now looked at and commented on by one of 7 very experienced vets who have been working in this discipline for many years. Edit - apologees, this is a subtle difference in using new graduates from member practices, it's not a bad idea and could provide that crucial second vet to cover OOH clinics Neil

Re: so what would you have done......?????

Christopher Saul — Sat, 08 Feb 2014 23:43:36 GMT

[quote user="Michael Woodhouse"]

[quote user="Christopher Saul"]I guess a structured OOH training programme , similar to a residency perhaps but less academic and more practical, might be a way forward.[/quote]

I'm not sure you can just throw a new grad into OOH work even with support and expect them to thrive. I'd say some grounding in general practice was needed. You need to build your confidence in things like surgery and routine lumpectomies and neutering is the way.

I wonder if there is scope to share new grads between the feeder practices and the OOH centre. That way they'd still get their day routine but maybe do a 4 week? 6 week? secondment over a flexible period of time? It could go towards passing their PDP as a new graduate and count as their first year CPD.

I don't know how the fee side works (ie quite how much these practices pay to use the OOH services) but would providing them with the staff allow that fee to be waived (or reduced) as they'd have a vet working for them and earning them money. Trying not to increase the OOH costs too much.

If you have people who want to dedicate themselves to OOH work gaining something like the CertAVP is not that academic and would lead to some recognition at the end. Where are you going to get the guys to supervise them? That's the other side.

[/quote] I have not agreed with many of your posts of late Michael.... But to be honest I like your thinking on this one. the main problem I guess would be political in terms of how you structure the rotas. I don't think finding supervision is a major problem; the rotating new grads would be in addition to the permanent, experienced OOH vets at the OOH centre.

Re: so what would you have done......?????

Christopher Saul — Sat, 08 Feb 2014 23:26:40 GMT

No worries

Re: so what would you have done......?????

Anthony Todd — Sat, 08 Feb 2014 22:48:05 GMT

[quote user="Christopher Saul"]PS no one's called me Saul since school[/quote]

Sorry, two christian names are my problem too, and being old...

Anthony Todd

Re: so what would you have done......?????

Christopher Saul — Sat, 08 Feb 2014 21:38:29 GMT

[quote user="Anthony Todd"]PS. Saul, Would you be happy to be on the end of a phone, say one night in 10, in return for 9 nights of freedom??[/quote]

I currently do 1 in 3 on call, so 1 in 10 would be a huge improvement!

PS no one's called me Saul since school