Vet Surgeon News RCVS President

RE: Vet Surgeon News RCVS President

cairncross — Wed, 20 Jul 2022 06:50:27 GMT

Sorry , not judging the vet involved in eiher in terms of merit work ethic principles ethics in any way. Absolutely agree that both have their role .

It is what can be achieved in terms of time commitment per case .

RE: Vet Surgeon News RCVS President

Alistair Graham-Evans — Tue, 19 Jul 2022 21:21:43 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/30360/vet-surgeon-news-rcvs-president/238161#238161"]It shouldn't be rocket science to judge accordingly[/quote]

What judgement are you making?

They are very different practices and each have their role.

RE: Vet Surgeon News RCVS President

cairncross — Tue, 19 Jul 2022 14:34:55 GMT

I guess like the start of the thread the realisation that we only have 30k vets v 300k medics , we could also do with some realisation of the Financial realities which could be very regional .

We are getting 75 to 100 quid per utch spay ex vat. Hysterectomy in Human hospital quotes are 4 to 6 grand , how heck can we even aim to provide a similar service level of care. I am doctor dentist pharmacist paramedic midwife etc I can't be specialist at all

If someone only does ortho specialism and sees 3 to 7 cases per day at x thousand each they can't be compared to someone having to see 40 or 50 cases at 40 to 50 pounds each.

It shouldn't be rocket science to judge accordingly

RE: Vet Surgeon News RCVS President

Alistair Graham-Evans — Tue, 19 Jul 2022 10:46:38 GMT

I am confused.

Are some suggesting tiers of general practice so there are budget clinics that have minimal facilities - no imaging, in house lab work and very basic surgical procedures available? I still maintain that the fees need to be based on the costs of running the clinics and paying staff although if reduced equipment costs and 5-10 minute appointments the basic costs could be quite low although the costs of more bad debts would have to be factored in. If you don’t still have a business plan and set fees according to perceived ability to pay you will probably fail. For clients who want more then they would be referred or go to another grade GP or referral clinic. Nothing stopping anyone setting up a budget clinic,if you can find vets who wish to provide basic advice and euthanasia. Targeting the less well off with a budget clinic doesn’t mean you sacrifice quality of advice- you just can’t treat other than basic problems.
The grim lack of staff is only set to get worse so the public will have to get used to being unable to source vet services in future. Of course the consequence of this is that there will be more chronic cases that become urgent and some clients may realise the only way to be seen is to exaggerate the urgency so OOH services are stretched to breaking point. These OOH centres then close due to staff fatigue and the public then have no service in some areas and the RCVS still insist that 24/7 cover be provided except there is a vacuum that has been created. See any parallels here? ( NHS wait times ) As the trend continues then the rate of attrition of vets accelerates and we get polarisation of the profession so the wealthier have great service and the majority are neglected and animal welfare slumps.

Another spin off is that more graduates are shoved into consultation production lines and fail to learn how to develop skills that GP’s used to do at a reasonable price so only expensive referral clinics are able to supply more than very basic services.

If this sounds depressing I’m sorry but the trend has been progressing for more than a decade and is going to continue. My archaic approach is to try and have the best GP facilities, provide well paid staff with interesting work and potential to develop skills and cater for all tiers according to ability to pay.

RE: Vet Surgeon News RCVS President

cairncross — Tue, 19 Jul 2022 07:48:23 GMT

Late to see this post , neighbouring practise closed at weekend no longer has staff? So lots of fallout to deal with.anon Seems to be in very similar situation to me and the closed practise Certainly no financial issue here or with the closed practise , unprecedented demand too just no staff . Targeting your service to what locals can afford surely can't be a bad business deal , just our profession has been perverted by the imbalance in supply and the extreme of pressure 24 7 demands which has meant targeting the top 25% of wealth sensible.

It just seems utterly wrong , we have rules in our profession such as the 24 7 one specifically to ensure welfare for all yet its being used to ensure welfare only for the wealthy. Those trying to continue a community service are falling foul and falling off

RE: Vet Surgeon News RCVS President

Evelyn Barbour-Hill — Mon, 18 Jul 2022 16:17:46 GMT

[quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/30360/vet-surgeon-news-rcvs-president/238103#238103"]External advice again two sources one paid one free local authority source both found the restrictions/obligations of 24 7 care incredulous snd it took significant evidencing them that this was a true bill so to speak and both suggested challenging this legally as a potential solution.[/quote]

That just shows how ignorant they are, unless they misunderstood.

My simple suggestion for what it's worth: get yourself a telephone answering machine. Arrange things so that you can't hear it ring Put a very stern message on it. Let it give another number to cal (a mobile, perhaps) in case of genuine serious emergency. With a warning that there is a hefty extra charge for night work. Let it also offer the option to leave a message – that should satisfy/ fob off a lot of the silly calls and you don't have to check the messages until you feel like it. A lot of people are so used to 24-hour helplines and that sort of thing they will phone just to see if you answer but won't be upset by getting an answering machine.

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30360/vet-surgeon-news-rcvs-president/238104#238104"]the general public as a whole has demanded more and more for less and less.[/quote]

You can always say no.

[quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/30360/vet-surgeon-news-rcvs-president/238112#238112"] my stubborness to do veterinary as I wish I would look to enjoy these more and not do veterinary as I don't wish ,[/quote]

Good for you.

RE: Vet Surgeon News RCVS President

Alistair Graham-Evans — Mon, 18 Jul 2022 11:18:47 GMT

When I saw the original post it seemed like a cry for help from someone who was not getting the best advice. Working yourself to exhaustion and despairing of your client’s inability to access affordable help is not a recipe to providing a useful service and ensuring a happy future.

In my view running a profitable clinic and providing a caring service are not mutually exclusive! Profit is not a dirty word - it rewards our efforts and enables us to look after staff and provide decent facilities. I stand by my statement that setting fees based on perceived ability to pay is a road to clinic financial collapse which benefits nobody.
We should be able to offer the best, appropriate diagnostic and treatment services ( in clinic or by referral), but also provide suitable care for people with a restricted budget. It does not mean tiers of practice are required- it can be achieved as an adaptable approach in one clinic.
The key to this realistic approach in my view is to maintain the skill of clinical examination ( not remotely!), use of diagnostic aids when appropriate and good communication. That’s it.

We may treat one dog with bilateral cruciate disease with TTO surgeries and another by discussing pain relief using inexpensive medication ( we do not have a cascade system here) and euthanasia if the dog cannot be given a reasonable life. The owners are treated with the same compassion and respect.

I am proud of what we generally achieve as a profession. On the human medical field, there are those who can afford amazing treatment and those who have to wait, painfully and sometimes have a preventable death. It’s an imperfect world. I also cringe when I hear of a friend’s dog that went to an OOH clinic with ear irritation and was ridiculously over-serviced with a massive bill when a simple quick consult, ear drops and advice to see her regular vet in a few days would have sufficed.

PS Words I loathe include “gold standard “, dinovet and holistic.

RE: Vet Surgeon News RCVS President

Arlo Guthrie — Mon, 18 Jul 2022 10:22:50 GMT

Back from holiday, and how lovely to come straight to a thread which is the very epitome of what this forum should be: supportive, kind, helpful, informed, informative. Brilliant.

[quote userid="2675" url="~/001/nonclinical/f/life-in-practice-discussions/30360/vet-surgeon-news-rcvs-president/238131#238131"]We have now enforced the ‘have to drive a Mercedes rather than a Dacia’ and then when the owner who genuinely cannot afford shiny, gets told it’s their fault which frankly is disgusting.[/quote]

I'd go a bit further than that.

It's not just the owner's who genuinely cannot afford the Mercedes.

I think it's also the ones that just prefer to buy a Dacia (possibly because they have other priorities in life) who are made to feel bad too.

RE: Vet Surgeon News RCVS President

Jill Butterworth — Mon, 18 Jul 2022 09:21:17 GMT

Gosh, you are right, I think we have lost our way on so many levels. Maybe a stated 3 t tier system where expectations are managed is a way forward. It might mean clients need to be prepared to move practices more fluidly, depending on the condition and the level of care they wish for (if practices/ could actually accommodate this as so many have closed their books, and the RCVS could allow it). OOH clinic have disproved the myth that the clients records are needed, as it's rarely essential.

It will present some more challenges, but I have always felt it is terribly unfair that clients only find out they are signed up with an expensive practice when they have a sick pet and can't easily get another quote/opinion. And why is that so unreasonable, we expect this with a car problem, for example?

There probably is still a place for old school//aka dinovet rather than 'so called gold standard'.

Re travel to OOH, collaborating somehow with a local taxi firm/ charity so a cheap van could be available might work?

RE: Vet Surgeon News RCVS President

Richard Carter — Mon, 18 Jul 2022 08:13:49 GMT

The problem is we need two (or three) different models ranging from fully insured/ money no object down to basic care (catering for those that have discovered a state pension of less than £1000/ month really doesn’t even pay the heating anymore) that are accepted by leaders and the profession in general who don’t fall for the shiny and expensive = good clinical care trap. We have now enforced the ‘have to drive a Mercedes rather than a Dacia’ and then when the owner who genuinely cannot afford shiny, gets told it’s their fault which frankly is disgusting.

As usual the propaganda in the profession for some time has been more (investigation/treatment etc) is better, tighter rules, more inspections in the name of ‘public good’. So if you now strike off people who fall asleep after working 10-12 hours it scares the hell out of anyone who might have been prepared to run a small basic service.

Having people on here basically saying pack up because you care or the business speak of raise your prices, reduce your clients and throw the others to the wolves is a sad reflection of where a caring profession has ended up.

RE: Vet Surgeon News RCVS President

Alistair Graham-Evans — Sun, 17 Jul 2022 22:28:28 GMT

What bit do you disagree with Lucy?

RE: Vet Surgeon News RCVS President

An On MRCVS — Sat, 16 Jul 2022 19:13:49 GMT

Out of hours is approx 120 hours per week. Like the comparison figures the new president highlighted the disparity ratio is similar . 120h on call is not compensated by 6 or 8 h off per week.

Daytime help is not in short supply , that it is relatively easily sourced is not a solution but a stark reflection of the unfairness consequences on life of contributing to the obligation v not having to contribute.

I do have daytime help and get 2 afternoons per week off but am back at work before family get home from school or work to allow those providing my afternoon off to get back to their family .

RE: Vet Surgeon News RCVS President

Jill Butterworth — Sat, 16 Jul 2022 18:52:08 GMT

If you really enjoy OOH why not invest in a regular locum for say one day/half day/2 half days to give yourself some time off to compensate?

RE: Vet Surgeon News RCVS President

An On MRCVS — Sat, 16 Jul 2022 15:52:30 GMT

Gosh , thank you and everyone else for all the help and extensive suggestions , I didn't mean to inspire such work!

No 5 on your list was in place until recently and takeovers have removed the option which largely triggered me.

6 also in place

I was not aware of some of the other flexibilities and merit consideration .

I don't want rid of 24h work I particularly enjoy the achievement of dealing with genuine emergencies . Perhaps I hoped to inspire some debate on the reality of the numbers actually contributing, and what standards we can provide across the affordability need spectrum

Rid of the obligation ? I don't know but fairly spread, very much yes. The sole reason for its existence I presume is to ensure welfare , if its only available to a high wealth few ?

RE: Vet Surgeon News RCVS President

Beats — Sat, 16 Jul 2022 13:43:54 GMT

I get that the thrust of this is more directed towards highlighting the issue and encouraging something (removal of 24/7 obligation? making more vets contribute to 24/7 obligation? no longer require vets to respond to complaints made regarding OOH care unless they specify themselves as an "OOH centre" and assuming they have a standing offer to attend an OOH centre instead? other?) to be done about it., but given it's not clear what externally will change your circumstances in the immediate future it's always worth thinking outside the box. Here are some suggestions that you may already have considered and are not appropriate to your circumstances, but no harm hopefully in me typing them (please disregard if not helpful, as I am not trying to suggest i know better than you what is best for you!):

1) Find a vet to do the on-call on a casual, occasional basis to give you some break (I can think of someone to ask, but no promises they would wish to - private message me if you want contact number), taking what they earn that night or some other arrangement? It may seem unlikely, but you never know. I'm aware that the out-of-hours centres are struggling for vets themselves in spite of paying on occasions for last minute cover more than they might take in a night... Failing that, find someone to field the phonecalls after a certain time and only call you if they feel it is really necessary. Overnight, on a weeknight, there are very few things that cannot wait a few hours until the morning. My general rule is that if I would be happy with the receptionist booking that for the afternoon when the owner phoned in the morning during day-time, then I don't need to see it at 2am. I once worked in a 2-vet clinic with phones put through to my mobile every other night and was only called twice in the year i was there (after 10pm) - this was purely down to the local culture which was remote and not 24/7 and a situation would have to be pretty dramatic and exceptional before they would phone the vet in middle of night, but does show how much stuff can wait until the morning...

2) Put the phones through to an out-of-hours provider from a certain time, or with the caveat to them that if one of your clients phones and it sounds like they actually need to be seen then the OOH centre are to call you on a given phone number to see if you wish to see them (again, call filtering). If you pay an OOH centre and leave them clear instructions they will, most of the time, follow those instructions (with the added advantage that your obligation is fulfilled should you not be available for any reason). you could even have a code word only given to trusted clients, and without this the oOH centre is not to contact you.

3) Direct certain procedures to an OOH centre, i.e. caesarean sections by folks you don't know or wish to know. to an OOh centre, advising that you do not / no longer / that specific night do not have sufficient staff overnight to be safely performing the procedure. Obviously you do need an agreement with another vet to take these cases, but that might not be a big issue. There are some clinics signed up to vets now that don't generally use them, but have the option when they wish to. I'm not a practice owner and don't know how much that could cost to have that arrangement?

4) Agree with the local competitors that you will all put the phones through to an OOH provider from a certain date, or on week nights only, or some other thing which means that you are not competing on OOH service with each other while all benefitting from having to do less of it (or share an OOH rota).

5) join an OOH rota with other clinics not using the OOH centre, even if they are a distance away. The nights you are "on" you will be busier and travel further, but you will have some nights "off". That might not be better, but it might be.

6) Charge a registration fee for new clients, extra if registering during the night to co-incidentally be the same amount as the OOH centre thus making there no advantage to seeing you instead. Payable by card in advance over phone otherwise directed to OOH centre (but again you really need someone else answering the calls for this to work, otherwise they already have you).

For me, once the phone has gone then that is sleep ruined, so being able to turn the phones elsewhere at least on occasions would be my priority.

[quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/30360/vet-surgeon-news-rcvs-president/238112#238112"]I am reluctant to take on anyone to work some daytime hours as this just generates further night time obligation[/quote]

I'm not totally sure that is always the case.

I find that the more that is done (i.e. more vets working) in the first half of the day, the earlier i get finished up and home in the evening. Unless you are turning folks away, having someone else working for you (if you can find one... and they are good...) should not increase the OOH work you face. if you are turning folks away, or they are being put off with appt until tomorrow etc, then having someone else may actually decrease the chances of those contacts ending up being seen OOH if seen during the day?

Not saying that taking on someone is a good plan per se, just considering what implications may be (situation dependent).

RE: Vet Surgeon News RCVS President

An On MRCVS — Sat, 16 Jul 2022 11:12:54 GMT

Thank you I am fine or at least think I am ? , I will be very angry if I lose veterinary but I don't feel trapped . There are lots of things in life I am missing due to my stubborness to do veterinary as I wish I would look to enjoy these more and not do veterinary as I don't wish , if the circumstances continue to tighten.

I am reluctant to take on anyone to work some daytime hours as this just generates further night time obligation , I don't need the income from a few more daytime consults or procedures and am struggling to coe with the ooh commitment my own work creates never mind that of others.

I have a significant fear on a macro scale re this encouragement of daytime staff back into practise re the amount of ooh commitment it generates with no reflection or preparation for those still small numbers coping with it.

RE: Vet Surgeon News RCVS President

Alistair Graham-Evans — Sat, 16 Jul 2022 11:09:17 GMT

A one person clinic should not really have many of their own clients presenting as OOH emergencies so if you want to do your own then you have to do tough triage or get an answering service to sift the calls for you eg redirect calls from anyone who is not one of your clients.
Remember that you are the boss and the only person who can change things - you shouldn’t be worrying about how people are going to transport animals to you. Interesting that the external providers were incredulous which illustrates the ignorance of the public to the pressure you are under. Please remember that when setting fees they should be based on what the service costs to provide and that includes giving yourself a decent return and being able to employ sufficient staff to help you. Under no circumstances should you set fees based on clients perceived ability to pay as that will end in disaster.

Choose advice carefully - a local authority adviser providing a free service may have no idea of the harsh financial facts and rides soon also stresses for your circumstances. If your clinic is busy then there will be a solution for you to improve things but you cannot be all things to all people and if you don’t look after yourself then everyone will lose.

There will be things you can change for the better so you can enjoy the job and function more effectively. I am in Australia so can’t provide practical help but surely there are trustworthy practical people you can access to set you on the right track but if 2 sources have said sell and run it may involve radical rethinking of the way you work to suit the location and altering your own mindset.

I am trying to be kind here but may I gently suggest that sometimes we are the problem and maybe with the best intentions you are too considerate and a slave to your clients? I hope there may be someone in your part of the world on this site that can guide you or link you with someone to provide practical help.

RE: Vet Surgeon News RCVS President

Jill Butterworth — Sat, 16 Jul 2022 11:04:13 GMT

Please, please don't fry yourself. The only way I could run my single handed practice was to use an OOH clinic, I got a little burst of joy every time I flipped the answerphone switch, it was a very small price to pay for my sanity. I am assuming you are feeling near the edge to have posted on here. When you are overworked, getting depressed and unable to solve your problems, you can start to have disordered thinking as you unable to step back and make good decisions for yourself. Remember the oxygen mask analogy, if you don't take care of yourself you will be unable to function effectively as a vet anyway. We have lost a vet under these circumstances on the forum already and I have lost a friend like this too. Client transport is their problem, not yours, although it is kind of you to care, you will not lose all your clients. Call Vetlife if you need to, there are crisis locum teams available I believe, altho it is not widely publicised.

Keep posting. There is a wealth of experience on here to draw from.

One compromise I can suggest is to switch the phones over at say 10pm so you will still get the income from evening calls but get a good night's sleep. Another idea is you might find a vet who would do just a couple of hours consulting at a mutually convenient time to let you have some space. There are plenty of vetmums who want a few hours but practices aren't flexible enough for them. Painful as it is, I bet you need to increase your prices. I had a supernurse who looked after the practice for me til 10am, she could manage most things til then and we had an arrangement that if she couldn't cope she would text 'red', and I would come in asap. She hardly ever needed to do it so I got time off.

RE: Vet Surgeon News RCVS President

Bob Russell — Sat, 16 Jul 2022 09:45:52 GMT

It is generally uneconomic to employ enough vets for smaller practices to cope with 24/7 themselves. The shortage of vets is unhelpful also.

I would prefer to do our out of hours if we could share the load but it is not a viable option.

Look after yourself because much of the time nobody else will. I have great family and staff and we all support each other!

RE: Vet Surgeon News RCVS President

David Shepherd — Sat, 16 Jul 2022 09:22:05 GMT

You do not have an obligation to provide the 24h service yourself - merely to take steps to see that it is provided (eg refer to OOH service). The financial implications of this for the pet owners are not your responsibility any more than the responsibility of the taxi service (I'm sure they will not transport the pets without being paid - probably more than you are charging). I think it is admirable that the profession as a whole feels this obligation towards pets and pet owners, but it is becoming clear that as more practices and individual vets are unwilling or unable to contribute, this is starting to produce unbearable burdens for small practices who cannot or more likely do not wish to outsource the OOH work.

RE: Vet Surgeon News RCVS President

Bob Russell — Sat, 16 Jul 2022 09:18:09 GMT

I hate to say it but your main priority has to be to yourself. You are not here to take on the problems of your clients and it is genuinely not your responsibility to make sure they can get to an OOH's clinic.

If you had asked me 30 yrs ago, I would have said OOH's is part and parcel of the job. The world has moved on and the general public as a whole has demanded more and more for less and less. This has led to cherry picking and intense market forces that until recently was pushing prices ever lower.

Don't worry too much about an OOH's clinic being competition. The fees will pi+s people off enough for them to stay with you. It will also filter out some of the clients that think a booster at 11pm is a good idea.

I think you are overthinking this. Offer a good service during the day and people will stay. Fall apart from stress and it will help nobody!!

RE: Vet Surgeon News RCVS President

An On MRCVS — Sat, 16 Jul 2022 08:06:29 GMT

Thank you for your sensitive and sensiible reply.

I have sought and and still am receiving formal/professional advice . Internally within the profession 2 sources. The advice directs towards sell up and run , except you can't really run and I don't yet wish to leave.

External advice again two sources one paid one free local authority source both found the restrictions/obligations of 24 7 care incredulous snd it took significant evidencing them that this was a true bill so to speak and both suggested challenging this legally as a potential solution. It did not seem so potential to me to take Judicial reviews etc.

The local authority advisory clinic had some good data on affordability footfall etc and agreed that local population would not be able on the whole to use the intended ooh service and would turn to any remaining local supplier still similarly struggling to provide . This essentially a daily or rather nightly pattern we have seen, 2 clinics on or geographical boundaries have changed to use an ooh provider in the last month. We have several phonecards emails etc daily requesting to join in case of emergency .

Geographically the one ooh provider is in reach ooh for those with their own transport but at night post evening public transport or even taxi service is not available. We have an understanding with a local taxi service who were willing to transport pets here in and we could give out their contact . However now the lack of general night time demand , reduced numbers of drivers few are willing to be on call at night for lucrative work let alone transporting an ill messy animal.

Financially it is not in reach

RE: Vet Surgeon News RCVS President

Alistair Graham-Evans — Sat, 16 Jul 2022 06:32:35 GMT

Wondering why you have to pay the out of hours provider?

Also if you have one available you must use them if you are getting no respite. The fee of the provider may make you uncomfortable but it should not be your direct concern to the extent that you are on the point of folding. If the provider fee is a big impact then you need to increase your fees across the board.

I feel you need some external guidance to assist you through this crisis - please seek some managerial/ business guidance to help as often there are surprisingly simple changes that can alter your life for the better. It can be very stressful on your own - and it can be tricky seeing the wood for the trees.