24 hour clinics

Re: 24 hour clinics

listhestar — Thu, 09 Apr 2015 10:11:38 GMT

[quote user="Anthony Todd"]All I was hoping to do was to make others aware that sometimes a bit of common sense and expediency by telephonists has to be applied, rather than a slavish recitation of data requests before the patient is even on it's way.[/quote]

And I see your point....but was there a protocol in place that had been 'taught' to everyone and MUST be followed otherwise you end up in trouble. NHS is very protocol driven and I can see why but sometimes people get hung up so much in protocol for fear of not following it and getting in trouble.

I don't like the coporate takeover that seems to be occuring - maybe that will change. My place runs like chaos sometimes and yes it could be better organised but my bosses are caring and when I needed to take emergency time off for things they just clear the deck and told me to go then followed up with phone calls to see how 'father/mother/husband' etc was. If I can justify a treatment I am allowed it within reason, no-one questions my use of the labs I use as long as I have a reason and fairly charge for it and when I need new equipment it will arrive. I keep case control but can ask for advice from colleagues. What makes my practice work is the indepedance and a great team.

I love my job but work/life balance has to come into it - an early departure from this world is not for me and normal hours with emergenices and routine consults when there is 3 of us is bad enough - a c section needs all the staff you can get and then trying to fit in a vaccination. Will just put off more vets. About 33% of my friends have left general practice now at 9 years out and I am sure that will increase with time.

I have been rung more times that I can think from certain coporates at my place of work to poach me away and I have resisted. Even their recruitment seems pretty aggressive, my boss laughed at their 'balls' to ring up work!

Lisa

Re: 24 hour clinics

Phil Hyde — Wed, 18 Mar 2015 18:16:01 GMT

[quote user="Braden Collins"]

unless they can work out some magical formula for staffing these clinics with high quality, motivated vets it's not going to have a great impact on "normal" clinics and may in fact help bond clients to your clinic.

[/quote]

We have done so. We pay a lot and are very fussy. It works. It ain't easy, but it works.

Re: 24 hour clinics

Braden Collins — Wed, 18 Mar 2015 13:20:34 GMT

For our out of hours, we share with another clinic in town. Our vets work 4 days/week 8:30am-6pm, 2 in 7 Saturday mornings, and 1 in 12 on call plus 1 in 12 covering inpatients (when the other clinic is on call). Our nearest OOH provider is over an hour away so not really an option for us to farm it out, though the nearby clinic that is now doing 8am-8pm is sending their OOH work there.

Re: 24 hour clinics

Anthony Dennison — Wed, 18 Mar 2015 13:08:43 GMT

I do OOH, but slightly different. I am on the 2nd on call rota: back-up every other Tuesday, and 1 in 4 weekends: 1 will be back up Friday night and working Saturday day, the other is working saturday morning and back up Sat evening and Sunday. Supposed to have a 4 day week with this but because I am in my new branch trying to build it up and there is limited staff to cover, I've stuck with my 4.5 day week and get a little extra holiday.

The 1st on call rota in my practice is 1 in 12, again 1 weekend in 4. One weekend is on call Friday night, working Sat morning. One is working Saturday day and on call that night, and one is working Saturday day and on call Sunday. Half day the day after a weeknight on call, and at least one day off in lieu for working a weekend.

Big variation in workload: sometimes there are 10 inpatients to look after plus calls, other times there is nothing. for OOH providers, it is hard to find a balance between hiring enough staff suspecting busy times and paying them to sit around drinking tea, or putting on skeleton staff and hoping it's not manic.

Re: 24 hour clinics

Neil Wheadon — Wed, 18 Mar 2015 12:50:41 GMT

[quote user="Braden Collins"]but unless they can work out some magical formula for staffing these clinics with high quality, motivated vets [/quote]

A good nugget that one

The OOH vets I work with are good vets but are usually there for a reason and these are often transitory. Childcare, in between job, fancy a change, in my case a way of staying in practice whilst working for AHVLA and looking after the children, latterly chronically itchy feet/wheels. The churn rate is eye waterlingly high and I've lost count of the E mails asking for cover and an OOH cover simply has to be there every night, the member practices rely on this.

Neil

Re: 24 hour clinics

Gareth C. — Wed, 18 Mar 2015 12:27:25 GMT

thats a good question. i do a one in 4 rota and have a half day each week. the oohrs is quiet. contrast friends who do no oohrs but work till seven and every other saturday. i prefer my work pattern (but ask me at 3am or whenever I am called out and you'll get a differnt response!)[quote user="Neil Wheadon"]

[quote user="Wren"]Out of interest how many people on here do OOH in addition to normal work?[/quote]

I think the latest figure is 55% contract out their OOH work, but unsure if equine and Large animal was in the stat as will squew that one a bit.

Here's a question

Would you rather work

0830 - 1930 and use an OOH provider

0900 - 1800 and do a 1 in 5

I'd go for the latter

Neil

[/quote]

Re: 24 hour clinics

Braden Collins — Wed, 18 Mar 2015 12:23:37 GMT

Anectote alert.

Saw a dog on Monday that had been treated at the neighbouring practice (the one that is now open 8am-8pm 7 days/week) for dog bite wound to its face. Seen by their recent grad vet on Sunday who thought it looked like just a graze so gave it some AB's (no pain relief) and sent it home.

By Monday, the whole face was swollen and the puncture wound was over 2 inches deep and packed with hair. The owners admit they went to the other clinic because it was open when we were shut, but now will never step foot in that clinic again and are quite vocal about the poor job they did.

I think this will become a familiar story with 24 hour clinics. People may go to them at times other clinics aren't open, but unless they can work out some magical formula for staffing these clinics with high quality, motivated vets it's not going to have a great impact on "normal" clinics and may in fact help bond clients to your clinic.

Re: 24 hour clinics

Clive Ansell — Wed, 18 Mar 2015 12:22:45 GMT

[quote user="Michael Woodhouse"]

[quote user="Clive Ansell"]The overriding factor here against providing the best standard of care is the clients unwillingness to pay for it[/quote]

How many clients are unwilling, and how many unable to pay?

Whilst I agree that owning a pet is a privilege, not a right, should the little old pensioner have to cough up £800+ for a pyo op OOH or she's evil and cruel to her dog?

[/quote]

Difficult to know one from the other, but my feeling is more are unwilling than unable. I try not to pass judgement or assume what they can or cannot afford, but will advise what I think needs to be done and the client has to decide what they will/can or will/cannot pay for. If they can't/won't pay then I work back from that by offering cheaper alternatives or PTS. I have lost count of the cases in OOH clinics where they have no money, then all of a sudden find it when PTS is offered (one example I remember was a Bulldog breeder with no money needing C-section; when PTS was offered he produced £1000 in cash out of his pocket!)

I don't think I have ever had a pyo reach £800 (mine yesterday was just short of £500 inc 48 hours IVFT and drugs), but if OOH and including diagnostic and supportive care, then that sounds fair enough and reasonable.

Clients, pensioners or not, should have the means for paying for veterinary care if they choose to own a pet. That could be savings, insurance, credit card, phone a friend, loan shark, whatever - but it is their responsibility and not that of the veterinary profession. I had a bill last November for a car repair for £910, guess what, - I had to pay.

Re: 24 hour clinics

Neil Wheadon — Wed, 18 Mar 2015 12:16:09 GMT

[quote user="Wren"]Out of interest how many people on here do OOH in addition to normal work?[/quote]

I think the latest figure is 55% contract out their OOH work, but unsure if equine and Large animal was in the stat as will squew that one a bit.

Here's a question

Would you rather work

0830 - 1930 and use an OOH provider

0900 - 1800 and do a 1 in 5

I'd go for the latter

Neil

Re: 24 hour clinics

Clive Ansell — Wed, 18 Mar 2015 12:07:10 GMT

5 practices I regularly locum for use OOH providers; 2 use Vets-Now, 3 use Independent ones. I shy away from locums that include OOH, although happy to check on the odd inpatient kept overnight on occasions.

Re: 24 hour clinics

Hannah Wynne Richards — Wed, 18 Mar 2015 11:51:14 GMT

I do.

Wynne

Re: 24 hour clinics

Wren — Wed, 18 Mar 2015 11:47:49 GMT

I see a lot of references to 'the good/bad old days' when we used to do our own OOH as well as the day job. I thought most people still did!

Out of interest how many people on here do OOH in addition to normal work?

Re: 24 hour clinics

Neil Wheadon — Wed, 18 Mar 2015 10:42:11 GMT

Budget day, so leaving the rhetoric to the professionals

We are seeing an extension to opening hours. Many practices in response to others are opening longer and longer

My observations are

1) The hours worked are too long in some cases 0830 - 1930 leaves no time to do other things, sleep, eat , work. extensions in hours need imaginative staffing and i'm seeing shift patterns with fixed 9 hour days - great

2) So this leads to more part time working as practices take on more staff. more vets/more part time, it's a fit

3) Practices are extending opening times, but is this simply leading to a shift in when clients come. With doctors, I have to go during the day I have no choice. If they extend will afternoons be quieter?

4) I've seen a practice open and employ 4-6 vets very quickly. They haven't had that decreased effect on the neighbours. They almost pick up clients no-one has seen before.

5) Ultimately it's coming, but for Vets Now I fear for them. They see on average 4 cases a night inc PDSA which don't pay the big fees (See website, 100.000 cases seen, divide this by 53 clinics and 450 shifts) If they lose the 1900 - 2200 work there could be trouble ahead and for all the member practices that rely on them, so look after the company, their heart is in the right place

Neil

PS Agree or disagree with Anthony, he tries hard to explain and is polite in replies (AKA Grumpy old Man - not missed at all except his cringe making comments - he's saved that for the Veterinary Times and Stoke)

Re: 24 hour clinics

Hannah Wynne Richards — Wed, 18 Mar 2015 09:23:13 GMT

Gillian and AnOn. Yet another reason (to add to the environmental and taxation ones) why I'm very very glad I've never had children!

Wynne

Re: 24 hour clinics

Anthony Dennison — Wed, 18 Mar 2015 09:12:02 GMT

[quote user="Michael Woodhouse"]How many clients are unwilling, and how many unable to pay?[/quote]

I find most of the time if people refuse to pay it's because they're unwilling. If a pet needs a procedure doing, owners will find the money.

Re: 24 hour clinics

mariette asselbergs — Tue, 17 Mar 2015 22:32:33 GMT

"I'm happy with my OOH provider, and am very grateful they are there. If V4P want to start doing boosters at midnight then good luck to them. I think they'll struggle to staff the place, but it won't impact on most practices. Look at Tesco on a Tuesday afternoon and then at midnight.... Few people have changed their shopping habits." Gillian

I actually once did vaccinate a dog at 02.00 am.

We got a phone call from an elderly lady who stated that she was at a party and had too much to drink to drive but would come with a taxi because her dog needed seen to. What was wrong with the dog? Oh it was old and had various problems and definitely needed seen. She knew because she had been married to a vet in the past so she knew it all. When she arrived she left the dog in the taxi because she first wanted to see what we were like. She said both she and her dog had a vet phobie, and the dog was very aggressive to the vets, and she would murder the last vet she had visited with the dog because he had maltreated the dog when it growled at him. And actually the dog needed to be vaccinated and she would pay anything if we managed to do it without a fight with the dog. We gave the lady a cup of tea and changed out of our vet shrubsuits so we looked like civilians, She then brought in this old shy labrador bitch in, which we easily took from her into the consult room and vaccinated without any problem feeding it treats and talking to her. We had to borrrow the vaccine from the host practice because as OOH service we didn't have any. But the lady paid I think £200 , was exceedingly happy and relieved, and we had a laugh and a story to tell.....

I think it was a social emergency, and I didn't mind at all to deal with it. What i really really like about working nights is that you have often all the time in the world to deal with upset owners and pets, and that it doesn't matter what in their opinion is an emergency. In the "good old days of the past" when we had to assist people at night and then work the next day, I might have resented people calling me out to remove a tick or something, but not now, when I am paid to assist people at night and know I'll sleep the whole day.

Mariette

Re: 24 hour clinics

Utlendigur — Tue, 17 Mar 2015 22:02:24 GMT

[quote user="Clive Ansell"] In fact the major issue seems to be clients who will not attend despite being strongly advised too, usual because of costs.[/quote]

Totally agree - and they usually take it out on the staff - it's all our fault for charging for services. We use an OOH provider but are open for several hours on a Saturday, This Saturday we had a phone call exactly 3minutes before closing from someone we'd not seen for over 5years wanting a home visit to pts an old dog (ie something that has probably been brewing for a while). The nurse asked if I'd go (as technically we could have directed her to our OOH provider) - thinking we'd be doing her a favour I said yes and worked out a quote (significantly less than our OOH provider). That resulted in a storm of abuse, and when the cheaper alternative of bringing the dog down and us waiting for her was suggested, she continued shouting before slamming the phone down. On Sunday she phoned the OOH provider and requested a visit because the dog was "collapsed" - which they were going to do, but the owner again "declined" (hopefully more politely) due to costs. I've spent the weekend worrying about the dog but what can you do if an owner won't even pay for basic care other than getting the RSPCA involved (and the RCVS don't like that unless you have actual knowledge of the animal's condition)

Re: 24 hour clinics

Gillian Mostyn — Tue, 17 Mar 2015 21:30:01 GMT

[quote user="An On MRCVS"]Anon for obvious reasons! I developed piles when I was pregnant- quite common apparently. Not painful. Not even when they swelled to baboon like proportions following the actual delivery of my daughter....[/quote]

Lol..no need to be anonymous.... I was thinking the exact same thing. I've yet to meet someone who managed to get through childbirth without them. Joy. Uncomfortable, but not an emergency eh?

Re: 24 hour clinics

Gillian Mostyn — Tue, 17 Mar 2015 21:27:24 GMT

No Michael ...she just needed to save up £150 for the spay!

Re: 24 hour clinics

An On MRCVS — Tue, 17 Mar 2015 21:26:44 GMT

[quote user="Hannah Wynne Richards"]

Not really. If I ever do develop piles, I faithfully promise to give you a detailed daily clinical bulletin.

Wynne

[/quote] Anon for obvious reasons! I developed piles when I was pregnant- quite common apparently. Not painful. Not even when they swelled to baboon like proportions following the actual delivery of my daughter....

Re: 24 hour clinics

Michael Woodhouse — Tue, 17 Mar 2015 21:12:29 GMT

[quote user="Clive Ansell"]The overriding factor here against providing the best standard of care is the clients unwillingness to pay for it[/quote]

How many clients are unwilling, and how many unable to pay?

Whilst I agree that owning a pet is a privilege, not a right, should the little old pensioner have to cough up £800+ for a pyo op OOH or she's evil and cruel to her dog?

Re: 24 hour clinics

Robin Grimmer — Tue, 17 Mar 2015 20:12:23 GMT

[quote user="Clive Ansell"]

[quote user="Gillian Mostyn"]

For the record, we've used an OOH provider for 6 years and have NEVER had a client refused a consultation by them.

[/quote]

I think you are right. I work in many different practices and cannot recall a single instance of an OOH clinic refusing to see anyone, or not seeing someone that they should of done. In fact the major issue seems to be clients who will not attend despite being strongly advised too, usual because of costs. Similarly, when I used to work in OOH clinics I cannot recall ever actually refusing to see anyone

[/quote]

This is exactly my experience too. The difference is you and I have actually worked in ooh clinics.

Re: 24 hour clinics

Gillian Mostyn — Tue, 17 Mar 2015 19:41:31 GMT

[quote user="J G Wray"]Mmhtlw.[/quote]

OK... I give up...eh????

Re: 24 hour clinics

Hannah Wynne Richards — Tue, 17 Mar 2015 18:45:58 GMT

Fine You OFFERED the care.

Wynne

Re: 24 hour clinics

Clive Ansell — Tue, 17 Mar 2015 18:39:20 GMT

[quote user="Gillian Mostyn"]

For the record, we've used an OOH provider for 6 years and have NEVER had a client refused a consultation by them.

[/quote]

Had a case in point today: a Westie with a pyometra. they phoned OOH clinic Saturday afternoon (1215 on a Saturday syndrome) and the VN taking the call suspected a pyo from the SHORT history she took and strongly advised seeing the dog. Owners declined and rocked up with me last night dog very toxic. I placed on IVFT and advised transfer to OOH clinic for overnight monitoring, again declined on costs so dog kept overnight unattended (clients DMITO status so not capable of monitoring at home). Op today, dog fine. The overriding factor here against providing the best standard of care is the clients unwillingness to pay for it.