IN the August instalment of this column I wrote about working in the shadow of large out-of-hours providers. I received a lot of correspondence (at firstname.lastname@example.org) after it went out so thought it would be worth publishing a small selection. Some was from ex-employees of these places, most from those affected by clients phoning them at night for home visits (or just to be seen in clinic) as the out-of-hours provider their usual practice subscribes to is too costly or distant. Interestingly, one of the recurring comments in most correspondence I receive when writing anything critical or controversial is that people ask me not to mention their names. I usually ask why and never get a satisfactory response. I am never quite sure what people are scared of: that the RCVS or an employer will “get them”, I suppose. I have only published anonymously once. At other times I use the pseudonym “Gareth Cross” and a fake photo, and any resemblance to vets living or dead is purely coincidental. Anyway, I will air some of the correspondence now and leave it anonymous except for that from our dear friends at Belgravytrain House.
Issue to be addressed
“Dear Gareth “I read your article in Vet Practice (August 2011) and would suggest that the problem of clients trying to access other vet practices’ OOH services when they find their own practice’s inconvenient, needs to be addressed by the RCVS and needs pressure from vets in practice for them to clarify acceptable procedures – which of course THEY (the RCVS) can debate in daylight hours at a time of their choosing, at leisure and within the parameters of reasoned debate with their peers; unlike me who has to argue with clients demanding I deal with them at night there and then! “I think that the Guide to Professional Conduct should be amended so that it is simply not acceptable for a practice to absolve itself of all responsibility to its clients needs out of hours once it has switched its phones to the OOH provider.” [Not sure that would be too popular, but an interesting oncept.] “I also, after having the inconvenience of some plonker coming and making a fuss in the waiting room one Saturday morning, and another client who was rude to my assistant, have the home telephone number and mobile number of the principal of the practice closest to us so that I can contact him direct if we get trouble with his clients. Why should I have to deal with problems to ME caused by HIM using an OOH provider – they’re HIS clients not mine! I hope this suggests a way forward for this – the alternative, of course, is probably what happens elsewhere, eventually the hassle is so much that everyone uses the OOH provider.” I think that maybe vet-to-vet contact could be useful, but in reality a practice that does not do out-of-hours will find it difficult to get up and running for surgery, etc., at night unless some sort of back-up call-out rota is in place, which defeats the object of contracting it out.
“I liked your very fair and balanced article on OOH providers and some of the problems they bring with them. Just one point re OOH/ESC clinics and home visits: The RCVS PSS Manual for ESCs states: ‘At least one on-duty veterinary surgeon, directly responsible for the care of in-patients and any new admissions or outof- hours appointments must be on the clinic’s premises at all times during all of the hours of operation of the clinic.’ “Thus, if a single VS is on duty at an ESC, they cannot just leave the premises to do a visit. Either another VS must be called to the clinic to take over, or another VS must actually make the visit.” To which the RCVS responded: “Ref the need for a vet to be on-site at all times in Emergency Service Clinics – here is an understanding that carrying out home visits may be necessary. The Guidance in the PSS Manual therefore states: ‘Accredited ESC status requires at least one on-duty veterinary surgeon to be on the clinic’s premises at all times during all of the hours of operation of the clinic. This does not preclude a veterinary surgeon attending off-site in the rare circumstances that this may be necessary.’ (see page 19, Out-of-Hours Patient Care: http://www.rcvs.org.uk/documen… practice-standards-manual/). “As a general point, colleagues in Professional Conduct have also reminded me that practices need to give owners details of out-of-hours costs in advance – e.g. cost for a call out – and that not all do that.” The need to be on-site and thus send a second vet out is, as I said, I think a valid one and why Vets Now charges about £350 for a call-out. This, they logically say, is to cover the cost of a locum if they can find one. How many subscribing practices tell their clients that? As the RCVS said, I am sure not all do that!
And here’s a further comment from a reader: “I used to work for Vets Now,
and now I work purely as an OOH vet in a big hospital (not Vets Now). I only cover for our own clients now. I worked for Vets Now for a year or so and generally it was a very good experience, excellent CPD and I think they have driven ECC training massively forward. “The prices were obviously higher for a lot of things, drugs and surgery especially, but as you say in your article this is really their only revenue stream. “I have a couple of points. I think
the comparison you put in your article for the GDV isn’t really fair, one GDV
and another can be very different surgeries, one may be very straightforward, take 45 minutes operating time and be up and about in
a couple of hours; other animals can be critical and this is where the ECC vet comes in – constant monitoring, constant ecg/repeat elects/blood gasses, etc., etc., etc.; this type of case can quite easily make it into the 000s. “I personally think as a purely OOH vet we should charge a premium
for things like surgery; at the end of the day we are doing abdominal surgery, which is a massively skilled job, at 2 in the morning. Why should this part of the job, as you say, lose money? “With the home visits, Vets Now
told me when I started that the price was that high in order to put people off requesting a home visit – i.e. they want their vets and nurses to stay in the clinic, and this I think is perfectly reasonable… I have 10-15 inpatients to look after on average every night… with the number of inpatients I have, many of which are critical, I usually can’t drop everything and go out straight away. “Lastly, I’m definitely not aware of Vets Now employees telling owners to look elsewhere for cheaper home visit costs, in fact we were expressly told never to give out info of other practices. “Thanks, not sure if I made any good points but thought I’d put my tuppence worth in.”
I did quiz the RCVS directly, one part of its response is above and the other was in response to this question I posed them and summarises the issue: “For clients shopping around for a visit outof- hours, which vet bears ultimate responsibility: (1) the client’s usual vet, (2) the out-of-hours provider, or (3) the vet who the client plucks out of the phone book? If a client was refused a visit by all parties that night and had a valid complaint to bring before the RCVS, who would be in the dock: vet 1, 2 or 3?” To which the College responded: “Ref clients shopping around, the guidance is the same for all vets, in that they must not unreasonably refuse to carry out a home isit. If someone calls a practice who is not a registered client, the vet may ask the person to go to their usual practice in the first instance. “However, they must not unreasonably refuse to carry out a home visit if requested.” So a bit of a slippery answer there. I was hoping the RCVS would tell all you who get pestered that you could relax and it’s up to the out-of-hours provider or their usual practice to sort it out. But after a few weeks of
deliberation (in daylight hours) that was all I got. Which is as per the Guide and understandably they would have to take it on a case-by-case basis, but it doesn’t allow any of you to get a better night’s sleep. I will leave it there for now, but I am sure the debate, and the nuisance late night phone calls, will continue…