Choosing a referral centre

Re: Choosing a referral centre

grumpyoldman — Thu, 11 Jun 2015 08:25:00 GMT

It depends on the area, London and the home counties maybe over 50% now , in North Staffordshire probably 10-15% of the total , and those that are insured have crap policies with limits of<1000 per condition 3000 in total , so they are essentially caping referral anyway without stubbing their toes the way RSA did. There is also geography ,some people do not drive more than 1 hour unless they are going on holiday , end of! . A lot of people like this dog will spend a bit of money on this dog but ultimately they are not that bothered and really just want a dog that works without a lot of hassle.

referral gives the top 20% of clients ( in terms of spending power) a (90%) chance of success ,but for the other 80% it is up to us to do the best we can and give them an 80% chance of success for 30% of the money . On the whole not a bad deal really , as long as it goes well . They can haunt you if it goes badly particularly if your a new grad. Its probably important for the owners/partners to watch carefully and try to stop those disheartening situations developing.

Re: Choosing a referral centre

J G Wray — Thu, 11 Jun 2015 07:17:50 GMT

[quote user="Gareth C."]Only about 15% of pets are insured. So 85% of pets or thereabouts have to be treated by a first opinion practice[/quote]

This oft quoted figure of 15% insured animals is an industry figure. The mistake in your thesis is that it is of all the animals in the UK, not all animals that are registered with vets or who engage with vets even every other year.

Damn statistics and facts.

Re: Choosing a referral centre

Evelyn Barbour-Hill — Thu, 11 Jun 2015 01:01:43 GMT

[quote user="Gareth C."]Only about 15% of pets are insured. So 85% of pets or thereabouts have to be treated by a first opinion practice / vet no matter what the problem is.[/quote]

Eh? I don't follow. Are they forbidden to go for referral if they are not insured?

[quote user="Gareth C."] It is therefore important not to allow first opinion practice to become deskilled or loose its ability to take on challenging cases. [/quote]

But that is true.

Re: Choosing a referral centre

Gareth C. — Wed, 10 Jun 2015 23:53:24 GMT

Only about 15% of pets are insured. So 85% of pets or thereabouts have to be treated by a first opinion practice / vet no matter what the problem is. Which referral centre to choose can be a hypothetical question in most cases. It is therefore important not to allow first opinion practice to become deskilled or loose its ability to take on challenging cases.

Re: Choosing a referral centre

grumpyoldman — Wed, 10 Jun 2015 19:12:56 GMT

[quote user="Gerry Henry"]

When I qualified the mantra was, if you can't refer and it needs doing, do it and if you fail better to have at least tried. Now it seems to be don't even try as the consequences of failure are too great.

[/quote]

The problem is that you can quote £ 1000 for a bilateral in house perineal hernia repair it will take 90 minutes or so you can chuck in an foc intra-operative castration and 90% of the time it will work well and be very successful, you will be a hero . Your local referral centre may be charging the insured and well healed clients 3500-4000 for the same surgery with some trimmings, its not that difficult. However to a scumbag or pikey £1000 is still a kings ransom ,he will have to steal and sell a lot of gear to make that and if it goes pear shaped you have robbed him ,it will get personal. He or his literate children/relatives can also click on complain ,they will move the goal posts into a no win no fee situation and with ADR they may well get it when some guru looks at it and says "Why wasnt this referred". So you do need to be very confident and have nerves of steel to venture outside the referral world if only blessed with the surgical experience of a new grad these days .

Re: Choosing a referral centre

Hannah Wynne Richards — Wed, 10 Jun 2015 18:45:37 GMT

I'm not claiming to be even approaching Eddie Straiton's work load - in fact I'm the first to admit to being the slow and sure type of surgeon. It's just that the number of operations per practice is meaningless without knowing how many veterinary surgeons are in the practice.

Wynne

Re: Choosing a referral centre

Anthony Todd — Wed, 10 Jun 2015 18:19:19 GMT

[quote user="Hannah Wynne Richards"]That's approximately the same as me doing a cat spay alternate days, a bitch spay or a dog castration once a week, and a cruciate every year and a half.[/quote]

Sorry to all those that I've p***sed off or disagreed with but you all must admit that the above is the put down of the month.

Refer to the legendary Eddie Straitton......

Re: Choosing a referral centre

grumpyoldman — Wed, 10 Jun 2015 17:28:22 GMT

TECA-LBOs regularly with 100% positive outcomes

Probably about 80% is more realistic ,the skill comes in managing the other 20% ,the ones that reappear with a retropharyngeal abcess where you need to re-open everything up and scrape it out ,trim a bit more bullae away and avoid pranging the facial nerve. The problem is that those will re appear 8-12 months later after the insurance renewal and with an exclusion so you will be doing it FOC or for not very much , By then the referral gurus have already put it on their successful outcome boxes. So if you can deal with the complications for FA you may as well do the original surgery and get paid well for it .

Re: Choosing a referral centre

Anthony Dennison — Wed, 10 Jun 2015 11:32:04 GMT

[quote user="Michael Woodhouse"]

[quote user="Hannah Wynne Richards"] I still don't know the total number of veterinary surgeons in the practice.[/quote]

19 pet vets listed on their website

[/quote]

Plus a part time vet, across 17 branches. Think we might be increasing to 20 within the next few months.

Re: Choosing a referral centre

Hannah Wynne Richards — Wed, 10 Jun 2015 11:29:15 GMT

Correction to above, I should have written my practice.

Wynne

Re: Choosing a referral centre

Hannah Wynne Richards — Wed, 10 Jun 2015 11:28:19 GMT

That's approximately the same as me doing a cat spay alternate days, a bitch spay or a dog castration once a week, and a cruciate every year and a half.

Wynne

Re: Choosing a referral centre

Michael Woodhouse — Wed, 10 Jun 2015 10:04:02 GMT

[quote user="Hannah Wynne Richards"] I still don't know the total number of veterinary surgeons in the practice.[/quote]

19 pet vets listed on their website

Re: Choosing a referral centre

Hannah Wynne Richards — Wed, 10 Jun 2015 09:55:42 GMT

I still don't know the total number of veterinary surgeons in the practice.

Wynne

Re: Choosing a referral centre

Anthony Todd — Wed, 10 Jun 2015 09:37:11 GMT

[quote user="Martin Atkinson"]I'd love to see the vet who does 10 cats spays and 4 bitch spays/dog castrates a day and finishes with a cruciate repair. Does he/she ever go home?[/quote]

MJV would, and consult too, mind you not too much " informed consent" in the consults, but the ops would all be perfect.

Quickest., most atraumatic and best surgeon I've ever seen.

Re: Choosing a referral centre

Anthony Dennison — Wed, 10 Jun 2015 08:55:19 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Dennison"]Our main hospital on average has 5-10 cat spays, up to 4 bitch spays/dog castrates a day. Less so with the internal fracture, possible one every couple of months, but at least one cruciate repair a month. Though it is the operating centre where about 10 branches feed into, so probably a bit skewed.[/quote]A lot skewed I'd say. Anthony and I were talking per vet not per practice or even per branch. I'd love to see the vet who does 10 cats spays and 4 bitch spays/dog castrates a day and finishes with a cruciate repair. Does he/she ever go home?

[/quote]

Well, she gets up an hour before she goes to bed before chewing on some gravel, then walks to work with no shoes on...

Shows you to always question numbers though doesn't it? In reality, on a busy day there all the vets present can be doing a lot, but then not every day is a mental day.

Re: Choosing a referral centre

Hannah Wynne Richards — Tue, 09 Jun 2015 16:56:41 GMT

That's why I wanted to know how many veterinary surgeons were in the practice.

Wynne

Re: Choosing a referral centre

Martin Atkinson — Tue, 09 Jun 2015 16:40:12 GMT

Re: Choosing a referral centre

Hannah Wynne Richards — Tue, 09 Jun 2015 16:08:06 GMT

There's also the fact that when things go wrong surgically, they usually do so faster and more irretrivably than with medical cases.

Wynne

Re: Choosing a referral centre

Bob Russell — Tue, 09 Jun 2015 15:59:42 GMT

Not sure I believe new graduates are afraid of the Royal College as much as just getting it wrong!

I remember early practice being quite worrying and I had plenty of support available. Pride and embarrassment tended to get in the way of using it that much as everyone around seemed so much more knowledgeable than I was.

Gossip suggests students might get some indoctrination about pitfalls and falling foul of the DC.

Re: Choosing a referral centre

Thomas Johnson — Tue, 09 Jun 2015 15:56:10 GMT

[quote user="Gerry Henry"]

[/quote]

Thinking back to my final year at university (12 years ago), we got a lot of experience managing complicated medical cases. We would see the client on our own first, take a history, examine the animal, present our findings to a clinician, who would then see the owner and animal to make sure we'd got all the right information. The animal would be admitted, we would decide what tests we thought should be done (bloods, ultrasound, xray, etc.), then discuss with the clinician who would either agree, or guide us into deciding on other tests. We would get the results back, and discuss with the clinician what to do next. We therefore started practice with a good idea of how to work up a medical case.

With surgical cases we started in a similar way, but when it came to the surgery we would scrub in to assist, and might be allowed to close the wound, but we got very little experience of tissue handling. We saw a lot of surgical cases, but got very little experience of doing surgery at vet school. Because they were referral surgeries they were beyond the competence of a lot of first opinion practitioners, so the culture was understandably one of "you need a lot of experience and training to do this". What I don't think we were taught, and should have been, is that once you have been in practice for a little while and improved your tissue handling skills doing straightforward surgeries, you should, ideally with some guidance from a more experienced practitioner, be able to carry out new, and more difficult, procedures.

I was fortunate that in my first job I was well supported and learnt how to carry out new procedures, and have continued to do so. But I have worked with vets who haven't been so fortunate, and have just had the fear of trying new surgeries reinforced.

Re: Choosing a referral centre

J G Wray — Tue, 09 Jun 2015 15:49:06 GMT

[quote user="Gerry Henry"]Except it isn't happening, new grads seem happy enough to dip more than a toe in to difficult medical cases but run a mile from anything remotely challenging that's surgical...They seem terrified of anything remotely challenging, so they don't do it, so it doesn't get done..[/quote]

There are those in our profession, the Toes In The Sand (geddit?) types, who have a fear of failure to start with, but they get over it.

[quote user="Gerry Henry"]Also they're terrified (and I mean terrified) of the College, pathetic really.[/quote]

Yeah, well RCVS knows no other way Bless'em.

[quote user="Gerry Henry"]Both my practices are on the doorstep of bad schemes (housing estates to you), it is a daily reality with us, nothing socialist about it.[/quote]

Faintly chippy.

[quote user="Gerry Henry"]I repeat, if this momentum continues first opinion veterinary practice will end up like our medical colleagues except there won't be a beneficent state to pay salaries.[/quote]

Eh?

If you want to stop a rot then why not get behind a move to enhance first opinion practice status and recognition of matery of their niche?

[quote user="Gerry Henry"]When I qualified the mantra was, if you can't refer and it needs doing, do it and if you fail better to have at least tried.[/quote]

Times move on

[quote user="Gerry Henry"]Now it seems to be don't even try as the consequences of failure are too great. [/quote]

Fear of failure hmmmmm that can be dealt with by objectifying the process rather than personalising it. Are you helping your junior colleagues to do this?

NIl desperandum, nemo te impune lacessit

Re: Choosing a referral centre

Gerry Henry — Tue, 09 Jun 2015 12:34:57 GMT

Except it isn't happening, new grads seem happy enough to dip more than a toe in to difficult medical cases but run a mile from anything remotely challenging that's surgical. Undoubtedly assiduous when it comes to attending CPD but do you ever listen to the comments/questions afterwards? They seem terrified of anything remotely challenging, so they don't do it, so it doesn't get done. Also they're terrified (and I mean terrified) of the College, pathetic really. Both my practices are on the doorstep of bad schemes (housing estates to you), it is a daily reality with us, nothing socialist about it. I repeat, if this momentum continues first opinion veterinary practice will end up like our medical colleagues except there won't be a beneficent state to pay salaries. When I qualified the mantra was, if you can't refer and it needs doing, do it and if you fail better to have at least tried. Now it seems to be don't even try as the consequences of failure are too great.

Re: Choosing a referral centre

J G Wray — Tue, 09 Jun 2015 12:00:16 GMT

[quote user="Gerry Henry"]I repeat, if you de-skill general practice.....[/quote]

I think the opposite is happening, that through conscientious self motivated CPD the GPVet is up skilling narrowing the asymmetry in knowledge and skills. If the award system implies a gulf is knowledge or skills then there is a fault in that system and it is a false assumption that absence of those awards means absence of knowledge or skills

[quote user="Gerry Henry"].... who will do the work for great uninsured masses, the working poor who can afford a reduced fee if they can pay it up, the utterly impoverished who haven't even got the nous to register with the PDSA, pensioners living on tight fixed budgets, who is going to do their cruciates, LWRs, TECAs, mammary strips, fracture repairs etc etc because I can tell you round here it won't be one of our (very good) referral centres. [/quote]

That's more like it - a bit of catastrophe mixed up with a faintly Socialist rhetoric to brighten the day, aaaaaaahhh.

The answer is an always was GPVets, once they get the recognition for their professional standing

Re: Choosing a referral centre

Hannah Wynne Richards — Tue, 09 Jun 2015 11:14:40 GMT

Total number of veterinary surgeons in practice?

Wynne

Re: Choosing a referral centre

Anthony Dennison — Tue, 09 Jun 2015 11:08:30 GMT

[quote user="Hannah Wynne Richards"]

Divided between how many veterinary surgeons?

Wynne

[/quote]

At the main hospital it can be anything from 2-4 vets, but at least one of them will be consulting all morning. At the other branches it's sole charge.