Practical solutions needed for 24/7 cover

Re: Practical solutions needed for 24/7 cover

Tracey Kernaghan — Thu, 26 Aug 2010 17:10:34 GMT

[quote user="Colin Cameron"]

[quote user="Tracey Kernaghan"]Monday morning after working almost constantly since the previous Thursday morning [/quote]

Did you get any time to eat or sleep at all during the 4 days or were you actually working " hands on" all the time ?

[/quote]

Like most people I carried 'emergency' food supplies and water in the car. I got home for some but not all meals but didn't spend very long there - just along enough to eat and restock the car with food and water. I did get a couple of hours sleep at some point during all of the nights but I don't remember getting more than about 4 hours per night maximum. The rest of the time I was working or driving to or from the surgery or on house visits. I lived 25mins from the surgery so each callout was a minimum of 50mins before I spent any time with the client. No, I couldn't afford to move closer on a vet's wages :)

Re: Practical solutions needed for 24/7 cover

Evelyn Barbour-Hill — Wed, 25 Aug 2010 16:24:00 GMT

[quote user="Bethan Cosgrove"]

[quote user="Evelyn Barbour-Hill"]Here's a thought which occurred to me. If the assistant is obliged to have a minimum eleven hour REST period, is the employer entitled, or even obliged, to ensure that the time is actually spent resting? What if it's spent surfing or fell running or mountain biking or driving to London and back to see the girlfriend? [/quote]

Is rest and space for the mind not just as important as physical rest? I would argue that fresh air and exercise is vital for health and wellbeing, even if this is carried out during the 11 hour 'rest' period.

[/quote]

I think you are confusing your day off with your rest period.

Other posters have written of how tired and ineffective they were after a too-prolonged busy spell on call; one even fell asleep driving to work on Monday morning. Your 11-hour statutory rest period is not going to make any difference to that hazard if you spend it surfing or fell-running or driving to London and back to see the girlfriend (or boyfriend), commendable activities though those may be.

However, my main point, which no-one really took up, was: if the employer is legally obliged to grant an 11-hour rest period, is the employer not also obliged, or at least entitled, to ensure that it is actually spent resting?

[quote user="Bethan Cosgrove"]Patients are given a full 'daytime' service at night.[/quote]

That's nice, but is it really vital? If the patient is comfortable and stable, can it not wait until regular working hours?

[quote user="Bethan Cosgrove"]I have worked in two small animal practices where patients were checked at 10pm by either the vet or nurse on call and if nothing was considered critical, left until 8am. How can this be considered superior for clients than a dedicated OOH provider? [/quote]

But it would not necessarily be inferior.

[quote user="Bethan Cosgrove"]The profession is changing for the better, clients should able to seek veterinary attention for their pets in the same way that the NHS provide us with A&E. You hope you'll never need it but the service should be there if you do. [/quote]

Well, that is not a change at all, not from the profession I entered anyway.

I think we do rather better than the NHS in our "A&E", whether we choose to contract out our OOH work or do it ourselves. No four-hour waits to be seen, no cobbling together of skin wounds after a quick wipe out with Savlon. All, right, yes, I know the NHS has difficulties that we don't....... But certainly if you are comfortable and stable you will be put in a bed and left till morning.

Re: Practical solutions needed for 24/7 cover

Colin Cameron — Wed, 25 Aug 2010 15:07:58 GMT

[quote user="Tracey Kernaghan"]Monday morning after working almost constantly since the previous Thursday morning [/quote]

Did you get any time to eat or sleep at all during the 4 days or were you actually working " hands on" all the time ?

Re: Practical solutions needed for 24/7 cover

Bethan Cosgrove — Wed, 25 Aug 2010 13:42:05 GMT

I have spent 5years previously working in first opinion 'daytime' practice, both large and small animal. All the practices i have worked for have done their own on call, under various different rota patterns. I now work for a dedicated OOH provider and I can safely say with first hand knowledge that the service that we provide in an OOH clinic is far superior to anything I have experienced previously, particularly when in most rota patterns, the OOH vet is due to work a full day again the next day. With a dedicated OOH provider, patients are not just stabilised as quickly as possible and left on a drip until the morning in order to try and grab just another couple of hours of sleep before another long day at work. Patients are given a full 'daytime' service at night. I realise there are some disadvantages from the clients' perspective but with effective communication their fears are quickly allayed and they value the service offered in a 24hr clinic.

I have worked in two small animal practices where patients were checked at 10pm by either the vet or nurse on call and if nothing was considered critical, left until 8am. How can this be considered superior for clients than a dedicated OOH provider?

The profession is changing for the better, clients should able to seek veterinary attention for their pets in the same way that the NHS provide us with A&E. You hope you'll never need it but the service should be there if you do.

Anybody who believes they perform at their best after missing a full night's sleep is kidding themselves. A good work-life balance is essential for health, happiness and personal wellbeing.

Re: Practical solutions needed for 24/7 cover

Utlendigur — Wed, 25 Aug 2010 13:23:08 GMT

[quote user="Tracey Kernaghan"]

and it wasn't the first time I had had to drive when I was really too tired to drive safely. It's not just our welfare versus our patients in the equation, but the general public as well.

[/quote]

Too true. Remember this? http://www.guardian.co.uk/uk/2002/jan/11/selby.railtravel . I wonder what would have happened if it was a sleep deprived vet on duty. Obviously the vet would be the one carrying the can, which is a bit of a rock and a hard place situation as we can't just stop being on-call midway through a weekend - but what would be the employer's liability? I seem to remember the RCVS on one of its roadshows being asked a similar question about driving when tired - the response was something along the lines of "ask a colleague to take over" - how? if they're all away - "or get the client to come to the surgery" (for LA work?, and you still have to drive to the surgery in most cases). Refuse to go out and you get struck off, drive tired and cause an accident and you get locked up, fined or lose your licence aswell as running the risk of killing someone.

Re: Practical solutions needed for 24/7 cover

Tracey Kernaghan — Wed, 25 Aug 2010 13:07:36 GMT

I worked in practices that did their own OOH for most of my career but now work in one that uses an OOH provider. The main reason for change was falling asleep driving to work on a Monday morning after working almost constantly since the previous Thursday morning (my weeknight on call being Thursday and thus running seamlessly into a weekend on call). Fortunately, I didn't hit the bus coming the opposite way down the country lane but it gave me a scare and it wasn't the first time I had had to drive when I was really too tired to drive safely. It's not just our welfare versus our patients in the equation, but the general public as well.

Re: Practical solutions needed for 24/7 cover

Phil Elkins — Wed, 25 Aug 2010 10:49:12 GMT

Yup! I'm full time, she works 2 days a week, both do a full vet's on call. Nursery takes James 2 days a week 8-6 and on the incredibly rare occassion we cannot tie our on call in properly, my parents come to Cornwall for a holiday!!

Re: Practical solutions needed for 24/7 cover

Utlendigur — Tue, 24 Aug 2010 17:59:08 GMT

I used to do a night oncall before a day off for a while - agree with the above. Almost invariably I'd get called out in the morning, and because everyone else was busy with morning surgeries, I'd be expected to/feel obliged to stay on - end result was working until mid morning or even lunchtime on most "days off".

Worst case was when I booked Mon-Fri off to do a series of running competitions in Cumbria, but was working the weekend. Friday night I had a dog in status epiletpticus and ended up sitting with it most of the night, Saturday night it started fitting again so sat up most of the night again, Sunday night I had a caesarian in the early hours. I drove up the M6 Monday am and made it to the start line of the race with 10 minutes to spare - decided to sit down in the sun - only to be shaken awake by the start official as everyone else disapeared into the distance....

Re: Practical solutions needed for 24/7 cover

Edward Jones — Tue, 24 Aug 2010 17:34:54 GMT

Only time I've been on call night before a day off was the transfer from a Sunday night to Bank Holiday Monday (and even then it was usually simply a swap of 1st and 2nd call). It's asking for trouble to be on call the night before catching a flight!

Re: Practical solutions needed for 24/7 cover

Wren — Tue, 24 Aug 2010 16:57:55 GMT

I agree with the points about not having a night on call before a day off. 3 examples come to mind:

1) Taking a Friday off work to go eventing. My regular night on call is a Thursday - I needed to have the horse loaded up and leave for the event by 6am of my day off. I returned from my night on call at 5am (a colleague had agreed to cover from 5.30am onwards) drove 3hours, competed all day and drove home again. All on zero sleep and, had I been a professional eventer rather than an amateur one, against the driving hours regulations.

2) Had a day off to attend a dressage clinic. Needed to leave home by 9.30am in order to get there. Was on call the night before until 8.30am. A colic came in at 8.20am, by the time I'd driven there, treated the horse and returned it was nearly 11am. Missed the clinic and lost the money that I'd paid for it, as well as half of my 'day off'.

3) Calving a cow at 5am the night (morning?) before leaving to go on holiday. Left for the flight an hour later than planned, caught it by the skin of our teeth. Don't suppose my boss would have refunded my holiday had we missed it!

Enough reasons for me to do whatever it takes NEVER to work the night before a day off.

Re: Practical solutions needed for 24/7 cover

Gillian Mostyn — Mon, 23 Aug 2010 23:38:16 GMT

[quote user="Phil Elkins"] I have 2 dogs, a baby on the way and a wife who will be going back to work part time soonish after having the baby as an equine vet. These are our decisions and we have to find a way to work with them. in all likelyhood that will mind finding child care that accepts that our finish times will be highly variable and at times care will be required beyond our proposed end of day. It also means finding practices that are flexible regarding on call rotas allowing at least 1 of us to not be on call every night. Neither of us would make the stance that if a sick animal comes in or a call for a sick animal happens towards the end of the day we would put it off so we finish on time.[/quote]

Just curious Phil - did you manage to fulfil all your requirements?

Re: Practical solutions needed for 24/7 cover

Colin Cameron — Mon, 23 Aug 2010 19:40:09 GMT

Just had another thought. In our 4 vet practice, assuming no locum employed, we would actually be 3 vets for 12 weeks ( holidays) and also to allow OOH vets holiday one vet would drop out the main rota and be the third OOH vet for a further 12 weeks so we would actually have to employ 7 vets to maintain a 3 man practice for 24 weeks of the year. Now thats what I call progress. I think not!

Re: Practical solutions needed for 24/7 cover

Gillian Mostyn — Thu, 05 Aug 2010 19:51:47 GMT

My concern with this rota would be holiday and illness cover - which for a 3 man practice will be at least 3 months every year. I wouldn't look forward to doing a 1:2 rota for 2 weeks, including late evening consultations every other day.

Re: Practical solutions needed for 24/7 cover

Colin Cameron — Thu, 05 Aug 2010 11:54:09 GMT

[quote user="Clive Ansell"]Total work including on call time is around 67 hours per week, still well in excess of the 48 hours set by the European time directive[/quote]

It depends to some extent whether you class hours on call, but not called out, as work. This is apparently the cause of much debate in the EC in the context of the EWTD. If it is called "hours worked" then as a 4 vet mixed practice we would have to employ 3 full time vets just to cover the 120 remaining hours in the week, as there are no options for OOH LA cover. Or we could, with agreement with our neighbours, jointly employ the 3 vets. Still a major expense which in my view is totally unnecessary. I don't suppose this thought has even entered their minds, Why can't they just leave us alone to get on with what we want to do when all in the practice accept the rota..

Re: Practical solutions needed for 24/7 cover

Julian Earl — Thu, 05 Aug 2010 10:37:35 GMT

This sounds like a good idea but it still demands extra staffing to a degree that will depend upon the size of the practice. So, extra staffing = extra salaries (unless people are accepting a disproportionate fall in salary) = higher charges = fall in client numbers (to some degree - no-one has convinced me otherwise yet) = some difficulty providing the extra salaries? There are a lot of variables in there such as the precise increase in fees, or reduction in vets' salaries, but there is still a circle that needs squaring.

Re: Practical solutions needed for 24/7 cover

Mark Holmes — Wed, 04 Aug 2010 15:35:38 GMT

It is a small animal practice but I can see it could apply to large animal work. It keeps the premises running for maybe 25% longer during the day and as the major capital investment that has got to increase its potential profitability. With regards to the working time directive, I am still a little unclear if "on call" or "being active on call " is the bit that matters, as the on call generated by a three vet practice is probably not that onerus, Particularly if you have had the bulk of the day off and the bulk of the following day.

It is as you say one night in three, but one week in three you are likely to be doing a 4 hour day, unless you consider sitting at home waiting for the phone to ring working. Now I would consider it working having worked 9-7 during the day but would be less likely to worry too much about it having just done 4-8pm.

Mark

Re: Practical solutions needed for 24/7 cover

Evelyn Barbour-Hill — Wed, 04 Aug 2010 15:20:47 GMT

[quote user="Mark Holmes"]

I appreciate this thread has been abandoned but a local practice to me has a solution to the on call problem, three vet rota, two vets work 9-4, one vet works 4-8 and on call. Everybody a winner, 9-4 is a short day for the day vets, 4-8 short day for the night vet and on call no longer a difficulty. the 4-8 slot allows extended opening times and is popular for consults. It also allows a certain competitive edge over other practices who close at 6/7 o'clock. Day vets are also more effective as a typical 9-7 day is a long slog

[/quote]

Not a bad plan at all. It must be a small-animal only practice though?

Re: Practical solutions needed for 24/7 cover

Clive Ansell — Wed, 04 Aug 2010 13:56:27 GMT

Looks a fairly good rota if you have to do you own OOH work. however, 1 in 3 nights and particularly 1 in 3 weekends on call is less than attractive. A dedicated ooh clinic still seems better though.

Total work including on call time is around 67 hours per week, still well in excess of the 48 hours set by the European time directive.

Re: Practical solutions needed for 24/7 cover

Mark Holmes — Wed, 04 Aug 2010 12:38:26 GMT

Re: Practical solutions needed for 24/7 cover

Gillian Mostyn — Thu, 09 Jul 2009 12:54:48 GMT

If I remember correctly, calculations already show that any practice with less than 5 vets would be unable to meet the WTD recommendations for hours worked.

Re: Practical solutions needed for 24/7 cover

Hanna Bennett — Thu, 09 Jul 2009 12:10:07 GMT

Curious to know how management would not have me operating and consulting the day after a bad night on call, do we then cancel the ops and appointments for the following day, or do we try and keep these quiet, just in case there is a busy night on call?

Surely that is self-defeating and a veterinary practice that employed such measures would quickly be out of business!

If there was enough staff to send me home after a bad night on call then there would be enough staff for me not to have to work the following day at all. But then that comes back to having sufficient staff but not then being able to make enough money to pay all those staff!!!

Re: Practical solutions needed for 24/7 cover

beldather — Wed, 08 Jul 2009 22:06:25 GMT

Something I never have really understood about the Uk has been its OOH system. As an associate in Aus I was payed 50% of any professional fee generated when On Call.It has taken quite a bit to get used to the concept of it being part of the 'package' and feel it is a big reason for the resentment that many associates have with OOH, I know that mine has definitely increased since moving here. While being properly compensated with either money or time does not completely remove the onerous nature of OOH it does drastically improve its palatability.

Regards

Blair

Re: Practical solutions needed for 24/7 cover

Gillian Mostyn — Wed, 08 Jul 2009 21:42:52 GMT

Some very interesting comments made by nurses on the subject - it is a shame they can't see this thread as their opinions, as they are also up all night, are very relevant. Have a look at the overtime/on-call thread on vetnurse.co.uk

http://www.vetnurse.co.uk/forums/t/3415.aspx

Re: Practical solutions needed for 24/7 cover

Gillian Mostyn — Wed, 08 Jul 2009 20:54:59 GMT

[quote user="Hannah Wynne Richards"]

That is why I pay my nurses well for OOH. That is one, but only one of the reasons they are on-side Obviously, it is not cheap for the owners, but competitive with the OOH provider

One for Arlo. I pay my nurses well over minimum wage, but read horror stories of nurses on or even below minimum wage. I also read of nurses moonlighting as bar-maids, cleaners etc in order to make ends meet. If some of these are working in practices which do not do their own OOH, would they prefer the chance to earn overtime in their proper jobs? Try it on the nurses forum, and see what response you get

Wynne

[/quote]

I posted the question on vetnurse - I was curious too as my nurses were all unanimously chuffed to not do on-call anymore. (Not that they aren't very dedicated - two happily stayed till 9pm with me last week to help with the caesar that came in at 6.30pm.) Anyway, the first answer was posted after 5 minutes and said what I suspected they would:

"What I didnt like was if you and vet were called out at silly o'clock, the nurse was still expected to be in work the next morning first thing but often the vets would not be in first thing or they would get to slope off home early. A small point but it used to irk me."

I hope employers aren't forgetting that the WTD applies equally to nurses...

Re: Practical solutions needed for 24/7 cover

Stephen Ashman — Wed, 08 Jul 2009 19:31:30 GMT

Sorry I forgot the quote:

[quote user="stephen sargent"]

[quote user="Hannah Wynne Richards"]I will only cover 1/2 a weeks livery (minus ) [/quote]

I think financial remuneration may play a big part in one's point of view. I did OOH as part of my job for 18years and never got paid anything for it, it was just part of the 'package' Now i get a better 'package' with no OOH. It's a no brainer.

If, Like Wynne, I had also earned a substantial amount for one call out, then my attitude may be somewhat different.

[/quote]

I very much agree.

The more you get called out: the less your rate of pay works out as, the more angry and disillusioned you become, and the more likely you are to try putting off seeing the next animal.

I also followed the 'no brainer' route.