The Dedicated Ophthalmology Referral Practice

Veterinary Business Journal August 2003 pg 2

The perfect site

Long ago, Paul had spotted what he was sure was the perfect site for a new hospital by a roundabout on the A49, the main Leominster-Hereford road.

Unfortunately, the local farmer who owned the field was not prepared to sell. “The land had been in their family for three generations and the story had been passed down that ‘that field is going to be worth something one day’. Eventually, I was able to persuade the current owner that his ship had come in,”Paul recalls.

These negotiations held up the project for nearly two years, but this delay had an unexpected benefit. Paul had shown his original plans to Joe Wolfer, a Canadian friend and fellow veterinary ophthalmologist.

Dr Wolfer was so impressed with the design that he borrowed the plans and used them as the basis for designing his own premises in Toronto. That project proceeded without a hitch and so on a trip across “the pond”, Paul was able to see a full-scale, three-dimensional representation of his new premises before the first turf was cut.

The first floor office and conference room

Paul had drawn up the plans in collaboration with a local architect, David Taylor, who had trained as a planner and had developed a good working relationship with officials at the county planning department.

The selection of a building contractor was also a straightforward matter. The farmer’s son ran his own building firm and it was a condition of the land sale that his firm should be given the contract, rather than it going out to tender.

This form of negotiated contract is not unusual in the building trade and with the architect acting as honest broker between the two parties, the arrangement worked very well, Paul explains.

Building work began in August 2001 and was finished on schedule in April 2002, at a total cost of about £800,000 including the £200,000 price of the two-and-a-half-acre plot.

But the project was not entirely trouble-free: the original plan to finance the building entirely through a SIPP (self-invested pension plan) hit the rocks of bureaucratic intransigence on the part of GOWM (Government Offices West Midlands), the local quango which was providing an enterprise grant.

So Paul had to seek an additional loan from his bank, HSBC.

Equine patients make up a significant part of the practice’s caseload: Izak Venter carries out an examination.

Also, there were a few minor glitches during the building work ­ including a fault in the underfloor heating in the prep room that caused hot water vapour to be forced out of the concrete subfloor, lifting the entire vinyl floor covering.

So it was not until June this year that the practice was able to hold the official opening, with the ceremonial duties performed by Keith Barnett.

The vinyl material used for the flooring also covers the walls and ceilings throughout the surgical areas and allows all surfaces to be thoroughly and efficiently cleaned.

The positive pressure ventilation alarm: when the red ball appears in the tube, it is not working.

Meanwhile, on the walls of the theatres and prep room are small devices containing red and green ping-pong balls to indicate that the positive pressure system is functioning properly. Paul spotted both of these features during a tour of Astra Zeneca’s research laboratories in Cheshire.

But apart from a relatively small number of kennel spaces needed in a low-throughput referral centre, the overall design and layout is not that dissimilar to that of any other modern veterinary practice.

Erecting a building that could readily be used as a general first opinion practice was always part of the plan in case Paul decides at any stage to sell the business. In addition, the design allows the option of creating a “mirror image” building on the western side to provide facilities for other referral disciplines.

One of the operating theatres

One factor that does distinguish the building from first opinion practices is the quality of the diagnostic and surgical equipment. Although most pet owners are only just beginning to come to terms with the idea of veterinary referral practices, the profession is already on the point of taking the concept a stage further, Paul suggests.

Even within such a small fraternity as the veterinary ophthalmology field, there is a further level of specialization due to the complexity of the equipment and the clinical skills used to operate it.

As a consequence, veterinary ophthalmologists are increasingly ready to refer on their own referral cases to their colleagues. So Paul is often asked by his peers to examine cases requiring techniques such as electroretinography (ERG) or laser diode surgery.

Such technology is obviously costly, but while about 40 per cent of clients are covered by pet insurance, the remainder are prepared to dip deep into their pockets to restore their pets’ sight.

Paul calculated that he needed a 10 per cent increase in turnover to service the debt on the new premises and at least 15 per cent before his accountant shed his anxious expression. Happily, during the first year the business more than met that target, and the turnover has continued to expand into the second year.

Like many colleagues in a similar position, Paul points out that referral practice is no sinecure.

“In a professional job there is no easy way to earn a living, but this is a very challenging and intellectually satisfying way to go about it,” he says. However, the job does require a willingness both to work hard at maintaining the highest standards and to go that extra mile in serving the needs of referring practices, their clients and their animals.

The practice has an unusual environmentally-friendly approach to sewage treatment: waste water is run through a reed bed system before going into a small pond which is rich in aquatic life.

Increasingly, this is becoming literally true. One of Paul’s recent cases involved a trip to Malta, taking his travelling microscope and 76kg of excess luggage to treat cataracts in an 850g Yorkie.

On other occasions he is even prepared to take a step further. Another animal treated at the practice was owned by an executive from one of the major IT companies, who was about to take a job at the firm’s headquarters in Silicon Valley, California.

“Who could you recommend to carry out the follow-up examination in a few months’ time?” the client asked.

“Don’t worry, I will do it myself,” said Paul, knowing that he would be passing through San Francisco later that year en route to the American College of Veterinary Ophthalmology meeting in Hawaii.

It is probably unlikely that house calls involving a 10,000- mile round trip will ever become a routine part of referral practice ­ but given the rate that it has developed during the past decade, who can say that it won’t?

Ground floor plan
click to see a larger version

First floor plan
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Paul Evans operating

Boris, the practice’s most famous patient to date: the news agency story about this Siberian eagle owl’s operation for cataracts was picked up by papers around the world.