Dishing out disciplinaries on social media

RE: Dishing out disciplinaries on social media

Arlo Guthrie — Fri, 12 Nov 2021 21:56:19 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233924#233924"]Perhaps he will expand on his reasons in here - I can't find his account handle Arlo Guthrie[/quote]

David Mills, it’s Neil Smith!

RE: Dishing out disciplinaries on social media

Clive Ansell — Fri, 12 Nov 2021 21:43:03 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233921#233921"]whilst they appear to have put in adequate cover from a nearby OOH provider for small animals [/quote]

It's 30 miles away, which is a fairly long journey in the event of a genuine emergency. It pretty much rules out an OOH home visit too, as it would take away a vet and nurse for 1 1/2 to 2 hours.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233921#233921"]I would agree with Michael Woodhouse that if everyone did their 'little bit' then things would be OK[/quote]

I'm not so sure it would.

How could one get everyone to do their bit? it would not be enforceable or possible.

Even if it were to happen, and folk did a few OOH shifts per month, it would take staff away from already overstretched and understaffed daytime practices. There simply are not enough boots on the ground.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233921#233921"] the market will find a solution.[/quote]

I'm not sure about that either.

At the moment most of the OOH care provision is in corporate hands, and it seems they all work against each other rather than together. They are likely to pursue what is financially lucrative and those unable to afford the ever increasing OOH fees will just be left to go hang.

RE: Dishing out disciplinaries on social media

David Mills — Fri, 12 Nov 2021 21:37:48 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233901#233901"]I have been unable to find the thread in question. Just looking left me close to loosing the will to live! Not a Facebook fan but I do occasionally put a toe in the water on vet voices.[/quote]

I suspect reason / a tap on the shoulder has meant sense has been seen and it has been taken down.

It was a quite remarkable misstep. Imagine one's employer posting something similar.

I suspect he was expecting a wave of support. Which would be funny were it not so worrying. The esteemed Col Smith was also involved in blanketgate/Chikosi I believe before sense prevailed.

What, unfortunately, it does show is the complete dissociation of those on Council from the mood of the profession and the difficulties being faced. We barely needed reminding of this, but there is was plastered all over social media. A lack of judgement. A high handed approach. Schoolmasterly. Ivory towered. The esteemed Col Smith has made a career out of committee, trustee and political work. How depressing that he is an esteemed steerer of Council.

Perhaps he will expand on his reasons in here - I can't find his account handle Arlo Guthrie

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233921#233921"]On the substance of the matter I am in broad agreement with the Colonel[/quote]

I don't disagree with his stance. It's a singularly crappy thing to do whilst everyone else struggles on.

But, and it's a huge but, it's the consistency of the critique that rankles with me. Th RCVS has been silent about the ludicrous situation in play currently where people are travelling huge distances and people can sit back and say 24h cover is a thing. The big players who have flooded council currently must be chuckling happily to themselves that they have got away this sleight of hand. As I say the only thing that will shake the establishment into action is a test case. The RCVS is on a sticky wicket.

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233921#233921"]Instead he has seen fit to make a lot of noise on social media, presumably so that the College appears to be doing something whilst simultaneously doing nothing.[/quote]

Indeed. It's an easy win for them, however it plays out. Pick on a small practice and turn the guns on them whilst sipping coffee at the MEG meetings nodding and agreeing.

As it currently stands I could open a clinic anywhere and take the whole of the UK's 24h provision, from Lands End to John O'Groats. There's nothing the RCVS could do. What a mess.

RE: Dishing out disciplinaries on social media

Francisco Gomez — Fri, 12 Nov 2021 19:47:22 GMT

Dissenting voice perhaps, but either the clientele or the corporate or both have decided that OOH is no longer making the animal comfortable until the practice or certificate holder is open the next day. Now, you need to do your work up at 9pm or 2am, whenever the client needs, and so doing your bit and sharing a night with your local practice by seeing a vet you don't know and still paying your OOH surcharge isn't near enough.

RE: Dishing out disciplinaries on social media

Alastair Welch — Fri, 12 Nov 2021 19:13:17 GMT

David,

Like you I am not a member of Vet Voices so I am reliant on what others have told me regarding this.

On the substance of the matter I am in broad agreement with the Colonel. Whilst it is well known that some veterinary practices do not appropriately fulfil their 24/7 obligations as far as I know Warren House are the first to openly advertise the fact that they are no-longer going to abide by the Code of Professional Conduct. Looking at their social media and website it appears that they have decided to stop doing any OOH in-house and whilst they appear to have put in adequate cover from a nearby OOH provider for small animals no such agreement is in place for their horse clients. It would appear that they are happy to continue doing horse work when the sun is up but when it is dark clients should open the Yellow Pages. Having done various on-call rotas (between 1 in 2 and 1 in 5) for the past 20+ years and having been regularly disturbed at night by clients of other practices (who for various excuses can't be raised) I can assure you that not doing your own OOH work (or appropriately out-sourcing it) is bad form. What is different in the case of Warren House is that the practice seem to be shirking their responsibilities in plain sight.

I am however in complete agreement that it is entirely inappropriate for the Colonel to raise the issue on social media. There is a well established process by which VS can be held to account and having sat on both the PIC and DC liaison committee the Colonel should be familiar with how the process works. Anyone can raise a concern about a VS and since there has been separation of the DC from Council there is nothing stopping the Colonel raising a concern in the ordinary way. Instead he has seen fit to make a lot of noise on social media, presumably so that the College appears to be doing something whilst simultaneously doing nothing.

I would agree with Michael Woodhouse that if everyone did their 'little bit' then things would be OK but for many (most?) the contribution to OOH care consists of pushing the button to switch the phones over. Unfortunately things have gone too far and I can't see a way out of this. The College should remove the requirement for 24/7 care in its entirety, the market will find a solution. It won't be perfect but its not as if the current situation is a good one.

RE: Dishing out disciplinaries on social media

Eamon McAllister — Fri, 12 Nov 2021 16:00:03 GMT

[quote userid="6406" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233892#233892"]does the RCVS provide 24/7 availability to its members when worries about the job keep them awake at night - just a thought[/quote]

I gave up ringing before 10.00am because on several occasions the person who I wanted to speak to hadn’t yet arrived at their desk.

RE: Dishing out disciplinaries on social media

Clive Ansell — Fri, 12 Nov 2021 11:02:48 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233906#233906"](Yes I know I'm in my nice rural bubble, but I've done anywhere from 1in 2 to 1 in 4 nights on duty for over 15 years now and not bitter or twisted. It's my professional obligation as a veterinary surgeon)[/quote]

That's just it, your situation is very different to the urban OOH clinic that is very busy, likely as not is understaffed (or even unstaffed at times). and could be providing cover for up to 30 practices. Add to that some branches are often unmanned at short notice, meaning cases are diverted elsewhere - that branch then could have a doubling of workload with no additional staff on hand. Also add to that, day time practices are not coping with workload and more cases towards the end of the day are pushed over to the already overstretched OOH provider.

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233906#233906"]I don't think we have any clients 35 miles away, but change that to 25 miles away and I'm on call now and would absolutely do it.[/quote]

Distance is one of the important points. In the current situation where OOH clinics are closed at short notice, sometimes only 2 or 3 hours notice, clients are diverted greater distances. I've spoken recently with clients that have driven 45-50 miles each way to access OOH care. In one case they left their pet for treatment and returned the next morning, totalling almost 200 miles!

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233906#233906"]I stand by the view that it's really not so bad if we all do our own little bit.[/quote]

Maybe that could be part of a solution? maybe every vet that takes daytime work, should be compelled to spend a percentage of that time providing OOH care too? whether it would be enforceable or enforced is doubtful though.

Someone pointed out on another thread, for every vet or practice working in the day, someone, somewhere is having to take the pressure OOH. A difficult circle to square.

RE: Dishing out disciplinaries on social media

Michael Woodhouse — Thu, 11 Nov 2021 20:57:34 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233904#233904"]Would they be able to accommodate a 3am home visit for a dyspnoic cat belonging to a housebound elderly owner, 35 miles away? [/quote]

I don't think we have any clients 35 miles away, but change that to 25 miles away and I'm on call now and would absolutely do it. Excluding cremation you'd probably squeeze it under the £200 mark. I'll even send them a bill.

I stand by the view that it's really not so bad if we all do our own little bit.

(Yes I know I'm in my nice rural bubble, but I've done anywhere from 1in 2 to 1 in 4 nights on duty for over 15 years now and not bitter or twisted. It's my professional obligation as a veterinary surgeon)

RE: Dishing out disciplinaries on social media

Julian Earl — Thu, 11 Nov 2021 20:54:22 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233903#233903"]a local independent OOH opened up. It worked really well, and off loading the 1 in 3 OOH rota was the best thing to ever happen. From the onset there was a voluntary back up rota of vets from all the user practices; so in the event of it getting very busy or the requirement for a home visit, it would all get done. [/quote]

Nicei theory but I am not sure it would work for mixed practices?Too much variation in the problems presented. Much more difficulty with distance I would expect? As well....,,

RE: Dishing out disciplinaries on social media

Clive Ansell — Thu, 11 Nov 2021 20:35:14 GMT

[quote userid="14700" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233900#233900"]I have pondered about suggesting that council members be available 24 hours ( on a rota basis obvs) so that we are able to check with them to ensure we're following the rules.....[/quote]

It may interesting to see what OOH provision is available, in practices that are allied in any way to council members. Would they be able to accommodate a 3am home visit for a dyspnoic cat belonging to a housebound elderly owner, 35 miles away?

RE: Dishing out disciplinaries on social media

Clive Ansell — Thu, 11 Nov 2021 20:05:24 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233895#233895"]I don't believe for a second that the move to outsource OOH has been a disaster. It has worked well here for the last 20 years but there have been staffing, 'pinging' and COVID/Brexit related problems recently.[/quote]

Agree 100%. I was still in my first job in 2001 when a local independent OOH opened up. It worked really well, and off loading the 1 in 3 OOH rota was the best thing to ever happen. From the onset there was a voluntary back up rota of vets from all the user practices; so in the event of it getting very busy or the requirement for a home visit, it would all get done.

I don't think there is any doubt, that this gave a higher standard of animal welfare, patient and client care, albeit it came at a price and clients would have to pay for it. No bad thing, as clients for years had enjoyed a cheap OOH service on the back of vets working ridiculous hours for peanuts.

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233895#233895"]The purchase of VetsNow by IVC is a concern because I am informed there is a history of boosting prices in practices just purchased.[/quote]

I think the mass corporatisation of the profession is part of the current problem.

I did a locum for Medivet late 2019 in a small one man practice. OOH their clients were directed to one of their own practices 45 miles away, despite there being 2 other OOH clinics much closer, one just 5 minutes away, owned by other corporates. Should they not be working together rather than against each other? A 45 mile journey is a long time with a patient in genuine distress.

RE: Dishing out disciplinaries on social media

Bob Russell — Thu, 11 Nov 2021 17:26:24 GMT

I have been unable to find the thread in question. Just looking left me close to loosing the will to live! Not a Facebook fan but I do occasionally put a toe in the water on vet voices.

RE: Dishing out disciplinaries on social media

rhmrcvs — Thu, 11 Nov 2021 17:07:00 GMT

I have pondered about suggesting that council members be available 24 hours ( on a rota basis obvs) so that we are able to check with them to ensure we're following the rules..... Do we think it will catch on?!

RE: Dishing out disciplinaries on social media

Evelyn Barbour-Hill — Thu, 11 Nov 2021 16:51:09 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233878#233878"]The Codes have (IMO) been crap waffle. The old guide gave people a feel for what would be accepted and what would not. It also gave specific advice on practice names etc which have gone out of the window with the likes of 'The Vet' which would have been totally unacceptable as it suggested it might be the only practice around.[/quote]

Exactly. You've got it. Dead right.

[quote userid="4294" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233890#233890"] lot more freedom for vets to turn down non-emergencies[/quote]

You do have that freedom. But it takes courage.

RE: Dishing out disciplinaries on social media

David Mills — Thu, 11 Nov 2021 11:42:23 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233895#233895"]Edit: The purchase of VetsNow by IVC is a concern because I am informed there is a history of boosting prices in practices just purchased.[/quote]

It's already happened since they took over I believe. Another issue is that several clinics have had to move out of host practices where these are owned by another corporate.

[quote userid="6353" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233870#233870"]By allowing such distant delegation (?derogation) of service the RCVS maintains the pretence of universal 24/7 provision, even when such service is either inaccessible or unaffordable. This is not a stance of which our Regulator should be proud, and I wait to see whether the ongoing OOH/Under Care review results in a Code of Conduct which is more honest with regard to the service the Public can expect from the Profession[/quote]

Yes it's a nod to PR, nothing else, in most cases.

We have, in London, seen clinics regularly closing/diverting across providers, meaning diversion to a service that is another 30-60 minutes away, and then relatively understaffed for the feeder practices using it - most OOH clinics work on 20-30 feeder practices which then would double if one clinic was closed. I dread to think what is happening across the rest of the country.

In this scenario, then, it seems even more bizarre that Col Smith decided to publicly take a practice to task when it was essentially doing what lots of practices has essentially done anyway. I suspect it would take some sort of judicial review to define what was an acceptable time/distance for someone to travel to an OOH centre - the current lip service to it is a sleight of hand, which conveniently lets the corp members who have flooded council nicely off the hook. I suspect a test case is on its way (unless to DC bury it) and hopefully the RCVS will be caught up in the melee.

RE: Dishing out disciplinaries on social media

Bob Russell — Thu, 11 Nov 2021 11:06:34 GMT

I don't believe for a second that the move to outsource OOH has been a disaster. It has worked well here for the last 20 years but there have been staffing, 'pinging' and COVID/Brexit related problems recently. We would require an extra body if we were to do our own OOH. This would make us more unaffordable!

You must have worked in a really nice practice or possess rose tinted specs if you believe small animal clients could be billed at the end of the month. I would guess over 90% of those would have remained unpaid for much longer or permanently!

Edit: The purchase of VetsNow by IVC is a concern because I am informed there is a history of boosting prices in practices just purchased.

RE: Dishing out disciplinaries on social media

ian bates — Thu, 11 Nov 2021 10:04:08 GMT

"From an animal welfare point of view the move to outsource OOH has been a disaster. "

....but from a workforce welfare point of view, it's probably the only practical option.

RE: Dishing out disciplinaries on social media

Minnie — Thu, 11 Nov 2021 01:02:20 GMT

does the RCVS provide 24/7 availability to its members when worries about the job keep them awake at night - just a thought

RE: Dishing out disciplinaries on social media

vs0u — Wed, 10 Nov 2021 21:31:51 GMT

The current arrangements are unaffordable for most pet owners anyway...add that to the distances (especially impossible for the large minority without a car, and no amount of prior planning can resolve that if you're in an area where everyone uses the same out of town OOH provider). I don't see the point of continuing to mandate 24/7 cover unless there are restrictions on cost and distance (clearly impossible as there aren't the staff to do it) so the RCVS may as well admit that 24/7 care is a luxury only for the pets of the rich, and let the practices decide whether to offer it. There would also need to be a lot more freedom for vets to turn down non-emergencies and non-registered clients, without fear of punishment, to keep it manageable for those who do want to keep offering this service to their clients.

In only about 15 years we've gone from a situation where in most towns and cities around the country, an owner with (say) a cat with a thrombus could call their vet out for an emergency PTS and pay a manageable bill at the end of the month, to the current situation where they are faced with a £500 call out fee (plus £200 for the PTS and disposal) payable immediately, or maybe an hour's journey each way to an unknown place with a cat in pain, paying a large bill plus maybe a taxi as well. Or the third option which is to just wait until the local vet opens again perhaps 12 hours or more later. Most of the people taking the third option won't even bother to phone the OOH centre as they know they can't afford it. From an animal welfare point of view the move to outsource OOH has been a disaster.

RE: Dishing out disciplinaries on social media

Julian Earl — Wed, 10 Nov 2021 12:16:23 GMT

Well-done Bob, The voice of reason!!

RE: Dishing out disciplinaries on social media

Bob Russell — Wed, 10 Nov 2021 10:01:00 GMT

It is about time everyone accepted that we have limited responsibility towards owners. If people chose to have pets they bear the responsibility.

We should be providing a service that is available within a reasonable distance to limit travel time as much as possible for welfare reasons.

The Codes have (IMO) been crap waffle. The old guide gave people a feel for what would be accepted and what would not. It also gave specific advice on practice names etc which have gone out of the window with the likes of 'The Vet' which would have been totally unacceptable as it suggested it might be the only practice around.

RE: Dishing out disciplinaries on social media

Chris Barker — Tue, 09 Nov 2021 19:43:44 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30058/dishing-out-disciplinaries-on-social-media/233871#233871"]I am unaware that there was ever a need to provide a 24hr service within the reach of those without transport nor those who may be housebound.[/quote]

That's one of the problems with only having access to the latest on-line version of the Code - all previous versions are history. The requirements for delegation of OOH service were originally far more prescriptive and the considerations required regarding clients with particular needs were spelt out in far more detail. The 'Animal Owners' Responsibilities' (Supporting Guidance Section 3) were only written into the Code following the post-Chikosi 24/7 consultation; prior to that reference to such responsibilities only appeared in a document well hidden in the depths of the RCVS website. The creation of this document was an initiative of the Standards Committee (then called the Advisory Committee), acting on a suggestion by yours truly, and was not approved of by then CEO Nick Stace who was extremely consumer-centric. How things have changed/moved on.

RE: Dishing out disciplinaries on social media

Bob Russell — Tue, 09 Nov 2021 17:33:04 GMT

I am unaware that there was ever a need to provide a 24hr service within the reach of those without transport nor those who may be housebound.

These would have been totally impractical for almost any practice and the abilities of the owners to travel and transport are not relevant to any practice. There have always been taxi's and neighbours.

There has always been a responsibility (possibly unwritten) to provide care near enough to minimise the welfare risks should a patient need to be transported. My rule of thumb is 30 minutes or so travel time is acceptable the further outside this, the less comfortable I am.

RE: Dishing out disciplinaries on social media

Chris Barker — Tue, 09 Nov 2021 16:07:24 GMT

And so it continues. RCVS Council will continue to maintain the demand that universal 24/7 be provided. The Regulator has no obligation to explain how this service is to be maintained by Practice in the face of the manpower shortages. And in order that the demand be seen to be 'maintained' the RCVS is prepared to turn a blind eye to the travelling distances required to assess such OOH services. There no longer seems be any enforcement of the requirement to provide a service within the reach of those without transport, or for those owners who may be housebound. Instead careful rewording of the Code allows the RCVS to rely on the argument that accessing care is entirely the owner's responsibility, and that travelling further to access a 'better' service is allowable.

Current Code of Conduct Supporting guidance

3.21 Owners are responsible for transporting their animals to a veterinary practice, including in emergency situations. The RCVS encourages owners to think about how they can do this and make plans before an emergency arises. Examples include their own transport, a family member, friend or neighbour’s transport, an animal ambulance or a taxi service that will transport animals.

3.33 Some models for providing and outsourcing 24-hour emergency cover mean that owners may be required to travel further than their usual practice to reach the service provider. Likewise, veterinary surgeons may need to travel further to visit clients than has previously been the case.

The only entries that seem limit the distance of delegation are

3.26 Information about the practice's 24-hour emergency cover provision should enable clients to make an informed decision about their animal’s veterinary care, particularly, where to go in an emergency. Special consideration should be given to clients registered as disabled who may have difficulty travelling, especially outside normal working hours.

3.33 .....Veterinary surgeons should seek to ensure that clients are expected to travel only reasonable distances and that their own response times are reasonable. What is considered reasonable will be influenced by local conditions.

By allowing such distant delegation (?derogation) of service the RCVS maintains the pretence of universal 24/7 provision, even when such service is either inaccessible or unaffordable. This is not a stance of which our Regulator should be proud, and I wait to see whether the ongoing OOH/Under Care review results in a Code of Conduct which is more honest with regard to the service the Public can expect from the Profession