Getting through the inspection process - Veterinary Practice
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InFocus

Getting through the inspection process

GARETH CROSS continues his series discussing matters of topical interest to colleagues

I AM writing this after recovering from a weekend suffering some degree of post-traumatic stress disorder, for last Friday was our Practice Standards Scheme inspection.

If you imagine sitting a four-hour finals viva, but without the benefits of youth that undergraduates have, then you will get a feel for the experience.

Part of the reason it took so long was my fault: I had concentrated so much on ensuring we had all the correct documents I hadn’t collated them in one place. I also had some notion that being in their normal place would add some authenticity to them.

In the event this led to a prolonged game of treasure hunt round the building as each item on the inspector’s list being read out led to someone being dispatched to the relevant filing cabinet to retrieve the relevant bit of paper. Even so, the most organised practice will spend at least one-and-a-half hours just checking paperwork, which is pretty draining for all concerned.

A lot of the scheme is paperwork based and as such has been the subject of some criticism. In its defence, however, it is difficult otherwise to inspect a practice.

Fair enough

For example, the theatre may look clean on the day, but unless there is an SOP (standard operating procedure) in place for it, the inspector can’t know what is being done or make comments to improve it. So I think that sort of paper exercise is fair enough, even though it seems odd to write up something everyone knows already.

In terms of the building inspection, we had put in a bit of work in some refurbishments earlier in the year anyway and just had some decorating to finish off before the inspection.

Some critics of the scheme do question why the RCVS should be involved in inspecting premises when they have no legal remit to do this (have a look at some of the online forums on the subject for some no holds-barred criticism!). It did seem strange too, though, to have one vet asking another for his boiler inspection certificate and such like.

However, the core role of the RCVS is to maintain standards in the profession and if they don’t do it then no one else is likely to. I recently telephoned the local council’s licensing department about veterinary practices and they had no knowledge or remit to inspect or license practice premises, bar a mention of planning change of use regulations.

They didn’t even know who did regulate vets at all: “Possibly DEFRA?” they suggested. So if vets and our premises are to be inspected it obviously has to be the RCVS.

I think the public would be amazed to know there is no compulsory inspection for vet practices and flabbergasted that until recently no such scheme existed. I always thought it odd that I have a legal remit to inspect and pass or fail kennels and catteries (and many of you do stables) on a variety of criteria including construction when my practice was subject to no such inspection.

On the whole we did fine really, and all criticisms or suggestions for improvement were constructive and largely about record keeping for the new pharmacy regulations. But after a while a criticism just sounds like a criticism and I have to say I felt pretty demoralised and drained at the end of the day.

The inspection does, however, provide a very useful and powerful vehicle for communicating to practices new legislation and RCVS advice, which is easy to just miss if you don’t read the RCVS News or forget it after you have done. When it’s part of your criteria to be accredited, you have to get it right.

Frequency of checks

One example was asking us to put something in our consent form to say how frequent the overnight checks are likely to be for hospitalised patients at hospital practices. The RCVS has received many complaints from owners who expect a nurse to be sat up with their pet literally all night and not just doing checks every few hours.

If it dies and it becomes apparent no one was actually there, it often causes problems. So this is an example of the RCVS passing on their experience in way you can’t ignore, i.e. do it or you won’t pass.

We also benefited from an experienced hospital inspector and practitioner casting his eye over the place and giving us some advice. However, most of us vets are independent-minded types who don’t like being told what to do and it wasn’t always easy to be on the receiving end of non-negotiable advice.

It’s obviously even more annoying when he is clearly right and you’d just never spotted it!

He also had some interesting and supremely practical tips for embarking on some clinical audit by way of a permanent point on the practice meeting agenda and once a month or so picking a subject or area for review. I think clinical audit is obviously a good idea but must be taken at a realistic level as an average size practice just won’t have the numbers of similar cases to make statistically relevant comparisons.

For example, I can state that my success rate for avian femoral fracture repair is 100%. I challenge any avian specialist to match that, and they definitely can’t beat it.

It would look great on our website and anyone “Googling” avian fracture repair would be hugely impressed. They wouldn’t know I’ve only done one in 11 years and got away with it…

Pharmacy regulations

The new pharmacy regs are the law (see www.opsi.gov.uk/si/si2008/ uksi_20082297_en_1) and like it or not (largely not) we have to abide by them.

So these inspections help you keep within the law and therefore protect us from prosecution. However, we had put most of our energies into the practice itself and over the years have, like all vets, wanted to concentrate on providing the best clinical service to patients and clients.

To have to devote so much to pharmacy regs, most of which seem a little over onerous for non-food chain animals, is a bit galling.

I felt like a sculptor who has spent years mastering his art and decided to enter a high-profile art competition one year and turns up with his prize sculpture to be told that this year it’s watercolours. That’s not the RCVS or the inspector’s fault, that’s just the way it is.

Cut-price vaccinations

Anyway, at the same time we have been going through all this we have learnt that a local practice group is going to run a cut-price vaccination van in our area. Strangely, though, not on their own doorstep.

There are a few genuine areas for concern with it apart from the commercial side. However, the RCVS seems pretty relaxed about it as several local vets have contacted them about it. I wonder if it will be a tier two or three van, or maybe just a core standards one…

On a brighter note, the weather this weekend was fantastic and we had a great camping trip on Dartmoor. The children even invented a new family campsite game as I dozed on the grass in the sunshine. It was called “Stand on daddy’s face” and just rounded my week off nicely.

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