Gold Silver and Bronze

Re: Gold Silver and Bronze

Anthony Todd — Wed, 09 Apr 2014 19:42:05 GMT

[quote user="Francisco Gomez"]How exactly would you reduce a complaint by implementing PSS?[/quote]

See my other post.

I've just read the PSS and the important changes and, frankly, I can hardly see anything that is not very obvious [keep the place clean and tidy!!!???] and all the other regulations that every veterinary employer or practicioner has to abide by already.

When I did look closer some of the detail is really vague and nonsensical for instance:

5.11 The practice must carry out monitoring of anaesthetic pollutants in

operating areas and maintain written records of this (L)

Written evidence of measurement of personal exposure to anaesthetic monitoring is

required. Monitoring must be carried out on an annual basis, or if the nature of the

anaesthetic equipment and circuitry is changed.

Inspectors will check that the readings recorded fall within the current Workplace

Exposure Limits for the agent(s) used. These are currently:

10ppm Halothane

50ppm Isoflurane

60ppm Sevoflurane

100ppm Nitrous oxide

All these values are subject to review and are calculated on an eight-hour Time

Weighted Average (TWA) basis.

If a sophisticated active scavenging system is in operation, it must be serviced

annually. An inspection certificate must be available and is an acceptable alternative

to personal dosimetry.

I mean monitoring on an annual basis, surely it should be constant, as for Xray exposure?

How and when do they check, what, pick a day in the year?

Then they talk about "active scavenging" or "personal dosimetry".

For heavens sake, you really need to know if these gases are around, certainly with halothane, and it's no good having "active scavenging" if the bloody pipe has fallen off [which is what is the usual reason!] [and you smell it and push it back on.....]

I'm really surprised at how valueless the PSS appears to be. We've got so much regulation now, which we all comply with, without it being regurgitated again.

It seems to me to be an expensive way to get a plaque on the wall and little else.

Re: Gold Silver and Bronze

Anthony Todd — Wed, 09 Apr 2014 19:25:30 GMT

Sorry, found it 2.2, pg 17 and here it is

2.4 The practice must have a means of monitoring client perceptions and

feedback

The practice must have a means of recording and considering client complaints.

The practice must have a written complaints policy and must keep a record of

complaints received and the responses made.

The practice must have a means of encouraging feedback from clients and acting upon the results of feedback.

We're discussing complaints made to the RCVS, aren't we, and my experience is that client complaints go straight to the College often without any prior reference to the practice or the vet concerned.

Re: Gold Silver and Bronze

Rob Loxley — Wed, 09 Apr 2014 19:20:52 GMT

http://www.rcvs.org.uk/document-library/practice-standards-scheme-manual/ (PSS Manual May 2013)

pages 11 (section 1.7) and 17 (section 2.4)

Re: Gold Silver and Bronze

Anthony Todd — Wed, 09 Apr 2014 19:16:42 GMT

[quote user="robloxley"]

[quote user="Anthony Todd"]Isn't PSS concerned completely with the presence of equipment and the management of it?[/quote]

No: the manual/requirements are online if you want to look.

One requirement is "The practice must have a written complaints policy"

I can see a rationale that if complaints are dealt with well by the practice then they might be less likely to proceed to an RCVS complaint?

[/quote]

Sorry Rob, I've been through it twice and I cannot find any reference to this, can you give me the page and secion refernece please, I've obviously missed it.

Re: Gold Silver and Bronze

Rob Loxley — Wed, 09 Apr 2014 18:05:37 GMT

[quote user="Anthony Todd"]Isn't PSS concerned completely with the presence of equipment and the management of it?[/quote]

No: the manual/requirements are online if you want to look.

One requirement is "The practice must have a written complaints policy"

I can see a rationale that if complaints are dealt with well by the practice then they might be less likely to proceed to an RCVS complaint?

Re: Gold Silver and Bronze

Anthony Todd — Wed, 09 Apr 2014 17:43:54 GMT

How many complaints have there ever been which are connected, even remotely, to PSS, which I understand have nothing to do with veterinary care apart from that already covered in our Code of Conduct.?

Isn't PSS concerned completely with the presence of equipment and the management of it?

Re: Gold Silver and Bronze

J G Wray — Wed, 09 Apr 2014 15:21:09 GMT

[quote user="Arlo Guthrie"]Sorry, maybe I am being thick. TV programme? Wot TV programme? [/quote]

http://www.bbc.co.uk/programmes/b00t66pb

[quote user="Arlo Guthrie"]are you aware of data which compares no of complaints to PSS practices vs non-PSS practices? Can you point me in the right direction?[/quote]

Nope, but you can start with RCVS Facts. By the way I don't think the critical point is number of complaints about PSS practices or others, because there aren't many and RCVS has no jurisdiciotn even if it receives a complaint. As mentioned earlier, it's care and communication. PSS no dealee with care, RCVS no dealee with communication.

The time effort and expense to reduce the burden on RCVS of general complaints about practices from 23 ( 14 were received about practice promotion by the way, though it doesn't say if they all come from some remote part of a Principality) to whatever is deemed acceptable looks absurd to me and not worthy of all the resources. Furthermore,RCVS received 24 complaints about OOH 24/7 in the same period. Now, as you may recall the President Col Smith feels that the brouhaha which has been stirred iin respect of 24/7 OOH s out of all propoertion to the burden of complaints received by the RCVS and therefore in no need of change. SO, if RCVS gets 23 complaints about Practice Standards it throws money and resources at it, but if 24 then there's no need.

Is there something odd here?

Re: Gold Silver and Bronze

Bob Russell — Wed, 09 Apr 2014 15:19:15 GMT

I wonder if he means the one where a vet was accused of charging for monitoring that was not done (and was struck off) being interviewed outside his practice next to the PSS accredited sign?

Re: Gold Silver and Bronze

Arlo Guthrie — Wed, 09 Apr 2014 14:57:28 GMT

[quote user="J G Wray"]

[quote user="Arlo Guthrie"]Whether or not PSS DOES reduce the number of complaints is another question altogether.[/quote]

Old fruit, to use your own wotsit look at what I wrote.

[quote user="J G Wray"]and the argument of the connection between the complaints and Practice Standards is specious, not least because it ain't changed 'owt in 8 years in this respect[/quote]

[/quote]

I saw what you wrote. Haven't checked yet to see whether overall complaints are up or down or sideways. But at this stage, that wouldn't (to my mind) matter. What would matter is whether there are less complaints about PSS practices.

[quote user="J G Wray"][quote user="Arlo Guthrie"] Is there any data concerning the number of complaints about PSS practices versus non PSS practices, I wonder?[/quote]

Well, there was a TV program.....as prev mentioned[/quote]

Sorry, maybe I am being thick. TV programme? Wot TV programme? Have I missed something in a previous post? Will re-read, but meantime, are you aware of data which compares no of complaints to PSS practices vs non-PSS practices? Can you point me in the right direction?

Re: Gold Silver and Bronze

J G Wray — Wed, 09 Apr 2014 13:41:45 GMT

[quote user="Arlo Guthrie"]Whether or not PSS DOES reduce the number of complaints is another question altogether.[/quote]

Old fruit, to use your own wotsit look at what I wrote.

[quote user="J G Wray"]and the argument of the connection between the complaints and Practice Standards is specious, not least because it ain't changed 'owt in 8 years in this respect[/quote]

[quote user="Arlo Guthrie"] Is there any data concerning the number of complaints about PSS practices versus non PSS practices, I wonder?[/quote]

Well, there was a TV program.....as prev mentioned

[quote user="Arlo Guthrie"] so it would seem to me to be a GOOD THING all round for the regulator to engage in activities designed to reduce the number of complaints.[/quote]

Well, to go back to 2006 and that letter in the VR where one possible gain from PSS was identified as

"Reduced indemnity insurance premiums, consequent upon improved management procedures and improved complaints handling;"

and rejected by Pres Hill in her response, then the current aspiration for the PSS seems to be coming in to line with what was written 8 years ago by someone.

The other aspirations were

Enhanced sales consequent upon RCVS Practice Standards Scheme participation, perhaps through increased registration of new clients;

Reduced indemnity insurance premiums, consequent upon improved management procedures and improved complaints handling;

Improved recruitment of staff, because we could look for staff willing to comply and staff would know what sort of practice they would get; and

Improved management procedures in general.

The person who wrote these aspirations all that time ago knew/knows how these are achieved in other standards systems and they don't match PSS. I wonder how long it'll be before they do.

JGW

Re: Gold Silver and Bronze

Bob Russell — Wed, 09 Apr 2014 13:01:37 GMT

PSS should start with one aim and that is to monitor and improve standards of care. There are more and more places offering access to vets but offering no genuine level of care.

As a profession we need to protect ourselves from these places. An inexperienced vet (often with limited English) arrives at a pet shop to vaccinate all and sundry for a pittance then is gone! These are 'sold' to the public as great vets and fully qualified on the website. They may well be very nice people and technically are qualified (legally) but are they likely to pick up the issues that are bread and butter for a regular practice? A puppy or kitten that is not thriving? A heart murmur that needs investigation?

The general public expects a certain level of competence and not just someone competent to wield a syringe full of vaccine. How are they to know? At least in the past inexperienced vets would be expected to have more experienced colleagues nearby.

I don't doubt that most of those behind the PSS have the best of motives but the idea that the present scheme will reduce complaints seems fanciful. People complain because the vet is seen to have made a mistake, something has gone wrong with case or the bill is more than the owner wants (or a combination!). I don't believe this will change PSS or not!

I look forward to seeing the ideas for change but will not be advertising the practice as bronze or silver even if we join!

Re: Gold Silver and Bronze

Arlo Guthrie — Wed, 09 Apr 2014 12:57:52 GMT

[quote user="J G Wray"]

[quote user="Arlo Guthrie"]Erm, I'm not being obtuse, but I genuinely find it difficult to follow this line of argument. Complaints are just a manifestation of client dissatisfaction (obviously). So it seems completely a completely fair and laudable aim of PSS to raise standards and thereby reduce client dissatisfaction. Whether it achieves these aims is another question. But I think unfair to criticise on the basis that the RCVS sees it as a way of reducing complaints. [/quote]

Just to be clear where this comes from

[quote user="David Catlow"] It is hoped of course that raising its profile will increase the number of PSS member practices so ultimately the investment will be repaid in increased financial return, although the chief aim of the scheme is of course to raise standards, reduce the numbers of complaints [/quote]

[/quote]

I know that's where it came from! Doesn't change the fact that reducing the number of complaints does not, to me anyway, seem specious or self-serving. Fear of complaint to the RCVS seems to be something that causes a great deal of concern amongst practitioners (see 24/7), so it would seem to me to be a GOOD THING all round for the regulator to engage in activities designed to reduce the number of complaints.

Whether or not PSS DOES reduce the number of complaints is another question altogether. I agree with you absolutely that it is your money being spent, and there should be evidence that it is an effective use of money. Is there any data concerning the number of complaints about PSS practices versus non PSS practices, I wonder?

[quote user="Francisco Gomez"]How exactly would you reduce a complaint by implementing PSS? You've got no grounds to complaint because your practice is not accredited? Or because you used a bronze practice?[/quote]

I'd assume that as a general rule, practices that had implemented PSS would be less likely to have a complaint made against them simply because they are working to a set of known (high) standards. That doesn't mean that non PSS practices are not working to a high standard. Just that a non PSS practice might be less likely to work to the same standards.

I don't know if that is actually the case.

Re: Gold Silver and Bronze

Gillian Mostyn — Wed, 09 Apr 2014 12:29:28 GMT

[quote user="Francisco Gomez"]How exactly would you reduce a complaint by implementing PSS?[/quote]

I assume that it would reduce complaints that are due to substandard premises or vets...... hmmm...... wonder how that is working out in the 'PSS vs non PSS' statistics.....

Re: Gold Silver and Bronze

Francisco Gomez — Wed, 09 Apr 2014 12:19:28 GMT

[quote user="Arlo Guthrie"]

But I think unfair to criticise on the basis that the RCVS sees it as a way of reducing complaints.

[/quote]

Where does it say that this was the reason behind creating the PSS?

And more importantly:

How exactly would you reduce a complaint by implementing PSS? You've got no grounds to complaint because your practice is not accredited? Or because you used a bronze practice?

Re: Gold Silver and Bronze

J G Wray — Wed, 09 Apr 2014 12:16:47 GMT

Just to be clear where this comes from

RCVS have a Statutory duty to deal with Disciplinary matters. It is 1/3 of their raison d'etre. They cannot avoid this. They have to do it. Devising a scheme to abrogate this serves them first and the argument of the connection between the complaints and Practice Standards is specious, not least because it ain't changed 'owt in 8 years in this respect. How many more years and iterations of this are needed until the connection is proven or not? It's all about evidence innit? In the meantime money is being spent, RFPs money.

[quote user="Arlo Guthrie"]Seem like good questions to be asked, but shame they're in the context of the earlier part of the post (self-serving and bonkers). [/quote]

For me it's rhetorical, but you can ask if you wish - Good luck with that.

JGW

Re: Gold Silver and Bronze

Arlo Guthrie — Wed, 09 Apr 2014 11:35:00 GMT

[quote user="J G Wray"]it is seen by the ideologues at RCVS as a means of reducing complaints to RCVS. RCVS are looking at their own problem, dealing with complaints and extrapolating to a PSS. It isn't serving its customers, either public or professional, it is finding a way, crassly in my view to reduce its own Statutory buirden.This is self-serving and bonkers.[/quote]

Erm, I'm not being obtuse, but I genuinely find it difficult to follow this line of argument. Complaints are just a manifestation of client dissatisfaction (obviously). So it seems completely a completely fair and laudable aim of PSS to raise standards and thereby reduce client dissatisfaction. Whether it achieves these aims is another question. But I think unfair to criticise on the basis that the RCVS sees it as a way of reducing complaints.

[quote user="J G Wray"]I keep coming back to whether the public want good practices or good vets first and foremost.[/quote]

It is surely not an either/or answer. Both are important. I guess most people would say a good vet is first and foremost. But if you ask that question with the assumption that training standards and regulation are already sound, and most vets are already 'good' (in general), then the practice becomes more important. I think it would be really interesting to find out what the public thinks (that other study earlier in this thread doesn't answer this question. It only asks what are the most important things about the vet).

[quote user="J G Wray"]The number of advice episodes for Inadequate care, surely what the Disciplinary process was set up for was 21 but the complaints were 340 - that's where RCVS should be raising personal standards, which is what they were empowered to do.

The other area identified for complaints was General communication, which was categorised as "Practice Standards - General Communnication". VDS' efforts in this area are beyond reproach. Whither RCVS'?[/quote]

Seem like good questions to be asked, but shame they're in the context of the earlier part of the post (self-serving and bonkers).

Re: Gold Silver and Bronze

Thomas Johnson — Wed, 09 Apr 2014 09:12:57 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]No, I don't think so. For example, our local orthopaedic referral centre has about 90 staff.[/quote]

Just for interest, how many specialist referral centres are there in the UK that are purely that ie no first opinion, no OOH [apart from their own]

[/quote]

I have no idea! And I'm not sure it wiould be an easy answer to find, is there any sort of register of practices that accept referrals? If there is some sort of list would it be practical to send out a questionnaire to find out how many are hospitals, how many also do first opinion work, how many do their own out of hours, and how many also do out of hours work for other practices?

Re: Gold Silver and Bronze

J G Wray — Wed, 09 Apr 2014 07:32:09 GMT

[quote user="Arlo Guthrie"]

It would beggar the question why anyone would bother, though I see practices see benefits to it beyond just marketing (effectively an external audit of how well they are doing). Maybe, with an optional system, that's not enough, so the choices are:

1. Make RCVS PSS compulsory and practices are not allowed to project 'accredited' to the outside world.

2. Farm it out to another organisation. In the architects profession, it is done by the equivalent of BVA / BSAVA (RIBA) and practices proudly display RIBA Chartered Practice.

3. Keep as is, and accept that inevitably, if you are allowed to project 'Regulator Accredited', that is a useful marketing tool.

[/quote]

Hmm. Situation - All practices are accredited. All are therefore the same. There is no marketing gain.

Some practices are accredited, as now. Is there any marketing gain if the public don't know or care about "good practices"?

One answer, create difference, create good, better, best, all marketing concepts because they permit differentiation.

I keep coming back to whether the public want good practices or good vets first and foremost.

I'm also aware, now that Mr Catlow has articulated it so clearly that PSS exists to provide disciplines in management for those who don't care to do it for themselves and in his most recent response, it is seen by the ideologues at RCVS as a means of reducing complaints to RCVS. RCVS are looking at their own problem, dealing with complaints and extrapolating to a PSS. It isn't serving its customers, either public or professional, it is finding a way, crassly in my view to reduce its own Statutory buirden.This is self-serving and bonkers.

From the last RCVS Facts the number of advice episodes given by RCVS on Practce Standards was 372, but the number of complaints was 23. I do not know if following the TV program investigating care at a PSS practice, this was the subject of a complaint. Incidentally the man that mopped that one up was Mr Nell a proposer for Ms Molyneux (SPVS stuff).

The number of advice episodes for Inadequate care, surely what the Disciplinary process was set up for was 21 but the complaints were 340 - that's where RCVS should be raising personal standards, which is what they were empowered to do.

JGW

Re: Gold Silver and Bronze

Anthony Todd — Tue, 08 Apr 2014 22:51:52 GMT

[quote user="Thomas Johnson"]No, I don't think so. For example, our local orthopaedic referral centre has about 90 staff.[/quote]

Just for interest, how many specialist referral centres are there in the UK that are purely that ie no first opinion, no OOH [apart from their own]

Re: Gold Silver and Bronze

Anthony Todd — Tue, 08 Apr 2014 22:49:03 GMT

[quote user="Thomas Johnson"]No, I don't think so. For example, our local orthopaedic referral centre has about 90 staff. They only take orthopaedic and neuro referrals, [/quote]

Fair enough, I didn't realise there was that demand.

Re: Gold Silver and Bronze

karen jones — Tue, 08 Apr 2014 21:48:51 GMT

Always annoys me when the vn colleges come individually ( we use two as take degree students and have our own fe) who the scrutinise all the paperwork taking hours to looks at when the autoclave was serviced , who check the fire extinguishers , did I make everyone sign they've read the h and s paperwork . The latest on was did we make sure the schools whose pupils came to us for work experience knew what thet were doing? I did ask what business was that if theirs surely the schools sorted that! I have files of paperwork which the only people who look at are the vn colleges and the pss inspectors. Some of the colleges would be better checking who did their lectures , one of our TVN came back with the news that the femoral artery in the horse was on the outside of the leg! Vn training now seems to have two lots of people doing the courses which are very different, differnt online things and differnt exams etc etc , not sure this is progress

Re: Gold Silver and Bronze

Malcolm Ness — Tue, 08 Apr 2014 21:02:14 GMT

[quote user="Evelyn Barbour-Hill"]Anyway, a powerful faction in Belgravia House wanted compulsory inspection and "accreditation" for all practices.They quickly saw that this was ultra vires – they had no power to do it. So they came up with the idea of a voluntary scheme that would be so managed as to eventually force every practice to join, whether from straightforward commercial calculation or from fear. It was not hard to think this up, for it is a classic strategy.[/quote]

I don't think that this is entirely true. It completely ignores the BSAVA scheme that was up and running before RCVS got their claws in and also, I believe that hospitals using deputising services is a rather recent thing - it certainly followed the establishment of the special deputising service category of PSS accreditation. As to why RCVS became involved, I believe it related to the possibility of combining a Vet Nurse TP inspection with a PSS inspection (BSAVA and BVHA simply weren't important enough organisations to do the TP inspection, or perhaps some people just wanted to keep their seat on the VN training gravy train, who knows?) Anyway, it was all a lot of hocus, RCVS took the PSS over in its entirety and invented a third tier (a good move, I think) but regrettably, the VN training people kept their lucrative inspection work and the governance of PSS has not yet progressed beyond something akin to the Church Flower Rota Committee with everybody being stakeholders and the lowest common denominator ruling everything except the spending of Members' money.

Re: Gold Silver and Bronze

Francisco Gomez — Tue, 08 Apr 2014 19:55:17 GMT

I see ...

Re: Gold Silver and Bronze

Evelyn Barbour-Hill — Tue, 08 Apr 2014 19:10:37 GMT

[quote user="Francisco Gomez"]

[quote user="Evelyn Barbour-Hill"]

Anyway, a powerful faction in Belgravia House wanted compulsory inspection and "accreditation" for all practices.

[/quote]

Thank you Evelyn. My question is more of why they 'wanted' this? Why would anyone want to do something that is more work?

There must be a reason behind it.

[/quote]

Because they like to boss people about? Because they are empire-builders? Because they are utterly convinced of their righteousness? You tell me.

Re: Gold Silver and Bronze

Utlendigur — Tue, 08 Apr 2014 19:07:47 GMT

And then more mission-creep in that they include a clause in the CTPC that insists that all vets must work for a practice that is equivalent to core standard. OK, so core-equivalent is pretty basic, but it sets a precedent for the RCVS to start to develop a way to control practices by controlling where individual vets can work, unless they want to risk disciplinary action, and to control minimum standards in practices by manipulating what is considered acceptable for a core standard practice. What happens when they decide that core (or equivalent non-PSS) practices must have a list of kit, or x number of RVNs.... They can't force practices to join PSS but they can go after individual vets.