OOH Cover Question

Re: OOH Cover Question

Anthony Todd — Thu, 06 Feb 2014 12:21:56 GMT

[quote user="Thomas Johnson"]Yes, but it quickly became clear that wasn't what the OP was asking, so it would be more helpful to forget that for the moment, give an opinion on the OP's query, and then once the OP had felt that we'd been helpful, go back to discussing, possibly in a new thread, the issue of out of hours cover for referral work.[/quote]

He did say "We seem to have got bogged down (possibly understandably) in referral ooh cases,"" so it was'nt clear to George either???

It is important to separate first opinion OOH requirements from referral OOH centre requirements and George appeared to be trying to lump the two together and therefore dump complicated referral procedures on your standard first opinion OOH centre.

I agree, a new thread may help.

Re: OOH Cover Question

Thomas Johnson — Thu, 06 Feb 2014 12:08:26 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]But we're not[/quote]

Um, this was the first line of the post in discussion which was a response to the OP.

"We seem to have got bogged down (possibly understandably) in referral ooh cases,"

and to that I was responding.

[/quote]

Yes, but it quickly became clear that wasn't what the OP was asking, so it would be more helpful to forget that for the moment, give an opinion on the OP's query, and then once the OP had felt that we'd been helpful, go back to discussing, possibly in a new thread, the issue of out of hours cover for referral work.

Re: OOH Cover Question

Bob Russell — Thu, 06 Feb 2014 10:29:36 GMT

[quote user="Michael Woodhouse"]

We share OOH work with a neighbouring practice. Charge drugs at list and fees with a 25% discount (ish). He bills his own clients, we get paid on the nose each month. He does the same for us.

If I was covering the other practices on call then no reason not to bill the other chap at your normal rate, and let him pass on the cost to his clients however his wishes.

[/quote]

But you are sharing OOH cover. This is a bit different to the OP case. There does not seem to be any reciprocal element to the arrangement.

Re: OOH Cover Question

An On MRCVS — Thu, 06 Feb 2014 09:45:30 GMT

[quote user="Anthony Todd"]

Remember we're talking about specialist post-op back up, not dogs under cars etc.

[/quote]

There is definitely no post-op cover - the vet in question doesn't do any surgery. We're really talking about the 'dogs under cars' stuff (albeit allowing for the fact that we don't do small ainmals!).

Re: OOH Cover Question

An On MRCVS — Thu, 06 Feb 2014 09:42:37 GMT

Thanks to those who worked out what I was trying to say and apologies if it wasn't initially clear.

The dermatology analogy is a good one. The person in question isn't a dermatologist, but the comparison works. Virtually no OOH cover required in his specialist field but some of his local clients may use him for 100% of their veterinary requirements and therefore need to see a vet OOH occasionally for normal first-opinion emergencies. I think with his further away clients he acst more as a consultant and will work with the clients' own vet so they will have cover in place via their own vet for OOH work. I suspect it's a box ticking exercise with the prospect of an occasional emergency but we do feel we ought to be remunerated for providing the service, even if the service is only 'being available' rather than going out to a lot of calls.

Thanks to those who suggest a figure, we'll take a look at it. If anyone has any more to add now that the situation is (hopefully) a bit clearer then please feel free.

Re: OOH Cover Question

Anthony Todd — Thu, 06 Feb 2014 09:29:27 GMT

[quote user="Thomas Johnson"]But we're not[/quote]

Um, this was the first line of the post in discussion which was a response to the OP.

"We seem to have got bogged down (possibly understandably) in referral ooh cases,"

and to that I was responding.

Referral centres must have different OOH facilities in place to cope with the specialist back-up that may needed, just because they have paid won't necessarily give the skills necessary.

Just because they've paid shouldn't absolve them from providing suitable OOH back up, and I would expect common sense and even the DC to agree with me.

Re: OOH Cover Question

Thomas Johnson — Thu, 06 Feb 2014 09:04:58 GMT

[quote user="Anthony Todd"]

Remember we're talking about specialist post-op back up, not dogs under cars etc.

[/quote]

But we're not, the OP has made it quite clear this isn't a vet offering referral level surgery. They're not being expected to provide back-up to this vets services beyond first opinion work.

Re: OOH Cover Question

Anthony Todd — Wed, 05 Feb 2014 20:07:09 GMT

[quote user="George Cooper"]the value to him to be covered. (FFS!)[/quote]

Yeahbut, although your specialist is legally "covered" in your opinion, what about the animal's that's had, say a portal shunt, but the OOH vet, straight off Ryanair from God knows where and is not really someone to be reopening this afternoon's pale and panting patient...

I'd love to see some sort of understandably inept salvage procedure going before the DC and your reply, as the referral centre vet would be "FFS,Sirs and Mesdames, we paid £XXX.00 per night for this cover, so I and the centre I work for, are totally innocent and should be absolved from any responsibility.

Remember we're talking about specialist post-op back up, not dogs under cars etc.

Re: OOH Cover Question

Michael Woodhouse — Wed, 05 Feb 2014 19:48:38 GMT

We share OOH work with a neighbouring practice. Charge drugs at list and fees with a 25% discount (ish). He bills his own clients, we get paid on the nose each month. He does the same for us.

If I was covering the other practices on call then no reason not to bill the other chap at your normal rate, and let him pass on the cost to his clients however his wishes.

Re: OOH Cover Question

Bob Russell — Wed, 05 Feb 2014 17:34:47 GMT

By offering this service the vet is getting value from it. It is therefore appropriate to charge. Offering this service to him may have extra costs (which would be substantial if it meant extra staff) in this case probably minimal.

If it is a regular occurrence why should he not pay? Some OOH's providers charge £300+ per vet per month so George's suggestion would appear to be perfectly in order to me and well worth it to keep the DC from the door!

Re: OOH Cover Question

Thomas Johnson — Wed, 05 Feb 2014 17:09:21 GMT

This conversation seems to have drifted from what the OP asked. The OP has made it clear that the other vet is not operating what we would consider to be a normal referral practice, so debates about post-op care are not relevant to their query, and the OP is only expecting to have to deal with 1st opinion type work from the other vet.

I would expect some remuneration for providing their out of hours cover, George Cooper's suggestion of £50-£100 a month would seem reasonable to me.

Re: OOH Cover Question

George Cooper — Wed, 05 Feb 2014 16:50:46 GMT

Yebbut there's that oddity called "value" to consider - the value to him to be covered. (FFS!)

Re: OOH Cover Question

Tim Charlesworth — Wed, 05 Feb 2014 16:48:54 GMT

I agree with the points previously made. As far as I understand it a referral centre does not have to have cover in place to take new cases 24/7 but does have an obligation to provide cover for patients already seen and that they need to use a cover-vet of the same level of expertise ie specialist for specialist. This can be "remote cover" ie somebody agreeing to cover from another practice aot somebody onsite during annual leave.

The OOH commitments will vary hugely on the discipline - if you're covering a dermatologist then you'll prob be fine, if its soft tissue or medicine then I'd advise that you have an arrangement whereby you're happy to take the call but expect the referral vet to be available for advice/to see the case if needs be. If that can't be arranged then you could simply offer to do OOH for his first opinion clients only?

Tim

Re: OOH Cover Question

Anthony Todd — Wed, 05 Feb 2014 16:45:37 GMT

[quote user="George Cooper"]What about £50 - £100 per month?[/quote]

FFS it's not about the money at all! I can't believe this was posted.

The thing is the referral centre have probably done some sort of advanced complicated procedure which needs their expertise to sort out.

I don't think anyone expects the OOH centre just to guess what's been done and give symptomatic relief to what may be an animal requiring skilled and specialised intervention.

Access to the case or procedure notes is vital and must be compulsory if alternative cover is to have a chance of dealing with post op. problems.

Re: OOH Cover Question

Hannah Wynne Richards — Wed, 05 Feb 2014 16:44:37 GMT

Clive. We're agreed !!!!!!!!!!!!!!!!

Wynne

Re: OOH Cover Question

George Cooper — Wed, 05 Feb 2014 16:29:58 GMT

We seem to have got bogged down (possibly understandably) in referral ooh cases, where the OP asked very simply for opinions on three options on the remuneration or not. If your practice is providing cover, it is not necessarily just the physical case that might and might not happen, it is creating additional albeit small, stress levels for you and yours. Further, without you providing this cover, his lifestyle would be severely curtailed , either on a W-L Balance level or on a professional level. Therefore, by doing his OOH you are providing a service to his benefit and your detriment, and this should be worth something in recompense. The nightly locum cover could be in the region of £50 or more, though that would be a bit punitive I think. What about £50 - £100 per month? That's my starter for now!

Re: OOH Cover Question

Rob Loxley — Wed, 05 Feb 2014 16:23:26 GMT

[quote user="An On MRCVS"]we'd only be expected to cover his clients in the immediate vicinity[/quote]

who is covering his other clients when he's on holiday??

Once had bad experience with a peripatetic specialist who saw a fairly straightforward case here which subsequently deteriorated while he was away with no backup to carry on its care...

Re: OOH Cover Question

Clive Ansell — Wed, 05 Feb 2014 15:44:27 GMT

[quote user="Hannah Wynne Richards"]

Or an orthopaedic referral centre which used to ( may still do ) "hospitalise " patients following major ortho or spinal surgery, when "hospitalisation" meant the animal being left in an empty building, with either an ordinary MRCVS or ordinary VN ( from the Vets Now ) up the road popping in once only during the night to check up and give 1 top up of analgesia.

Wynne

[/quote]

A scenario I have come across a few times now, is where a roaming Orthopaedic surgeon attends a standard first opinion practice with his own equipment, carries out sometimes lengthy and complex procedures, then disappears into the the night without providing any 24/7 back up cover for their work. The practice is not 24/7, is unmanned overnight, and in the event of a complication the client would have to attend the practices usual non specialist OOH provider. Cases are always discharged the same day, and if ongoing analgesia is needed they are sent to the OOH clinic. Does this fall short of the C to PC? I don't like it and will not offer it as treatment option , and feel cases should be referred to a specialist center that provides on site 24/7 cover.

Re: OOH Cover Question

Mark Hedberg — Wed, 05 Feb 2014 15:32:36 GMT

[quote user="An On MRCVS"]

It's difficult to give exact details without giving the identities away, but we're not in small animal practice and this chap's 'speciality' does not involve surgery and is not in an area where you generally expect emergency situations. I expect any work we do for him OOH to be 'normal' work, the sort of stuff we do day to day anyway.

I don't think he'd be able to reciprocate - he's often out of the area or abroad at nights/weekends due to his main line of work.

Hope this helps, I don't think I can give much more detail.

[/quote]

Skin vet, is he?

Re: OOH Cover Question

An On MRCVS — Wed, 05 Feb 2014 15:24:41 GMT

I don't think he'd be able to reciprocate - he's often out of the area or abroad at nights/weekends due to his main line of work.

Hope this helps, I don't think I can give much more detail.

Re: OOH Cover Question

Bob Russell — Wed, 05 Feb 2014 14:06:54 GMT

Our referred patients continue to be cared for by the referral centre where appropriate. They would never be expected to go via a third party OOH's service.

Re: OOH Cover Question

Anthony Todd — Wed, 05 Feb 2014 13:38:06 GMT

[quote user="Mark Holmes"]Client called as I was covering the member practice. Her dog had had major abdominal surgery as a referral at a well known referral centre.[/quote]

I wonder if the "Guide" might say that there is a requirement for emergency OOH cover by the referral centre post-op, but only post-op.

Would any of us like to go into someone else's abdomen 'cos for sure it'll be the OOH guy who takes the can, even if he can find out what the problem is.

Again it should be a requirement that OOH centres have access to or are given the notes of such a case, just in case they are needed.

Re: OOH Cover Question

Hannah Wynne Richards — Wed, 05 Feb 2014 13:20:09 GMT

Wynne

Re: OOH Cover Question

Mark Holmes — Wed, 05 Feb 2014 13:07:43 GMT

[quote user="Neil Wheadon"]

Consider the position I had last night

Client called as I was covering the member practice. Her dog had had major abdominal surgery as a referral at a well known referral centre. She called me as the dog looked sleepy and had stopped eating. Prior to this it had been hospitalised for 4 days at the centre.

It was in the dogs best interest to see the referral centre and so I asked her to contact them.

So are you happy to deal with these scenarios?

Neil

[/quote] That is a good point. I do have some concerns with practices performing ops in the day and having insufficient staff or ooh cover to address associated complications at night. For example tie back ops and no trach tubes or people to fit them out of hours. Out if hours cover should be at a similar or better level of expertise.

Re: OOH Cover Question

Neil Wheadon — Wed, 05 Feb 2014 12:32:11 GMT

Consider the position I had last night

It was in the dogs best interest to see the referral centre and so I asked her to contact them.

So are you happy to deal with these scenarios?

Neil