Hi everybody and welcome to another special episode of Vet Chat. Today I am made up to be joined by someone who I know is making a massive impact on the profession already, Nuala Summerfield, who is the co-founder of Virtual Veterinary Specialists. Now those of you who've been in first opinion practise over the years, we have all seen that case that we've looked at and just gone what the hell is going on here?

So, you know, these guys are really honed in on a problem for people in first opinion practise that maybe can't look at referral services as a, as a go to for for certain cases, but can look at really upskilling you in practise. So Nuala, it's brilliant to have you with us. I just wonder if you could just take a minute first to to introduce yourself and sort of explain to everybody who you are, what you do and how you've come to doing this with your veterinary profession and career.

Hi, Ben. Thank you so much for inviting me to join you on this today. So, my name is Nuala Summerfield.

I'm a cardiology specialist, and I came to forming VVS with my co-founder, basically from personal experiences in my career. So I had worked in academia and, and, private referral practise as a cardiologist for About, it's been about 18 years now. And really during that time had become more and more aware of the referral process becoming very black and white.

So you either refer the case or you don't refer the case, but there isn't really a middle option for those patients who need some specialist input, but they may not be able to be referred for a whole number of reasons, whether that be, you know, cost constraints or pet can't travel, owner can't take time off work. Vet would like to, you know, the vet would like to keep the case in-house. You know, there's so many different reasons why patients don't end up in a referral, clinic.

And to be honest, as, as a referral specialist, you see such a small number of patients anyway. Relative to the large number that are out there in in being managed in first opinion practise. So I really felt there was a need to support colleagues in first opinion practise to manage their cases more in-house, particularly having spoken to colleagues in in practise who were keen to do more for their patients in-house.

The clients obviously very bonded to the practise, wanted to work directly. With the practise or stay with the practise, rather than be referred to somebody they didn't know. So there seemed a real need there to bring referral back into, or the the referral, input back into a first opinion setting.

And support, first opinion colleagues to manage those, those cases, with remote specialists. Yeah, and you touched on something very interesting there, which is, I, I find that, you know, a very topical piece of conversation across the profession at the minute, which is this sort of perception of relative de-skilling of the sort of GP first opinion vet, and obviously, you know, one of the nuanced. Of what you guys are doing is that it's very much serving to upskill those first opinion clinicians and and you know, bring an an added element to their clinical work rather than sort of, you know, being stuck in the mundanity of the day to day normally and not being able to deal with the complicated cases.

But I wonder how you felt sort of being on, on the other end of the, the table, you know, have you found that rewarding? And that's one of the things I love most about this, this role, is being able to work directly with colleagues in practise and help them to achieve more, essentially, to, to achieve things that perhaps they may not be able to, to have done otherwise, simply because there wasn't the support in the practise to, to do that. I think we all know that when you learn on your own cases, it's, there's a lot more context to the learning.

So you tend to retain the The knowledge rather than sitting in the lecture. So essentially by working with vets to help them manage their, their cases, in my case, cardiology cases improve, help people to improve their cardiac ultrasound skills. So, using the, the technology that we have, we can actually live stream the ultrasound in real time across our platform directly from their ultrasound machine.

So it's not a, you know, a smartphone looking at their ultrasound machine. We're actually hooked up to their ultrasound machine and live streaming in HD from the ultrasound machine, but also have cameras so we can see the hand and see the patient. And it really feels like we're in the room with them.

And I've done a lot of teaching of ultrasound and cardiology over the years. So for me, it feels very second nature to, to teach in this way. But it's, so it's educational.

It's also very clinical because we can actually really accelerate clinical decision making in the practise of actually seeing patients when they come in. As urgent or emergency cases into the practise and assist the vet, you know, they contact us, say this, this case has just walked in. Can you help me?

And actually being able to meet them on the platform, see the patient with them, examine the patient with them. So we use digital stethoscopes where I can hear. The heart sounds, grade the murmur, hear the arrhythmia, live stream the ECG so we look at it together if the animal's presenting with a significant arrhythmia, diagnose that together, do the ultrasound together.

So it feels very much like we're we're working hand in hand. It's a it's a very collaborative process. And that's the same for all the different disciplines, really, whether that be neurology, dermatology, oncology, internal medicine.

It's very collaborative and it is about empowering colleagues in in practise to upskill in both their knowledge, practising evidence-based medicine and also learning practical skills. Yeah, and obviously sort of, you know, there's various different presentations. Of of telehealth services that are are very much coming to the fore in the light of COVID-19, some of which are, you know, sort of helping practises, and I dare say some of which are are actually hindering practises in the short term, but you guys have have obviously been around for a few years now, so it's not a knee jerk reaction to an overnight need.

But how have you found sort of demand for your service. And have changed in the light of the disease and the way that we've had to change functionality and practise, and you know, sort of, have you, have you noticed that that more people are using the service, or is there a different type of case, or is it basically being that it's carried on as it was before for you guys? Well, I think for our partner practises, so practises that have been working with us before the COVID-19 situation.

They have, our technology in-house, and for them it's very much been, we're still there to support them. We still work with them regularly, and the, the shift of the case will have changed clearly because we're helping with urgent and emergency cases. We're not seeing the more routine cases, but we're still able to, to assist our vets to manage those routine cases remotely.

So giving them advice, perhaps to help them. Manage the case, triage the case when they're doing video consults with their owners. But the cases we're seeing using our technology will be very much the urgent and emergency.

So for example, live guiding people through. Pericardiocentesis, if they've not drained a pericardium before, live guiding through FNAs if, you know, if, if, if that's an urgent or emergency case that's come in, diagnosing, arrhythmias, helping with heart failure, all of those things which are emergencies that we did before, but obviously we're doing a lot of now. And For us in terms of the technology, I think we were an advantage in that we're used to working remotely.

We're a remote company, so we have a group of, of specialist consultants that will work as a team. We're all working remotely anyway, so that hasn't really changed. What we are doing obviously is supporting practises now who hadn't worked with us prior to the COVID-19 situation.

They don't have our technology to be able to do the live guided workouts, but there are many ways that we're helping these practises with very practical advice. I think one advantage we have is that we're very, because of the focus of of VVS has been to support practises to do more for their patients in-house for those cases where, you know, referral is not an option. We're not trying to replace referral.

We're another option. There has, there have to be other options for patients that need specialist input. It can't be either referral or nothing.

So we're very used as a team of specialists to giving very practical input in terms of what is possible in that current situation, whether it be that cost constraint or that animal's personality or, you know, the the the constraints the owner might have in terms of of coming for follow up. So I think the advice that we're able to give in that way is actually very relevant for the type of of management that has to go on, you know, in some situations now as well, and particularly we're seeing that with oncology and medicine, the type of advice that needs to be, I suppose, implemented at the moment is not your gold standard work up, but it's what's practical at the moment, what's safe for our veterinary colleagues and clients, but also trying to make Maintain, you know, the best that we can for animal health and welfare. Yeah, and I think it's interesting that you allude to gold standard and I for me, gold standard has always been a very, very variable concept because actually gold standard for one client with their pet might be completely different to gold standard for another client with their pet.

Of course, if you're insured with a 12,000 pounds policy, then your gold standard may be significantly different to if you've got 20 quid in your bank account and that's all you can afford to spend on. Case. So I think you know that's it's very interesting and of course having a, a different option, for how to, to offer that best service that we can for what an owner can afford, is always very attractive, you know, I can certainly allude to multiple clients I've seen over the years who simply, you know, referral to a specialist hospital wasn't an option for them, on the basis that, you know, they're.

They simply didn't have the funding for it. But obviously you, you guys as a service, you know, it's not just cardiology that you obviously offer yourself. What, what other disciplines are there that you can utilise?

So we have a pretty, I suppose, multidisciplinary team. So we have specialists in internal medicine, feline medicine, oncology, dermatology, neurology, ophthalmology, what allergies have I missed out there? Obviously, cardiology.

And we're just about to start an exotics service and also launching an equine telemedicine service as well. So quite extensive services then. And obviously, you know, you look at, you look at sort of the veterinary marketplace.

And you look at the, the human medicine, services that are offered, and I certainly know, you know, I'm, I'm fortunate to be surrounded by medics in my family, my brothers-in-law in-law is a neurosurgeon, my sister's a gastroenterologist, and my wife's a paediatric cardiologist, so I see the, the really. You know, what I would inverted commas just call cool treatment options that they have there, and a lot of the stuff that they're doing virtually, you know, in a similar concept to yourself where, you know, they're supporting teams out in Africa that maybe that haven't got, you know, the the facilities that that that we've got in the UK, but they're supporting them and doing procedures. And you see that as a, as a possible evolution within the veterinary profession.

Do you mean for more sort of remote? Support of colleagues in in other countries and and Yeah, so just thinking, you know, outside, obviously, you know, in the UK we are inverted commas in a very, very privileged environment in terms of how we go about that. But of course, you know, our, our expertise is world leading when it comes to sort of veterinary services.

Yeah, no, absolutely. And one of the driving forces or or reasons behind VVS initially, were some experiences of visiting. Places where they, they don't have veterinary specialists available.

So, for example, some of the Channel Islands, you know, that people are having to bring their animals over to, sort of the mainland UK to be able to access veterinary specialists. I mean that, you know, there's a real need there and technology makes that so easy and so possible. We do have practises that use our services, you know, here in the mid.

At least, some of the countries in Europe where they have very limited veterinary specialists. So we definitely as a company, want to be able to do that to actually improve access to specialist input, you know, globally really, because it shouldn't just be. Something that that we here in the UK and, and, you know, countries like the US, you have access to it really needs to be much more widely available for, you know, for owners and their pets in, in all countries and that we can all sort of help and support each other in that way.

Yeah, I think it's quite exciting to sort of see actually how we can disseminate that information and that support further afield, and I think that's something that I certainly will be watching with with bated breath in in in in the years ahead. But just looking at sort of success stories and of course, you know, it's easy for us to say, well this is working. Are there any cases.

That you've been involved with that really sort of stand out to you that have sort of been the, you know, this is why I do what I'm doing, sort of cases, and I know I look back at my own clinical experiences and there's always those cases that jump out and you go, yeah, you know what, that's why we do what we do. But if you had any from your own experiences with VBS. That that really sort of galvanised.

Definitely. I mean, there are lots of of individual animals that I can think of that have really benefited and really done well simply because we were able to support perhaps with different treatment options. So, you know, if you've never tried using a drug protocol before or drug combination before, but somebody's actually going to support you to do that, obviously, that gives you that additional layer of comfort and and makes it much less stressful.

But I think the things that, that really stick with me more so than the animals now are, are the, the colleagues that I work with and more seeing the, I suppose the successes that they have. And that, that's what really that's what really, I suppose, makes, makes me feel good when I know that I've helped somebody to manage a case. But I see or I can appreciate, you know, their, the fact that that, that's brought them a lot of job satisfaction, and they're able to speak to their client and explain what's going on confidently, and they know what kind of follow up, you know, they're going to do and they They can plan appropriately and they feel in control of that situation, and they know that they're doing their best and they know that they're doing a great job for that client and that pet, and, and there are numerous examples of that and the feedback that we get from the practises we work with is so So good.

It just, it makes, you know, this is why we do it, all of us. We love teaching, all of the specialists that work with EBS. We love teaching.

We love, helping our colleagues to do the very best that they can for their patients. And, and I think, yeah, that's what really resonates with me more than the individual patients, is, is the colleagues that we work with and how we get to know them and, and the improvement and, and successes that, you know, that we experience with them. Yeah, and I think, you know, it's just, it's, it's great to see vets and nurses across the profession being upskilled and being supported, and I think, you know, there's been this concern across the profession for so long about how, you know, the, the experienced vets are leaving clinical practise and that side of things, and, and the younger vets haven't necessarily got that support, but it's great having something that will be there as a go to for them.

But if you're a vet or a nurse. In practise, or indeed a practise manager who, who's listening and and thinking actually, do you know what, I'd like to find out more about that. How does, how do you get in touch with, with, with you guys at VVS and, and how does the whole system work at the moment?

How, you know, how would I go about engaging that as a, as, so the best thing to do would be to email us. The best email to use would be [email protected].

That's VET. And, just, you know, what we typically do is when, when we start working with the practise, we like to find out about you as a practise because it isn't just a sort of a, a, a product that we just sell you and then you get on and use it. This is a service, it's very bespoke.

It's It's, it's, we essentially become an extension of your practise team. So we need to understand your practise, the dynamics of your practise, the size of your practise, the vets that you have, what their interests are in terms of their sort of clinical interests in in different subjects. Are any of them working towards further qualifications?

Do you have new graduates that need specific support? What equipment do you have? We advise, you know, there are practises that will ask us advice on certain equipment that they want to upgrade if they're using the service.

There's a lot of discussion that goes on initially for us just to really understand what your needs are. What are you looking for this type of sort of telehealth, telemedicine service to provide your practise? Therefore, we can essentially design the service to suit the practise.

So it's really initially an email contact and then we followed it up with a discussion. And then we arrange a trial and the, the trial is typically a month. And we're really proud to say, you know, during that month, we, we work very closely with the practise and, and they try the different disciplines and see how it would work.

And I think, you know, we, we have really worked on that process to make it a very a very rewarding experience and, and we're really proud to say that so far every practise that has trialled our service has remained. A client, and we still work with every single practise that we've, we've, started working with, so we still have our very first practises working with us from when we started up three years ago. Well, I think, I think that in terms of, you know, sort of, to, to use modern sort of tech startup terminologies when you've got a, a churn rate of 0, I think that is pretty much the holy grail of of business approaches, so I think, you know, that is clearly something.

I think to be to be looked into if you're a practise owner or manager or someone who's involved in the delivery of services there. So, Nuala, it's brilliant to chat, it's brilliant to get a great insight into what's going on with with VVS. I know having spoken to vets who've been helped and supported by you guys over the years, that it really is a, a valuable service and I think as well as anything, it's so good to see and so encouraging to see.

First opinion vets being supported and upskilled to to deal with cases that they would perhaps not have felt comfortable with on their own, and that to me is, you know, a real triumph to be cherishing, so I know that you've got a series of webinars that you're, you're hosting with the webinar vets, about, you know, sort of dealing with, with these more complicated cases in the. Light of the coronavirus outbreak and sort of how those services might be challenged and interrupted, so I know that we can direct people to to to watching those and hopefully helping upskill them even further. So thank you very much for your time and and I'm really looking forward to seeing how things.

Thank you, Ben. I really appreciate that. And yes, please, .

Everyone, be aware that we have got some webinars that are completely free for people to watch, written by our specialists, specifically about, helping you triage and decision make, during this COVID situation. The first one is Is Cancer an emergency by Claire Nottenbelt, who's our oncology consultant. And also we've produced some, again, free clinical guides that are written by the specialists really to help support vets who are maybe frontline, sole charge to deal with these sort of situations like status epilepticcu, DKA, really to give that step by step, very practical guidance.

How do you manage those safely in this current situation? Awesome, Nuala, thank you so much and I'm looking forward to people here. Lovely, thank you so much, Ben.