RCVS Candidate - Huw Stacey

RE: RCVS Candidate - Huw Stacey

grumpyoldman — Fri, 03 Mar 2017 22:55:12 GMT

Everytime I go to a CPD course, which is often,I meet JVPs who feel trapped in a web, A common grumble is that once you start to make 60k+ the empire comes in and finds another interesting clause to take more off you. They are not happy and feel trapped and on a hamster wheel.

They also get roped into endless marketing scams and deals which they feel devalues them and their status in the eyes of the public. Getting out is also a nightmare. This would appear to be a constant theme.

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Fri, 03 Mar 2017 21:51:29 GMT

[quote user="Bob Russell"]

Inexperienced/young vets seem to be shouldering an immense burden with limited experienced veterinary input. They are 'burning out' and leaving the profession within a few years.

Do you believe that the RCVS should be encouraging sustainable high quality practice that cares for itself as well as the general public?

[/quote]

This has been happening for a long time (forever?) - anecdotally I heard a lot of stories from vets who graduated around my time (2000 so pre-PDP, back when there was no expectation on practice owners to support them) of grads breaking down, burning out and dropping out of the profession. I'm sure many practices DID take care of their young vets (I know I was well looked after in my first role), but hopefully the bottom end of the spectrum is no longer quite so bad.

I can almost hear the "boo, hiss!" that will accompany this, but the corporate groups are recognising that the best way to have good vets in your business is to get them in early, take care of them and develop them. Take a look at the Grad programs of all the major groups for evidence of this.

RE: RCVS Candidate - Huw Stacey

Danny Chambers — Fri, 03 Mar 2017 20:39:31 GMT

[quote user="Utlendigur"]

[quote user="Huw Stacey"]- A code requirement for client informed consent to include reference to the evidence base underlying (or undermining) a treatment. [/quote]

And this is supposed to be done for every single treatment, for every condition?... The law of unintended consequences would kick in and vets could potentially find themselves at the mercy of the CTPC for failing to provide a reference for trying a shot of nsaid in a limping dog or similar.

[/quote]

No one would argue that that every single treatment we administer has a proven and extensive evidence base, indeed it is possible that almost half of the treatments provided by the NHS are of unknown efficacy (1). This does not mean that unproven conventional treatments can be compared to homeopathy or other equally outlandish schools of thought. At least there is normally logical clinical reasoning behind many of our mainstream treatments as opposed to homeopathic remedies, Reiki, and crystal healing which have no rational basis.

Members of the public put their trust in veterinary surgeons because they assume that their medical knowledge and training was gained during an accredited degree at an accredited university. They do not assume that they will be offered the veterinary surgeon's personal beliefs in therapies that have absolutely no basis in science.

(1) Clinical Evidence. How much do we know?http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

RE: RCVS Candidate - Huw Stacey

Rob Loxley — Fri, 03 Mar 2017 13:44:01 GMT

[quote user="Huw Stacey"]New JV practice openings provide business ownership opportunities to vets in a market where more traditional routes to partnership are being wiped out by corporate acquision of established practices[/quote]

So your solution to corporate ownership is corporate ownership? The J in JVP still takes a lot of the ownership away from the vet

RE: RCVS Candidate - Huw Stacey

Bob Russell — Fri, 03 Mar 2017 11:05:08 GMT

Thank you for replying!

I am not particularly having a dig at JVP or any other specific model but we are in a profession where salaries are dropping, working conditions especially for younger members of the profession are getting tougher and tougher.

Inexperienced/young vets seem to be shouldering an immense burden with limited experienced veterinary input. They are 'burning out' and leaving the profession within a few years.

We are drawing in vets from other countries because things are even worse there. It was rumoured that a full time post somewhere south of London was offering £19000 a year.

My belief is that the profession is on a collision course with disaster. Corporate chains having more value as a result of growth rate rather than profitability. The profession cannot keep expanding practice numbers indefinitely as some of the bean counters seem to believe.

Do you believe that the RCVS should be encouraging sustainable high quality practice that cares for itself as well as the general public?

(I am looking for a second vet albeit not very hard! My position is not based on owning a struggling practice!!!)

RE: RCVS Candidate - Huw Stacey

grumpyoldman — Thu, 02 Mar 2017 23:42:08 GMT

[quote user="Huw Stacey"]Necessary disclaimer:[/quote]

I am sure it was .

[quote user="Huw Stacey"] JVPs tend to be experienced clinicians (around 10 years post-graduation) so whether they count as "young" or not depends on where you are in your own career.[/quote]

Quite often a lot less than that often with ,a VN in toe who has also mortgaged themselves upto their eyeballs ?

[quote user="Huw Stacey"]the traditional veterinary model (put your animal in the car and drive across town for a short £30 appointment during normal working hours) isn't ideal for a lot of people.[/quote]

Should those people have a dog they clearly do not have the time to exercise properly either ?And are you also suggesting their dentists and doctors should also be available for consults at 8pm ?.

When was the last time you worked a Sunday/Late night in a pets at home store ?.

[quote user="Huw Stacey"]More diverse business models means more varied career options for vets in practice. For example, 'conventional' veterinary practice is notoriously incompatible with child-care arrangements. [/quote]

So its far better to put part time females on a treadmill hamster wheel for 3 days a week and make them run unlike hell because they have 4 days off to recover and hopefully notice their offspring are still breathing ?

[quote user="Huw Stacey"]If there is an expanding market for vets services then this will undoubtedly lead to wage inflation - something that few salaried vets will complain about.[/quote]

Or leading to more cheap new grads from Eastern Europe ?

[quote user="Huw Stacey"]Market forces will, ultimately, determine which business models in which locations will be successful and viable long-term.[/quote]

Thats great if your selling groceries or cars but its not fantastic if your in a group that only refers within its own limits and puts anything else in a body bag.

There is also the question of effectively using VN JVPs as cheap veterinarians particularly in stores on Sunday mornings without veterinary supervision, when they are getting a "cut' the temptation to overstep the mark is irresistable.

And no, I am not voting for you .

RE: RCVS Candidate - Huw Stacey

Nicola Cole — Thu, 02 Mar 2017 22:16:31 GMT

[quote user="Huw Stacey"]

[quote user="Nicola M"]

'telemedicine' as in the recent survey regarding remote/internet consultations etc? If that's what you're talking about then in general I think it's a terrible idea. It may benefit owners but certainly won't benefit the actual patients in most circumstances.

[/quote]

If it's a choice for the client between talking to an actual vet online or googling the French Bulldog Owners Forum or asking their facebook friends for advice, I think telemedicine is good for patients.

In my mind it is NOT a replacement for conventional practice, but makes initial expert advice accessible to animal owners in a cheap and convenient manner. The advice given may then convince them that the time and expense involved in visiting a 'bricks & mortar' veterinary practice is necessary.

[/quote]

They already have access to advice in a cheap and convenient manner-they can phone the practice and discuss their concerns for free!

RE: RCVS Candidate - Huw Stacey

Iain Richards — Thu, 02 Mar 2017 22:15:41 GMT

"The vast majority of these (>90%) have no element of misconduct, so for the RCVS to do its due diligence and investigate them wastes vast resources and ultimately results in a poor outcome for both vet and client."

Misconduct can only be determined by DC. Prior to that each complaint has to be investigated to see if there is a potential misconduct case to answer. It's due legal process. I feel the cases could be investigated quicker, but the actual process is laid down in law and can't be changed without changing the law and that isn't going to happen. I'm broadly in favour of the VCMS process though. It would be nicer if the website said it was paid for "by the profession" not "the RCVS"

"Is blame culture just a phrase that allows individuals to abrogate responsibility and shortcomings?

RE: RCVS Candidate - Huw Stacey

Evelyn Barbour-Hill — Thu, 02 Mar 2017 22:07:57 GMT

[quote user="Huw Stacey"](put your animal in the car and drive across town for a short £30 appointment during normal working hours) [/quote]

What about a long £30 appointment?

RE: RCVS Candidate - Huw Stacey

Iain Richards — Thu, 02 Mar 2017 22:00:47 GMT

"expert advice accessible to animal owners in a cheap and convenient manner."

Anyone notice something wrong with this sentence?

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 21:48:48 GMT

[quote user="Nicola M"]

[/quote]

RE: RCVS Candidate - Huw Stacey

Nicola Cole — Thu, 02 Mar 2017 21:43:33 GMT

[quote user="Huw Stacey"]

As vets our role is to provide clinical expertise to improve the welfare of animals under our care, and I think that anything that makes this more accessible (home visits, telemedicine, sunday/late night openings) is a benefit to clients and patients.

[/quote]

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 21:24:16 GMT

[quote user="Bob Russell"]

Do we really have room for an additional 40-50 new practices a year without damaging the profession as a whole?

A vast number of practices opening within a small area may appear to be good for client choice and reduced fees but is it sustainable and good for clinical standards?

Is this good for the profession, clients or patients?

[/quote]

This thread is about my RCVS candidacy as an individual veterinary surgeon rather than my employer. As such, I'll attempt to comment on the changing market in general. (Necessary disclaimer: All views within this post are personal and do not necessarily reflect those of my employer).

New JV practice openings provide business ownership opportunities to vets in a market where more traditional routes to partnership are being wiped out by corporate acquision of established practices. JVPs tend to be experienced clinicians (around 10 years post-graduation) so whether they count as "young" or not depends on where you are in your own career.

I think that diversification of service offering is of benefit to clients - the traditional veterinary model (put your animal in the car and drive across town for a short £30 appointment during normal working hours) isn't ideal for a lot of people. As vets our role is to provide clinical expertise to improve the welfare of animals under our care, and I think that anything that makes this more accessible (home visits, telemedicine, sunday/late night openings) is a benefit to clients and patients. I do however think that it's important that all business models are treated the same from a regulatory point of view eg. requirement for 24/7 provision for animals 'under their care'.

More diverse business models means more varied career options for vets in practice. For example, 'conventional' veterinary practice is notoriously incompatible with child-care arrangements. This might bring the benefit of less vets (and of course nurses) leaving the profession.

If there is an expanding market for vets services then this will undoubtedly lead to wage inflation - something that few salaried vets will complain about.

Market forces will, ultimately, determine which business models in which locations will be successful and viable long-term.

RE: RCVS Candidate - Huw Stacey

Anthony Todd — Thu, 02 Mar 2017 21:11:31 GMT

[quote user="Huw Stacey"]

Mountford & Webb (2009) When Clinicians Lead - it's a key concept of the NHS Leadership Academy.

(Please visit the site to view this file)

[/quote]

Done it, just more of the same, obvious, fluffy, obvious waffle that anyone could write about any service or organisation.

In fact I wouldn't be surprised if there is a template for sale somewhere where, for a fee, all you have to do is fill in your organisation or mission.

Here's an example for 10:

The ................. faces daunting challenges. Across developed countries, cost inflation continues unchecked; the average ........... household, for example, spends more on .................. than on mortgage repayments. Profound quality and safety problems persist—there are about ............avoidable .........a year in ............ alone. Many ................. face recruitment challenges despite large pay raises for ............, and an increasing number of .............. say they would advise young people against choosing careers in............ So further change is still needed, despite years of progress in the quality of ......................

Police anywhere?

Pilots anywhere?

Ambulance service anywhere?

Social services anywhere?

etc.?

RE: RCVS Candidate - Huw Stacey

Anthony Todd — Thu, 02 Mar 2017 21:05:14 GMT

[quote user="Huw Stacey"]This is how exactly how safety in aviation works.[/quote]

Of course it is, but the key thing is that there is meticulous relentless investigation, publication comment, and recommendation.

See C4 tonight [?] re hospital errors, "wrong arm" wrong patient etc. etc.

We must encourage this in veterinary practice.

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 21:03:04 GMT

[quote user="Iain Richards"]

Does a profession with approx 800 complaints from several million client interactions actually need any modification? [/quote]

Yes. RCVS is now getting c1,000 complaints per year. We are a profession of c25,000 vets (of whom a proportion are in non client-facing roles and have no realistic prospect of being complained about eg. academia/industry). The vast majority of these (>90%) have no element of misconduct, so for The RCVS to do its due diligence and investigate them wastes vast resources and ultimately results in a poor outcome for both vet and client. If successful, the VCMS will help to address this. Failure to do so will harm the credibility of the profession and lead clients towards legal action or simply rounding up a social media rent-a-mob and attacking the practice/vet in question.

[quote user="Iain Richards"]

Is blame culture just a phrase that allows individuals to abrogate responsibility and shortcomings? [/quote]

Absolutely not - it's the biggest obstacle to improving clinical standards, and can also have a serious detrimental effect on the welfare of vets and nurses.

[quote user="Iain Richards"] Can leadership ever exist in a disparate group of individuals with a high sense of their own worth? [/quote]

Well if medics can manage it sometimes, I'm sure that we can.

RE: RCVS Candidate - Huw Stacey

Anthony Todd — Thu, 02 Mar 2017 20:54:24 GMT

[quote user="Iain Richards"]Does a profession with approx 800 complaints from several million client interactions actually need any modification?[/quote]

Too right it does!

Probably an animal died!

Maybe someone did something bad!

Almost certainly things could have been done better!

Unless we know what, it may happen again!

There need be no blame, just awareness!

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 20:47:52 GMT

[quote user="J G Wray"]

There are numerous definitions and characteristics of leadership. Here are three:

Purpose

Vision

Clarity

Please could you articulate the purpose as you see it of your leadership, the vision you have for those you wish to lead and how clear this vision can be through RCVS or, to put it another way, the compelling case for following your leadership?

[/quote]

Hi Jonathan

I've been thinking a lot about how to answer your question (big questions require big answers) but after a lot of consideration I think it boils down to one thing:

My purpose of standing for Council is to make a positive contribution to the profession. This includes its welfare, its credibility and its long-term viability.

Written down this sounds like meaningless words, but I think all visions do when viewed in isolation.

I've expanded on a lot of my thoughts about what this means and how it might be achieved in this thread, and will continue to do so. If you have any specific questions or comments I will do my best to answer them.

RE: RCVS Candidate - Huw Stacey

Iain Richards — Thu, 02 Mar 2017 20:30:11 GMT

Does a profession with approx 800 complaints from several million client interactions actually need any modification?

Is blame culture just a phrase that allows individuals to abrogate responsibility and shortcomings?

Can leadership ever exist in a disparate group of individuals with a high sense of their own worth?

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 20:20:18 GMT

[quote user="Malcolm Ness"]

[quote user="Huw Stacey"]This is how exactly how safety in aviation works.[/quote]

I don't think it is.

[/quote]

Apologies in advance for referencing a wiki, but it is the quickest summary to hand of what I believe to be the case:

https://en.wikibooks.org/wiki/Professionalism/The_Aviation_Safety_Reporting_System#How_it_works

Without some form of protection clinicians won't want to report incidents, fearing repercussions. Another alternative is that reports are collated by a third party that is independent of The RCVS so any direct link to the regulatory arm of the college would be absent.

RE: RCVS Candidate - Huw Stacey

Evelyn Barbour-Hill — Thu, 02 Mar 2017 20:20:11 GMT

[quote user="Anthony Todd"]You've only got to read one line to realise that this is a sort of.... .no., on second thoughts, anyone who uses "highly visible" and "formal leadership" and "roles" in the opening sentence and follows it with the one of the longest uninterrupted paragraphs, except that which is describing a sexual encounter, hasn't really got anything of significance to say.....![/quote]

RE: RCVS Candidate - Huw Stacey

Anthony Todd — Thu, 02 Mar 2017 20:14:50 GMT

Many people associate clinical leadership with highly visible, formal leadership roles. These are certainly part of the equation, but our research suggests that there are at least three distinct types of clinical leaders (exhibit). The most obvious are the institutional leaders: sophisticated clinical leaders who often occupy formal, executive-level roles. They can communicate a powerful, clinically based vision and have deep, broad skills in both leadership and administration. These skills are both “hard,” such as strategic thinking and planning, and “soft,” such as negotiation and influence. A typical institutional leader might be a medical director who manages services across a multisite organization, earning the support of colleagues by demonstrating how change will improve quality of care. Service leaders are the second type: passionate advocates of their own units or teams, who are also aware of the context and requirements of the whole organization. They have detailed knowledge of the relevant clinical evidence base and constantly innovate to improve patient care. Service leaders are accountable for the overall performance of the service, both clinically and financially. Third, frontline leaders are great clinicians who focus squarely on the direct delivery of patient care but also see continuous improvement in the way the organization delivers care as their responsibility. If, for example, clinical records repeatedly go missing from consultations, or if patients frequently fail to show up for appointments, frontline leaders take ownership in solving the problem. To do so, they need some awareness of systems- and quality-improvement techniques and must know the basics of leadership, such as an awareness of their personal style and how to.....

You've only got to read one line to realise that this is a sort of.... .no., on second thoughts, anyone who uses "highly visible" and "formal leadership" and "roles" in the opening sentence and follows it with the one of the longest uninterrupted paragraphs, except that which is describing a sexual encounter, hasn't really got anything of significance to say.....!

Future suggests some branch of politics, me thinks.

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 20:09:45 GMT

[quote user="Malcolm Ness"]

However, as written you are likely to impact the use of, for example Nutraceuticals in Arthritis for which there is nought but anecdote or the majority of "therapeutic diets". Both of these are used by many, perhaps most "conventional" practitioners yet would fall foul of your proposal. Similarly, how are we going to evaluate the efficacy of surgical procedures? Are we going to ignore learning curve effects/ expertise effects/ co-morbidity effects or are we just going to exptrapolate straight from the literature?

[/quote]

Good point Malcolm.

In the past I did a tour of duty with a certain nutraceuticals company and I learned that the evidence for nutraceuticals is, at best, mixed.

I recognise that in reality many of the things that we do every day as part of "conventional" medicine actually don't have hard published evidence that they work. So much EBM/EBVM at all levels (eg. Nottingham's BestBets for Vets all the way up to Cochrane Reviews) shows there's weak evidence for efficacy or no evidence. So be it - we slide down the evidence pyramid and settle on 'case reports' or 'expert opinion' and the world keeps turning.

That's vastly different to treatment modalities where there are multiple high quality meta-analyses demonstrating no evidence of efficacy beyond placebo. There comes the point where we should stop saying that 'more studies are needed' and recognise that there have been enough studies and maybe we should make some choices with all the evidence for lack of efficacy.

For procedures that's a really interesting question - maybe one day studies or collated clinical records of surgical outcomes will show us what works and what doesn't?

RE: RCVS Candidate - Huw Stacey

Malcolm Ness — Thu, 02 Mar 2017 20:02:08 GMT

[quote user="Huw Stacey"]This is how exactly how safety in aviation works.[/quote]

I don't think it is.

In [some much publicised parts of] aviation there is an encouragement to report errors. Unlike our situation, there is no third party complainant or any loss (perceived or actual). In aviation where there is loss there are complaints and legal actions and no immunity. Look at what happened to Capt ?? Sullenberger - the guy that parked an airliner in the Hudson River - he was interrogated and at jeopardy for months before he was exonerrated.

RE: RCVS Candidate - Huw Stacey

Huw Stacey — Thu, 02 Mar 2017 19:59:01 GMT

[quote user="Anthony Todd"]P P P P Paragraphs help Perception and Persuasion......[/quote]

Sorry about that - it had paragraph breaks when I wrote it in the preview page!

[quote user="Anthony Todd"]And what "guru" devised "distributed leadership"[/quote]

Mountford & Webb (2009) When Clinicians Lead - it's a key concept of the NHS Leadership Academy.

www.vetsurgeon.org/.../when_5F00_clinicians_5F00_lead_5F00_2009.pdf