Seeking answers to questions about OOH care, home visits and charges - Veterinary Practice
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Seeking answers to questions about OOH care, home visits and charges

THIS month I am looking into an issue that is frequently discussed, debated, argued about and moaned about by many vets in practice – more specifically by those vets in practice who work within the catchment of a large out-of-hours provider.

THIS month I am looking into an issue that is frequently discussed, debated, argued about and moaned about by many vets in practice – more specifically by those vets in practice who work within the catchment of a large out-of-hours provider.

The main grumbles of these vets are as follows:

  • We get people who aren’t our clients calling us at night because we are cheaper and or nearer than their own vet’s out-of-hours provider.
  • We get people who aren’t our clients requesting home visits at night because the out-of-hours provider refuses to provide them. n We then feel obliged to provide the above services because if we don’t the RCVS may discipline us.
  • The RCVS should not in any way oblige us to see these cases.

The issue was flagged up this time when a reader of this column e-mailed me after reading the June issue (where I reviewed an RCVS disciplinary case involving some of the points noted above).

There is usually enough going on in practice or in the wider veterinary world to provide material for this column, but if anyone wants to e-mail in on, do please get in touch with comments or issues that you think need investigating.

Controversial topic

I am not making out I am a veterinary Donal MacIntyre, or even a Jim’ll fix it, but I am always interested to look into the next controversial topic. It also often takes a third party to put the two sides together. Lots of people may complain about a certain problem but it is not often put straight to the other side, and if it is there is rarely a way of opening that up to a wider audience.

The e-mail I received concerning working in the shadow of a large out-of-hours service provider gave me an opportunity to air both sides of the argument.

I won’t reproduce the whole e-mail here but I will quote parts of it and follow with the relevant response from the out-of-hours provider in question, who in this case is Vets Now.

Vets Now has 50 emergency clinics and provides out-of-hours cover for 2,000 full-time-equivalent vets. As such it is the largest provider of emergency care in the UK and has by far the largest geographical spread. So, just due to the size of this operation, many of the complaints you hear about out-of-hours providers are about Vets Now.

As a large company it also employs a PR company and much of the material I will quote has come via that company to me. A PR company is something most small practices could only dream of having.

  • “Our branch of Vets Now … has stopped refusing to go out point blank, but quotes £400 for the house call plus treatment, and when the client gasps in horror they are invited to shop around amongst the other local non-aligned practices. In other words, if we have to come out you’re paying for a locum for the night while we attend.”

‘Widespread myth’

Vets Now responded: “There does appear to be a widespread myth within the profession (sadly even within the RCVS echelons) that Vets Now don’t do house visits which is simply baloney. More than 100 visits by Vets Now teams in the last year rather speaks for itself but old rumours evidently die hard even in the face of hard evidence and many happy clients… Our house visit policy clearly states that we will not hand out the numbers of other veterinary practices to clients requesting a house visit. That doesn’t stop clients choosing to make their own enquiries.”

I checked this as I found it hard to believe the price quoted. I telephoned a Vets Now clinic this evening posing as a client with an old dog that was “just fading away” and needed a home visit to be put to sleep. I was indeed quoted about £350 for a home visit.

This was, I was told, because they would have to get a locum vet and nurse to cover the practice whilst the duty vet and nurse attended me. I was also told it would take some time. I decided my imaginary dog could wait until the morning.

It’s an interesting angle and you can all make your own judgement on it.

Certainly, with the recent RCVS disciplinary ruling discussed in the June issue of this column (look up the Albring case, January 2011, on the RCVS website), the RCVS does not believe that if an emergency centre vet is required to do a home visit, then any cover is needed back at base.

I think the RCVS is wrong in that and Vets Now is right. But I also find it hard to stomach charging someone £400 for a home visit. Please e-mail in with an answer to that conundrum.

Not a lot…

As to the hundred home visits carried out, well for 2,000 vets that’s not a lot. As a full-time vet on an equally shared rota, I do maybe just under one out-of-hours home visit a month, say 10 a year. So for one FTE vet at 10 a year, Vets Now should be doing 20,000 a year, not a hundred (I have double-checked the figures).

Who is doing the rest? Probably the likes of my correspondent.

  • “The PDSA are interesting, in that they are still using it [Vets Now] but employing their own nurses to vet and triage the emergencies before contacting Vets Now on the client’s behalf; in other words, they don’t trust them either!”

Vets Now responded: “During the out-of-hours shift, a PDSA Animal Care Auxilliary (ACA) is on site to take telephone calls from PDSA clients and others enquiring about PDSA’s charitable service. This is to ensure that callers to PDSA are given the correct advice on issues such as eligibility and the services that PDSA can offer.”

Lastly, an interesting case comparison from the correspondent’s own experience of covering out-ofhours emergencies for clients who should be going to Vets Now.

“There was an incident with two simultaneous GDV cases turning up at the same time, both 10-year-old Dobermanns. The private client had surgery for £2.5k; the PDSA client was told surgery of that sort was not permitted on a PDSA client’s dog of that age, it would need to be euthanased. We saw him and fixed it for £750. He told the other fee-paying client who marched into [his daytime practice] the following day to ask why their surgery cost £1,750 more? Tricky isn’t it?”

A different model…

Vets Now responded: “Vets Now treatment fees are representative of the high quality, trained, fully staffed outof-hours service we provide. We work to a very different model to daytime practice which is reflected within our pricing structure… However, to put the fees in context, last year Vets Now made a pre-tax profit of approximately 5% of turnover, considerably less than most daytime practices would expect to make.

“This is a reflection of the true cost of delivering high quality OOH care to those pets who require urgent OOH care. If a daytime practice chooses to cross subsidise the cost of running its night service from daytime profits, then of course it can do so although most practices I speak with admit they don’t actually know the true cost of running their OOH service, they’ve just always done it that way.”

It’s an interesting response and I am sure that the pricing structure of traditional practices operates on a policy of out-of-ours basically being done for little income and effectively provided for free by the vets, as we just get up and work the day before and after an on-call shift. As to the pre-tax profit level, the cynic in me thinks they must just have a good accountant, but that’s what they told me.

Positive impact

That is a selection of quotes from both parties. I think that Vets Now has made a huge, positive impact on the profession in recent times.

Graduates can now realistically plan a career with never having to do on-call. That has to be a good thing for the many graduates who go on to have children.

Conversely, a career in emergency medicine is now a viable option. Vets Now has made huge contributions to CPD (e.g. its emergency care conference that I have attended and learnt a lot from) and also its involvement with the Pet Blood Bank.

There are problems as discussed above with the group’s working practices and many independent practices which do not use them feel put upon by Vets Now clients shopping around. These vets are then too scared of the RCVS to refuse to see these clients.

Frequent criticism

The fees charged by Vets Now and other out-of-hours providers are frequently criticised.

For example, in the recent SPVS “Question Time” debate by Brian Pound of CVS who suggested that the high fees charged by OOH providers and “inexperienced vets” employed by them may be bringing the profession into disrepute.

In the same debate, Peter Jinman (then RCVS president) said to the assembled vets: “If your practice does a home visit, your OOH provider must be willing to do the same.” Which is a strange comment as by RCVS diktat all vets must be prepared to do a home visit, therefore so must all OOH providers.

I think that the RCVS should be clear that a vet who does not subscribe to an out-of-hours provider should have the right to refuse to see the out-ofhours provider’s clients if he or she so wishes.

I also think that all vets should have the right to decline to do home visits out-of-hours if they choose not to, without having to worry about defending themselves against a complaint to the RCVS. Clients should take responsibility for their own lifestyle and choice of pet.

It is a side of the profession that has changed hugely in the last 10 years. And out-of-hours clinics are not going away, much to the relief of the thousands of vets who use them. However, for those who choose not to use them but work near them, the ground rules need to be made clear and fair.

As to the fairness to the client of the fees charged, that’s another discussion altogether.

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