Standards Committee's Recommendations on 24-7

Re: Standards Committee's Recommendations on 24-7

ruths — Mon, 09 Jun 2014 18:11:40 GMT

Have had concerns about going out to visit animals, but I worked in charities. I was often a bit concerned for my safety in the clinic anyway to be honest. I

Re: Standards Committee's Recommendations on 24-7

Gareth C. — Mon, 09 Jun 2014 13:38:34 GMT

[quote user="Chris Barker"]

[quote user="Gareth C."]

What's the timeframe for it going into the code?

[/quote]

Standards are to meet probably in the first week of July to agree the final text; if felt necessary the text can submitted for final approval by Council at RCVS Day, so I suspect the guidance will be brought into use by August

[/quote]

That's great. I've written about this subject quite a bit over the years in veterinary review magazine and veterinary practice and it has been a major cause of concern for practicing vets. It has also, I think, been one of the major causes of dissatisfaction between the practicing profession and the disciplinary process and the rcvs. If this is taken up by the code it could lead to a major improvement in how practicing vets feel about the rcvs. as someone has pointed out even if it does get in only time and "case law" will show how much has really changed. Let's hope this is the last chikosi or Baird case for the foreseeable future.

Re: Standards Committee's Recommendations on 24-7

Anthony Todd — Mon, 09 Jun 2014 09:33:17 GMT

[quote user="Neil Wheadon"]Or put it another way 24% had concerns.[/quote]

Surely the surveyors had the wit to ask for a brief description of the circumstances!?

I recall one of my colleagues being seriously threatened by a publican on a visit but that is all in about 30 plus years.

Would the RC count an invitation to a glass of brandy by a rather nice lady at 11am as a "threat" or a "promise"?

For me, apart from that, nothing.....

Re: Standards Committee's Recommendations on 24-7

Bob Russell — Mon, 09 Jun 2014 09:28:55 GMT

I thought this 76% bit was a wonder of spin. If 24% genuinely feel concern regarding personal safety there is a whopping big problem. How many other jobs would allow 24% of their staff to feel at risk?

Of course 24% are not likely to be at real risk of real injury but this is still a concerning statistic, not a comforting one!

Re: Standards Committee's Recommendations on 24-7

Thomas Johnson — Mon, 09 Jun 2014 08:38:31 GMT

[quote user="Michael Woodhouse"]

Neil - I went to college in London. I don't think a day went by when I didn't have 'concern for my personal safety'! That doesn't mean I was at any particular risk or that anything happened to me.

It's natural to be concerned in an unfamiliar environment.

If 24% had been assaulted and robbed then it's massively significant!

[/quote]

I wonder if there is any way of doing a study to determine how good we are at assessing risk to our personal safety, and of those who had concern what proportion were genuinely at risk, and perhaps more interestingly what proportion of those who hadn't had concerns for their personal safety should have had them?

Re: Standards Committee's Recommendations on 24-7

Michael Woodhouse — Sun, 08 Jun 2014 22:06:26 GMT

Neil - I went to college in London. I don't think a day went by when I didn't have 'concern for my personal safety'! That doesn't mean I was at any particular risk or that anything happened to me.

It's natural to be concerned in an unfamiliar environment.

If 24% had been assaulted and robbed then it's massively significant!

Re: Standards Committee's Recommendations on 24-7

Neil Wheadon — Sun, 08 Jun 2014 21:44:43 GMT

I thought there was one extraordinary statistic in the report and this was highlighted with an underline and it was on page 15　

The majority of respondents (76%) report that they have not had any concerns for their personal safety in the last 12 months.

Or put it another way 24% had concerns. Bear in mind that the number of home visits are not common OOH, this means that every 4 years a vet on call will have concerns about their personal safety. Does anyone else feel this is acceptable, and why has the RCVS chosen to emphasis the not? Are they trying to in some way trying to justify a change that although welcome isn't exactly seismic?

Neil

Re: Standards Committee's Recommendations on 24-7

Chris Barker — Sun, 08 Jun 2014 19:47:42 GMT

[quote user="Gareth C."]

What's the timeframe for it going into the code?

[/quote]

Re: Standards Committee's Recommendations on 24-7

Gareth C. — Sun, 08 Jun 2014 01:07:19 GMT

Well done jo. If that goes into the code as is it will be great. As has been pointed out the public can see the code and now cannot absolve themselves of financial and welfare responsibilities by picking up the phone. It will also make all vets feel less under pressure to do unnecessary visits, and we can all do the necessary ones just as we always did.

What's the timeframe for it going into the code?

Re: Standards Committee's Recommendations on 24-7

J G Wray — Sat, 07 Jun 2014 12:08:02 GMT

[quote user="Jo Dyer"]More importantly,..and to everyone who was brave enough to sign the petition and put their name out there in the public domain[/quote]

Hear, hear.

JGW

Re: Standards Committee's Recommendations on 24-7

Jo Dyer — Sat, 07 Jun 2014 10:13:20 GMT

[quote user="Arlo Guthrie"]for the thousands that signed the petition, I think this looks like a pragmatic, well thought through and substantive change to the guidance[/quote]

I am really pleased with the wording of the recommendations and I hope they go into the Guidance pretty much verbatim. They have made the owner primarily responsible for their animal's welfare; stated that the interests of the animal are best met at the practice; left it to the vet's personal judgment whether to visit or not; taken away the ridiculous 'the vet is responsible the minute the owner makes telephone contact' clause; and stated that disciplinary action will only be considered where there is wilful disregard for animal welfare.

When I was at the Standards Committee investigation, I got the impression that one of their major concerns was that the impaled cat must attended to, on the rare occasions when that situation or similar might arise. They don't want to be prescriptive and state this, but I would be willing to bet that there won't be any disciplinary cases except in the situation where a vet refuses to attend an animal which physically cannot be moved by a member of the public.

[quote user="Gillian Mostyn"]I do genuinely hope that when all this is finalised that you are happy with the results of all your campaigning Jo[/quote]

Thank you to everyone for the kind words. More importantly, thank you to everyone who made the effort to write to the 'Call for Evidence' and to everyone who was brave enough to sign the petition and put their name out there in the public domain. It was a potentially controversial subject, and knowing that you were almost certainly traceable by any member of the public who wished to do so was a sobering thought. (As it turned out, it was more controversial within the profession than amongst the public!)

By taking up these recommendations, as I sincerely hope RCVS Council will do, they would be sending out the signal that vet welfare is as important as animal and client welfare; a long overdue message, and one which I hope all vets will take to heart and believe themselves.

Re: Standards Committee's Recommendations on 24-7

Bob Russell — Sat, 07 Jun 2014 09:40:54 GMT

I had to get an owner to take his dog for overnight monitoring (bad adder strike) for pretty much the first time in all the years I have used VetCall/VetsNow.

I had done all the necessary work, they closely monitored the dog overnight (including fluids) and pain relief for £200. Not at all unreasonable. They did no bloods or unnecessary work.

Perhaps we have a particularly good VetsNow but I have no evidence it is any different to any other!

Re: Standards Committee's Recommendations on 24-7

Michael Woodhouse — Fri, 06 Jun 2014 22:24:27 GMT

Sarah - I have no problem with Vets Now. I do have a problem with some aspects of contracting out your OOH commitment (transporting animals back and forth, the high costs, the levels of potentially unnecessary work, the misrepresentation that they are ECC specialists, distances animals need to travel for treatment). I also don't doubt you saw more sick animals - you are covering for dozens of vets, it a scale thing.

I do know (from people I know who worked there) the majority of stuff presented was not an emergency (much like human A&E). The vets had some nights doing very little other than catching up on sleep! Occasionally they were slammed with a lot of serious cases.

In the 'big debate thread' a number of people from the OOH centres suggested that because another serious case might come in then that was a reason for the vet not leaving the centre to attend an animal that does need attention. That will never sit comfortably with me.

Re: Standards Committee's Recommendations on 24-7

Sarah McGurk — Fri, 06 Jun 2014 22:00:54 GMT

[quote user="Michael Woodhouse"]

Vets Now's Ivory towers practising emergency and critical care on the vaguely unwell......

[/quote]I saw more GDVs, more Addisonian crises, fitting dogs and many, many more life threatening RTAs in a year at Glasgow Vets Now working twenty hours a week than I had seen in the preceding seven years in general practice. Not only that, but in the first year I was there, they spent more on my (wholly relevant) CPD than I had probably received during those yearlier ears as well. I realise that not everyone who has worked for Vets Now will have had such a positive experience, and that you may have a perfectly valid reason for not liking Vets Now, but I find your continual negativity about a company I was very proud to work for quite sad, particularly given the irrelevance of your dislike to this particular topic.

And Jo, many thanks for all the time you have put in with your petition, and with your ongoing work with the various committees. It looks like a great result.

Re: Standards Committee's Recommendations on 24-7

Stephen Courtney — Fri, 06 Jun 2014 21:15:59 GMT

[quote user="Michael Woodhouse"]

[quote user="Thomas Johnson"]My reading of the new guidelines is that they don't change my responsibilities as a vet, so if I refuse to go on a visit that is 'necessary' I can still be brought before the DC.[/quote]

Yea - that's why I said (in the other thread) this 'new' guidance changes nothing.

Refusing a home visit where clinically necessary (without a good reason for refusal caveat) could still get you struck off. Whether you are a simple vet (such as myself) looking after your own patients OOH or in Vets Now's Ivory towers practising emergency and critical care on the vaguely unwell......

[/quote]

The only reason cutting edge ECC is practised on the vaguely unwell is because of moronic owners who are placing vets under unreasonable amounts of pressure - including knowing their rights and demanding visit because they happen to be full of chardonnay or gin and have got their knickers in a twist. If someone brings an animal to OOH as the clinician you do need to make sure the animal isn't hiding something serious - after all, surely the owner wouldn't be there at 1am unless they were seriously concerned....surely?

Everyone else gets cutting edge ECC because they need it.

Much the same could be said of routine vet work too - i am sure thatt 50% or possibly more of the cases i see every day would get better by themselves. hurry up and treat it before it gets better! I still have to charge for my work - and OOH cover costs more money to provide.

Re: Standards Committee's Recommendations on 24-7

Michael Woodhouse — Fri, 06 Jun 2014 20:38:37 GMT

Yea - that's why I said (in the other thread) this 'new' guidance changes nothing.

Re: Standards Committee's Recommendations on 24-7

Bob Russell — Fri, 06 Jun 2014 17:10:43 GMT

Petition to bring back the old guide?

It gave examples and was more useful IMO. As much of it evolved following DC case decisions it was a really good book to have on the shelf! Not sure if it is still available anywhere to download but less experienced vets (plus members of the DC!) could do far worse than spend an hour or so going through it!

Some is still there on the RCVS website as guidance notes!

Re: Standards Committee's Recommendations on 24-7

Evelyn Barbour-Hill — Fri, 06 Jun 2014 17:03:45 GMT

[quote user="Bob Russell"]We need to decide if we are a profession and therefore expected to make professional decisions, professionally! If ethics have deteriorated so far that a suffering animal is allowed to suffer more because a vet cannot be bothered to visit then it is not the profession I entered many years ago.[/quote]

I agree entirely.

Which is why a Guide to Professional Conduct is far superior to a prescriptive Code.

Re: Standards Committee's Recommendations on 24-7

Martin Atkinson — Fri, 06 Jun 2014 16:36:34 GMT

[quote user="Anthony Todd"]Come on, it was the basis of Chikosi, even if it was conveniently turned onto the delay.[/quote] At the risk of starting another Chikosi thread the DC considered a complaint the basis of which was the delay and the stupid bit about the blanket which they later rescinded but made their judgement because he cocked a snook at them by not attending and they were pissed off.

[quote user="Anthony Todd"]How on earth can a vet make a clinical judgement over the phone and therefore decide on clinical need?[/quote] Erm...given that even the nurses when making appointments do it several times every day and get it right 99.9% of the time, I'd say that unless you're very inexperienced - very easily.

Re: Standards Committee's Recommendations on 24-7

Anthony Todd — Fri, 06 Jun 2014 16:23:19 GMT

[quote user="Martin Atkinson"]Maybe I have interpreted this differently but when has the owner ever been in a position to make a clinical judgement? It has always been at the discretion of the vet as to whether the owner's judgement was correct. I don't believe anyone has ever been disciplined for refusing a house call just because the owner demanded it if was determined that there was no clinical need.[/quote]

Come on, it was the basis of Chikosi, even if it was conveniently turned onto the delay.

How on earth can a vet make a clinical judgement over the phone and therefore decide on clinical need?

The subsequent disquiet resulting in the recent "clarification etc." by the RC was solely due to the perceived belief that any refusal to visit any animal in any circumstance could result in the DC's involvement.

Re: Standards Committee's Recommendations on 24-7

Thomas Johnson — Fri, 06 Jun 2014 16:10:39 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Thomas Johnson"]I think it's a really good result, vets still have to visit if absolutely necessary,[/quote]

Yeah, but only if it's in their personal judgment that it's necessary (second clause). The vet that doesn't want to go can just say, "well, it wasn't necessary in my judgment". For which he might get strung up if it was necessary in DC judgment. So those who want their guidance very detailed and prescriptive are no further forward, still having to second-guess DC.

[/quote]

My reading of the new guidelines is that they don't change my responsibilities as a vet, so if I refuse to go on a visit that is 'necessary' I can still be brought before the DC. But hopefully they will give worried vets, particularly in out of hours clinics, the confidence to refuse visits that they don't consider necessary.

Re: Standards Committee's Recommendations on 24-7

Bob Russell — Fri, 06 Jun 2014 15:56:06 GMT

It puts the onus on the owner and makes it clear that it is expected that a pet will need to be transported to the surgery. I cannot see what more can be done.

We need to decide if we are a profession and therefore expected to make professional decisions, professionally! If ethics have deteriorated so far that a suffering animal is allowed to suffer more because a vet cannot be bothered to visit then it is not the profession I entered many years ago.

There are plenty of reasons why a vet may decide they cannot or should not visit but these changes should give younger vets the confidence to decide based on the available facts!

We will still have to second guess the DC as we have done for years but short of a full, detailed veterinary manual, including flow diagrams this is how it is (and should be IMO).

There have been many changes to the profession, many not for the better but at least we retain the right to make decisions for ourselves. I believe these changes supports our ability to decide on clinical grounds and reduce the pressure from bullying clients.

Re: Standards Committee's Recommendations on 24-7

Evelyn Barbour-Hill — Fri, 06 Jun 2014 15:31:26 GMT

[quote user="Thomas Johnson"]I think it's a really good result, vets still have to visit if absolutely necessary,[/quote]

Re: Standards Committee's Recommendations on 24-7

Thomas Johnson — Fri, 06 Jun 2014 14:39:56 GMT

I think it's a really good result, vets still have to visit if absolutely necessary, but it should make it much harder for owners to pressurise and blackmail vets into unnecessary visits.

Re: Standards Committee's Recommendations on 24-7

Bob Russell — Fri, 06 Jun 2014 13:00:11 GMT

Sensible and well thought out IMO. Not sure why Wynne is so concerned, it is still a requirement to visit in the rare cases they are absolutely necessary.

It looks like a great result. The vet still faces the DC where there is wilful disregard for an animals welfare, just as it should be!

Well done Jo and all those who campaigned and those on the Standards Committee!

A bit of a shame that Mr Stace feels it is appropriate to take a pop at the 'vocal few' who are 'not representative' but seem to dominate the various forums' (this weeks Q&A Vet Times). I suspect many of the vocal few are pretty representative of many!

(Not completely sure about Mr Wray as many of his posts go way above my head in their cleverness)