INFLATION in veterinary fees has
reached unsustainable levels and the
only solution is to change the
structure and expectations of small
animal practices, members of the
British Veterinary Hospitals
Association were told at their annual
meeting in London in October.
The meeting discussed
the changing face of
veterinary services in
the UK and the
developing role of out-
of-hours emergency
centres and specialist
referral practices.
Chris Laurence,
veterinary director of
the Dogs Trust (and a
past president of the BVHA), warned
that this stratification in veterinary
provision must continue if the
profession is to continue offering an
affordable service.
As the person responsible for the
welfare of 4,000 chronically sick dogs in trust shelters, he has witnessed an 8 to
10% inflation rate in veterinary fees
over the past six to seven years. This
trend simply cannot continue as the
general public would not accept an
effective doubling of fees every 10
years, he said.
Mr Laurence blamed this problem
on the current structure of first opinion practices
which were all trying to
provide the same high
level service, requiring
expensive equipment
that cannot be cost
effective. “They all want
the same toys,” he said.
Instead,
practitioners must accept that it is usually in the best interests of
the client and the patient to refer the
case on to an appropriate specialist. He
pointed out that the role of general
practitioners in the National Health
Service was essentially that of a filter,
dealing only with the more
straightforward cases. Everything else
was sent to the local hospital where it
would enter a triage system, which
would determine which patients needed
to be seen at a specialist centre.
Need to reassess policies
Dr Clive Elwood, managing director of
Davies Veterinary Specialists in
Hertfordshire, agreed that many first
opinion practices needed to reassess
their policies on referring patients.
“There are lots of cases that we see
where money has not been spent
wisely,” he said. “The insurance money has all gone and we
are expected to pick
up the pieces.”
He maintained
that while referral
practices charged
much more for their
time than first
opinion practices,
this was usually
much better value for money for the
client.
BVHA members, however,
recognised that practitioners will vary
considerably in their willingness to refer
cases. Some believed that inexperienced
practitioners may often lack the
confidence to tackle unusual but
relatively straightforward cases and will
sometimes refer cases unnecessarily.
This was a reflection of how society
has become highly risk-aversive and
now demands that children wear safety
glasses before they can play conkers,
one suggested.
Developing skills
The availability of clinical cases on
which young graduates can develop
their professional skills is an important
issue in the development of emergency
services. Amanda Boag, clinical director
of Vets Now, said the biggest problem
facing her company was in recruiting
veterinary surgeons with the necessary
competencies for this specialised branch
of veterinary practice.
If newly qualified vets are unwilling
to risk taking on more challenging cases,
this will only exacerbate the problems
caused by the European working time
regulations, which are likely to become
acute if the rules on rest breaks and on-
call time are interpreted more strictly.
Chris Laurence believed that the
claims of more senior veterinarians that
their younger colleagues were unwilling
to participate in on-call rotas was a
myth.
He believed that newly qualified vets
were very keen to put in the extra hours,
knowing that this was the only way that
they would gain vital experience now
that on-duty hours were restricted to a
maximum of 48 hours a week.
But other members insisted that for
a traditional small animal practice,
providing an out-of-hours service was a
serious problem. Once they had been
qualified for a few years, colleagues were
no longer prepared to accept a one-in-
three rota.
Amanda Boag pointed out that there
were no official figures on the numbers
of small animal practices that now used
specialist out-of-hours service providers,
but she estimated that it was approaching 50%.
It was no surprise that the majority of those practices that still provided
their own out-of-hours service were
concentrated in areas of low population
density, north of the Scottish central
belt, in Wales and the south-west of
England.
She reminded colleagues that the
concept of specialist practices was still
very young and she believed that the
profession had the ingenuity to develop
new business models designed to deal
with the challenge of maintaining high
standards of service for clients.
Challenges
The BVHA was also facing challenges
in providing an appropriate service to its
members, noted the outgoing president,
Chris Trickey. Acknowledging that the
introduction of the Royal College
practice standards scheme had taken
over part of the BVHA’s role in
encouraging practitioners to improve
the standards of their facilities, he said
that as a consequence the association’s
executive would be reviewing its future
role and activities over the coming
months.
One major initiative was the practice
design guide which will be published
shortly and give advice to members on
how to redevelop their premises. The
print version will be sent out to all
members who will then be sent
electronic updates at regular intervals.
