Week 18 and counting.....

On Tuesday David Mountford (CEO) and I went to DEFRA and met up with Richard Drummond and Siobhan Taylor to discuss the results of the Review of the Minor Procedures Regime (RMPR) project surveys mentioned in last week’s blog. BEVA have undertaken 2 separate surveys as part of the evidence gathering for the review, one on the subject of Musculoskeletal Therapies, including small animals (Survey 1) and the other one about Equine Dental Care (Survey 2).  Survey 1 was targeted at musculoskeletal therapy associations (12 responses), individual musculoskeletal therapists (623 responses) and horse owners (5,796 responses).  Survey 2 was targeted at the equine dental associations (1 response), individual equine dental care providers (378 responses) and horse owners (5,796 responses).

Both surveys make for interesting reading:

Survey 1

-          25% of horse-owners would not contact a vet if they thought that their horse had a musculoskeletal problem, nearly 50% might contact a physiotherapist and just over 40% might contact a chiropractor.

-          Some therapists report vets being unwilling to engage/liaise

-          Better regulation is desired

-          Minimum educational standards of a Degree or Masters are supported by the majority of therapists

-          Current regulations are considered to be impractical and ill-defined and there is poor enforcement

-          There are currently no minimum standards / qualifications for therapists

-          Therapists consider that there is veterinary indifference and ignorance.

-          Estimated number of therapists offering musculoskeletal therapy to horses in the UK – 1120.

         Survey 2

        

-          Vets are often not the owner’s first choice for equine dental care

-          Word of mouth/reputation is the primary differentiator used by owners

-          Qualifications are important to owners but are not checked

-          Association membership is important to owners but is not checked

-          The majority of qualified EDTs comply with “accepted practice”.

-          BAEDT members appear to be slightly more compliant than others

-          ¾ of unqualified EDTs do not comply with “accepted practice” or the VSA

What a fantastic piece in last week’s edition of In Practice under “A Practitioner Ponders”.  It mentions the outcome of the Injury Survey we commissioned in 2013 and discussed the use of Personal Protective Equipment (PPE).  Key facts worth consideration are that according to the Kentucky Trauma Registry, “50% of horse-related fatalities of riders were from incidents on the ground,” and that the wearing of a safety helmet, “confers an 80% increase in the chance of survival in the event of a head injury”.  I would urge you to find a copy of the journal to read this article (In Practice: January 2015, Volume 37:1), http://inpractice.bmj.com/content/37/1/48.full.pdf+html

Week 17 and counting…..

Yes, I know the last blog was my 14^th but I did have 2 weeks off from BEVA things over the Xmas and New Year period and therefore no blog was forthcoming!  2 weeks off, except of course for the continuous influx into my Inbox; although it was reduced to about 30 a day.  But sadly not 2 weeks off from the practice and the Xmas & New Year Rota, which included the first Point-to-Point fixture in the area for the 2014/2015 season.

New Year and new resolutions: to answer emails by return and not just let them sit in my Inbox, whilst I ponder them; to only read texts, when I’m in a position to respond to them rather than read them whilst I’m driving with the intention of responding when I’m stationary and then I invariably forget.

The first edition of the year of the Horse and Hound included an article on the hopes of a number of vets, including myself.  I’m surprised that there hasn’t been more fallout from my concerns about some rider’s weight compromising their horse’s welfare.

It was straight back into it at the start of the week with a trip down to the British Horseracing Authority (BHA) headquarters in London on Tuesday for a meeting of the Veterinary Committee.  The implementation of their Anabolic Steroid Policy has been delayed until March 2015 because of the difficulty in defining who is deemed to be the “responsible person” either prior to a horse entering training or during those periods of time when the horse is “out of training”.  No further information was available at the time of the meeting but it is hoped that these loose ends will be tied up by February after further consultation with the National Trainers Federation (NTF) and the Racehorse Owners Association (ROA) …watch this space.

I tabled a paper about equine dental procedures being performed on BHA licensed premises.  This is part of our ongoing campaign to inform all horse owners / trainers / carers about the legislation surrounding “the horse’s mouth”.  One of the things, which has become apparent to us over the last few months both from the BEVA e-Survey of our members and the survey, which we undertook for the Review of the Minor Procedures Regime (RMPR) board on Equine Dental Care is the surprising amount of ignorance about and understanding of the subject.  The RMPR survey included dental care providers, including vets, and horse-owners.

BEVA has been trying to promote the regulation of “horse dentists and dentistry” for years in order to protect animal welfare.  Achieving this goal is currently being hampered by the fact that anything other than Category 1 dental procedures are considered to be acts of veterinary surgery.  However, we are still condoning / supporting the practice of Category 2 procedures by “suitably qualified” non-vets.  This is an anomaly and until there is an exemption order in place, which we are working on with DEFRA, it will remain theoretically illegal for non-vets, suitably qualified or not, to perform Category 2 procedures.  However, in the meantime, I think that we should recommend that only “suitably qualified” dental technicians should be performing any (Category 1 or Category 2) procedure in a horse’s mouth.  I think we’ve all seen the results of the damage that a non-qualified individual can do using a set of rasps, albeit legally - whose idea was it for unqualified people to be allowed to rasp sharp enamel points anyway? 

At the meeting I requested that the BHA take a lead on this and recommend that only suitably qualified EDT’s or vets be undertaking any form of equine dentistry on BHA licensed premises.  Obviously it will be difficult to implement this with immediate effect but I suggested that those individuals working on BHA premises who are not qualified are allowed a period of maybe a couple of years to gain suitable qualifications in order to retain the work.

I have a meeting with DEFRA next week to discuss the RMPR survey where I hope we can progress the subject of equine dentistry further.

Week 14 and counting……

Fortunately the weekend on call, although reasonably busy, didn’t result in me losing too much sleep and so I was able to shake off the jetlag quite promptly.

The main BEVA item this week was the Council Review Meeting, http://www.beva.org.uk/aboutus/MeetTeam/Council, which was held at Trinity Hall in Cambridge.  As a Liverpool graduate I am unfamiliar with the City of Cambridge and its collegiate system.  My only visit to Cambridge as an undergraduate was on a rugby tour and all that I can recall is the pub, the kebab house, the rugby pitches and the fact that we won…. which was a surprise as the players who appeared on the pitch on the Saturday afternoon were definitely not the ones we were drinking with the previous night; I think we’d been entertained on the Friday evening by the 1^st XV “drinking team”.

However, what a remarkable scholastic city, steeped in history and tradition.  Although not all Council members shared my enthusiasm – “There’s nothing makes me want to vote socialist more than f…..g Cambridge,…” exclaimed in the best Lancastrian accent – guess who?

We welcomed 4 new members onto Council at the meeting, namely Gayle Hallowell, Ben Sturgeon, Hannah Yeates and Jon Pycock, who’s doing his second stint on Council – his first one being about 10 years ago.  It was really encouraging in advance of Congress in September that we had sufficient people who applied to join Council that an election was required – did they all think, “If Harrison can do it then anybody can”.  For those of you who weren’t successful this time or others of you considering Council, I strongly encourage you to apply next year – you really will get a lot out of it.  I urge more practitioners to apply, particularly female ones - after all that’s the vast majority of members, which the Association represents.  If you think Council’s full of “old, male, tweedy farts” (see Blog 7), put your money where your mouth is:

http://www.beva.org.uk/aboutus/MeetTeam/Council/JoiningCouncil

Topics discussed included:

The Association’s Operational and Financial Reports

-          The total membership stands at 2678, only a fraction up on last year.

-          Membership subscriptions can now be paid by monthly direct debit.

-          There is a NEW concessionary rate for those earning < £15K or on parental leave or studying full time for a full time veterinary related qualification.

-          The Scientific Programme for the 2015 Congress is almost completed.

-          The BEVA Database and Website are being re-built

-          The BEVA offices at Fordham are undergoing some renovation works in 2015.

The Role of The BVA

-          The BVA have asked for feedback from the divisions on its structure and governance.

Do we want to be Doctors!

-          I’d rather “vet” something than “doctor” it!

Following the meeting, we had our Christmas dinner, again at Trinity Hall, which included all Council Members and partners and the BEVA Office Staff and all had a late, great night.

The following day I attended the Winter Clinical Workshop at Duxford Airspace, Cambridgeshire, http://www.iwm.org.uk/visits/iwm-duxford, what an inspired choice of venue.   The meeting covered predominantly “Regenerative Medicine” and its use in orthopaedics – New Treatments for Lame Horses – Do They Work?  It was a really informative day and was fully subscribed with over 75 attendees.

Over Xmas – the BEVA offices closed down although I’m lead to believe that DM is “beavering” away behind the scenes! 

However, no such luxuries at TCEH – although this year Luise and I are both off over Xmas as we both worked Xmas Day and Boxing Day last year.  We were both out till early evening on Christmas day and the kids were Home Alone.  They said it was the best Christmas they’d ever had – they watched the television all day.

Compliments of the season to you all and I’ll catch up in the New Year.

AH

Week 13 and counting……

A quarter of the way through my year already – “Is that all?” I hear David Mountford cry.

Our trip to Toronto airport did involve a stint on the wrong side of the road as I left a “gas station”, which did cause much anxiety for the other driver and my passenger.  So onto Salt Lake City (SLC) via Chicago for the 60^th AAEP Convention – “Howdy!”.  I thought that I wasn’t very well travelled but approximately 70% of Americans don’t have a passport.  But why would you need to in just a huge and diverse country?

Our hosts could not have made us feel more welcome.  On the Saturday night we were entertained at the President’s reception and met up with the outgoing AAEP President, Jeff Blea DVM and his wife, Annie also DVM.  His is an interesting career; his career as a flat jockey of a few years was curtailed after he was involved in a serious riding accident where he was “slammed” into the running rail, which left him with a totally paralysed left arm.  After this he re-trained as a vet and is a now a practitioner who does racetrack work - with effectively only one arm.  I am truly in awe of people like Jeff who conquer serious disabilities to succeed – respect.

The weather was unseasonably warm with clear blue skies and temperatures above freezing.  The Convention format is very similar to BEVA Congress with an opening ceremony and plenary lecture, which most delegates attend, followed by multiple streams running concurrently, but as you would imagine it was a lot bigger.  Also I’ve never seen so many Stetsons or cowboy boots in one lecture theatre.

The plenary lecture was delivered by Marvin Beeman DVM, an 82 year old practitioner who still works a 4½ day week in the mid-west and hunts twice a week during the season.  He gave a very thought provoking and inspiring insight into his work ethic both as a professional and a businessman.  He invited us to join him and his family at the Convention dinner on the Tuesday night - what an inspiration and he fully deserves to be wearing the crown!

There were a handful of UK delegates including Nenad Zilic , from Barn Equine, Sue Dyson, Lynn Hillyer, Tim Mair representing Equine Veterinary Education (EVE), Roger Smith, Chris House & Jane Jackson, Rob van Pelt and our very own David Mountford.  Even Gavin from BCF made an appearance in the trade-stand area (which as previously mentioned was a lot bigger) and managed to lure me into buying one of their new DR systems – it’s ok the deal wasn’t clinched in the bar and my partners do know.

There were several opportunities to collaborate with the AAEP – for example, there was an evening meeting of their Internship Awareness Program (sic).  This involved approximately 60 equine clinics, usually called hospitals, advertising their wares in an informal setting to undergraduates and recent graduates.  Their programme is far more advanced than BEVA’s Internship Awareness Proogramme but gave us some good ideas as how to progress ours.  David and I also had an informal meeting with a company who are keen for BEVA to collaborate in an Equine Veterinary Conference in China in the latter part of 2015.

 

SLC is another 2 hours behind Toronto causing even more disruption to my sleep patterns.  Every morning I was wide-awake at 3 am regardless of the time I went to bed.  Understandably, I vacated the room and was in the “lobby” by 3.15am doing emails etc..  It’s not unusual for me to be in the hotel reception at 3.15 am at BEVA Congress but not usually doing emails!  The return journey coincided with my body clock having finally adapted to the SLC time zone.  It was an overnight flight arriving in Heathrow at 11am and then straight back to work and into a weekend on call….

Week 12 and counting….

I had a late night on Sunday trying to submit my application to the RCVS for Advanced Practitioner Status, http://www.rcvs.org.uk/education/advanced-practitioner-status/, before the closing date of, err…Sunday night.  Nothing like a deadline to focus the mind – bit like exams really!  I struggled with the technology but just dipped in under the bar.  I believe I wasn’t the only one with the middle name, “Justin”: in the final week leading up to the deadline the number of applicants rose from about 250 to 700, (approximately 40% of which were equine) - good to hear I was in good company.

The rest of the week until Wednesday night was in the practice culminating in our annual dinner for our referring vets at The Corse Lawn Hotel http://corselawn.com/.  The evening ended sampling malt whisky at 2am with our houseguest, Henry Tremaine.  This was followed by a 7am departure to catch a flight to the 60^th AAEP Convention in Salt Lake City http://www.aaep.org/info/annual-convention-318.”I was buckin’ and squealin’” as Liam Kearns, one of my partners would say.  We dropped Henry back at the hotel to collect his car and wended our way to Heathrow, finding an “early starter” en route.

On our way to Salt Lake City we stopped off at Toronto to spend a couple of nights with Luise’s uncle, University Professor-Emeritus Geoffrey Sumner-Smith DVSc (Liv), MSc, BVSc FRCVS – that number of letters after a name was never going to be from my side of the family!  Geoff qualified from Liverpool in 1951 and after spending a few years in large animal practice in Malpas, Cheshire, followed by some Small Animal practice in Bristol, moved to Ontario Veterinary College (OVC) at the University of Guelph in 1967 for a 2 year post – and in his words, “…I’ve been here ever since”.  Geoff was one of the pioneers of internal fixation (AOVET) in small animals and has published widely on the subject of small animal orthopaedics.  Obviously we had to visit the OVC, where Luise also spent 12 months as an intern from 1987 to 1988.

Another early start on Saturday, which didn’t matter, jetlag had already kicked in, for our flight to Salt Lake City via Chicago.  I’m an early riser most days but 3am is even a shock to my system!

So, to the US to experience The Great American Dream….

Week 11 and counting…..

It’s probably been the quietest week so far from a travelling perspective, although that doesn’t stop the emails coming in thick and fast – (approximately 50 – 60 per day).  Only one trip to the “big-smoke” on Thursday afternoon for a meeting, the Equine Insurance Forum (EIF), with representatives from the insurance industry, including KBIS, NFU, SEIB, E&L etc..  The meeting was held on the 15^th floor at Catlin Insurance, situated in the heart of The City – what a vista - and the insurers are crying poverty: I wonder how many responses that comment will get?

The “insurers” had already had a meeting in the morning, which included one of their veterinary advisors, who was also present at our meeting, Paul Farrington MRCVS, who I haven’t seen for some time.  The seating arrangements did confer a feeling of us (David M, Huw Griffiths and me) at one end and them (including Paul F) at the other – whose side is Paul on I ask?

There were many issues raised, including the discussion points raised on EVG earlier in the year, which at the time came across as quite a “full-on” insurance bashing session.

Owners tend to compare horse insurance with their car insurance, which as the facts below indicate, is comparing apples with oranges.

Equine Insurance Key Facts:

-                          approximately 1 in 4/5 Vet Fee policy holders makes a claim per annum, which is far higher than any other policy type, e.g. car insurance is approximately 1 in 100….I bet I’m higher than that.

-                          The average claim is approximately £1750

-                          85 – 90% of Vet Fees is on diagnostics

-                          Car insurance doesn’t cover for mechanical repairs, which would I suppose is equivalent to a fracture repair or colic surgery.

With these facts in mind I think that Equine Insurance is good value for money and that we should promote it to owners as such. 

One of the valid discussion points raised on the forum was that the cost of insurance becomes prohibitively expensive once horse numbers exceed 2 or 3.  Inevitably in that situation, it is always the uninsured individual, which gallops through the fence or gets colic!  A possible solution to that scenario is for the owner to be strict about putting the insurance premium into a savings account for that rainy day and they can spend it on the, likely only one horse, which does have a problem.  After all, insurance policies are just another savings plan for that rainy day.  Good idea in theory but the reality is the Harrison’s (Luise) would just spend it!

Other issues included the reason why insurers don’t pay vets directly as BUPA or other insurers pay our medical fees directly to the provider.  It is related to the fact that the with vet’s fees the insurers indemnify the policyholder’s loss, i.e. costs for treatment, whereas with, for example BUPA, the insurer provides the “medical service”.  This automatically lead into the subject of the insurers expressing their desire to explore the option of using preferred providers, which would result in practices automatically being paid directly.  This is a subject which is very topical for TCEH at the moment; a client has very recently been paid by the insurance co. (over £2K for a nearly £3K bill) and the money, “has been swallowed up by my bank account”!.... I love my job.

The insurers did also ask us to remind our members that the £5000 vet fee cover on most policies is a limit not a target.

Week 10 and counting…..

It’s been a far quieter from a BEVA perspective this week - thank goodness!  I did make a “cameo” appearance at TCEH – I thought I’d say it before my colleagues did.

However, it has given me time to catch up and also time to reflect on last week’s activities.  There were so many issues raised during the FEEVA PPE meeting, which I mentioned last week.  There are so many similarities and yet so many differences between the whole process of PPE across Europe.  For example, the majority of European countries do not see the horse ridden during the examination.  The period of strenuous exercise is performed on the lunge or loose schooled.  In many European countries, it is the buyer who engages the vet to perform the PPE, which inevitably results in the seller paying for the examination.  On that note, in Denmark, if the horse “passes” the buyer pays and if the horse “fails” the seller pays.  Which brings into question the issue of “conflict of interests” in such circumstances.

On Wednesday night I gave a joint presentation with Hereford and Worcester Fire and Rescue Service (HWFRS) entitled “Large Animal Rescue” for the Wyvern Veterinary Society, probably one of only a handful of the BVA Divisions, which is still active.  The evening was divided into a formal lecture, outlining the vet’s role at rescues followed by a practical demonstration by HWFRS under the floodlights on the 1^st team pitch at Bromyard RFC.

Lamenting the Demise of (some of) the BVA Divisions - when I first started in practice my local division was the Lancashire (and Cheshire) Veterinary Society, which at the time was the epitome of a Divisional Veterinary Society.  Sadly it is now in the process of being disbanded.  It was the perfect opportunity for a new graduate to the area to meet and socialise with local colleagues and encourage good inter-practice relationships – working with J B Johnson, the consummate politician, I was never going to be destined to a life of all work and no play.  Not to mention the CPD element of the meetings.  Following that I joined the Cotswold Veterinary Society (CVS) and acted as Treasurer from 1996 till it’s disbanding in the mid 2000’s.  At CVS we discontinued the programme as attendance waned to embarrassingly low numbers, where on occasion there were more organisers, speakers and sponsors than there were delegates.  With far more CPD available, including Webinars, which can be viewed in the comfort of your own home.  However, I think it’s missing out on interactions with colleagues in other disciplines and fragmentation of the profession.  Which leads onto the bigger picture and something closely related, which was a question raised, by the BVA as part of their Strategic Plan & Governance Review, at last week’s VPG meeting (see Blog 9), which was, “What should the BVA do?”  After all they are the over-arching, non-species specific body representing the whole profession.  Ask yourself, “What do they do for you?” and “What should they do for you?”  Have your say and feedback to the BVA directly or via the BEVA office.

I attended the BVA Gala Dinner at the Chelsea Harbour Hotel on Thursday night, which was the most stunning location.  Fiona in the BEVA office had organised very reasonable accommodation for me in the shadow of Stanford Bridge.  I haven’t broken the news yet to my brother-in-law, a die-hard Chelsea fan.

I attended the London Vet Show (LVS) at Olympia on Friday where I met up with a couple of classmates from uni, Johnny Carr and Miles Williams, who I’ve barely seen since graduation.  Another classmate, in fact housemate, John Cook, who I’ve seen only once since graduation, delivered a lecture at LVS on the Thursday.  Meeting up with these former colleagues coupled with the sheer size of the commercial exhibition made me realise that as a horse-vet I’m only a small part of a far bigger industry – which is a good thing and long may we remain united.

Finally, it has been brought to my attention this week that the British Horseracing Authority’s (BHA’s) detection time for omeprazole of 72 hours is based upon the drug being used at the manufacturer’s recommended maintenance dose of 1mg/kg (¼ of a syringe) for 28 days.  However, in reality many trainers use a maintenance dose of 2mg/kg (½ syringe) once daily.  When used at this dose rate it is very likely that a positive test will ensue.  Please advise your trainers accordingly and recommend that they allow a greater drug withdrawal time, when using omeprazole at this rate.  Unfortunately there are no data available, which can offer a reliable detection time when the drug is used at a dose rate of 2mg/kg SID.

Better late than never…..