Practice inspection - is it value for money?

Re: Practice inspection - is it value for money?

Evelyn Barbour-Hill — Tue, 07 Sep 2010 13:09:15 GMT

The only thing I like about this Medicine Dispensing Premises Licence (£40 a year plus £250 every four years) is that a cheapo practice I occasionally collide with has to pay for each of its many branches, tee hee!

Re: Practice inspection - is it value for money?

Bob Russell — Tue, 07 Sep 2010 09:17:07 GMT

Not really arguing on this point. The cost of inspection is not evenly spread. A large practice will pay the same fee as a single-man practice. Some of us just have to do the best we can as the difference between making a fair profit and making none is sometimes small.

I would expect an outsider's overview to be useful but PSS inspection is yet another cost on top of many others.

Re: Practice inspection - is it value for money?

bob lehner — Mon, 06 Sep 2010 22:33:41 GMT

The slightly worrisome thing there is that, (again in my personal experience), many practices presenting themselves for PSS inspection for the first time and having had the benefit of all the guidance notes etc. still fall down in some areas and will benefit from guidance from the inspector as to how to rectify these deficiencies or omissions. An independent outsider's overview of the practice can, I think, be very useful.

Re: Practice inspection - is it value for money?

Bob Russell — Mon, 06 Sep 2010 17:57:18 GMT

I accept this. I use the guidance notes from the various organisations for PSS accreditation so to a certain extent I am 'parasitic' on the PSS!!! It is free!!!!!

Re: Practice inspection - is it value for money?

bob lehner — Mon, 06 Sep 2010 17:52:10 GMT

My apologies for misunderstanding your original posting and then setting off to defend the PSS !

One point tho' - if your practice is in the PSS then the VMD have said that they will leave you alone and not subject you to their random spot-checks (with associated £250 fee) . Plus you get reassurance that hopefully you are compliant with multiple other rules and regs, with less to worry about if HSE or the Environment Agency pay you an unsolicited call.

Re: Practice inspection - is it value for money?

Bob Russell — Mon, 06 Sep 2010 12:12:28 GMT

I have working in a number of practices over the years and have never seen 'high risk' activity. Failure to keep the controlled drugs register in the required format is not acceptable but if it records accurately reflect arrivals and use it is not likely to be irresponsible.

I was not having a dig at the PSS but it did not protect Medivet from having issues with Panorama and I clearly remember a suspended vet being filmed by the Tonight programme standing outside next to his practice sign with the RCVS accredited logo clearly on display. PSS acreditation does not automatically confer responsible status.

The real point of my post was is it good value? Was it a small number of practices (or even one) in which case £500K is a lot for our profession to pay? Or was it many? The VMD have not given any indicator of how many practices are not conforming.

£250 may not be a lot of money for a large practice but it is not peanuts for a single handed one. The burden of all this legislation and regulation is relatively much greater for small practices compared to larger ones.

Re: Practice inspection - is it value for money?

Bob Russell — Sun, 05 Sep 2010 21:45:03 GMT

Apologies - the title was not well formulated. It should have read VMD inspection - the faults discussed in the recent reports are not unimportant and rereading my original post makes me wish I had taken a little more time writing it.

Temperature control for medication is critical and basic to proper running of a practice. Over temperature vaccines may well be useless.

Controlled drugs use and recording is a basic part of our responsibility in practice and is set down in law (and has been for many, many years).

If these problems are common then practices need more inspection not less = if we cannot get this right then the profession needs a lot of help. Were these common issues or an isolated few? If they were isolated cases it is a lot of money for the profession to spend, if common it is not enough money.

My main point is - are 'routine' four yearly visits - announced weeks in advance the most efficient way of spending £500K upwards?

If the issues found so far are the only real issues then the potential for a random visit to keep us on our toes strikes me as a more effective way to go instead of the present VMD inspection system. I suspect there would be less inspection overall and the money could be spent more efficiently.

My practice is not PSS registered as I cannot see a commercial advantage to it but we work hard to make sure that we work to a similar/equivalent standards both clinically and structurally!

Random visits (as can happen with human pharmacies) would seem a more efficient way to 'police' the profession.I for one would accept a random visit as long as the inspector is willing to wait a bit if we are busy!!!!

Once again I apologise for the slipshod original post. I am interested in value for money!!! There is no smiley for sorry!!!

Re: Practice inspection - is it value for money?

bob lehner — Sun, 05 Sep 2010 17:12:34 GMT

Yes -thanks - I take your point and realise that comment could have been phrased better.

I will amend my opinion to 'some' rather than 'most'. Don't wan't to be accused of making sweeping generalisations and offending those law-abiding non-PSS practitioners.....

Re: Practice inspection - is it value for money?

Evelyn Barbour-Hill — Sun, 05 Sep 2010 15:30:29 GMT

[quote user="bob lehner"] It has been my experience that the majority of non-accredited practices do not keep these products in a very responsible way.[/quote]

Careful, Bob. That's the sort of assertion which the Belgravia House PSS enthusiasts love to make to the public, though (of course) only by implication: " If the practice is not RCVS Accredited, it probably has low standards".

I know you mean well, but .............

Re: Practice inspection - is it value for money?

bob lehner — Sun, 05 Sep 2010 14:23:26 GMT

Being a PSS inspector, not surprisingly, I do strongly support the scheme and am disappointed by the negative comments about it. Don't forget that the PSS is there to provide assurance to clients (and staff) that a practice is functioning in a legal, safe and responsible way and also has appropriate clinical facilities.

We all know that there is a multitude of laws and regulations out there, some of which apply to all businesses, whilst others are specific to veterinary practices. I think even the most conscientious practice principal/manager acting in isolation can have difficulty assimilating them all and not missing out on something important. The PSS brings all these rules under one convenient umbrella and covers such disparate areas as employment law, health & safety, COSHH, medicines legislation, radiation safety, electricity regs, waste disposal etc. etc. A practice owner can probably sleep a lot easier once accredited, with less worry about an unannounced visit from the HSE, VMD , The Environment Agency etc.

The fact that some rules and regs may seem petty or illogical, unfortunately does not absolve one from complying with them. Standing up in court and saying 'Yes, Mi'lord I did deliberately flout that particular law, because I feel it is stupid ' would not provide a very robust defence.

Many practice principals (myself included, when I was one) sail through life blissfully unaware of some important legislation - for example the fact that owners of business premises are required to have the electrical wiring checked and certified every 5 years. Failure to do this might invalidate your building insurance in the event of an electrical fire. Could be an expensive mistake !

[quote user="Bob Russell"] - Products not stored at correct temperatures (not clear how many practices involved).[/quote]

Storing meds properly is important. Do you really feel happy dispensing drugs which may have been stored well above (or below) the manufacturer's recommended temperature range ? Glass bottles on a shelf directly in front of a window, with summer sun blazing through, can reach very high temperatures - and there is no guarantee that the product inside will retain its potency thereafter. I know for a fact that in the old days many LA/equine practitioners were very casual about looking after temperature-sensitive meds like vaccines, which were carried in vehicles. These could either cook in the summer, or freeze in the winter. I'm quite certain that many horses will have received less than fully-effective 'flu vaccines as a result. Similarly, dispensing out-of-date medicines cannot be defended.

[quote user="Bob Russell"]Misuse of Drugs Regulations registers not filled in the correct manner (no indication of actual misuse given).[/quote]

I presume you are referring to the Register of Schedule 2 Controlled Drugs ? If so, I think it is really important that vets store these dangerous and potentially addictive products safely and keep a properly configured register of them. Criminals know that vets carry these substances, which can have considerable value in the drugs-underworld and many practices have been broken into by thieves looking for the likes of morphine or ketamine. It has been my experience that some non-accredited practices do not always keep and record these products in accordance with the regulations.

y-[quote user="Richard Carter"]

Keeps some important people with clip boards in a job!!

[/quote]

This is a bit unfair - the College specifically tells PSS inspectors not to treat inspections as a 'clip board/box-ticking' exercise, but to engage with and talk to as many practice staff as possible. Personally I find many vets and nurses, as well as the bosses/managers welcome the chance to quiz the inspector about things which may not be entirely clear to them. The inspection is not meant to be an adversarial business - after all the College wants practices to become accredited ! The inspector will want to try and help the practice to remedy any deficiencies which turn up and again, in my experience, this is often appreciated by those in charge.

I often ask practice principals why they have put themselves through what is a relatively stressful and expensive process, in order to become accredited under the PSS - which is of course entirely voluntary. They almost invariably tell me that they want the re-assurance that their business is being run in a safe, legal and responsible way and that their clinical facilities are comparable with other similar practices.

Re: Practice inspection - is it value for money?

Richard Carter — Fri, 03 Sep 2010 14:07:49 GMT

Keeps some important people with clip boards in a job!!