How Far is Too Far?

RE: How Far is Too Far?

Anthony Dennison — Fri, 16 Nov 2018 15:52:27 GMT

[quote user="Gillian Mostyn"]

[quote user="robloxley"]On call vets start at 4.30pm, finish about 10am the next day. [/quote]

Thats a long shift!! So obviously they'll be off to bed that day. So do they then get another day off too?

[/quote]

They are very rarely up all night - we have a bed that they use to sleep in. It's like an on call a lot of practices do after a day working (weeknights on call at my wife's practice have an 11am start, and then finish 1pm the next day - they also have an on call flat to sleep in) rather than dedicated night work.

We changed it to this system after consultation with all the FTE vets. They're happier with it overall.

[quote user="Phil Hyde"]One of my biggest problems when running an OOH service was the working time directive. How do you deal with that? Do you just ignore it and hope it will go away?[/quote]

Luckily I'm not high enough up to have to worry about that. I think the way it is worked around is that the vets aren't considered to be working all the time - there is a down time period where they're expected to be sleeping (but wont always be). However, don't quote me on that.

RE: How Far is Too Far?

Anthony Todd — Sun, 11 Nov 2018 13:20:25 GMT

[quote user="Clive Ansell"]Isn't it time that everyone put their heads together and amalgamated to one OOH centre with multiple vets?[/quote]

Tony Self at the RS had this idea in the early 70s. ALL of the vets in North London, and some in Central London, got together and shared the nights; one night a week ish I seem to rememeber.

Worked well; no poaching, and a good camaraderie quickly established.

Prior to that I used to do calls from N10 to as far as Royal Mint St [night watchman's foxie] 'cos there was noone else and another colleague was revered in Soho by a lady in a nightgown, so he claimed.

I think all, even today, will be surprised at the cooperation when you dangle "nights off with no phone" in front of your nearest "enemy".

RE: How Far is Too Far?

Chris Milligan — Sat, 10 Nov 2018 17:38:47 GMT

[quote user="Wren"]Surely that's too far to provide adequate emergency care? The practice has been focussing on emphasising the quality of OOH care provided, but as many clients are pointing out it's not much good to them if they either can't get there at all, or can't get there in time.[/quote]

I run an emergency hospital in british columbia - our clients can come from up to 6 hours drive away. We don't do house visits - there's dedicated vets for this purpose. The only rule for GPs is that they have to make arrangements to send it to an out of hours clinic so they typicaly shut their doors at 5 or 6pm and switch their phones over to us. I suppose it's great for your quality of life if you work in general practice - home every evening on the dot, no working holidays or weekends. Terrible if you're a dog with a GDV but even they can usually survive a bit of a journey - our experience is if they need more than a 2 hour drive they're probably not going to survive. Owners understand this as there isn't an alternative. But these are remote communities, not the urban sprawl of the UK of course where I think people would be a lot less forgiving about such things.

The reason for this setup is simple: there are nowhere near enough vets to provide coverage even during the day. The same is true in the UK and the college should stop pretending it can fulfil all the same out of hours provisions as the human health service. Switching to localised OOH providers is a solution to this and is working well in a lot of parts of the UK with the odd exception or individual gripe general practices have. You have to consider what is reasonable. With a few exceptions (refractory seizures, pneumothorax, respiratory emergencies, overwhelming bleeding etc) most things can travel a bit of a distance if they need to, and if they're receiving dedicated 24 hr care with a team that does this day in day out all the time then the extra distance is sometimes worth it over letting them languish in a kennel with a check every 8 hours from the OOH vet on duty.

RE: How Far is Too Far?

Clare Tapsfield-Wright — Sat, 10 Nov 2018 16:59:22 GMT

[quote user="Martin Atkinson"]

[quote user="Clare Tapsfield-Wright"]In 1978 my starting salary was £1500 a year ,[/quote]Sounds like someone took advantage of you big time Clare. My first job straight out of Uni in 1975 was a 6 week locum at £50 a week. After the first week when I saw what they were taking and they commented that it was more than the regular vet took I demanded £100 or I walked. They agreed. First full time job the same year was £5.5K/yr with similar hours to those you described only it was alternate Saturdays. OK it was London and there were a lot of jobs offering a lot less in the rest of the country but I set that as the minimum I would accept.

[/quote]I was just so glad to get a job , and I didn’t have a clue what salary to expect. Not many jobs around at that time , especially for a woman in mixed practice . I didnt have any time to spend any money anyway, and a car and a bedsit which was sited over the non refrigerated dead dog storage of the surgery was included.

RE: How Far is Too Far?

Gillian Mostyn — Sat, 10 Nov 2018 14:59:25 GMT

No, we were talking hourly rates and I said £14!

I dislike comparing yearly salaries. The hourly rate is the only way to compare wages. (At only £15 an hour, 2 hours a week makes a £1500 difference to your salary!)

RE: How Far is Too Far?

Clive Ansell — Sat, 10 Nov 2018 14:50:37 GMT

[quote user="Gillian Mostyn"]I'm not sure whether that is crikey good or crikey bad...but I didn't think £30k was too bad tbh. [/quote]

Bad. you said £14k, was that a typo?

RE: How Far is Too Far?

Martin Atkinson — Sat, 10 Nov 2018 14:49:44 GMT

RE: How Far is Too Far?

Gillian Mostyn — Sat, 10 Nov 2018 13:54:15 GMT

[quote user="Clive Ansell"]Crikey! when was that[/quote]

Last year. 4 days plus 1 in 3 Saturday mornings. Averages out about 41 hours per week.

I'm not sure whether that is crikey good or crikey bad...but I didn't think £30k was too bad tbh.

If I work out your starting ssalaryWITHOUT on call you got £11 per hour.

BUT, with on call, assuming 2 nights a week plus one weekend in 3, it drops to less than £6!!!

I know I worked for less than £5 an hour in my first job. Depressing.

RE: How Far is Too Far?

Clare Tapsfield-Wright — Sat, 10 Nov 2018 11:46:42 GMT

In 1978 my starting salary was £1500 a year , the hours were 9am until 8pm , plus one night on call a week plus one weekend in four plus every Saturday.

I had no social life at all and slept throughout most of the holidays when I usually contracted a really bad cold. It’s a wonder I’m not a complete basket case. NOT the good old days

RE: How Far is Too Far?

Clive Ansell — Sat, 10 Nov 2018 11:13:37 GMT

[quote user="Gillian Mostyn"]In my (corporate owned) practice our new grads started on £14.[/quote]

Crikey! when was that?

in 1996 I started on £26k; full time with a half day off every week, and every third week a full day off. 1 in 3 Saturday 0900-1200 and 1 in 3 on call for a year after which it became 1 in 13.

RE: How Far is Too Far?

bevs2251 — Fri, 09 Nov 2018 22:53:57 GMT

[quote user="Gillian Mostyn"]

There are better paid jobs out there in the UK. In my (corporate owned) practice our new grads started on £14. I graduated in 1999 and am on just a little more than you (32 hour week).

I'm pretty sure the ad is for an independent practice!

[/quote]

Saw a job advertised for $120,000 recently (very few ever advertised in 6 figure range !) including superannuation component of 9.5% >> UK66,500. Works out as $55/hour for 38-40 hour week UK30.50/hour. Would be for a very experienced vet that can also do orthopaedics. I'm on lower-mid end of level 4 (top level vet here - capable of taking over running/managing the practice, if necessary). I don't do orthopaedics but can still do caesarians, pyos, foreign bodies, splenectomies, if required. Most level 4 vet jobs here are around $90,000-$100,000 salary package 38-40 hour week (UK50,140) and includes superannuation, 4 weeks holiday, one week study leave (paid) + public holidays paid, if rostered on that day normally (at least 12 per year here in Oz ) so around $40-$45/hour (UK22.30-25.00).

RE: How Far is Too Far?

Clive Ansell — Fri, 09 Nov 2018 22:21:09 GMT

[quote user="Phil Hyde"]

[quote user="Anthony Dennison"]

On call vets start at 4.30pm, finish about 10am the next day.

[/quote]

One of my biggest problems when running an OOH service was the working time directive. How do you deal with that? Do you just ignore it and hope it will go away?

[/quote]

One of the independent OOH clinics I locumed for had 3 full time vets, and over a 3 week rota each would work 7 nights (1900 -0830) and 2 weekend days (0830 - 1900), and average over the 3 weeks of around 38 hours a week. Ticks the WTD easily.

What I don't know, is how does one tick the box for statutory rest breaks if as is usually the case there is only one vet on duty, given that the night shifts are 13.5 hours?

RE: How Far is Too Far?

Phil Hyde — Fri, 09 Nov 2018 12:31:19 GMT

[quote user="Anthony Dennison"]

On call vets start at 4.30pm, finish about 10am the next day.

[/quote]

One of my biggest problems when running an OOH service was the working time directive. How do you deal with that? Do you just ignore it and hope it will go away?

RE: How Far is Too Far?

Gillian Mostyn — Fri, 09 Nov 2018 07:41:16 GMT

[quote user="bevs2251"]Level 4 vet $36/hour (UK 20) but most paid more than this. I'm on $45/hour (permanent part-time so plus superannuation, holidays etc) - UK 25. [/quote]

There are better paid jobs out there in the UK. In my (corporate owned) practice our new grads started on £14. I graduated in 1999 and am on just a little more than you (32 hour week).

I'm pretty sure the ad is for an independent practice!

RE: How Far is Too Far?

bevs2251 — Fri, 09 Nov 2018 01:47:43 GMT

[quote user="vs0u "]47 hour week at £11 per hour?[/quote]

Minimum wage in Australia (checkout operators etc $18.93/hour or UK 10.50/hour). Minimal vet wage absolute new grad $25.50/hour (approx UK 14/hour). Level 4 vet $36/hour (UK 20) but most paid more than this. I'm on $45/hour (permanent part-time so plus superannuation, holidays etc) - UK 25.

Maybe post this ad somewhere so everyone can write in and "tell-em they're dreamin' " !! Need to offer at least double IMO

RE: How Far is Too Far?

janine redman — Thu, 08 Nov 2018 23:15:02 GMT

We have five part time and four full time vets so it ends up as a reasonable out of hours rota and we are starting by vets coming in later and working till 7.30pm . So it would be one late night per week with time of in lieu

RE: How Far is Too Far?

Gillian Mostyn — Thu, 08 Nov 2018 21:06:45 GMT

[quote user="robloxley"]On call vets start at 4.30pm, finish about 10am the next day. [/quote]

Thats a long shift!! So obviously they'll be off to bed that day. So do they then get another day off too?

I ask because a friend of mine was told she would have a day off in lieu after working all day immediately followed by doing a night on call (where she was working all night.) Then she was literally just given the following day off....which she obviously spent in bed. Hardly a day off! I compare it to being told you can have a night off after working all day!

RE: How Far is Too Far?

Rob Loxley — Thu, 08 Nov 2018 19:15:20 GMT

[quote user="Anthony Dennison"]

On call vets start at 4.30pm, finish about 10am the next day. Weekend work is split so no one is on call for a whole weekend (one shift will do 9-3pm Sat, on call Sunday) and everyone gets time off in lieu. Working week is 40 hours, extra hours worked on-call is given back as time in lieu. There is a senior vet (at least 3 years experience, most over 6 years) second on call to assist with any big operations or if it's really busy, or to do home visits if required. OOH home visits, we will often travel up to an hour away because we're the only OOH provider in the area that does them.

re: recruitment - we are fully staffed, the practices whose OOH we are doing are struggling to recuit

[/quote]

I think the fact that you seem to offer a good balance (of OOH and TOIL) with good support might explain why your recruitment and retention is better than other practices.

RE: How Far is Too Far?

Michael Woodhouse — Thu, 08 Nov 2018 19:06:00 GMT

[quote user="vs0u "]47 hour week at £11 per hour?[/quote]

No. I assume an hour for lunch and 4 hour Sat AM every other week so 42 hours a week, that's a 'normal' working week as I see it. That takes it up to £12.22/hour.

I agree it's not great but then there could be other aspects of a package that is on offer and not detailed.

RE: How Far is Too Far?

Clare Tapsfield-Wright — Thu, 08 Nov 2018 17:52:44 GMT

[quote user="Julie Innes"]

We are about 25 mins from our OOH provider, but for some clients who travel to come to us that will either be shorter or longer!

I am ok with that. If I look at all the recent reports from my OOH service I see very few things that 1. were actual emergencies or 2. needed seen immediately

Kennel cough (already diagnosed), dog bites, pulled dew claws, funny noise from tummy, enlarged prostate, lumps. One dog was seizuring, but even then they didn't want to transport it, just seeking advice. I'm trying to think of a situation (and I'm sure someone will!!) where an animal that will die within 25 minutes can be saved within that time

[/quote] In 36 years the only animals that I think I genuinely saved the lives of , in acute emergency, within minutes was a cyanotic GSD with a ball stuck in its throat and a Springer spaniel that had fallen through the ice on the canal, and was apparently lifeless on presentation but recovered in a tepid bath.

Last week at dog training a man told me he had been on a walk with a friend and his dog and it has suffocated with a tennis ball occluding the airway. So sad , they were probably trying to get it out but pushing it further down , in any case I don’t think it would have made it even with a vet close by.

That golden hour is well known in human medicine , maybe that holds true in many cases for our patients. Some cases are just destined to die unless they are extremely lucky to have trained help close at hand.

RE: How Far is Too Far?

Anthony Dennison — Thu, 08 Nov 2018 15:31:15 GMT

We do our own OOH, and cover a large area (furthest branches away approx 45-60min). I would say 95% of clients don't have any issue and will travel, and the 5% that do have an issue go elsewhere, then come back to us as they weren't happy with the care provided.

We do all the OOH for the local IVC practices as well now. There has been a bit of an increase in the amount of OOH work done, but not much more than the natural progression we have seen over the last 3 years or so.

re: recruitment - we are fully staffed, the practices whose OOH we are doing are struggling to recuit.

RE: How Far is Too Far?

Clive Ansell — Wed, 07 Nov 2018 18:59:49 GMT

[quote user="vs0u "]

[quote user="Evelyn Barbour-Hill"]

[quote user="Gillian Mostyn"] I made a comment that our RVNs get paid a better hourly rate and wouldn't be expected to work such an awful rota...[/quote]

What's so awful about the rota?

[/quote]

47 hour week at £11 per hour?

[/quote]

Shelf stackers and checkout operatives at Aldi are on £10.41, so £11 seems a fortune to me. Be a long time before one buys that yacht and holiday home though!

RE: How Far is Too Far?

vs0u — Wed, 07 Nov 2018 16:12:34 GMT

[quote user="Oliver Morrison"]I think there is massive benefit to doing your own OOH's in terms of case continuity and working your own cases up rather than transferring to the care of another vet[/quote]

Agree with this, but it's not a massive deal if clients have to go to an OOH provider either - there are pro's and cons to each. Clients do get used to having to travel a bit. The worst is when they are completely unprepared and are having a panic in the middle of the night. But after a few years word seems to get round.

If the practice can't get vets and has to close then obviously it will be worse for clients than for on the odd rare occasion to have to go to the OOH.

RE: How Far is Too Far?

Gillian Mostyn — Wed, 07 Nov 2018 16:06:19 GMT

[quote user="Evelyn Barbour-Hill"]What's so awful about the rota?[/quote]

Each to their own, but I wouldn't be prepared to work till 6 or 7pm every weeknight (40hours per week) plus every other weekend.

RE: How Far is Too Far?

vs0u — Wed, 07 Nov 2018 16:06:16 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Gillian Mostyn"] I made a comment that our RVNs get paid a better hourly rate and wouldn't be expected to work such an awful rota...[/quote]

What's so awful about the rota?

[/quote]

47 hour week at £11 per hour?