The RCVS and OFSTED: taking the PSS? - Veterinary Practice
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The RCVS and OFSTED: taking the PSS?

GARETH CROSS thinks the RCVS might be overreaching in considering how to make the practice standards scheme more like the schools scheme, and he urges more study and a realistic approach…

IT’S inspection time again, though this time not for the practice but OFSTED for the school my youngest attends and I am currently a governor at (although just coming to the end of my term of office).

A short while ago there was some comment from our RCVS that it was considering making the practice standards scheme (PSS) more like the OFSTED and also more comparative, and this is now happening with the RCVS looking to award “Good” and “Outstanding” on top of the current accreditations.

The article I read quoted someone from the RCVS having seen an OFSTED banner from a school advertising its outstanding status. Coincidentally around the same time such a banner appeared next to ours on a local fence.

I am not having a go at the RCVS here as there is much to be admired in the OFSTED scheme, but I thought a little light-hearted look at both systems from someone (me) who has some experience of both might be worth a go. I am a fan of the PSS in most respects and think it is something that a professional body needs to have.

The full OFSTED inspection has been anticipated at school for the whole year as we knew we were due. Good schools are inspected every three to five years. The catch is that you only get 24 hours’ notice.

This is for the full inspection where teachers have lessons observed, governors are interrogated and also we, as parents, receive a letter requesting us to go online to report back on the school direct to OFSTED.

Imagine all your clients being contacted by the RCVS and asked to comment on your practice the day before your RCVS inspection. Imagine the cost in reading and assessing all that feedback.

Compare the markets

A quick look at the OFSTED website reveals there are about 24,500 state schools (including nurseries, etc.) in the UK and OFSTED has a permanent staff of about 1,300 and 2,700 contracted inspectors (all paid to inspect over two days plus expenses). Compare that to us where there are about 5,500 vet practices in the UK and about 2,700 of these are in the PSS [source: RCVS practice facts].

If we equate a practice to a school and assume equivalent compulsory inspection, we would get 606 inspectors and 291 staff, but schools are bigger than vet practices.

I know the budget of our school and its staffing, and that of my practice, and how big they are relative to what’s out there in terms of schools and practices, so if we quarter that number to account for big comprehensives (but bearing in mind also small nurseries and childminders are covered by OFSTED) we could guess that, pro rata, we would need 151 inspectors and 73 full-time staff just working on the PSS at RCVS to produce an OFSTED level of compulsory inspection. How that would factor into retention fees I wouldn’t like to imagine.

Also the inspection day when it comes is much dreaded by the staff, but in addition to this day schools continually harvest, process and publish data on every child on at least a half-termly basis.

This information is used for online reports to parents (do any readers publish clinical audit to clients?), is used by staff for monitoring, is used by the head to monitor staff, is used (in an anonymised form) by governors to check the school, and is used by OFSTED.

Different groups are compared and any gaps studied in depth (e.g. boys v. girls, children in care v. those not, free school meals children v. those not having free school meals).

What I am saying is that the level of educational data used for the inspection is immense and detailed; that equivalent data just do not exist for veterinary patients to be inspected.

Much of what is inspected for the PSS is paper-based, looking at systems not results, e.g. policy documents, SOPs, etc. I am not criticising the RCVS for this – it has to inspect on the basis of some sort of hard evidence. The other huge difference is the lesson observation carried out by OFSTED.

Unconcerned with clinical

I was surprised at both my PSS inspections (approximately four years apart) that the inspector did not really observe any clinical work being carried out. This would be hugely controversial for the RCVS to get involved with and very difficult to moderate, requiring a lot of inspector training. Those wishing to go for the new additional levels about to be offered by the RCVS may have to have more of this type of observation.

This all brings me round to my main concern with looking to OFSTED for inspiration. It is clear to me that the UK veterinary profession does not have the resources or the manpower to aspire to match OFSTED. I have tried to sketch that out above. OFSTED does produce comparative results, i.e. one school is Good, another Outstanding. One may require improvement, or RI. OFSTED has the clout and resources to put this label on a school. I do not think the RCVS will ever or should ever get into telling the public that one practice is better than another.

A personal example: we rent premises in a mixed use building. We have the ground floor and above us are two flats and a hairdresser. One of the stipulations of our PSS is to have an electrical safety certificate.

As the supply is shared throughout the building and we do not even have access to much of it we asked the landlord (many, many times) to get one done. We are still waiting and are possibly going to lose our PSS accreditation because of it.

Does having a poor landlord make my practice and our vets not as good as a practice up the road? (We are just about to start building a whole new premises, not just for the sake of an electrician’s certificate but it will be good to take control.)

So in looking at OFSTED as a model of inspection for veterinary practices, there is much to be studied, but also we have to be realistic about what can be achieved with the finances, person power and data available.

I am sure the RCVS wasn’t meaning it was intending to follow OFSTED directly, but I thought a brief look at the differences was worth an airing. The RCVS is beginning to go down this route already with practices able to apply to be assessed as “Good” or “Outstanding” in certain areas.

The RCVS is currently looking for practices to go for these awards as a trial, so contact the PSS team if you are interested.

It is something the public will be interested in and something that the larger and corporate practice groups will better have the resources to pursue than smaller businesses. I think it is very difficult ground to get into for the PSS.

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