John Williams is one of the UK’s leading experts in soft tissue surgery. A University of Cambridge graduate, he has worked extensively in small animal practice, is a former chairman of the BSAVA’s Congress Committee and chief examiner for the RCVS Diploma in Surgery, and is a respected CPD lecturer.
Seeking a fresh challenge, Prof Williams joined Vets Now in 2016 as national surgical lead and is predominantly based in the company’s state-of-the-art hospital in Manchester, where he continues to carry out soft tissue surgery.
When the Covid-19 lockdown was introduced last March, everything changed in the veterinary professions due to the temporary closure of hundreds of daytime practices. With all hands to the pump, Prof Williams, who has been dealing with referral cases for 30 years, returned to working on the front line of emergency.
And even when the first lockdown restrictions started to ease last summer, it proved to be far from the end as further lockdowns have continued to test his mettle as never before.
Here, Prof Williams reveals what the most challenging year of his life has been like, and how he was happy to roll up his sleeves at a time of national crisis.
When I joined Vets Now it was the opportunity to be involved in setting up a new hospital in Manchester. Starting the out-of-hours service and the referral hospital from scratch – having a completely clean sheet – was a challenge I felt I needed.
I’ve never been prepared to just settle down and I get easily bored on a plateau. So being involved with Manchester, as well as working to ensure consistently high standards across all our 24/7 sites, was really stimulating. But what I couldn’t have imagined was the very different challenge that lay ahead.
All change for COVID
Pre-Covid, I’d combine the referral work with meetings and planning right across our hospitals and clinics, but that came to a shuddering halt as soon as lockdown came in. The guidance from the RCVS and BVA was that we could no longer see routine cases, only emergency work.
That’s where all our teams stepped up really well. In Manchester, for example, we have an OOH team and a referral team, and we split the clinicians into two teams. One worked the front end of the week and the other the back end, swapping across at the weekend.
So it meant all the vets had to see emergency cases as we stopped seeing those routine referral cases simply because so many local practices closed; a lot of the cases they’d have seen as emergencies came directly to us.
As a referral surgeon I was now seeing vomiting patients, cats with abscesses and dogs with diarrhoea. Thankfully, having spent six years in first-opinion practice, I still had the skill set to deal with those cases. Some of us might be a little bit rusty as to treatment options, but we all have that training and those skills.
You still do the thorough clinical examination and ask the right questions of the client; all of that really doesn’t change. Yes, it was very different seeing non-surgical cases, although, equally, there were surgeries to do within the hospital and I would carry out those procedures.
The other big change was no longer having direct contact with clients. Initially that was difficult, but I think that both clinicians and clients adapted really well to not having that face-to-face contact.
I really grew to enjoy being able to use the video call set-up we have. It lets you pick up on those non-verbal clues and I think it makes it easier to form a relationship when you see someone, even if he or she isn’t physically there. So, while in Manchester we had to keep a distance for everyone’s safety, everyone was still very accepting of that way of working.
In my normal surgical work I often have patients come to me with a specific set of symptoms and I expect that I’ll know the answer. So, in going back on the front line, I found the challenge was coming to a diagnosis of the unknown. But I guess that diagnostic challenge is what draws a lot of us to veterinary work in the first place.
Even though I may not have dealt with a diarrhoea case for a long time, the underlying premise for dealing with it really hasn’t changed in the past 30 years. And in the cases where it was a bit more involved, I could always go and have a chat with a colleague here at Vets Now. So, if it looked like a really medical issue, you could talk through the most recent treatment or diagnostic options.
In the early stages of lockdown some of the diagnostic options could be limited as a lot of external labs weren’t working either. But we had the ability to go back to other alternatives. I found myself getting back into the swing of it very quickly and, while I’m not saying it’s something I’d want to do for a massively long period of time, I have to admit that I did enjoy it.
Even as senior vets there were times we just had to get stuck in and do things we wouldn’t normally do. It was a really interesting time and, as a smaller team, it brought us together really well. Everyone was doing everything, and I think that helped us get through that part. The nurses, animal care assistants and vets all worked well together as a team.
We have an ethos of supporting each other and I really believe how we reacted showed Vets Now at its best. Being in a position to have an overview, I think we were very responsive to introducing change into our working practices.
And I must pay credit to our group of interns in Manchester who really stepped up. Their training was massively curtailed and instead of being, to an extent, hand-held, they were asked to step into doing more of what we did, and I was very proud of them.
Within a week of lockdown starting we were constantly busy seven days a week and I know we were providing a vital service for pet owners at a critical time.
More referral work started coming in during July, but I didn’t fully step away from helping with the front-line emergency work for more than three months.
It was good to get back to my day job eventually, but rolling my sleeves up, as it were, and getting stuck in again is definitely one of the most interesting, if unexpected, things I’ve had to do.
But just as it looked like a sense of normality was returning, everything changed as Manchester went back into further restrictions with the introduction of tiers. While we had started to see more routine referral work and had reverted back to working in one big team, it was still working in a different way.
We had been driving a practice of working more in smaller groups and trying to reduce crossover between teams as much as possible. So our surgery, medicine, and emergency and critical care groups all tried to stay together. We finessed shift patterns to reduce the total number of people we had in the building and as lockdowns were reintroduced, we accelerated that process, with the administrative staff encouraged to work from home.
The biggest thing was that our morning rounds were massively reduced, with people joining virtually and the numbers physically standing around cut back dramatically. But while working according to Government, RCVS and BVA guidelines, we’ve also tried to ensure we have that team ethos and are still one big family.
We’ve obviously returned to seeing only essential cases in this current lockdown, although, as we haven’t gone back to emergency only, I haven’t returned to first-line work.
We are prioritising which cases we have to see urgently and which ones can wait a little while. It is still, though, far from being able to work normally, with a reduction in the number of daily cases to reduce the travel for people as much as possible.
In it for the long haul
Once again, everyone has mucked in as I think we all understand that we are in this for the long haul. Working in the smaller groups has made the individual teams much stronger and as a group I think we have pulled together really well. We try to communicate changes as quickly as we can and, most importantly, we talk to and look out for one another.
We all have our blue days when you start to wonder if there will be light at the end of the tunnel, and there are times you know people aren’t at their best, but I think we are much more understanding of each other’s feelings. And, as a company, we have processes to support people, both inside and outside the company, if they need it.
Like the situation we found ourselves in almost a year ago, I’m just proud of how our people have come together and made it work, and I’m just glad I’ve played my part – including rolling the clock back a bit – in what has been a real team effort here during some quite extraordinary times.