Emergency Referrals

Re: Emergency Referrals

Hannah Wynne Richards — Mon, 11 Jan 2010 11:33:05 GMT

I agree with Malcolm, that some referral centres provide inadequate emergency/overnight provision, and many Universities are over-dependant on inexperienced residents to provide a clinical service This is why, despite the distance I always try to persude owners to trek the lenghth of the M4 to Davies' in Herts They provide a proper 24 hour service, animals are seen by Specialists, and even though the owners have a long journey, at least there's no time wasted with them sitting for ages in the waiting room whilst I am phoning all over the place, and waiting for people to ring me back- you can easily waste an hour that way !!!!!!!!!!

Wynne

Re: Emergency Referrals

Hanna Bennett — Sun, 10 Jan 2010 20:34:17 GMT

surely it is illegal to differentiate on the basis of insurance or not? at the very least they need to be warned that they need to work on their phrasing!

Re: Emergency Referrals

Utlendigur — Sun, 10 Jan 2010 20:13:12 GMT

That was the phrasing used by the referral centre. I thought it was odd aswell but put it down to a slip of the tongue, perhaps they meant complex cases - or that I'd got hold of the wrong end of the stick injury ('scuse the pun ). Surely, the level of care should depend on the needs of the case not whether the owner or the insurance company is paying....

Re: Emergency Referrals

Laurence Webb — Sun, 10 Jan 2010 19:45:26 GMT

Yes, that was the 1st thing that struck me when I read the thread.

Re: Emergency Referrals

Hanna Bennett — Sun, 10 Jan 2010 18:40:47 GMT

[quote user="Utlendigur"] I tried them but they said insured cases were handled by a consultant and he was out of the country at the time[/quote]

interesting phrasing - not sure if this is yours or the referral centre's - do uninsured cases get treated differently?

Re: Emergency Referrals

Malcolm Ness — Sun, 10 Jan 2010 17:27:29 GMT

This is something that has caused me considerable hassle and concern over the years but from the other side of the fence.

We are a surgical referral practice currently with two Specialist surgeons (Eurpoean/RCVS) and one resident (Cert SAS and studying for ECVS Diploma). We will soon be joined by another who is currently a vet school surgery lecturer. Having grown from a single handed surgical referral service I write from first hand experience.

As long as we have advertised our willingness to do surgical referral work, we have had a specialist (European or RCVS diplomate or better) surgeon available or on call. Before that, I had a reciprocal arrangement with a similarly qualified friend in private referral practice such that we were able to provide adequately expert surgeons to deal with just the scenario that Gillian describes. There should indeed be an obligation to provide back up cover for when a referral clinician is away and I for one would like to see the heat turned right up on that obligation but it simply will not happen.

Two reasons: first, our legislator is in effect RCVS council which is dominated by unelected University people. The last thing theyare going to do is change a system which currently allows a university referral service to be staffed by a junior resident with no proper surgeon available until "after the holiday". Similarly, the universities will not tolerate anything that will force them to "come clean" about the real level of expertise behind some parts of their referral service. Several departments in most of the vet schools are very thin when it comes to clinical experience and expertise. You don't really belive that nice Professor XXX in his sixth decade is really making himself available 24/7 to help the intern/junior resident out if the get into difficulties do you?

The other problem is the plethora of certificate holders setting up single handed referral practices - this seems to be most common in surgery or itmight be that because of my own interest, that is what I know most about. Although some of these chaps are good, many suffer from what Prof Lane at Bristol famously referred to as an "excess of confidence over competence". RCVS appears to be reluctant to involve themselves with any kind of regulation or quality control with regard to these guys which might limit their "freedon to practice" suggesting instead that free market economics and the selectivity of referring vets is all that is needed. My experience suggests otherwise.

The GTPC makes clear the obligations on referral vets and I would encourage Gillian to take this up first with the practice that hasn't, apparently, made adequate provision for holiday cover, and also with RCVS if necessary. The GTPC also details the responsibility upon the referring vet to make sure that the vet to whom they are referring the case is of the right calibre - this probably doesn't happen often enough!

I don't know the specifics of this case but I would always encourage vets in primary care practice to contact prospective referral practices and get to know them and what they can do.

Malcolm N

Re: Emergency Referrals

Gillian Mostyn — Sun, 10 Jan 2010 13:39:36 GMT

I had a similar problem on a Saturday morning in early November - this time a cardiac case in a Newfoundland that really needed to be seen and receive intensive care over a weekend. Our local referral practices didn't have cardiology staff available. As luck would have it the vet on duty at Liverpool Uni happened to be the cardiologist, so he went there. If they hadn't been on duty we would have had the same problem there. I'd agree that there needs to be some sort of provision made.