Navigating COVID-19 for Veterinarians in Practice in Australia – 30 March 2020

Dear Veterinarians and Amazing Support-crews,

As you well know we are in unprecedented times in social, economic and health terms. We are all swamped with (and I don’t even want to mention it as I feel saturated from every angle with it) COVID-19 news. https://COACHINGLINK.as.me/IntroCall

However, there is a lot of information being pumped out about how to implement safe practices and complying business as veterinarians in a scenario where Government has decreed only essential businesses may remain open and everyone else needs to uphold self-isolation – so I thought I would sort through some of it for you and provide some reputable links.

For those who don’t know me, I am a veterinarian and work as a veterinary career and business coach, a locum, a mum (homeschooling – WHAT?!!) and I am a small business owner myself who contracts and employs workers so I have been working to get across the different resources and supports in place for all of us. I will provide more on the supports available later – but first lets look at the puzzle presented to veterinary business this week – how to maintain veterinary practice and business in the current environment.

Please note that this isn’t formal advice – and you will need to seek and use your professional advisors such as your veterinary registration body, the Australian Veterinary Association HR Team, relevant legislation, your accountant and legal advisors to formalise the advice that is correct for your personal situation. But I hope this little collation is a useful collection of information.

Veterinarians and continuance of veterinary services

·       On 27 March 2020, the Australian Veterinary Association advised that in Australia veterinarians were deemed an essential service by the government. The only restrictions were for vets to practice social distancing and hygiene practices, also vets can apply for an exemption to cross State and Territory borders for essential work purposes. See media release at: https://www.ava.com.au/coronavirus/vets-an-essential-service-during-the-covid-19-crisis/

What does being an ‘Essential Service’ subject to social distancing and hygiene practices mean for veterinary businesses?

How this will be applied to registered veterinarians and approved veterinary premises is ultimately at the discretion of the relevant legislating bodies – each State and Territory Veterinary Surgeons Board. However, it is reliant on the veterinarian’s professional judgement to uphold the governments requirement that only essential services are provided, and it is upon us to uphold the integrity of our profession to interpret this status and ability to work with due respect for the gravity of the situation at hand. Thus, in my reading of it, we should not be looking to continue business in any way usual and status as an essential service will mean some versions of:

1.       Veterinary premises can continue to offer some services in an altered manner.

2.       Many traditional consultations where the owner and the vet are in proximity co-handling the animal cannot occur.

3.       That social distancing measures must be implemented to protect staff and clients (under WH&S legislation)

4.       That creating a team’s approach to staffing – where a vet, nurse and receptionist works together as a team is a useful way to limit unnecessary person to person contact when we then minimise this teams interaction with other teams.

5.       That a minimum 1.5m distance between each person (approximately 4m2 floorspace per person indoors) must be upheld in the workplace and in the waiting room, so the practice must adopt new processes for handling clients, animals, payments and people waiting in the practice waiting rooms.

6.       That routine surgeries and procedures should be deferred and only services essential for the current health and welfare of pets be undertaken.

There are several inventive protocols that a veterinary business can implement to uphold these requirements and stay functional. I have heard of client-free consultations where owners are called before during and after the consult but remain outside the consult room while the animal is examined, some clinics have restricted clients to one person presenting with the animal per consult and of course there is now the emerging possibility of veterinary telemedicine – as below. The AVA has provided some useful guides on this topic which can be found here:  https://www.ava.com.au/coronavirus/covid-19-risk-management-for-workplaces/

What about telemedicine?

Alongside the interpretation of ‘veterinarians as an essential services’ the use of telemedicine will currently be being discussed by the veterinary surgeons boards in Australia, each jurisdiction will develop its own specific rules – the AVA posted their guiding policy here. At a high level the AVA recommends that:

·       Veterinarians conducting veterinarian-to-client telemedicine consultations must ensure that they are registered to practise in the state or territory in which the patient is located, or that their current registration is recognised in that jurisdiction. They must adhere to the relevant legislation in both locations, if the animal resides in a different jurisdiction.

·       A bona fide veterinarian–client–patient relationship must be established, except when acting only in a tele-triage (emergency) capacity, or in an emergency health situation where human face to face contact is not advisable.

Each Veterinary Surgeons Board will have the ultimate decision on the conditions of telemedicine in their area, as relevant and covered by their legislation and the policy they implement. It is imperative that you check and abide by the approach to telemedicine provided by the VSB you are registered with. Links to your Veterinary Surgeons Board policies on telemedicine can be found here on the Australian Veterinary Boards Council (AVBC) site (the AVBC oversee the Australian veterinary boards).

Notably in the UK the Royal College of Veterinary Services (the singular UK registration body) has provided temporary permission (of 3 weeks) for veterinarians in the current scenario to undertake telemedicine consults and dispensing to cover the immediate need, they will be reviewing this and providing an update in the next week.

Not all States and Territories in Australia have published their approach to telemedicine – but in NSW the guiding policy states that:

1. Technology-based patient consultations must only be performed by a person registered as a veterinarian in both the State or Territory in which the animal patient is located and, if different, in the State or Territory from which the veterinarian provides this service

2. Before agreeing to perform a technology-based patient consultation the veterinarian must be satisfied that this form of consultation is appropriate in the circumstances and does not in any way compromise the safety or welfare of the patient

3. When providing technology-based patient consultations for animals located in NSW and when providing technology-based patient consultations from within NSW for animals located outside NSW veterinarians must abide by the Regulation (sch 2) Veterinary Practitioners Code of Professional Conduct (Code)

4. Veterinarians providing technology-based patient consultations must ensure they understand the legislation, policies and guidelines of both the jurisdiction in which they are based and the jurisdiction in which the animal patient is located

5. Veterinarians based in NSW may provide technology-based patient consultations from either licensed premises (hospitals) or unlicensed premises

However PLEASE NOTE this only applies if you are registered with the NSW Veterinary Practitioners Board, and you must check the conditions and limitations of your own registering body. I will endeavour to provide further information as it becomes available.

How can I protect my veterinary practice team? 

Obviously, veterinarians are skilled in managing infectious agents, however your junior staff and clientele might not be, and as the veterinarian and/or business owner it is your responsibility to provide leadership and sound approaches to minimising risk. Appropriate ways to protect your team could include:

1.       Pre-screening phone calls for all people intending to attend a veterinary practice.

o   Ask them about their health, and

o   Any known history of being put in contact with a potential COVID19 risk, or

o   If they are currently in isolation for COVID-19 – and if so advise them they should not attend the veterinary practice (nor be leaving the home they are self-isolating in), and

o   Assist them to arrange suitable care for their animals.

2.    Lead by example: Through taking personal responsibility in implementing the social distancing measures and Personal Protective Equipment (PPE) seriously. From this position you can strongly encourage others to comply as well – and by not partaking in any veterinary related scenario that are clearly in breach of the guidelines vets are to be operating in, sadly even a couple of days ago I had heard of business as usual consulting occurring.

3.   Prudent usage of Personal Protective Equipment (PPE) We need you to be protected, but we must understand that supplies of PPE are limited in Australia currently and  we should use them thoughtfully and be respectful that the call might come for equipment and PPE to be diverted to the medical staff who are working in close contact with COVID-19 infected patients. For more information please go to: https://www.ava.com.au/coronavirus/reuse-of-surgical-or-p2n95-masks/ 

4.       Providing practice protocols for your staff around how to run altered consultations and uphold social distancing. Then seeking feedback from your team as to how the system is working and if they can see any easy ‘tweaks’ to the system that will result in a better and/or safer outcome for all involved – and updating the protocol and the advice to staff appropriately.

5.       Providing calm leadership for your team in a time of social upheaval your team will look to the business owners and veterinarians for leadership in navigating such tricky times. As leaders we can give regular clear, calm updates on what you know and what you are doing to manage the business and its valued staff through this unknown situation. Highlighting that you value your team and are taking action for them will help in itself.

Stressed people make mistakes, so it is upon the leadership of a business to set a high standard and a calm tone with lots of steady communication to successfully steer their team safely through this time. Notably you don’t have to have all the answers in every instance – but communicating honestly and earnestly that you are working on it for them and indeed are finding out answers will help mitigate the level of stress they are feeling also.

I hope this has been of help – if you have comments or if this has raised questions for you – please send them through to me at: myveterinarycareer@gmail.com

~Love Your Veterinary Career ~

from Dr Emma Davis BVSc, Veterinary Career and Business Coach