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Learning lessons from the nhs...

by
01 August 2015, at 12:00am

PERISCOPE continues the series of reflections on issues of current concern

HOO…bloody…ray! At last some prominence is being given to a subject I have been banging on about for a number of years in various articles in various veterinary publications.

Now it is up there in lights in this month’s Vet Futures blog and I urge all of you (especially those of you just starting out on your career) to read it, understand it and implement it. It might not just make your career more rewarding both financially and emotionally, it might just save your marriage, your sanity, even your life.

What I’m talking about is the blog by Erwin Hohn and Adi Nell, senior partners at Medivet. And I should stress here that I have never met either of them or have anything whatsoever to do with Medivet. But what they are saying in their blog is quite simply music to my ears.

In my view the veterinary profession has to change if it is to fulfil the expectations of the general public (in providing a high-quality affordable service to their animals), and the expectations of us as vets to earn a reasonable crust doing something we enjoy while still having time and energy to spend on our families and friends, and doing the sorts of things we enjoy away from veterinary practice.

The secret, as espoused in the aforementioned blog, is to stop trying to become a one-stop shop for everything veterinary and instead to concentrate on those areas where we have a particular interest and expertise.

The model for all this (and I know there are some of you out there who will throw up your arms in disgust at this suggestion) is our very own National Health Service, because for all the gripes about the failings and inadequacies of the NHS there are many things that it does very well, and certainly things that it does much, much better than it did 20, even 10 years ago. We don’t need to follow those things it fails at, just those things it is good at.

Let me give you an example. I recently went to my GP with a problem that caused him to refer me for a gastroscopy examination. Within a week of seeing him I had a letter from the hospital asking me to phone to make an appointment, which I duly did.

I had a choice of three hospitals I could attend and one was able to carry out the procedure three days later. I arrived for my appointment at 10.45am expecting to be waiting in a huge queue for several hours but was seen within 15 minutes by a nurse who did all the preliminary checks (I was going to be sedated with diazepam).

Half-an-hour after arrival I was lying on my left side in the endoscopy suite being put off into what turned out to be a glorious sleep (I remember nothing about the procedure at all, just the warm glow when I awoke of feeling at peace with the world).

Beautifully handled

Once fully awake I was given a cup of tea and a sandwich, had a brief chat with the other patients who were also recovering, and was then ushered into another room where a nurse explained that no abnormalities had been found and that my GP would be receiving a letter within a few days reporting those findings. It was all handled beautifully.

What can we in veterinary practice learn from this experience? Well, as the Vet Futures blog suggests we can also refer our patients to specialist centres for endoscopy, or MRI or CT scanning, or laparoscopic surgery or diabetes stabilisation – the list is virtually endless.

The endoscopy suite I attended in the NHS is working full on six days a week (I was offered a Saturday appointment), staffed by nurse practitioners and doctors who are expert at this sort of thing. They know the difference between normal and abnormal (I hope!), because that’s what they do.

The very expensive equipment is utilised to the full, making the capital cost per examination almost insignificant (compare that to the situation when an endoscope, or an x-ray machine for that matter, might get used relatively infrequently in any particular veterinary practice).

Instead, what we currently have is thousands of pieces of expensive kit lying around in a myriad of veterinary establishments and used only infrequently and nowhere near to their full potential. Why? Because we still cling to that belief that we must do just about everything for every patient and every animal and that to refer is either an admission of defeat or a lost opportunity for revenue. But if we really worked out the true cost of securing that revenue, I don’t think it would stack up as a sound financial decision.

What we have to do as a profession is to start specialising far more and to integrate our “specialities” with veterinary practices with other specialities, and to stop seeing them as competitors for our clients and instead to educate clients that there are different vets for different problems and that this is in the best interests of their animals. And of course ultimately it is in the best interests of ourselves too and I suspect would have a huge impact on improving the mental health and well-being of vets in general.

How do we get there? That is the difficult nut to crack, but it is no more difficult than it was once perceived to be for one premises to provide an out-of-hours service for several other practices. And that has become more or less the norm in many parts of the country. So it is achievable given the will to make it work and by the building of mutual trust between otherwise fierce competitors.

So please, read the blog with an open mind and think what might be possible given the will to make something like this work. It could be an opportunity that if grasped would improve both the bottom line and the work/life balance of countless hard-pressed and stressed veterinary surgeons up and down the country. What is there not to like about that?