HOW can the veterinary profession square the circle of providing emergency services at realistic cost, while still staying within the law? This is the challenge that the RCVS has set itself during the summer with the aim of producing new guidance for its members by the year’s end.
This debate on the future organisation of out-of-hours services began with a meeting at the Royal College headquarters following the council meeting on 4th June.
Opening the discussions, a former president, Professor Neil Gorman, noted that the problems of providing emergency care have been a fixture on the council’s agenda for at least 20 years. But pressure to come up with practical solutions to these difficulties has intensified as practices attempt to cope with the restrictions on maximum working hours and rest periods required under the European Working Time Directive.
For small animal practices in urban areas, the solution is simple with the growth in specialised companies offering emergency cover. But for those vets living in less densely populated areas, as well as farm and equine practices, that is not a feasible solution, warned Carlisle practitioner Chris Barker.
Uneconomic
He reckoned that up to 60% of UK practices feel obliged to provide their own 24/7 services. Employing the numbers of clinical staff needed to comply with the regulation would be uneconomic for those practices, but the financial risks of ignoring the rules could be even greater.
He said that there have been cases where the police have checked the work rotas of staff who have been involved in a road traffic accident. If that person is found to have exceeded the legal limits on working hours, then the potential insurance claim against the practice could be ruinous, he said.
Richard Hillman, immediate past president of the SPVS, calculated the numbers of vets needed for an on-call rota with different combinations of working week and oncall times. The numbers of vets needed for a shared rota increases sharply if the clinicians work more than about 42 hours a week. In many cases the only solution is for practices across a wide area to share an on-call rota and for clients to have to travel further to access out-of-hours services.
Responding to a question from horse owner Alison Bruce, he argued that if no emergency service was available then it was for the owner to decide whether he or she should be keeping animals at all.
Mrs Bruce, a lay appointee to the RCVS Council who currently chairs its disciplinary committee, wondered whether a profession that refuses to see animals at night would retain the demand for its daytime services.
Increased cost
One inevitable consequence of maintaining an emergency service is increased cost to clients as practices will no longer be able to support the staff costs through cross subsidies from the rest of the business.
Past president Lynne Hill, who chairs the RCVS preliminary investigation committee, believed that clients would understand the need for realistic fees. She pointed out that complaints to the Royal College about emergency service rarely focused on financial issues, the public was more concerned about the quality of care.
Rebecca Davies, a veterinary surgeon with the market research company Onswitch, also vouched for the public’s common sense. Interviews conducted with pet owners have consistently shown that they are relaxed about having to travel some distance to an out-of-hours clinic provided that they know about the arrangements in advance. It is up to the veterinary profession to keep their clients properly informed, she said.
Practices which are large enough to be able to maintain their own outof-hours rota are likely to find it a useful marketing tool. Mrs Davies noted that when questioning clients on their choice of veterinary practice, about 10% based their decision on the quality of the out-of-hours service. Essex practitioner and BEVA representative Christopher House said out-of-hours care was a similarly high priority for equine clients.
Yet overall, information about clients’ attitudes to emergency care was still fairly limited and more research will help in devising an economically sustainable system, argued Barbara Saunders, a Privy Council appointee to the RCVS ruling body. Harrogate practitioner Bob Partridge was more sceptical about the value of market research, noting that the stressed owner of a late night emergency case might offer different answers when questioned in the cold light of day.
One of the more intractable problems for practices when trying to provide emergency services is in responding to requests for domiciliary visits. Council member Catherine Goldie believed that removing the obligation to carry out such visits would be extremely popular among practitioners who resented the service being abused by owners with no intention of paying.
Past president Dr Bob Moore assured members that the Royal College took a pragmatic view if a complaint was received as a result of a practitioner refusing a visit. The RCVS accepted that in most situations it was in the best interests of the animal to be brought to the surgery.
He added, however, that members of the preliminary investigation and disciplinary committees would be less sympathetic if there was a blanket refusal by the practice to visit clients under any circumstances. There would always be the occasional, exceptional case in which a home visit would be essential, he said.
