This week, on Newstalk’s Pat Kenny Show vet spot, we considered the issue of the availability of vets for after-hours emergencies.
If you have an emergency with your pet, and the local vet has closed for the day, what are you meant to do?
The good news is that if you live in Ireland or the UK, you just need to phone your vet’s normal phone number: you can be assured that you should be put in touch with a vet ready to help you immediately.
Are all vets obliged to provide after-hours cover?
In most European countries, there is no obligation on vets to provide after hours cover. Instead, it’s left to the market: vets can choose whether or not to provide this, and pet owners can choose whether or not to choose a vet that includes this service. In Ireland (and in the UK), ALL vets are obliged to provide 24 hour cover. If they do not offer this, they risk being struck off the veterinary register and being prevented from practising.
This has a legislative basis. Under the Veterinary Practice Act 2005, the Veterinary Council publishes a code of professional conduct. Vets are legally obliged to comply with this code of conduct. If they do not comply with it, they are open to disciplinary action which could extend so far as to stop them from continuing to practice. The Code of Professional Conduct sets out the general principles that apply to all areas of veterinary practice, which includes specific provisions for 24 hours care.
ARRANGEMENTS FOR 24-HOUR CARE
Vets must make arrangements to provide 24 hour emergency cover for the care of animals that during normal working hours could be considered as being under the care of the veterinary practice. Additionally, when providing 24 hour emergency cover a veterinary practitioner must not unreasonably refuse to provide emergency first aid and pain relief for the following situations:
- for any animal of a species routinely treated during normal working hours.
- for all species of animal at least until a more appropriate veterinary service accepts responsibility for the animal.
- for any animal normally under the care of another veterinary practitioner.
- for any animal even where no immediate payment is forthcoming.
DEFINITION OF EMERGENCY COVER
Emergency cover means the provision of at least immediate first aid and pain relief and this may be organised in cooperation with other practitioners. Vets must have details of how to access emergency cover on the phone whenever their clinic is closed: they don’t need to do it themselves, but must arrange for it to be done somehow. Pet owners must be informed of how emergency cover is provided – this must be made clear in practice information via signs in waiting room, leaflets, website. Where veterinary practitioners, especially single-handed practitioners, find it difficult to provide a 24 hour service, they should co-ordinate arrangements for the treatment of all out-of-hours cases so that clients can obtain help from some other member of the profession with whom prior arrangements have been made and who is sufficiently close at hand to be able to provide services. Referring of out of-hours cases to other veterinary practitioners, whether in private practice or working for animal welfare charities, without their consent is unacceptable and unethical.
Where the personal safety of a veterinary practitioner might be at risk in conducting house calls, particularly at night, the situation must be explained to the client who should be asked to bring the animal to the practice base.
Telephone answering machines and similar services may be used when a practice is unattended either out of practice hours or because no one is immediately available to answer the telephone. However, there are stipulations on how these should be used:
- The system must give to the caller information as to how the call will be dealt with and the time within which a recorded message will be listened to or must give an alternative number to ring in an emergency; and
- Preferably it should not be necessary for the caller to ring more than one additional number before they can discuss the situation with a person on duty.
What happens if a vet does not provide out of hours cover?
If a complaint was made to the Vet Council because a vet was accused of not providing adequate after hours cover, the whole case would be looked at rather than defining strict rules about aspects such as how far a client would have to drive to reach the vet, how long a delay was before a vet was available, etc.
What about hospitalised animals at vets?
In addition, under the Veterinary Council Premises Accreditation Scheme, vets are obliged to provide 24 hour cover for in patients under their care. For overnight patients, there is no requirement for someone to be on the premises overnight, but vets should inform clients what level of service is provided so that there is no misunderstanding. It is important that pet owners question their vets on this: too many people presume that someone is watching hospitalised cases all the time. The reality is that the vets and nurses may often go home, leaving the animals on their own. Vets will explain this if asked, but may not always tell people directly if not asked. It’s important that people realise this, and ask questions if not sure.
There are broad rules that apply to different classifications of veterinary premises:
- For a registered veterinary clinic, all hospitalised animals must be checked as necessary over a 24-hour period.
- For a registered veterinary hospital, continuous patient monitoring must be provided as necessary on a 24-hour basis by a registered person. A written duty rota must be available.
The future of veterinary after-hours care
It’s expensive to provide after hours cover. If a vet is an employee, they must be paid if they are working after-hours. Who should cover this cost? As it stands, vet clinics absorb the expense, but arguably, pet owners should pay a monthly fee to their vet for the provision of this service. That’s how it works in other walks of life (eg if you want the AA to provide breakdown cover, or a maintenance engineer to be available to service a machine if it breaks down in a factory). You pay a monthly fee, and this covers the “on call” facility. Some would argue that vets should charge pet owners a monthly fee to be allowed to access their after-hours service.
The provision of after hours care is a real cost to vets that is usually disregarded by the public: to most pet owners, it feels as if the higher charge of having a pet seen after-hours should cover it. But if you consider the many hours that a vet may be on call, waiting for the phone to ring, an occasional call out will not be enough to cover the cost.
The working time directive
There are also issues with the Working Time Directive – every employee needs to have 11 hours continuous rest every day: this may be difficult if they are on call and busy seeing patients, and they then need to work the next day. In Ireland, there are three ways that this challenge is dealt with:
- Many vets are self employed and so Working Time Directive does not apply. However, arguably this places undue stress on the vets, as they have to work excessive hours to comply with the law.
- In many areas, vets share on call duties between practices, so that instead of working every night (or every 2, or 3 nights or whatever), vets share work so they might only be on call one night in 7, 10, or whatever.
- In urban areas (e.g. Dublin), there may be a Pet Emergency Clinic. This is a worldwide phenomenon which involves the provision of a dedicated emergency centre at a location within e.g. an hour’s drive of many practices. The emergency clinic may service 20 – 40 vet practices, so there are enough cases to justify the employment of dedicated vets and nurses who do not have day jobs – their day job is a night job. They are awake all night, seeing new cases and caring for in patients. This provides the optimal care for animals but it is only possible with the economies of scale provided by so many practices sending in their cases. It is not possible in a rural environment with lower population density.
Pet Emergency Clinics
The pet emergency clinic is helpful for sudden emergencies after hours, but also for seriously ill patients that need ongoing intensive care. e.g. last week two dogs with severe poisoning were transferred from my clinic in Bray to the Pet Emergency Hospital in Belfield when we closed at 7pm. This meant they could be watched continuously by a vet and nurse, with their treatment topped up as needed.
There are many other occasions when this happens: e.g. after big operations, or on any other occasion where I am not confident that the animal will be comfortable and safe in an unsupervised kennel overnight.
Listeners’ questions answered in this week’s podcast
- My dog wakes up every three hours needing to urinate. What can I do?
- I was in the dog park yesterday. One man allowed his dog to terrorise the rest of the dogs. What can I do about this?
- My dog sometimes goes off her food for a few days: is this OK?
- How can we train our cat to sleep on a cat bed?
- What do we need to do to import a dog from Australia to Ireland?
- How can we stop our Rottweiler eating our Doberman’s poo?
- My dog has a bad temper if he doesn’t get his own way. What can we do?
To find the answers, listen to the podcast below.