Practice Profile: Eastcott Referrals Veterinary Hospital

Staff: full-time vets 40 • registered veterinary nurses 53 • practice administrators 37 • vet interns 6 • student veterinary nurses 17

When VBJ paid a visit to meet the team at Eastcott Referrals, the practice was just settling down following an ambitious expansion programme that had taken 18 months and more than £3 million to complete.

The project – finished at the height of lockdown – has expanded the site significantly and delivered a new emergency and critical care (ECC) unit, a sector-leading dental suite, three extra operating theatres, a new super-powerful MRI machine and – among many other things – a medicine investigation room.

It means the practice now covers all the main referral bases with cardiology, dentistry, neurology, diagnostic imaging, ECC, ophthalmology, internal medicine, oncology, oral and maxillofacial surgery, orthopaedics and soft tissue surgery available under one roof.

So despite the fact the newly expanded building now boasts more than 4,000 sq ft of clinical space – with another 4,000 upstairs for labs, training rooms and a new staff room – every inch of that space is used, especially with a thriving first opinion operation still based in the building, too.

This has always been a busy practice, but it is clearly a very different world from the days when Eastcott was still based on the other side of town in Cricklade Road.

The journey

Peter Southerden, a European and RCVS-certified specialist in veterinary dentistry, said: “We are so proud of the journey we have made as a practice, and obviously very pleased to have completed such a significant amount of work. We can do so much now; I came home the other day and told my wife Ibby that the team had been doing some brain surgery, and it made me think how different things are and how far we have come.

“I think back, originally we had a very small first opinion practice in a quite run-down building and we didn’t have any kennels for our dogs so dogs had to actually be tied on to little secure points on the wall in the operating room and there was an occasion, I think I was in the consulting room, where the sink fell off the wall – it was fairly basic stuff.

“We have seen such a fantastic transformation in the business over the years to now – we’re at a point where we’ve got a brilliant primary care service, but we’ve also got a multidisciplinary referral service. We’ve now got MRI, we’ve got all of our disciplines doing some fantastic work; I don’t think I could have really imagined it, so it’s been quite a real journey, but it’s been exciting. And that’s all been based on the people who have been with us along the journey.

“We’ve had fantastic clinicians and nursing staff, managers and administrative staff who have all played an enormous part in that, so it’s been good; it’s been exciting.”

Adding to the excitement was the sale of the practice by Peter and business partner Richard Gowshall to Linnaeus in the autumn of 2018 – right at the start of the planned expansion programme. It was not a decision Peter or Richard rushed into, but with the practice growing at between 30% to 40% per annum in recent years, both felt the practice needed more investment to continue its development.

“It was becoming increasingly evident before we were acquired that it was going to become very difficult for us to compete as an independent referral hospital,” added Peter. “We just didn’t have the resources to invest to keep up with what was going on in the wider industry and, therefore, at some point the business was going to have to be acquired by a bigger organisation.

“I think if we look back with hindsight, we’re very pleased that Linnaeus was interested in us and we chose Linnaeus, because – and I think this goes for all people, not just Richard and I – all of us who have been around for a long time were very keen that the ethos of the business was maintained.

“It had to remain a place that people wanted to come to work, and would come to spend a significant part of their career with us, and to do that we obviously have to have an organisation that really values or has a long-term plan for the business, which we’re happy it has.”

Building the business

Two people who know the culture and history of Eastcott better than most are clinical director Duncan Barnes and hospital director Niki Burton. The pair have more than 40 years’ experience at the practice; Niki on the business side of the operation, while Duncan is an RCVS-recognised specialist in small animal orthopaedics and a member of the practice’s early referral team.

Duncan said: “Ida Gilbert, who is our head of ophthalmology, was one of the early referral clinicians with Peter, and then myself and Tim Charlesworth, who started with orthopaedic and soft tissue referrals probably 10 years ago.

“So we started off with those four disciplines and then essentially, over the past four or five years, started to up the referral side of things, so we are now a truly multidisciplinary referral practice and able to accept referrals in all disciplines. We’ve started our neurology service this week, so it’s sort of the final missing piece in many ways. We’ve really got to the point where we can accept pretty much any kind of case, and we would really look to work that up and deal with any kind of case that comes to us really.”

Niki’s background with the practice is just as lengthy, having started with Peter and his team more than 20 years ago as a receptionist before rising through the ranks to become hospital director. In this role, much of the work required to ensure the building work was done on time while the hospital remained open for business fell to Niki.

She said: “Linnaeus bought the practice two years ago – just as we started the building work, right at the beginning. Two different architects, two different sets of builders, the original owners and then Linnaeus. That was a challenge, so we had a structure, a change of ownership, as well as the build going on and referrals growing as quickly as it was, so the disciplines growing at that time, taking on more and more new disciplines.

“So we were closing sections of the building. We were limited; we were growing in terms of our staff numbers so we recruited. Since we’ve been here we’ve probably doubled in size. We’re up to about 160 people. So with new staff coming and limited space because we were closing sections down, I think that was the most difficult thing, moving equipment and people, and being able to provide that service to the patients that are being rushed in at all times.

“So you couldn’t have a gap with offering that service. And then on a Sunday night that department would close down, we’d open up the next one and move them into a different area so that a new section of the building could be worked on by the builders. So it was just closing sections, juggling all the time. And moving departments. We didn’t close the building at any time at all throughout that.”

Building the team

Although the practice is clearly thriving and more than able to compete with other referral centres in the area, such as Langford and Highcroft, recruitment remains a challenge.

With the European or American boards now the only remaining route to specialism following the closing of the RCVS in-practice option, it can be challenging to recruit the clinicians needed, as Duncan explained: “I think there’s a lack of specialists for the requirement that we have as an industry, absolutely, and that’s well recognised really.

“And certainly one of the things that we’ve been really pleased to be able to do is to set up a number of residency programmes and do our bit to try to help that situation, grow our own, but also for the good of the profession really to get those people trained up and out there. It’s fantastic when we grow our own and then keep them because it’s just extremely satisfying to see people go through that development process.”

While finding specialists is a nationwide problem, Eastcott does have a well-developed vet nurse training scheme, as well as a graduate training programme for vets. Niki added: “We do student nursing programmes, so that’s helped a lot of our referral nurses who started as kennel assistants back in the day and have then gone through the student nurse programme, and then we do a similar one with the primary care vets.

“We take on new graduates who have just come out of university and put them through a two-year programme and then they usually end up as part of the primary care team. It’s definitely a good model to work with.

“There was definitely a challenge when you start a new discipline I think – one of the challenges was the specialists quite like to come to a team, so if you’re starting a new area, I found that quite challenging.

“Medicine (and imaging) is an example. Because they’re not coming to a team and it’s new for us, you don’t know what you’re walking into so that was a challenge, although now it’s a little bit easier I think because we’re more established with more disciplines, people are sort of coming to us now and knocking on our door a bit more.”

The new normal

The coronavirus pandemic has, of course, impacted on Eastcott, too, but in many ways the impacts have not been as severe or deleterious to the business as has been the case elsewhere.

So while there have been negatives from 2020, it is clear there have been plenty of positives, too, as Peter added: “If you looked at it from a purely business perspective, we were really hard hit in the month or two around or immediately after lockdown, but if you look at the last two periods [Mars works on 13 four-week periods rather than months in the calendar year] we’re between 30% and 40% up on last year, so we’ve got significant growth, and that growth is coming from both the primary care service and the referral service, which is fantastic.

“I think if we had looked forward from the beginning of the pandemic and said that if by August/September time we’d be 40% up on the previous year, we would have probably not believed it, so that has been great.”

Peter also acknowledged the fact the practice has been luckier than some in that there have been a relatively low level of COVID-19 cases in the area, but the challenge has still been significant. He added: “We had to implement some massive changes in working patterns, putting new safety measures in place and with the way we saw clients.

“But it’s the people who are at the front line who are having to put those new working practices into place. I think it’s been incredible really to see how people have managed that and I think, again, the sort of resilience we have developed and learned in that time as an organisation will stand us in really good stead.

“Nobody would have wished for the pandemic to happen and there’s an awful lot of hard stuff that has happened within the wider world, but from a business point of view there have been a lot of things that have come out of it, which I think we’ll take forward into the future and have helped to develop a lot of qualities within the business that might not otherwise have happened. There’s been a lot of positive stuff as well.”