OOH cover and other practices

Re: OOH cover and other practices

Vikki Halliday LLB — Sat, 27 Mar 2010 00:03:28 GMT

And as I've now reached the 200 post mark, ARLO, I await my bottle of champagne...............

Re: OOH cover and other practices

Vikki Halliday LLB — Sat, 27 Mar 2010 00:02:23 GMT

Is anyone prepared to hazard a view on what is an acceptable distance / time to travel OOH?

I am facing this quandary myself as looking to establish a new practice in a semi-rural commuter area. The local Veterinary Hospital ( to whom I would like to pass on all ortho referrals), have declined to provide OOH cover on a contract for us, however we are aware they already provide for other local practices.

I'm not sure therefore if they feel genuinely overworked with the potential extra caseload, or are suspicious of any potential competition.

Our other option is a dedicated OOH provider but 27 miles on good road links, with a normal OOH journey time of about 30 mins.

I cannot physically commit to carrying out all of the on-call myself, but am prepared to rota share if complete contracted OOH is not an option.

Any suggestions?

Re: OOH cover and other practices

Rachel Tucker — Mon, 22 Mar 2010 21:55:31 GMT

[quote user="Hannah Wynne Richards"]It's illegal to put surcharges on, but perfectly legal to have a basic fee which exceeds that of the OOH provider, and then DISCOUNT for your own clients.[/quote]

The practice I work at discounts for regular clients. We are one of few practices in the area that run our own OOH cover, but I don't find too many people unwilling to travel there once I explain they should use their own vets service provider. I'm just as much a strange vet as the one at the clinic thats open.

I have seen some people who insist on being seen by me as their pet is "bleeding to death in front of them and will never make it there in time" to find they only have a small graze somewhere or other, so they can get out of the journey. Humph

Re: OOH cover and other practices

Hanna Bennett — Mon, 22 Mar 2010 20:00:42 GMT

[quote user="Catherine Williams"]

We've debated this versus the unregistered emergency surcharge for the out of hours non-clients. At the moment we're trialling the surcharge while we assess how big a problem this is going to become. Can we insist on them changing vets? Getting continuity of care with 1 practice can sometimes be a problem. There do seem to be a number of people around here who come to us when the dog is sick, we question the missed vaccine to be told they've gone somewhere else for that. It seems to be difficult to persuade these clients that they should let us know if they've been elsewhere, seems quite frequently the vets do not - never sure if this is the vets at fault or the clients not being honest with the vets!

[/quote]

We worry that the very least we have to do is inform the other vet we have seen their client as soon as possible. However in this area we also worry about clients being registered at more than one vets and running up debts at more than one vets. If their reason for coming to us is because we are open at convenient times then they need to transfer properly. However the problem is always that some folk lie and claim not to be registered anywhere, but as long as we try!

Re: OOH cover and other practices

Catherine Williams — Mon, 22 Mar 2010 14:51:57 GMT

[quote user="Hanna Bennett"]We are in the same boat - open on a Sat afternoon while everyone else shuts at lunchtime (and no other local practices do routine appts on a Saturday either which amazes me - we see more boosters on Sats than any other day of the week!). We worried that the RCVS might perceive us to be 'poaching' clients who come in on Saturday afternoon, and this service was set up for our clients only. [/quote]

We have the same as well as our OOH difficulties, we're open until 6 on a Saturday and for 3hrs on a Sunday...much cheaper + more convenient than going to our neighbour's rather distant OOH provider. Amazing how when questioned which vets they're registered at clients will suddenly decide they were unsatisfied with their previous vets and they want to change.

[quote user="Hanna Bennett"]If they still insist on coming to us then we tell them they must transfer to us for good, giving us permission to contact their old vets on the Monday morning to request any history. [/quote]

Re: OOH cover and other practices

Hanna Bennett — Mon, 22 Mar 2010 13:49:41 GMT

[quote user="Hannah Wynne Richards"]I know you have a problem Hanna, in that you don't have a local branch[/quote]

Do you think I've a bee in my bonnet about this one

Re: OOH cover and other practices

Hanna Bennett — Mon, 22 Mar 2010 13:48:55 GMT

[quote user="Gareth Dowdeswell"]

Almost all the practices in my town, including us, use an OOH provider about 30min drive away. We are however, the only practice in town open on Saturday afternoons, so whilst not being in quite the same situation as you, we do have occasional clients from other vets on the afternoon. Usually it is an urgentish problem that needs to be seen, so we've never refused to see them, but if it's a problem which will need further treatment after the weekend I encourage them to return to their own vets.

[/quote]

We are in the same boat - open on a Sat afternoon while everyone else shuts at lunchtime (and no other local practices do routine appts on a Saturday either which amazes me - we see more boosters on Sats than any other day of the week!). We worried that the RCVS might perceive us to be 'poaching' clients who come in on Saturday afternoon, and this service was set up for our clients only. So we have the rule that they are directed back to their own vets in the first instance. If they still insist on coming to us then we tell them they must transfer to us for good, giving us permission to contact their old vets on the Monday morning to request any history. They are still charged the emergency registration fee as previously discussed, but this is less than the call out charge from the OOH provider so we have acquired some new clients this way.

We try and make clients aware of our OOH setup - all new clients get a leaflet with directions etc to the clinic in Sheffield, and we sent this out in each months booster reminders for a year after changing to them, and we have a notice up in reception. Our answerphone explains that you call our vet til 10pm then the OOH clinic after 10pm, so they know who they are contacting - one local practice just diverts their phones straight through so clients do not realise they are speaking to someone from outside the practice. A direct mail to all registered clients was just too expensive I have to admit but we figure we've tried our hardest. The only thing we haven't got up is prices in reception which we need to sort out as I know this is something else the RCVS is hot on.

Re: OOH cover and other practices

Gareth Dowdeswell — Mon, 22 Mar 2010 09:34:21 GMT

[quote user="Catherine Williams"]

Just wondered does anyone else have this situation and what do you do? (Also a slight rant as I've just been called out by one of these clients) Do you stick to your guns and send them to the designated OOH provider...if so any hints how? Do you welcome all comers as a source of business (I get paid the same if I get to sit at home all evening or if I spend all night seeing clients) in which case do you ask them to then register with you, or register if repeat offenders (but this smacks of stealing clients), or do you charge a surcharge for non-registered OOH users?

[/quote]

[quote user="Catherine Williams"]

I know there is increasing discussion of making clients aware of OOH provision, the latest news from the RCVS suggests there will be a drive about this. However I tend to find the majority of clients don't think about this until the situation arises and often there's a "oh it wont happen to me" attitude. A proportion of clients seem happy to ring round until they find someone convenient (have to say I've never understood that, if a vet is not good enough to look after my animal routinely for whatever reason why would I want to trust them in an emergency)

[/quote]

The RCVS mentioned their drive to make clients aware of OOH provision at one of their recent regional meetings that I attended. The basic message was that as clients are very unlikely to pay for the cost of sufficient staffing levels for vets to provide on-call and still comply with working time regulations, clients need to accept all the inconveniences of an OOH provider. Not quite sure where that leaves mixed/large animal practices...

Re: OOH cover and other practices

Julian Earl — Sat, 20 Mar 2010 16:31:52 GMT

[quote user="Hannah Wynne Richards"]

It's illegal to put surcharges on, but perfectly legal to have a basic fee which exceeds that of the OOH provider, and then DISCOUNT for your own clients.

[/quote]

The RCVS stated that it was acceptable to charge differentially - they may be wrong, but they definitely said so at our regional meeting.

Re: OOH cover and other practices

Hannah Wynne Richards — Sat, 20 Mar 2010 10:08:16 GMT

It's illegal to put surcharges on, but perfectly legal to have a basic fee which exceeds that of the OOH provider, and then DISCOUNT for your own clients. Having a small practice, I know most of my clients, so if a stranger rings up, they will be asked if they are on benefits, and if so, directed to PDSA-I know you have a problem Hanna, in that you don't have a local branch

Wynne

Re: OOH cover and other practices

Clive Ansell — Sat, 20 Mar 2010 08:55:25 GMT

[quote user="Catherine Williams"]

OOH cover is obviously a hot topic at the moment and I've seen a number of discussions on the forums about using specialist OOH providers. The practice I'm at does it's own out of hours cover - we feel our clients prefer to be seeing vets they know and not having to find an unknown practice in the middle of the night. I'm not sure our clients fully understand that we work the day, do a night on call then work the next day, they often seem surprised to see us in again but generally it works OK and although I'd say I get called in most nights on call, the all nighters are rare enough (touch wood, I'm on call at the moment).

A number of our local competitors have switched to OOH providers and what I'm finding increasingly is I'm getting calls from their clients wanting to be seen as they wont or can't travel to the out of hours provider. I suspect these clients might be travelling about 30-45min to get to the correct OOH surgery, we're generally about 20min away. I always recommend going to the correct surgery, however as the OOH cover has no access to current records etc then arguments tend to fall on deaf ears. Some clients avoid admitting they're registered elsewhere until pushed, others are quite upfront about refusing to travel, I get the occasional "I can't get hold of my vets" but these clients usually admit the reason for calling us when I offer to try to reach their vets. I feel I cannot refuse to see a potential emergency, I don't want to hear "my dog died because you refused to see it" but have to say I'm starting to feel a little resentment. My on call seems to be getting busier because our local rivals have opted out. We're busy enough that I don't need the extra calls, particularly when I'm trying to recover after a busy day, our clients are potentially subsidising our OOH service that these non-clients are then using and it's our clients that then have a tired, slightly grumpy vet the next day.

[/quote]

There is only an obligation to provide 24 hour cover for your own clients, not a full on 24 hour service. When I do on call, which isn't very often, I fairly forcibly direct non clients to their own practice or OOH provider, if they are not happy with the distance involved or the fees they need to discuss it with their own practice during normal hours. There are very few cases where a travel time of 40-45 mins is going to make any difference compared to 20-30 minutes, other than convenience. If they want to change practices, then it is done during normal hours not at 3am. If they "cannot get hold of their vet", I will try and if unsuccessful (never has been yet) would offer to see.

If someone doesn't have a vet or it is an emergency where the difference in distance may alter the course of events I would offer to see on the basis that they would be transfered to their own practice/ooh provider if/when fit to travel.

Guidance for 24-hour emergency cover

http://www.rcvs.org.uk/Templates/Internal.asp?NodeID=89763&int2ndParentNodeID=89738&int1stParentNodeID=89642

7. If an owner of an animal, who is not a client of the practice, requests an emergency out-of-hours consultation, the veterinary surgeon may reasonably direct the owner to his or her usual veterinary surgeon and decline to carry out the consultation. However, immediate first aid and pain relief must be provided to the animal if, for whatever reason, the owner cannot contact his or her usual veterinary surgeon. The veterinary surgeon should be aware that holiday-makers, new owners and other categories of animal owner may not have a 'usual veterinary surgeon' in the locality.

Re: OOH cover and other practices

Karen Eggleton — Fri, 19 Mar 2010 23:26:05 GMT

[quote user="Catherine Williams"]do you charge a surcharge for non-registered OOH users?[/quote]

We did exactly this when I worked for a practice in Nottingham many years ago and we were about the only practice that did not opt in to the new OOH service provider as we were mixed.

We got fed up of people calling us as they, quite understandably, did not want to travel some distance north of the city to be seen by vets they did not know.

So we charged an OOH reg fee for these clients. Can't quite remember how this went down with neighbouring practices as far as the ethics of it went as we ended up seeing their clients, but at the end of the day it is very difficult (if not impossible?) to refuse to see a client if you cannot refer back to their own vet.

Don't remember being particularly chuffed at seeing other practices emergencies and left the job from burn out a few years in as we were only a 2 man practice. Sadly as I had the loveliest supportive boss but the business was new and we could not afford to increase staff.

Re: OOH cover and other practices

Hanna Bennett — Fri, 19 Mar 2010 23:16:27 GMT

[quote user="Gillian Mostyn"]

Unfortunately, as I'm sure you know Hanna, it doesn't stop the ones for whom 'money is not an issue' - either they have lots, or they have none, but either way, you're not getting any.

[/quote]

i know, but at least they don't wake me up at 2am any more

Oh, and can i recommend deposits to reduce bad debts!

Re: OOH cover and other practices

Gillian Mostyn — Fri, 19 Mar 2010 23:13:00 GMT

[quote user="Hanna Bennett"]we charge an 'emergency registration fee for unregistered clients OOH, which brings us in line with the local OOH service. Having said that we use said OOH service after 10pm at night (they see very few of our clients and gives us qol)[/quote]

Unfortunately, as I'm sure you know Hanna, it doesn't stop the ones for whom 'money is not an issue' - either they have lots, or they have none, but either way, you're not getting any.

Re: OOH cover and other practices

Michael Woodhouse — Fri, 19 Mar 2010 23:10:52 GMT

I work in a slightly unusual situation - myself and my girlfriend both work for 2 neighbouring 2 man practices which share on call. It means a 1 in 4 rota (1 in 2 in our house!) but we do see the same clients in the day as we work basically job share and spend half my time at each practice.

The problem we get is there is another practice in the town that has a base a good 20-30 minutes drive away and they want people to often go there OOH. We get calls from them ever few months. In the first instance we would always refer them back to their origional vet. On a couple of occasions when they claim not ot be able to get hold of their own vet I have taken their phone number, rang their own practice and passed on the details!

We are paid a £5 call out bonus so it's not worth leaving the house unless I have to!

(on call ATM - 2 calvings so far)

If we see other practices clients we charge the same, but we probably shouldn't.

Re: OOH cover and other practices

Gillian Mostyn — Fri, 19 Mar 2010 23:10:25 GMT

We had the exact same problem. We decided to go with an OOH provider too, 18 months ago. Our reasons?

[quote user="Catherine Williams"]we feel our clients prefer to be seeing vets they know and not having to find an unknown practice in the middle of the night.[/quote]

Absolutely. In the same way I'd love to see my own GP if I'm ill, or my own dentist if I break a tooth. But although the clients like it, they really don't EXPECT it. We have had NO complaints about clients having to use the OOH provider - even from the 'demanding' clients who we were convinced wouldn't like it. But that does depend on having a good OOH provider, local to you.

[quote user="Catherine Williams"] I'm not sure our clients fully understand that we work the day, do a night on call then work the next day[/quote]

They don't understand, and most of them don't care. Put your own welfare, and that of your daytime clients, first. Afterall, that is your primary job and income.

[quote user="Catherine Williams"] However I tend to find the majority of clients don't think about this until the situation arises and often there's a "oh it wont happen to me" attitude.[/quote]

In our experience, most OOH calls were from unknown or infrequent clients. They are the ones that leave the animal as long as possible to see if it gets better on its own. The good clients plan ahead and come in at a sensible hour. The good clients with genuine emergencies are happy to see anyone in the middle of the night, as they understand that it is an emergency!!!!

As I said, I do understand your position. My husband and I ran our practice 24/7 for 4 1/2 years. It was a very difficult decision to give up the on-call, and we were worried we would live to regret it. We never have - our time off is our own now, we've not had any complaints from clients, and we are always fresh to face the day. Win-win situation.

If you continue to do your own OOH, I can't see any solution to the problem of other practice's clients, unless the RCVS allow us to only see registered clients. And I doubt that will happen. We didn't want to wait........

Re: OOH cover and other practices

Hanna Bennett — Fri, 19 Mar 2010 23:01:26 GMT

we charge an 'emergency registration fee for unregistered clients OOH, which brings us in line with the local OOH service. Having said that we use said OOH service after 10pm at night (they see very few of our clients and gives us qol)