PetsApp Podcast - Feline Patients and Virtual Care

Description: Thom and Ellie discuss how Ellie decided to become a vet, and her journey to partnership at Castle Vets. We look at the challenges of being a clinic owner and a veterinarian, and explore the incredibly successful introduction of virtual care at Castle Vets. Finally, we discuss how virtual care is particularly relevant to our feline patients.


Thom Jenkins (00:09): Hello and welcome to the first ever recording of the PetsApp podcast. I'm joined today by Ellie Marriott. Ellie graduated from Bristol in 1999, joined Castle Vets in 2005 and became a partner in 2010. Ellie Is an RCVS advanced practitioner in small animal medicine with a focus on feline medicine and has been admitted to the ISFM Academy of Feline Practitioners. So excited to talk to Ellie about all things cat today. Welcome Ellie.

You and I met back in January, but I want to start a bit before that, when and how did you know you wanted to be a vet?

Ellie Marriott (00:46): Oh, that was a bit of a funny one, really. I didn't have a huge calling to become a veterinary surgeon, which is unusual, I think in our profession. I was really interested in science - my dad is an academic and a scientist. So I knew I wanted to do that, but I didn't want to work with people. So I didn't want to be a doctor because that was working with people. And a friend of mine at sixth form was like, 'Oh, just shut up Eleanor and apply for veterinary medicine because we know that's what you want to do really.' Um, and so I listened to her. What I discovered when I became a vet, is actually being a vet is a lot about looking after people, you know, interacting with people. But contrary to what my 17 year old self thought, I actually really enjoy that. That's my favourite part of the job - making people happy and obviously looking after pets, but it's a nice mix.

Thom Jenkins (01:42): Definitely, definitely. It's that collaboration with the owner to make sure that pet gets what they need.

Ellie Marriott (01:48): Yeah, absolutely. That's it. And it's like different people have different needs and wants. And I think the nicest thing about being in general practice is you have a real spectrum of people with different beliefs about their pet and different wants. And we get to do a whole different range of things from very basic medicine to really advanced stuff.

Thom Jenkins (02:10): Yeah. And you've now been a partner at Castle Vets for what a decade? How has that changed?

Ellie Marriott (02:16): Yeah, well, that's just flown by. I just can't really believe it's been that long really. And there's been a lot of learning on the job and the practices changed a lot since I became a partner. We are a lot bigger team now - probably three times what we were in terms of nursing and support staff. So it's been, it's been a journey and I'm still learning all the time. I love it. Yeah. It's, it's hard sometimes, you know, to be running a business, where, I'm still working full time as a clinical vet as well, but yeah, I really enjoy it. It's another, another challenge.

Thom Jenkins (02:50): Yeah. And involves working with people on a whole other level.

Ellie Marriott (02:55): That's right. Yeah absolutely, human resources is a whole kind of area. Which is a big challenge I think. And, you know, just learn learning every day about that is fascinating. I did do some business modules with the University of Liverpool as well to finished my CertAVP. Because I started as an AVP in Feline Medicine, and then the ISFM had announced that they were going to recognise the Australian memberships, which is equivalent to a certificate basically in the field of medicine. So, I switched track and I went off and did that. And then got my memberships of the Australian College in medicine of cats. And then thought what should I do with this AVP that's half finished. So, I finished that in business studies, which has been really interesting and, marketing and human resources and strategy were my three modules. So enjoyed that too.

Thom Jenkins (03:52): Hats off to you keeping so firmly abreast with your continuing professional development and working as a full time vet while running a business! I remember when I used to run new practices, uh, sitting as a vet in a new location, kind of hoping people wouldn't come in so I could get my work done. And that's when I knew that had to come to an end because that's not a good position to put yourself in - hoping that people won't come through the door! As a vet and a business owner. What are some of the key difficulties/frustrations you face?

Ellie Marriott (04:26): I think time management, like you say. There's so many things I want to do with the business and so many ideas I have and I think it's frustrating because I only get a 10th of the time that I would like to have. And, so yeah, I think that time management would be my answer.

Thom Jenkins (04:52): Yeah. And so Castle Vets went live with PetsApp in March, 2020. Has that done anything to help you with the time management? Has it been another drain on your time? Has it been one more thing? How has that been?

Ellie Marriott (05:06): No, not at all. I think to the contrary, actually, we were really lucky with when we installed PetsApp. Because you know, we met in, in January. I chatted to you and I was impressed with PetsApp, so decided to go ahead and install it. And I think we did the training a week before lockdown happened. And it's just been amazing in lock down because we have been able to - I know you guys are really hot on this sort of prioritizing the chats - being able to answer people in your own sweet time. That's been so helpful, especially when we've all been worked so hard - we furloughed 75% of our staff. So there have been very few support staff, trying to do an awful lot of things every day. And just being able to sort of manage that, manage our time with our clients. And the clients love it too. Because they can send us a message in the middle of the night if they want to. Then we can get back to them when we're open at eight.

Thom Jenkins (06:01): So you're receiving messages during the night, but there's no expectation that you're going to be responding to them out of hours.

Ellie Marriott (06:07): No, not at all. I mean, we customised our little message, you know, there's an automated message that goes back to the clients when they send us a message saying we only answer these between eight and four, Monday to Friday - that's obviously bespoke to us. Everybody can set what they want. And that was realistic for us at the time of COVID - we may review that as time goes on. And it's been great for the bank holidays and stuff - VE day this year, which was, you know, a bit of a non-event, unfortunately wasn't it? But that was a bank holiday and I was able to change that and say, we are closed today as it is a bank holiday, remember! And so that's been really helpful.

Thom Jenkins (06:45): Brilliant, brilliant. And how have the team responded to it? I mean, you said that you had a lot of them on furlough, have they started coming back? What does that look like?

Ellie Marriott (06:52): So I think COVID was really helpful to us for, for implementing change actually, because that's always a big battle with anything like this. I've certainly tried to implement change unsuccessfully previously. But I think with this particular situation, because we only had four nurses working with the three partners - they quickly realised how useful it was for being able to manage their time.

We did have email - we were allowing clients to email us. We were trying to avoid phones because we have voiceover internet phones at our practice. So we have unlimited lines coming in. So we were trying to discourage people from phoning us, because there weren't enough people to answer the phone and they quickly saw how cumbersome emails are for having a conversation with people. Because you can't follow the thread easily.You can't take payment in an email for example. So quite quickly I think the nurses who were working could see the contrast between PetsApp, which was doing everything we wanted and more, versus emails and people phoning us to pay us over the phone, which is really painstakingly, slow and fraught with difficulties. So, I think that was great. And then because the four nurses that were sort of working with us in the early days when we were in proper lockdown, they quickly got used to it and enjoyed it. And then as we brought people back from furlough gradually, they've kind of just picked that up from the people that were already there and the expectation is this is how we do things now. That's been really helpful. Not that I would wish anyone to have a pandemic so that they can change it!

Thom Jenkins (08:31): We certainly didn't buil the product in anticipation! We had no more foresight than anyone else, but it's certainly been an interesting time to manage a business through and you guys have done phenomenally well. Your engagement on PetsApp has been incredible. And it's interesting what you're saying there, that there's this sweet spot between a telephone call and a sort of video consult, which is a live interaction. And then there's email, which is painfully asynchronous. And then text chat kind of sits somewhere in the middle there, where it's something you have a bit longer to respond to it and you don't have to respond instantly, but you could, depending on the appropriate level of prioritisation.

Ellie Marriott (09:14): Yeah, absolutely. I think that's it. And I mean, even on the weekends, if I'm on call I will keep a check on it. Because if someone write in, in need of help, 'my dog's bleeding to death', then I can respond to that and say, I'm going to phone you. But you know, there's no need for me to respond to those and to check those. So, yeah, it's great being able to sort of prioritise your workload and have some kind of - I think it's really important for stress management to have some grasp of your own workflow, to be able to pick and choose when you work. I know that that's considered a major stressor to people in our profession because quite often you just don't have that control over your workflow. But with the chats you definitely do. And with video consults, if you're setting those for certain time of day, then you can set for a time that suits.

Thom Jenkins (10:08): Yeah. We talk about the tyranny of the telephone. And I remember just training the teams that I used to manage. You've got three rings to answer the phone and if it's rung any longer than that you've sort of fallen short of expectations. And you've got to prioritize the telephone because, like you say, the patient on the other end of it could be in desperate need or it could just be someone with a non-urgent request. You don't know, you've got to interrupt the service interaction that's in front of you to take that call and then you're on the phone and it's hard to get off the phone again. So definitely have sympathy with that. Did you find that you did achieve a fall in telephone call volumes?

Ellie Marriott (10:47): Yeah, definitely. We implemented a menu options, which, you know, everyone hates, we implemented that. And at the beginning of that, it was like, if you're calling about anything routine, if you want to book an appointment or order medications, please use PetsApp. So we were trying to divert people off the phone and I definitely feel that that really helped

Thom Jenkins (11:12): Brilliant. So, PetsApp enables text chat, video consults, digital payments among a few other things. If you could only keep one of those features, which would it be?

Ellie Marriott (11:22): Oh, I think it would probably be the text chats. I mean, we have used video consults definitely. And we've found them really helpful for lots of situations, especially during the lockdown. But I think the text chats for me because of the prioritisation of the work, et cetera, that would be the one I would keep. But I would like to keep them all please!

Thom Jenkins (11:47): Of course, of course! No we won't taking anything away - we'll be adding things! I think that's interesting because there has been this emphasis on consults as if a video consult can be a like-for-like replacement of a physical consultation. And that was never really our aim. That was not our ambition. We were seeking to augment their current experience, not replace any one part of it.

Ellie Marriott (12:09): Yeah. I mean, I think the classic one is post-op checks, which, because we're still working at 50%, you know, reduced work efficiency at the moment because consults take us longer. And we don't have nurse consults running. We just have the vet ones running. So, we have limited space for consultations. And so things like post-op checks, it's been great for that because you know, really at the end of the day, you need to ask the owner that the pet's well and eating and drinking, going to the toilet okay. And you want to see the wound, but do you need to see every patient physically? Probably not. And so that's been really helpful for those sorts of ones where it's just a quick two day check. It saves the owner bringing them to us. It saves our appointment times. We've done that either via video or photos in the chats and a little chat with the owner to check the patient's doing okay. And then seeing them back seven to 10 days post-op to, you know, give a physical check. I can really see us carrying that on going forward.

Thom Jenkins (13:09): Brilliant. I think doing that sort of thing, at least this was the vision, you increase compliance - the owner's more likely to follow up with that. You're more likely to be able to have that chance to advocate for that patient. And if they need to come in, you're there to be able to tell them, you know, hey, come in. I think that's important, isn't it? That there's no hesitation to say if they need to come in, then come in.

Ellie Marriott (13:31): Yeah, absolutely. And I think that the owners like the reassurance that they're doing the right thing by contacting the vets, you know, so we'd get a lot of photos and things coming through just in the general chat to the reception team, you know, is this a problem? Should I, you know, what should I do about this? And often we convert that to a physical appointment. They're like, yeah, you need to come in and see the vet about that. So it's driving footfall, which hopefully as restrictions ease, then, you know, we'll be driving footfall and increasing turnover.

Thom Jenkins (14:06): Brilliant. So it sounds like you're using it in two ways: to improve your capacity, but then also increase footfall as and when you have that spare capacity.

Ellie Marriott (14:20): Yeah, absolutely. I think that's what we will be using it more and more for. And I think, with my cat hat on, that we know - and I forget the exact figure - but a lot of cats don't ever see a vet. They did a load of research in the States not long ago. And there's a staggering number of cats that have never been to a vet. Some owners just don't see that as necessary, but I'm hoping that as I promote this, you know, we're a cat friendly clinic with the ISFM. So, I'm hoping that as things ease, I will be able to start to promoting that as a way for cat owners who perhaps haven't ever been to a vet to get in touch with us and see what we can do to advocate for their pet.

Thom Jenkins (15:03): Yeah. That was something that frustrated me when I was in practice, is that we seem to see cats less and less as they get older, when we really should be seeing them more.

Ellie Marriott (15:15): Yeah, that's it. And just the opportunity to have a conversation with people about their pets and you know, about their cats and what to look out for and why they should be coming for a health check and a blood pressure check. You know, though, that would be really awesome if we managed to encourage people who perhaps don't bring the cats in to, to bring them in. And we could do that through - as well as us just mounting a general marketing campaign round that - we could also use, obviously the push notification campaign in PetsApp to contact our current PetsApping clients who might have brought the dog in six times since lockdown began, but haven't actually ever brought that cat to the vet. And that will be a way of us contacting them.

Thom Jenkins (16:01): Yeah, we've seen that actually, Ellie. We've seen clinics send invites to people who they thought were dog owners to join PetsApp, and then they've also added a cat that the practice never knew about.

Ellie Marriott (16:13): Yeah, that's it because if you've never seen that cart you wouldn't know that they exist, but they're kind of encouraged to add all their pets in. So yeah, I'm very excited for the future in terms of providing better care to the pets around here. You know, I do offer home visits as well to owners who are worried about the cats and they worry about traveling them, but there are so many things that we can do to help with travel. But if I can just have that conversation to begin with to say, you know, yeah your cat needs to see a vet, and ifyou're worried about putting them in the box, well, how about we try some Feliway? How about we try some Gabapentin? Um, how about, you know, um, we get them used to the box in the house. There's so many things that we can do to help. How about I come out to you and do a home visit? You know they're all possibilities, but I think people don't realise they exist. And so, yeah, it'll be great to get the message out to people.

Thom Jenkins (17:08): Definitely, definitely. So what would you say to someone considering implementing virtual care at their own clinic?

Ellie Marriott (17:16): Do it! Yeah, absolutely. Without a doubt, it's the future. I'm very much an early adopter of technology and it was certainly my passion for that which led to me go into the digital stream at SPVS in January where I saw you talk and was just really impressed with PetsApp. Because I went to the exhibition before any of the lectures to look around because I was thinking that this was something we needed to implement. And I thought PetsApp was the best out of all the ones that were on show at SPVS. And then I heard you talk and I thought, yeah, this is the one for us.

Thom Jenkins (17:56): Thank you for that. We echo that! Thank you, Ellie, for joining us for the first ever episode of the podcast and for all your patient advocacy efforts, and for the engagement that you and your team have had on the platform. Really appreciate it.

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