Practice Profile: Southern Counties Veterinary Specialists

Staff: full-time vets 55 • specialists 27 • clinicians 3 • residents 18 • interns 10 • registered veterinary nurses 77 • student nurses 5 • VCAs 28

It would be fair to say that SCVS has become something of a behemoth since first opening for business in October 2008 at Forest Corner Farm in Hangersley, near Ringwood.

What started as an orthopaedic and cardio-respiratory referral service run from a first opinion practice is now one of the largest multi-disciplinary centres in the UK.

The latest development, completed in October last year, saw SCVS’ footprint more than double with the addition of a new two-storey building, which now houses reception, 10 consult rooms, lecture theatre, offices and meeting rooms, as well as a separate hydrotherapy/ physiotherapy facility and surgical theatre complex.

At 30,000 sq ft, the practice joins a growing number of other super-sized centres, including the likes of Southfields, DWR, Willows, Paragon, Davies and IVC Evidensia’s new Blaise hospital, which is due to open in Birmingham later this year.

Like those other referral practices, SCVS has become a true multi-disciplinary operation over the past decade, with anaesthesia, dermatology, diagnostic imaging, internal medicine, neurology, oncology, ophthalmology and soft tissue surgery added to the original offering of cardiology, orthopaedics and rehab.

It’s a far cry from the early days when the business occupied one small business unit in a corner of a site it now dominates, as clinical director Stephen Collins explained. He said: “We have been planning this latest development for some time. Because we are located within the New Forest National Park, we had a lot of challenges around planning, so it was imperative that we created a facility in keeping with the surrounding environment, sympathetic to wildlife and our neighbours.”

Something the team clearly got right as earlier this year the new development was awarded the New Forest National Park Design Award for Best Non-Residential Building.

Stephen continued: “We worked closely with our architect Kevin Jones and his team at Sheerin Bettle Associates (the same firm that designed IVC Evidensia’s new Blaise hospital) and ended up with a facility that works exceptionally well, and which the clinical staff and clients are really pleased with.

“It has been a long journey getting to this point. We opened a hydrotherapy and behavioural training facility on the site in 2005. At that time our referral services had been running out of Cedar Vets in Ringwood (partners Chris Trickey and Stephen Collins).

“Space was getting very tight, so we decided to relocate the referral service to the same site as the hydrotherapy facility. SCVS was founded, with Harry Scott (orthopaedic specialist) joining the partnership team. We converted the original hydro facility into a dedicated referral-only hospital, opening for business in September 2008.”

Latest development

Back then SCVS employed just 15 staff, but after a decade and a half of constant growth the team now numbers more than 200 people.

To keep pace with such rapid expansion the partners grabbed existing units at the site as other businesses vacated, and while planning consents were a challenge in the early years, over time veterinary planning consent was granted for the whole site, allowing for the more recent developments to be more strategically managed.

The cornerstone of the latest round of work is a new two-storey building that has added a spacious new reception and waiting area with a private waiting room for sensitive cases, 10 new consulting rooms and additional out-patient procedure rooms.

All consult rooms are bespoke to the various disciplines on offer and, despite cats only making up 10% of the caseload, SCVS’ International Society of Feline Medicine cat-friendly gold status means feline patients are well looked after.

The redevelopment also delivered a new physiotherapy and hydrotherapy suite, with a water treadmill and dedicated physiotherapy consulting room, as well as a large arena area with gait analysis capability.

On the first floor of the new building there is a large staff area, including offices, meeting rooms and kitchen, as well as a new lecture theatre for hosting on-site CPD events and teaching and training of the large team of resident vets, intern vets and training nurses at SCVS.

Theatres of dreams

Aside from these new facilities, the £10 million investment has also delivered a separate theatre complex, which includes five new surgical theatres, all with advanced equipment to expand the level of treatment offered on site.

The theatre block was designed to optimise infection control, with only theatre staff able to enter and movement strictly controlled with automated doors throughout and separate staff and animal entrances.

This area has been divided into a “clean area” and a “sterile area” where the five theatres are located; each designed specifically for neurology, cardiology, orthopaedic and soft tissue surgery and ophthalmology.

Again, infection control was key, with all five theatres using a positive pressure ventilation system ensuring outward air flow at all times.

The sterile zone also houses a spacious instrument prep area featuring a washer-disinfector (MMM Uniclean PLII 10), twin steam sterilisers (MMM Selectomat PL) as well as anprolene sterilisers (Andersen AN74 and EO Gas 4) and a Miele professional laundry for washing theatre uniforms.

In the “clean” area there is a large anaesthesia prep room, as well as quiet induction room (cats, nerve blocks), x-ray room, holding kennels and staff kitchen/office area.

Stephen said: “Although we had a decent budget, we had to balance spending carefully. Equipment choices were a blend of new and ex-NHS purchases, allowing us to equip the hospital to the very highest standards. We installed a brand new Fuji Visionary x-ray room and Brandon theatre-lighting system, for example, but purchased ex-NHS theatre tables for a fraction of their original cost.

“There was a lot of consultation between the clinical teams and the architectural teams at design stage, and we worked hard to get the hospital working from a vet’s and nurse’s perspective.”

Development continues

Stephen went on to explain that developments at SCVS are not quite complete. As part of the £10 million investment, some of the older buildings on the site are set to be totally redesigned and refurbished, creating a new diagnostic imaging suite including new MRI facility (Siemens Altea 1.5T MRI), improved CT facility (Siemens 64-slice ECG-gated Somatom), a second x-ray room (Fuji Visionary system) and two dedicated ultrasound rooms.

This work will also deliver new medicine and oncology areas with dedicated endoscopy, fluoroscopy and chemotherapy rooms, as well as a dedicated neurology area as part of the new MRI development.

Stephen added: “We are in the process of sorting out detailed architectural planning for that now and are hoping to start building this next phase March-April time, which will hopefully be ready for clinical use this time next year (October 2024).

“Further to that we are planning to re-organise some of the remaining buildings, which will include an extension to our hospital ward capacity and the development of an extended ICU, HDU and isolation facility, as well as improved hospital dispensary and staff facilities.

Stephen concedes that the ongoing redevelopment of the site would not be possible without the backing of IVC Evidensia, which purchased the practice in February 2015.

He continued: “There is no way the original directors of this business could have kept up with the level of demand for an ever-increasing range of services or build the facilities and provide the volume of clinical staff needed to provide them.

“Joining IVC Evidensia meant we were able to make these investments and ensure that we could continue providing (and developing) the level of expertise and service that our referring vets have come to expect from us.”

Wider responsibilities

The near-exponential growth seen in the UK’s veterinary referral sector in the past decade or so has, according to Stephen, been largely client driven. And in this respect, the veterinary sector has mirrored many of the advances in the human sector.

Not so long ago, the owners of dogs and cats with serious conditions and diseases had limited options, but advanced technologies and growing clinical expertise in recent years has meant those options have increased dramatically. Another reason behind the rapid rise of referral services is – at least anecdotally – an increasing tendency among some GP practices to refer cases that might have been handled in-house in the past.

Stephen added: “There is certainly some complex stuff that GP vets shouldn’t be tackling in practice, but we have seen a trend towards less complex cases being referred as well. There are probably a variety of reasons for this, such as, less out-of-hours cover within their own practices, fear of litigation, less opportunity for skills development within their own practices. A lot of vets have sold their practices and retired, so we have lost a significant number of senior vets (and mentors) in the GP environment.

“I would love to see a future where centres like SCVS could play more of a role helping and mentoring our colleagues in general practice, welcoming them into this referral environment and giving them opportunity to learn and develop their own skills.”

Stephen also spoke about the future of referral practices and what that might look like. Although this is a controversial subject for some, he believes strongly that the profession needs middle-tier as well as specialist-level referral offerings. “Ultimately, the level of service that we’re offering here is not going to be for everybody, so it’s about keeping enough people out in the community with certificate- level skills who can help service the needs of the pet-owning public,” he added.

“It’s not just a cost issue, but also access.”

Stephen attained his RCVS Diploma through an alternate track residency, but this has not been an option for more than a decade, with the only two routes available through either European or American specialist colleges.

Positions for residency training have been in short supply and this has led to an ever-growing shortage of specialist vets across the sector.

Stephen said: “I think there’s a need in the profession for alternative track residencies, and more opportunities generally for career progression, be that specialist, certificate holder or GP level.”

The future of referral

Like other referral centres, Stephen and his team remain mindful of the pressures put on their clients by the current cost of living crisis. And, despite popular perceptions that referral is a high-profit business, Stephen explains that margins are far tighter than most people would suspect.

He said: “The cost of running a centre like this is huge. Aside from the cost of investment in building and equipment infrastructure, there are very substantial costs in maintaining a genuinely multidisciplinary referral offering 24/7. One of the biggest on-going challenges in the referral sector is recruiting and retaining specialist teams of vets and nurses, where staff costs are relatively high because we (the profession) are not training enough people.

“To some extent we have weathered that storm at SCVS by training our own residents, many of whom have stayed with us when they become boarded specialists. By having the right balance of specialists and residents we have been managing to keep the services we offer affordable, but it is not easy.”

Since the new building opened last year, SCVS has seen an increase in its caseload and it seems the story of continued growth looks set to continue.

Stephen concluded: “The team at SCVS is very excited about the next few years, and very much looking forward to using the improved facilities to deliver an ever-better veterinary referral service.

“We are very proud of what we have achieved at SCVS and visitors are very welcome to come along and see for themselves. We are keen to use our expertise and facilities to help our colleagues out in the veterinary community in whatever way we can; be that with referred cases, helping them with their CPD and career development, or just providing advice, support and maybe inspiration.”